The projected economic burden of non-communicable diseases attributable to overweight in Brazil by 2030

OBJECTIVES

The prevalence of overweight increases the risk of several non-communicable diseases (NCDs) and, consequently, the costs of health care systems. In this study, we aimed to project the economic burden of NCDs attributable to overweight in Brazil between 2021 and 2030.

METHODS

A cohort simulation of adults (17-117 years) using multistate lifetable modeling was used to estimate the costs of NCDs attributable to overweight in Brazil. The projections of direct health care costs (outpatient and inpatient expenses in the Unified Health System) and indirect costs (years of productive life lost) considered different trajectories of the prevalence of overweight between 2021 and 2030.

RESULTS

In 2019, the prevalence of overweight was 55.4% in the adult Brazilian population. We estimate that around 1.8 billion international dollars (Int$) would be spent on the direct health care cost of NCDs between 2021 and 2030, through the continued increase in overweight prevalence observed between 2006 and 2020. The indirect costs over the same time would be approximately 20.1 billion Int$. We estimate that halving the annual increase in body mass index slope from the beginning of 2021 until 2030 would save 20.2 million Int$ direct and indirect costs by 2030. In the scenario of keeping the prevalence of overweight observed in 2019 constant until 2030, the savings would be 40.8 million Int$. Finally, in the scenario of a 6.7% reduction in the prevalence of overweight observed in 2019 (to be achieved gradually until 2030), 74.1 million Int$ would be saved.

CONCLUSIONS

These results highlight the high economic burden of overweight in the Brazilian adult population.

Preventable incidence cases from non-communicable diseases attributable to insufficient physical activity in Chile

OBJECTIVES

Lack of sufficient physical activity (PA) has been associated with an increased risk of several non-communicable diseases (NCDs) and all-cause mortality. This study aimed to estimate the number of preventable incidence cases of NCDs attributable to insufficient PA in the Chilean population.

STUDY DESIGN

Comparative risk assessment modelling study.

METHODS

This study examined data from 5834 participants aged ≥20 years from the Chilean National Survey (2016-2017). PA was assessed by the Global Physical Activity Questionnaire (GPAQ), and metabolic equivalent of tasks (METs) were assigned according to PA intensity. Estimated incidence cases of NCDs in Chile in 2019 were obtained from the Global Burden of Disease study. Relative risks for breast cancer, colon cancer, ischaemic heart disease, diabetes and stroke were obtained from a published meta-analysis and applied to the prevalence of insufficient PA estimates through the potential impact fraction equation.

RESULTS

High levels of PA (≥8000 MET-min/week) could potentially avoid more than 22,000 (64.6 %) incidence NCD cases, ranging from 498 (10.1 %) preventable cases of breast cancer to 5629 (14.7 %) cases of diabetes. Other modelled scenarios also showed to reduce the incidence cases of all five NCDs but to a lesser extent; where at least PA recommendation was achieved, preventable NCDs were reduced by 6522 cases (18.7 %), and where a 10 % relative reduction in insufficient PA level in the population was achieved, preventable NCDs were reduced by 651 (1.8 %) cases.

CONCLUSIONS

The study results provide estimates for the incidence cases of preventable NCDs attributable to insufficient PA, highlighting the important role of PA in NCD prevention in Chile.

Temporal trends in sleep pattern among Chinese adults between 2010 and 2018: findings from five consecutive nationally representative surveys

OBJECTIVES

This study aimed to comprehensively analyze the time trends in average sleep duration and prevalence of short sleep, poor sleep quality, and high sleep debt among Chinese adults.

STUDY DESIGN

This was a cross-sectional study.

METHODS

The study used nationally representative data from Chinese Family Panel Survey (CFPS) among adults aged ≥18 years. Linear regression and logistic regression were used to calculate P-values for trends across waves, and absolute difference in prevalences were calculated by linear regression. Poisson regression analysis was used to calculate the prevalence ratios of sleep-related problems.

RESULTS

In 2018, the estimated average sleep duration in adults was 7.6 h/d. A shorter sleep duration, higher proportion of short sleep, and poor sleep quality were observed in people aged ≥65 years, women, people with primary school education or below, and residents in Liaoning province. The average sleep duration slightly decreased from 8.2 h/d in 2010 to 7.6 h/d in 2016, and then remained stable from 2016 to 2018. The prevalence of short sleep duration has markedly increased from 11.8% in 2010 to 24.1% in 2016, and then there was a decline in prevalence from 2016 to 2018, although this decrease was not significant. The prevalence of high sleep debt among employed people increased from 6.2% in 2010 to 8.6% in 2018 (absolute difference, 2.4 p.p; P trend = 0.063). In addition, the prevalence of poor sleep quality increased from 15.6% in 2012 to 21.3% in 2018 (absolute difference of 5.7 p.p; P trend<0.001). For all the sleep-related variables, the degree of changes varied by sociodemographic subgroups.

