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Background and Aims: Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. Methods: This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. Results: Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB (small bowel) transit time for the first indicative image of MD was 57% of the total SB transit time. Conclusions: Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.

Background The systemic scleroderma (SSc) is connective tissue disease of unknown cause. The key points in development of SSc are the increased number of high collagen-producing fibroblasts in the skin, endothelial dysfunction and immune activation. Recent studies report various metabolic disturbances in SSc patients. Purine and pyrimidine metabolic pathways are underlies the central processes of cellular life. The changes in activity of purine and pyrimidine metabolism enzymes in blood plasma and lysed lymphocytes depending on the SSc activity were described by us earlier [1]. At the same time, there are publications that confirm the relationship between changes in ADA activity in red blood cells and pronounced immune disorders [2]. Objectives to characterize enzymatic patterns of the major purine and pyrimidine metabolic pathways enzymes in lysed red blood cells depending on the SSc activity. Methods 51 SSc patients and 30 healthy controls were enrolled in the study. The diagnosis was verified in accordance with the international standards (ACR/EULAR 2013). Disease activity was assessed in accordance with the national classification [3]. Adenosine deaminase (ADA; EC 3.5.4.4); adenosine kinase (AK; EC 2.7.1.20); guanylate kinase (GK; EC 2.7.4.8), dihydroorotate dehydrogenase (DODH; DC 1.3.1.14); IMP dehydrogenase (IMPDH; EC 1.1.1.205); purine nucleoside phosphorylase (PNP; EC 2.4.2.1); thymidine kinase (TK; EC 2.7.1.21); thymidine phosphorylase (TP; EC 2.4.2.4); uracil/thymidine dehydrogenase (UDH; EC 1.17.99.4); cytidine deaminase (CDA; EC 3.5.4.5) activities were measured in lysed red blood cells. Results Mean age of patients (Mean± SD) was 42.8±1.3years, mean SSc duration was 7.9±0.7 years. We revealed substantial changes in enzymatic activities related to both purine and pyrimidine metabolism in lysed red blood cells of SSc patients. The increased ADA (p Conclusion The progression of SSc goes with the imbalance of the purine and pyrimidine enzymes in a regular manner. Activity of the autoimmune inflammation is the factor that underlies the enzymatic pattern of purine and pyrimidine metabolism. References [1] Mozgovaya E., Bedina S., Trofimenko A., Zborovskaya I. The association between activity of purine and pyrimidine metabolism enzymes and disease activity in systemic scleroderma patients. Annals of the Rheumatic Diseases2018;77(2):1280. [2] Cowan M.J., Brady R.O., Widder K.J. Elevated erythrocyte adenosine deaminase activity in patients with acquired immunodeficiency syndrome. Proc Natl Acad Sci U S A. 1986Feb;83(4):108. [3] Guseva N.G. Systemic scleroderma. M.: Medicine,1993.268 p. Disclosure of Interests None declared

