Abstracts / Clinica Chimica Acta 493 (2019) S730–S732 effects of Fab fragment and to increase the expression levels. Furthermore, the utilization of the library is not restricted to the Fab in question but can be readily applied to any Fab or secreted molecule in E. coli. Conclusions doi:10.1016/j.cca.2019.03.1342 doi:10.1016/j.cca.2019.03.1343 M370 M371 The significance of chitotriosidase in the diagnosis of sarcoidosis and tuberculosis Serum levels of endogenous opioids in children during multimodal anesthesia Z. Sumaraca,b, V. Mihailoviç-Vucinicc,d, S. Filipovicc, J. Videnovicc, V. Skodric-Trifunovicc,d, M. Stjepanovicc, M. Omcikusc, M. Vukovice a Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia b Faculty of Pharmacy Novi Sad, University Business Academy, Novi Sad, Serbia c Clinic of Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia d Medical Faculty, University of Belgrade, Serbia e General Hospital, Valjevo, Serbia B. Kościelniak-Meraka, I. Batkob, K. Sztefkoa, K. Kobylarzb, P. Tomasika a Department of Clinical Biochemistry, Pediatrics Institute, Jagiellonian University Medical College, Krakow, Poland b Intensive Care Unit, University Children's Hospital, Krakow, Poland Background-aim Sarcoidosis is a multisystem granulomatous disease, whose unpredictable course has prompted research into biomarkers useful to predict outcome. Chitotriosidase, a chitinase produced by activated macrophages, has recently been proposed as an indicator among the potential markers of sarcoidosis. Increased macrophage activity is also present in tuberculosis. The aims of this study were to evaluate value of chitotriosidase as a marker of sarcoidosis, as well as applicability of it in the diagnosis of tuberculosis. Methods 217 biopsy positive sarcoidosis patients were analyzed. 80patients had acute sarcoidosis (duration b2 years), 137 patients were with chronic sarcoidosis (duration longer than 2 years). At the time of the study 105 patients had symptoms and signs of active disease, 57patients experienced reactivation of sarcoidosis and 29 patients experienced relapse of chronic disease. 71 patients had a proven active pulmonary tuberculosis. Chitotriosidase activity in serum of patients and 264 healthy controls was determined using the spectrofluorometric method with fluorogenic substrate 4-methylumbelliferyl-®-D-N-N′-N″-triacetylchitotrioside. Results Sensitivity of chitotriosidase in patients with clinical signs of active sarcoidosis is 76.8%, while the reliability of chitotriosidase to exclude the disease activity in patients without clinical signs of diseases activity (specificity) was 90.4% (cut off 159.9 nmol/mL/h). Logistic regression confirmed that patients with high serum chitotriosidase had likelihood of active disease comparing to patients with low serum chitotriosidase (odds ratio = 18.06; Confidence Interval for odds ratio from 7.24 to 45.03; p b .001). Logistic regression (classification of 88%) in groups active/not active sarcoidosis revealed the sensitivity for serum chitotriosidase test of 90.1% and specificity of 87.6%; (+) PV (predictive value) =88.6 and (−) PV = 89.3. Patients with tuberculosis had significantly lower values of chitotriosidase than patients with sarcoidosis (p = .000). This recent study strongly supported the hypothesis that serum chitotriosidase could be a marker of sarcoidosis activity and severity. Background-aim Endogenous opioids are neuropeptides involved in the painrelieving processes. In the peripheral nervous system (PNS) endogenous opioid peptides induce analgesia via binding to the related opioid receptors. This cause the cascade of interactions leading to inhibition of releasing the substances involved in the pain transmission eg. substance P. In the periphery they are synthesized and stored in cells of the immune system. In the current study, we describe the fluctuations of endogenous opioids concentrations in the postoperative period in children in regarding multimodal anesthesia. Methods Forty-four children undergoing major spinal surgery were enrolled in the cohort study. They were divided into two groups: They were divided into two groups: group A (n = 21) generally anesthetized with rocuronium, fentanyl, morphine, propofol, dexamethasone, acetaminophen and a mixture of oxygen/air/sevoflurane and group B (n = 23) where in addition to the above-described anesthesia patients' were given i.v. lidocaine as a co-analgesic. We also recruited 20 healthy age- and gender-matched children (control group, CG). We measured endogenous opioids levels in serum using immunoenzymatic methods. We evaluated postoperative pain intensity using numerical or visual pain scale. Results The levels of measured endogenous opioids were similar in control and in studied groups before surgery. We noted that group B patients had lower pain intensity when compared to the group A subjects. In group B, the elevated serum concentration of ®endorphin, enkephalin and dynorphin in the postoperative period were noted. We also reported that the area under the curve of the levels of endogenous opioids was negatively correlated with summary postoperative morphine dose. Finally, we noted positive correlation between lidocaine concentration and endoopioids levels. Conclusions Multidrug pain management including lidocaine seems to be more efficient than models without lidocaine. The endogenous opioid system should be considered as a novel target for pain relief therapy in children. doi:10.1016/j.cca.2019.03.1344