CONCLUSIONS

In this nationally representative survey of the Chinese population, the average sleep duration slightly decreased from 2010 to 2016, and then remained stable from 2016 to 2018. Poor sleep quality, and high sleep debt increased among most of the sociodemographic subgroups. Future studies are needed to understand the drivers of changes in sleep health among Chinese adults.

Cut-off points for isometric handgrip and low limb explosive strength in relation to indicators of overweight/obesity in people with intellectual disabilities: analysis by age groups

BACKGROUND

The prevalence of overweight/obesity has been increasing globally and in people with Intellectual Disabilities (IDs), this problem is exacerbated even more, which added to a low physical condition that contributes to the deterioration of functionality and increases the risk of developing chronic diseases in the course of life. Therefore, the aim of this study was to establish cut-off points for levels of isometric handgrip and low limb explosive strength in children, adolescents and adults, which identify overweight/obesity in people with IDs and their respective associations.

METHODS

The sample was made up of 131 individuals with IDs, belonging to four special and community educational centres in the city of Santiago, Chile. Body mass index (BMI) and waist-to-height ratio (WHR) were used as indicators of overweight/obesity. Handgrip strength was used as a measure of isometric strength, and countermovement jump was used as a measure of low limb explosive strength. For the comparison of variables by age group, the analysis of Ancova, Kruskal-Wallis and chi-square tests were used. The total area under the receiver operating characteristic curve of isometric handgrip and low limb explosive strength was identified as an indicator of overweight/obesity according to age groups. A logistic regression model was used to quantify the effect that strength categories below the cut-off point have on the risk of overweight and obesity.

RESULTS

Significant differences were observed between the age groups for body weight, height, BMI and WHR, as well as in the levels of absolute handgrip strength and vertical jump with countermovement (P ≤ 0.05). Children showed the lowest cut-off points for absolute and relative strength. The adolescent group showed the highest cut-off points for relative strength and countermovement jump and adults showed the highest value for absolute strength as indicators of overweight/obesity. Different associations between cut-off points with BMI and WHR were found.

CONCLUSIONS

Adolescents showed the highest cut-off point for relative strength and countermovement jump, and adults showed the highest value for absolute strength, according to overweight/obesity indicators (BMI and WHR). It is suggested to adjust resistance training programmes according to age categories for the prevention of overweight/obesity in people with IDs.

Oscillating Solitons and ac Josephson Effect in Ferromagnetic Bose-Bose Mixtures

Close to the demixing transition, the degree of freedom associated with relative density fluctuations of a two-component Bose-Einstein condensate is described by a nondissipative Landau-Lifshitz equation. In the quasi-one-dimensional weakly immiscible case, this mapping surprisingly predicts that a dark-bright soliton should oscillate when subject to a constant force favoring separation of the two components. We propose a realistic experimental implementation of this phenomenon which we interpret as a spin-Josephson effect in the presence of a movable barrier.

Implementation of self-monitoring of blood glucose for patients with insulin-dependent diabetes at a rural non-communicable disease clinic in Neno, Malawi

BACKGROUND

Self-monitoring of blood glucose (SMBG) is a widely accepted standard of practice for management of insulin-dependentdiabetes, yet is largely unavailable in rural sub-Saharan Africa (SSA). This prospective cohort study is the first known report ofimplementation of SMBG in a rural, low-income country setting.

OBJECTIVES

To evaluate adherence and change in clinical outcomes with SMBG implementation at two rural hospitals in Neno, Malawi.

METHODS

Forty-eight patients with type 1 and insulin-dependent type 2 diabetes were trained to use glucometers and logbooks. Participantsmonitored preprandial glucose daily at rotating times and overnight glucose once a week. Healthcare providers were trained to evaluateglucose trends, and adjusted insulin regimens based on results. Adherence was measured as the frequency with which patients checked anddocumented blood glucose at prescribed times, while clinical changes were measured by change in glycated haemoglobin (HbA1c) over a6-month period.