Background: Cytotoxic immunosuppressants are widely used nowadays for outcome improvement and better quality of life in severe systemic lupus erythematosus (SLE). As purine and pyrimidine metabolism suggest to be the major targets of most cytotoxic immunosuppressants, enzyme profiling of these metabolic pathways is recognized as an important step for a better balance between efficiency and safety in clinical practice. Objectives: To characterize enzymatic patterns of the major enzymes of purine and pyrimidine metabolic pathways in systemic lupus erythematosus. Methods: The research was carried out in agreement with the WMA Declaration of Helsinki principles. 50 adult SLE patients from the rheumatology unit of Volgograd Clinical Emergency Hospital #25 and 30 healthy controls were included in the study. Diagnosis of SLE had been established using ACR criteria (1997), and activity was assessed by means of ECLAM scale. Activities of 10 major enzymes involved in purine and pyrimidine metabolic pathways: adenosine deaminase (ADA; E.C. 3.5.4.4), adenosine kinase (AK; E.C. 2.7.1.20), guanylate kinase (GK; E.C. 2.7.4.8), dihydroorotate dehydrogenase (DODG; E.C. 1.3.5.2), IMP dehydrogenase (IMPDG; E.C. 1.1.1.205), purine nucleoside phosphorylase (PNP; E.C. 2.4.2.1), thymidine kinase (TK; E.C. 2.7.1.21), thymidine phosphorylase (TP; E.C. 2.4.2.4), uracil/thymidine dehydrogenase (UDG; E.C. 1.17.99.4), cytidine deaminase (CDA; E.C. 3.5.4.5) were measured in blood plasma and lysed lymphocytes. Results are expressed as mean±standard error. Statististical comparison tests are selected in line with common guidelines, differences were considered significant when p Results: Enzymatic profiles in plasma of SLE patients are characterized by increased PNP, AK, UDG, IMPDG, CDA, TK, and DODG activities; ADA and GK were found to decrease. Lyzed lymphocytes are revealed however to increased AK, IMPDG, TK, as well as decreased PNP, ADA, GK, CDA, and TP activities. We have also found that most enzyme activities significantly correlate with ECLAM score in accordance with our previous results [1]. Plasma PNP, AK, UDG, IMPDG, CD, TK and DODG activities positively correlated with ECLAM score, as well as lymphocyte AK, IMPDG, and TK activities did. Negative correlations with ECLAM score were revealed for plasma ADA and TP, and also for lymphocyte PNP, ADA, GK, UDG, CD, TP, and DODG. Plasma PNP, AK, IMPDG, and lymphocyte PNP, ADA, AK activities had the closest relations with minimal SLE activity, being a candidate markers of it. Conclusion: The enzymatic patterns studied can be used as auxiliary markers of SLE activity, with special emphasis on minimal disease activity. References [1] Zborovskaya IA, Martemyanov VF, Zborovsky AB, et al. Purine nucleoside phosphorylase activity in rheumatic diseases. Ann Rheum Dis. 2009;68(Suppl3):764. Disclosure of Interests: None declared

Background:The oxidative-related enzymes are involved in the pathogenesis of various stages of systemic sclerosis (SSc). SSc is a chronic autoimmune disorder that is intimately associated with vascular damage and therefore with chronic perfusion/reperfusion and oxidative organ injury. Mesenchymal cell activation in SSc is now also considered to be mediated primarily through oxidative burst. Regulation of oxidative stress by specific enzymes including several purine metabolism enzymes is likely to play an important role in SSc progression.Objectives:to characterize interrelationships among circulating xanthine oxidase (XO), xanthine dehydrogenase (XDH), superoxide dismutase (SOD) activities and SSc activity.Methods:The study was performed according to bioethical standards. 51 patients with verified SSc and 30 healthy controls were included in the study. The diagnosis was verified according to ACR/EULAR 2013 criteria. We assessed SSc activity in compliance with the original activity scale that is commonly used in Russia [Guseva N.G., 1993] and by the 2001 European Scleroderma Study Group Activity Index. XO (EC 1.17.3.2), XDH (EC 1.17.1.4), and SOD (EC 1.15.1.1) plasma activities were measured using spectrophotometric techniques as previously described [Dubinina E.E., 1986; Karpova O.V., 2006]. Results are expressed as mean±SD. The Mann-Whitney U test and Spearman’s correlation coefficient were used for statistical analysis.Results:Mean age of patients was 42.8±1.3 years, mean SSc duration was 7.9±0.7 years. Mean enzymatic activities in normal controls were 3.43±0.56 nmol/ml min (for XO), 5.19±0.71 nmol/ml min (for XDH), and 5.40±1.03 units (for SOD). The respective enzymatic activities in SSc group were 3.91±0.62 nmol/ml min, 7.10±0.71 nmol/ml min, and 7.10±2.19 units. All these mean activities were significantly higher in SSc patients comparing to healthy individuals (pConclusion:SSc is characterized by an increase in the intensity of oxidative and antioxidant processes, more pronounced in high disease activity. A close relationship between function of prooxidant/antioxidant enzymes and some of the key SSc pathogenetic mechanisms, especially vascular disease and fibroblast activation, is widely considered. Overall increase of oxidative stress in patients with higher disease activity, as well as depletion of antioxidant capacity can be also linked with disturbance of purine metabolism through XO and XDH modulation. Pathogenetic influence of this imbalance can also be mediated through initial phase of neutrophil extracellular traps (NETs) formation, an eventual source of nucleoprotein containing autoepitopes.Disclosure of Interests:None declared