RESULTS

Participants brought their glucometers and logbooks to the clinic 95 - 100% of the time. Adherence with measuring glucose valuesand recording them in logbooks eight times a week was high (mean (standard deviation) 69.4% (15.7) and 69.0% (16.6), respectively). MeanHbA1c decreased from 9.0% (75 mmol/mol) at enrolment to 7.8% (62 mmol/mol) at 6 months (mean difference 1.2% (95% confidenceinterval (CI) 0.6 - 2.0; p=0.0005). The difference was greater for type 1 diabetes (1.6%; 95% CI 0.6 - 2.7; p=0.0031) than for type 2 diabetes(0.9%; 95% CI 0.1 - 1.9; p=0.0630). There was no documented increase in hypoglycaemic events, and no hospitalisations or deaths occurred.

CONCLUSION

SMBG is feasible for patients with insulin-dependent diabetes in a rural SSA population, and may be associated with improvedHbA1c levels. Despite common misconceptions, all patients, regardless of education level, can benefit from SMBG. Further research onlong-term retention of SMBG activities and the benefits of increasing frequency of monitoring is warranted.

Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer

BACKGROUND

Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer.

METHODS

Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted.

RESULTS

Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score ≥ 3, age-adjusted Charlson Comorbidity Index ≥ 5, lymph node ratio ≥ 0.15, p/ypTNM Stage III and return to intended oncologic treatment.

CONCLUSIONS

Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

V-037 PARASTOMAL MESH INFECTIONS WITH INTESTINAL FISTULA: 2 RARE SURGICAL CASES AND HOW WE FIXED THEM

Parastomal hernias (PSH) occur in 50–80% after stoma formation and its treatment is considered a real challenge. According to the recent literature, the use of prophylactic mesh at the time of primary stoma should decrease the odds of hernia formation. The most common occurrences after PSH surgery are: recurrence, seroma and wound complications.

In this video, we report 2 cases of mesh infection with fistula necessitated removal after 10 and 4 years of mesh placement.

The first patient was a 66 years-old male.

In 2007 he underwent radical prostatectomy and pelvic lymphadenectomy following radiotherapy. He underwent a radical cystectomy and Bricker's cutaneous uretero-ileostomy for stenosis of the vesicourethral anastomosis. In 2012 for PSH he underwent laparo-alloplasty with a placement of an intraperitoneal mesh. In February 2022, with fever and dyspnoea, at the CT-scan of the abdomen we found air bubbles near the mesh and a suspected sigmoid-to-mesh fistula.

The second patient was a 66 years old male.

In 2018 the patient underwent neoadjuvant radiotherapy, then Miles’ procedure and prophylactic 3D intraperitoneal mesh, subsequent adjuvant therapy. During the oncological follow-up an abdominal CT-scan showed air bubbles around the stoma and suspicion of fistula on the adjacent intestinal loops.

In both cases there was an infection of the area around the stoma due to a fistula between the mesh and the intestine. We proceeded, in laparoscopy, to remove the infected mesh. We converted in open surgery with the resection of the fistulized intestine tract and we did a new ostomy.

AB0537 DRY EYE SYMPTOMS STRONGLY CORRELATE WITH OCULAR AND EXTRAOCULAR PAIN IN PRIMARY SJÖGREN’S SYNDROME. INTERIM REPORT OF A PILOT CROSS-SECTIONAL MONOCENTRIC STUDY

Background

Ocular involvement in primary Sjögren’s Syndrome (pSS) has been traditionally assessed by Schirmer’s test, Tear Break Up Time (TBUT) and Ocular Staining Score (OSS)1. The role of Ocular Surface Disease Index (OSDI), Visual Function Questionnaire-25 (VFQ-25) and Numerical Rating Scale (NRS) in measuring ocular pain and discomfort in pSS have not been yet investigated in detail.

Objectives

To explore the prevalence of ocular pain in patients with pSS, and to investigate the potential correlations between dry eye, ocular pain, extraocular patient-reported outcomes and disease activity.

Methods

In this ongoing cross-sectional study, OSDI, VFQ-25 and NRS for ocular pain were administered to 19 consecutive patients with a definite diagnosis of pSS at our outpatient clinic. All patients signed an informed consent for the study. Pearson coefficients were obtained to assess correlation among EULAR Sjögren’s Syndrome (SS) disease activity index (ESSDAI), EULAR SS Patient Reported Index (ESSPRI), erythrocyte sedimentation rate (ESR), TBUT, OSDI, VFQ-25 and NRS.

Results

In the study, 19 consecutive patients have been enrolled so far. The sample demographics and disease-related features are representative of a typical pSS population (10% male sex, median age at diagnosis of 49 [IQR 24], median ESSDAI = 1 [IQR 6] being biological, haematological and glandular involvement the most represented). Prevalence of ocular pain of any grade (NRS>0) was 11/19 (58%); 6 patients (33%) reported severe ocular pain (NRS≥5). The correlation analysis was significantly strong for patient-reported dryness (ESSPRId), ocular surface-associated symptoms (OSDI), and stability of the tear film (TBUT) with NRS for ocular pain. Moreover, ocular pain also correlated with generalised pain (ESSPRIp) and fatigue (ESSPRIf), while a significant correlation was outlined for OSDI (but not TBUT) with ESSDAI and ESR. Detailed results are summarised in Table 1.

Table 1.

Pearson r coefficients calculated for self-reported ocular pain (NRS), patient-reported outcomes (ESSPRI, OSDI, VFQ-25), physician-assessed dryness (TBUT), disease activity (ESSDAI) and erythrocyte sedimentation rate. *p<0.05 **p<0.01

NRSTBUTESSDAIESSPRIdESSPRIpESSPRIfOSDIVFQ-25ESRNRS-0.95**+0.25+0.73*+0.69*+0.59*+0.68*-0.54+0.19TBUT-0.95**+0.40-0.56-0.58-0.64-0.57+0.24-0.67ESSDAI+0.25+0.40+0.14+0.43+0.12+0.77**-0.33+0.55*ESSPRId+0.73*-0.56+0.14+0.73**+0.36+0.61*-0.60*+0.11ESSPRIp+0.69*-0.58+0.43+0.73**+0.53*+0.51-0.63*+0.32ESSPRIf+0.59*-0.64+0.12+0.36+0.53*+0.09-0.31+0.73OSDI+0.68*-0.57+0.77**+0.61*+0.51+0.09-0.60*+0.56*VFQ-25-0.54+0.24-0.33-0.60*-0.63*-0.31-0.60*+0.05ESR+0.19-0.67+0.55*+0.11+0.32+0.73+0.56*+0.05

Acronyms: NRS - Numerical Rating Scale (for ocular pain); TBUT - Tear Break Up Time; ESSDAI - EULAR Sjögren’s Syndrome (SS) disease activity index; ESSPRI - EULAR Sjögren’s Syndrome Patient Reported Index (d= dryness; p=pain; f=fatigue); OSDI - Ocular Surface Disease Index; VFQ-25 - Visual Function Questionnaire-25; ESR: erythrocyte sedimentation rate.

Conclusion

Ocular pain may represent an additional criterion for pSS patient stratification. The unexpected association between ocular pain and extra-ocular symptoms is a novel datum which may suggest that nociceptive mediators could be involved in the genesis of symptoms in pSS2. Indeed, OSDI seemed to perform better than TBUT in assessing the sufferance of the ocular surface thus mirroring a systemic inflammatory activity.

References

[1]Ramos-Casals M et al, EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies, Ann Rheum Dis 2020.

[2]Gebreegziabher EA et al, Neuropathic Pain in the Eyes, Body, and Mouth: Insights from the Sjögren’s International Collaborative Clinical Alliance, Pain Pract 2021

Disclosure of Interests

None declared

AB1370 MICROVASCULAR CAPILLAROSCOPIC ABNORMALITIES AND AUTOANTIBODY OCCURRENCE IN SARCOIDOSIS PATIENTS

Background

Sarcoidosis (S) is a granulomatous disease with multi-organ involvement displaying a mixed immune-mediated pathophysiology. Raynaud’s phenomenon (RP) has been occasionally reported in S patients [1] and serum positivity for autoantibodies has been detected in S patients but their significance is debated [2].

Objectives

We described nailfold videocapillaroscopy (NVC) findings and estimated the prevalence of serum anti-nuclear (ANA) and extractable nuclear antigen autoantibodies (ENA-Abs) in S patients, comparing them with age- and sex- matched healthy controls (HCs) and patients with primary Raynaud’s phenomenon (PRP). Secondarily, we analysed potential correlations between NVC findings with the occurrence of autoantibodies, immunomodulatory treatment, laboratory parameters, variables of pulmonary function and whole-body imaging.

Methods

Twenty-seven (27) S patients, classified according to WASOG criteria[3], were assessed through NVC examination, laboratory parameters (including serum concentrations of angiotensin-converting enzyme [ACE], C-reactive protein [CRP], calcium, phosphorus, albumin, 25-hydroxyvitamin D, parathormone, ANA and ENA), pulmonary function tests (PFTs), chest-X ray and positron emission tomography/computerized tomography (PET/CT).

Among NVC parameters, we analysed capillary dilations, giant capillaries, haemorrhages, nonspecific abnormalities, and capillary absolute number for mm [4].