212 (37%) had rDBE. There was no difference in age, gender or indications between the two groups. Mean age of patients who underwent aDBE was 68.5 years (21-94); and rDBE was 61.2 years (21-92). Gender distribution for aDBE: 181 (50%) male, 180 (50%) female. For rDBE, the gender distribution was 104 (49%) male, 108 (51%) female. Indications for aDBE were obscure overt GI bleed (OGIB) 158 (44%), occult GI bleed 131 (36%), abdominal pain 35 (10%), diarrhea 19 (5%), nausea & vomiting 10 (3%), suspected inflammatory bowel disease (IBD) 13 (4%) and surveillance of familial polyposis syndrome (FPS) 5 (1 %). Indications for rDBE were OGIB 67 (32%), occult GIB 59 (28%), abdominal pain 48 (22%), diarrhea 20 (9%), suspected IBD 18 (8%) and FPS surveillance 3 (1%). There was a significantly higher diagnostic yield with aDBE for vascular lesions(table 1). There was no difference between aDBE and rDBE for SB inflammation or tumors. There was also a significantly higher therapeutic yield with aDBE (table 2).There was a higher complication rate of bleeding with antegrade DBE (nZ10, 3%) compared with retrograde DBE (nZ1, 0.4%). There was one perforation (n Z 1, 0.4%) with retrograde DBE. Conclusion: Antegrade DBE has a significantly higher diagnostic and therapeutic yield than retrograde DBE for all SB lesions, mainly angioectasias. Our results support antegrade DBE as the initial approach for majority of patients with suspected SB disorders. Retrograde DBE may be useful when antegrade DBE is negative, and in management of patients with known distal SB lesions. Table 1. Diagnostic Yield with Antegrade and Retrograde DBE

detect harmonic signals from the US second-generation contrast agent (SonoVue, Bracco). Four patterns were chosen to define the intensity of enhancement: nonehnancement, hypo-enhancement, iso-enhancement, and hyper-enhancement. The results of the CE-EUS were compared with the final diagnosis based on pathological examination of specimens obtained by EUS-fine needle aspiration with 22-gauge or 25-gauge needle (EUS-FNA) or surgery (gold standard). The endosonographers were not blinded to other techniques’ results and patients’ clinical history. The interpretation of the CE-EUS was done immediately during the procedure, before the adequacy and the results of the EUS-FNA were available (on site cytopathologists). Results: From January 2009 to October 2012, 4330 pancreatic EUS were performed. In 37 patients with pancreatic solid lesions (19 females and 18 males; mean age 56 14 years) CE-EUS through iv bolus injection of 2.4 ml of SonoVue was performed. All the patients underwent EUSFNA, and of these 13 patients underwent surgical resection. Mean size diameter of lesions was 19 14.3 mm. The CE-EUS pattern of the lesions showed a hyper-enhancement in 34 cases (91.9%). In 27 cases of hyper-enhancement the diagnosis of PNT was confirmed (79.4%). In the other 7 cases of hyperenhancement, rare diagnosis were observed: nesidioblastosis (1), solid serous cystoadenoma (2), schwannoma (1), solid pseudopapillary tumor (1), accessory spleen (1); in the latter case the FNA was negative. In the 2 cases of nonenhancement, in one the FNA revealed mucinous material, and in the other case a PNT was diagnosed. In a case of hypo-enhancement, the surgical diagnosis was a lipoma. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of CE-EUS for the diagnosis of PNT were 78.4% (95% CI: 0.6970.835), 79.4% (95% CI: 0.747-0.822), 66.7% (95% CI: 0.130-0.982), 96.4% (95% CI: 0.907-0.998), and 22.2% (95% CI: 0.043-0.327), respectively (P 0.14). Conclusions: CE-EUS is useful to confirm the expected diagnosis of PNTs or to add information to basal EUS in case of suspicious of PNT, that appears as hyperenhanced lesion.