Pulmonary involvement was classified by X-ray Scadding staging system (SSS) scoring S patients in 4 grades [5]. From PET data, the maximum standard uptake value (SUVmax) was quantified as a variable of tissue 18-fluorodeoxyglucose hyper-uptake: consequently, S patients were defined PET-positive when SUV value ≥ 2.5. NVC parameters and ANA/ENA dosage were recorded also in 30 PRPs and 30 HCs.

Results

We excluded, among the cohort of S patient, one participant having a systemic sclerosis in overlap with S. The remaining 26 S patients (mean age 56.5 ± 12.5 years, 53.8 % of females, disease duration 28.4 ± 55.1 months, 27% glucocorticoid-naïve) showed a significant higher rate of dilations and nonspecific abnormalities and a lower mean capillary absolute number than PRPs and HCs (p < 0.01 for all comparisons). (Figure 1)

The prevalence of ANA positivity was significantly higher in S patients compared with PRPs and HCs (p < 0.02 for both). Among the whole cohort of patients only one S patient displayed a positive ENA-Ab (Ro52).

In the analysis of S patients’ subgroup, a significant negative correlation was detected between serum ACE levels with the presence of capillary dilations (rho = -0.45, p = 0.04), between CRP and mean capillary absolute number (rho = -0.49, p = 0.02) and a positive correlation was also detected between the mean capillary absolute number and the forced vital capacity percentage (FVC%) (rho = 0.40, p = 0.04).

Conclusion

Our findings suggest a microvascular involvement in sarcoidosis whose investigation by NVC could be useful for the detection of an overlapping connective tissue disease and for the monitoring of the phenotypes of S patients displaying RP.

The positivity for autoantibodies in S patients is in line with literature data suggesting, at least partially, autoimmune features of the disease or the production of autoantibodies reactive to tissue damage.

The correlations between NVC findings with ACE levels and lung function variables generate hypotheses of a potential partial vascular impairment in sarcoidosis disease activity and lung involvement.

References

[1]Nigro A et al. Reumatismo 2004; 56: 278-81.

[2]Kobak S et al. Autoimmune Diseases 2014

[3]Judson M.A et al. Clin Rev Allergy Immunol 2015; 49: 63-78.

[4]Smith V et al. Autoimmun Rev 2020; 19: 102458.

[5]Scadding J.G. Br Med J 1961; 2: 1165-72.

Disclosure of Interests

None declared

Observation of Massless and Massive Collective Excitations with Faraday Patterns in a Two-Component Superfluid

We report on the experimental measurement of the dispersion relation of the density and spin collective excitation modes in an elongated two-component superfluid of ultracold bosonic atoms. Our parametric spectroscopic technique is based on the external modulation of the transverse confinement frequency, leading to the formation of density and spin Faraday waves. We show that the application of a coherent coupling between the two components reduces the phase symmetry and gives a finite mass to the spin modes.

Inferior vena cava ultrasonography before general anesthesia cannot predict arterial hypotension in patients undergoing vascular surgery

INTRODUCTION

Intraoperative hypotension (IH) is an independent predictor of mortality. Some experts have suggested that ultrasound measurement of the inferior vena cava (IVC) in spontaneous ventilation can predict IH.

OBJECTIVE

To evaluate the capacity of ultrasound measures of IVC in spontaneous ventilation to predict episodes of IH after anaesthesia induction.

PATIENTS AND METHODS

We studied 55 high-risk cardiac patients undergoing vascular surgery. The maximum (dIVCmax) and minimum (dIVCmin) diameter of the IVC were measured and the collapsibility index CI = (dIVCmax-dIVCmin)/dIVCmax was calculated prior to anaesthesia induction. Three definitions of IH were used: systolic blood pressure (SBP) less than 100 mmHg, mean arterial pressure (MAP) less than 60 mmHg, and a decrease in MAP greater than or equal to 30% compared to baseline.

RESULTS

There were no significant differences in dIVCmax or in CI between patients presenting IH after anaesthesia induction and those who did not. ROC curves for dIVCmax showed an area under the curve of 0.55 (0.39-0.70), 0.69 (0.48-0.90), and 0.57 (0.42-0.73) and ROC curves for the CI were 0.62 (0.47-0.78), 0.60 (0.41-0.78) and 0.62 (0.47-0.78) for the 3 definitions of IH (<100 mmHg, MAP < 60 mmHg, and MAP ≥30% baseline), respectively.

CONCLUSIONS

Ultrasound measurements of IVC in spontaneous ventilation are not good predictors of IH after anaesthesia induction in these patients. The optimal cut-off points show low specificity and moderate sensitivity for predicting IH.

On-chip magnetophoretic capture in a model of malaria-infected red blood cells

The search for new rapid diagnostic tests for malaria is a priority for developing an efficient strategy to fight this endemic disease, which affects more than 3 billion people worldwide. In this paper, we characterize systematically an easy-to-operate lab-on-chip, designed for the magnetophoretic capture of malaria-infected red blood cells. The method relies on the positive magnetic susceptibility of infected red blood cells with respect to blood plasma. A matrix of nickel posts fabricated in a silicon chip placed face down is aimed at attracting infected cells, while healthy cells sediment on a glass slide under the action of gravity. Using a model of infected red blood cells, i.e. erythrocytes with methaemoglobin, we obtained a capture efficiency of about 70% after 10 minutes in static conditions. By proper agitation, the capture efficiency reached 85% after just 5 minutes. Sample preparation requires only a 1:10 volume dilution of whole blood, previously treated with heparin, in a phosphate buffered solution. Nonspecific attraction of untreated red blood cells was not observed in the same time interval. This article is protected by copyright. All rights reserved.

AB0354 FDG-PET-DETECTED LARGE VESSEL VASCULITIS DOES NOT PREDICT DISEASE OUTCOME IN PATIENTS WITH GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA

Background:

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are tightly associated inflammatory conditions of the elderly [1]. Both disorders can exhibit an increased articular and vascular uptake of 18-fluorodeoxyglucose (18-FDG) at positron emission tomography (PET)/computed tomography (CT) scan [2].

Objectives:

This study evaluated if large-vessel vasculitis (LVV) detected by PET/CT in patients with PMR and/or cranial GCA had a negative prognostic value.

Methods:

108 patients (35 men and 73 women) with a median age of 74 years (range 50-92 years) were prospectively enrolled in our centre over 4 years. PMR was diagnosed by Bird et al. criteria and GCA by the ACR criteria. Six patients died shortly after the first visit (V0) and six were lost at follow-up. Of the remaining 96 patients, 77 were classified as PMR, 6 as GCA and 13 were affected by both diseases.

At V0, patients underwent a clinical, laboratory and PET/CT evaluation, and were stratified according to the presence or not of LVV. Follow-up visits were performed every 6 months for a median of 40 months. Disease outcomes were: prednisone (PDN) use and its cumulative dosage, need of methotrexate (MTX), number of relapses, patients’ death, and PMR disease activity score (PMR-DAS). The independent variables were age, sex, disease duration, fever, C-reactive protein (CRP) concentration, platelet count (PLT), presence of cranial GCA, degree of joint and vascular uptake of FDG, and presence of LVV. The predictive role of LVV was tested by multiple regression.

Results:

LVV was seen in 47 patients (49 %), 31 with PMR, 6 with GCA and 10 with both diseases. Patients with or without LVV did not significantly differ in terms of demographic and laboratory parameters except for a non-significant higher number of PLT in patients with LVV. Clinical and laboratory parameters at V0, stratified per disease and considered together, did not significantly change between PET+ and PET- patients (table 1). Lastly, none of the independent variables, including LVV, could predict disease outcomes.

Conclusion:

The presence of a PET-detected LVV at diagnosis does not seem a negative prognostic factor in PMR and GCA. As a consequence, routine investigation by PET/CT of patients with PMR and GCA is not indicated to predict disease outcome.

References:

[1]Dejaco C, Duftner C, Buttgereit F, Matteson EL, Dasgupta B. The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease. Rheumatology (Oxford). 2017 Apr 1;56(4):506-515. doi: 10.1093/rheumatology/kew273. PMID: 27481272.

[2]Blockmans D, Coudyzer W, Vanderschueren S, Stroobants S, Loeckx D, Heye S et al. Relationship between fluorodeoxyglucose uptake in the large vessels and late aortic diameter in giant cell arteritis. Rheumatology (Oxford). 2008 Aug;47(8):1179-84. doi: 10.1093/rheumatology/ken119. Epub 2008 May 31. PMID: 18515868.

Table 1.

Clinical, laboratory and imaging features between PET+ and PET- patients at V0

Features at V0PET+ patientsPET- patientspMorning stiffness (min)30 (0-480)60 (0-360)0.20Haemoglobin (g/dL)12.3±1.512.6±1.50.28Platelets (x 103/mm3)349 (108-643)297(159-571)0.08C-reactive protein (mg/dL)35.5 (3.4-149)36.2 (2-149)0.54Erythrocyte sedimentation rate (mm/h)62.5 (10-120)57.5 (10-120)0.29Total Vascular Score at PET20 (4-41)6 (0-12)0Total Joint Score at PET18 (5-30)18 (5-32)0.77

Disclosure of Interests:

None declared

POS0862 NAILFOLD CAPILLAROSCOPY IN UNDIFFERENTIATED AND MIXED CONNECTIVE TISSUE DISEASES

Background:

Microvascular damage is a frequent feature in connective tissue diseases (CTDs) and can be easily detected trough nailfold videocapillaroscopy (NVC) (1,2). Mixed and Undifferentiated connective tissue diseases (MCTD and UCTD) do not show a specific and unique NVC pattern (3). However, a variety of microvascular abnormalities can occur in these two CTDs, both non-specific or specific for the scleroderma like-pattern (3-5).

Objectives:

To retrospectively assess and compare nailfold microangiopathy observed by NVC in MCTD and stable UCTD versus primary Raynaud’s phenomenon (PRP) (6). In addition, the aim was to correlate NVC findings with serum levels of autoantibodies (Abs) against extractable nuclear antigen (ENA) detected in UCTD.

Methods:

Files of fourty-six MCTD patients (Kasukawa’s criteria) (mean age 42.8±16 SD years), fourty-seven UCTD patients (mean age 47.7±16.1 SD years), fifty-one PRP (mean age 45.9±17.3 SD years) were retrospectively evaluated in the study. Among UCTD and MCTD patients 95% of both showed Raynaud’s phenomenon. Main NVC parameters (i.e. dilated capillaries, giant capillaries, microhemorrhages, abnormal shapes and number of capillaries) and related semiquantitative scale (score 0–3 for every parameter), were analyzed and compared between the two distinct CTD groups and PRP. Furthermore, ENA Abs (in particular, Ro/SSA, La/SSB, Scl70 and Jo1) were evaluated. The CTD patients were receiving different immunosuppressive treatments. Statistical analysis was performed by non-parametric tests.

Results:

Among UCTD group, 36% of patients showed a normal NVC pattern, 53% had non-specific NVC abnormalities and 11% had a scleroderma like-pattern. The latter was significantly more frequent in MCTD than in UCTD (p<0.001), in fact 22 out of 46 (48%) MCTD patients presented a scleroderma-like pattern. On the other hand, normal pattern or non-specific NVC abnormalities were respectively found in 9% and 43% MCTD patients. Therefore, CTD patients showing giant capillaries, abnormal shapes (i.e. angiogenesis) and lower capillary density were significantly more affected by MCTD than UCTD (p<0.001). Finally, the absolute number of capillaries was found significantly lower in MCTD versus UCTD patients (mean 7±1.7 SD vs mean 9.2±1 SD, respectively, p<0.001). Not any statistical correlation was observed between NVC parameters and specific Abs ENA in UCTD. PRP showed a normal NVC pattern in 2% and non-specific capillary abnormalities in 98%, (including dilated capillaries and microhemorrhages).

Conclusion:

NVC features in UCTD patients seem very close to the pattern observed in PRP (mostly non-specific capillary abnormalities), conversely in MCTD the scleroderma-like pattern was found significantly prevalent together with a significant capillary number reduction. The transition from the scleroderma-like to the scleroderma pattern (mean systemic sclerosis) is matter of actual investigation.

References:

[1]Cutolo M. et al. Best Pract Res Clin Rheumatol 2008; 22:1093-108.

[2]Sulli A, Ann Rheum Dis. 2008;67:885-7.

[3]Smith V. et al. Autoimmunity Reviews 2020; 19:102458.

[4]De Holanda Mafaldo DA, et al. Lupus. 2007; 16:254–8.

[5]Smith V, et al. Ann Rheum Dis 2010; 69: 1092-96.

[6]Antunes M, et al. RMD Open. 2019, 26;4.

Disclosure of Interests:

None declared

AB0330 ANTIPHOSPHOLIPID ANTIBODIES AND ANTICOAGULANT TREATMENT: CAPILLAROSCOPIC FINDINGS

Background:

Antiphospholipid syndrome (APS) is an autoimmune condition characterized by arterial and/or venous thrombosis and/or obstetric morbidity, associated with the presence in the serum of antiphospholipid antibodies (aPL) [1]. Subjects with confirmed positivity of aPL in absence of thrombotic/obstetric manifestations are identified as aPL carriers [2] The microangiopathy detected by nailfold videocapillaroscopy (NVC) in APS and in aPL-carrier patients is poorly investigated, as well as the possible interference of anticoagulant drugs [3].

Objectives:

To compare microvascular damage in APS, aPL carriers and a group of patients (CTR) without aPL positivity and on regular warfarin therapy for cardiovascular indications

Methods:

NVC investigations were performed as part of standard procedures in APS patients (18, mean age 50.0±12.8 years), aPL carriers (24, mean age 46.4±16.4 years) and CTR without aPL (18, mean age 74±12.5 years) in therapy with oral anticoagulant (warfarin) for non-immunological vascular complications (atrial fibrillation, mechanical heart valve, deep venous thrombosis). Only patients affected by primary APS form were selected from data files (2006 Sapporo classification criteria). The following NVC parameters were availble: dilated capillaries, giant capillaries, microhemorrhages (with particular attention to linear and thin hemosiderin deposits, arranged perpendicularly and parallel to the nailfold bed, “comb-like”), abnormal shape (i.e. brunched “bushy” capillaries) and capillary number reduction. Those parameters were scored according to a semi-quantitative scale [4,5]. Statistical analysis was performed by non-parametric tests. Any p values equal or lower than 0.05 was considered statistically significant.

Results:

APS patients showed a higher score for dilated capillaries (p=0.001), more frequent microhemorrhages (p=0.03), in particular “comb-like” microhemorrhages (p=0.007) than simply aPL carriers. Of note, there wasn’t a statistically significant difference in the number of microhemorrhages between APS and CTR group (p=0.23), but again the number of “comb-like” hemorrhages, was almost absent in the CTR group (p=0.03). No significant correlation was found between the different aPL subtypes and the NVC parameters.

Conclusion:

APS patients showed significantly higher number of non-specific NVC abnormalities than aPL carriers. Anticoagulant treatment could represent a further risk factor for the appearance of microhemorrhages in all the patients, being the NVC “comb-like“ pattern mainly associated with the APS. Further investigations with larger cohorts of patients are needed for the definition of a possible APS specific NVC-pattern.

References:

[1]Ruiz-Irastorza G et al. Lancet. 2010;376(9751):1498-509. 2. Pengo V et al. Semin Thromb Hemost. 2012;38:322-7. 3. Sulli A et al. J Rheumatol. 2000;27:1574-6. 4. Smith V et al. 2020. Autoimmun Rev. 19:102458. 5. Sulli A et al. Ann Rheum Dis. 2008;67:885-7.

Disclosure of Interests:

None declared

Robotic versus laparoscopic distal pancreatectomy: multicentre analysis

BACKGROUND

The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP.

METHODS

A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above).

RESULTS

A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004).

CONCLUSION

The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.

Ventricular arrhythmias among patients with implantable cardioverter-defibrillator during the COVID-19 pandemic

Background

Coronavirus Disease-2019 (COVID-19) has been associated with myocardial injury and higher risk of arrhythmic complications. However, no reports are available about the effect of the ongoing pandemic on arrhythmias in patients at risk.

Objective

To describe the effect of COVID-19 pandemic on arrhythmic burden among high-risk patients.

Methods

This is a cross-sectional study on the incidence of ventricular arrhythmia (VA) during the pandemic outbreak (study period), compared to the same timeframe in 2019 (reference period). Inclusion criteria were age (>18 years) and having an implantable cardiac defibrillator (ICD).

Results

Among 455 patients enrolled (mean age 64.9 ± 15.7 years; 25.1% females and 39.6% with CRTD), in the study period, 45 (9.9%) patients experienced a total of 86 VA; 8 patients (1.7%) required antitachycardia-pacing (ATP) and 6 (1.3%) at least one shock. In the reference period, a total of 69 events occurred in 36 patients (7.9%). Six patients (1.3%) required ATP and three (0.7%) at least one shock. The number of patients that suffered from any arrhythmic events in the study period (9.9% vs 7.9%) did not significantly differ from the reference period (χ2 = 1.09, P = .29). The main predictor of VA during the COVID-19 pandemic was the previous history of any ICD therapy (OR = 3.84, P < .001).

Conclusions

No evidence of an increase of arrhythmic burden was found during the COVID-19 pandemic among patients with an ICD.

Water vapor therapy (Rezūm) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study

Purpose

Rezūm is the latest developed minimally invasive treatment for benign prostatic hyperplasia (BPH). We aimed to carefully assess the functional outcomes of patients treated with Rezūm for BPH.

Methods

We prospectively followed 135 consecutive patients treated by Rezūm at 5 institutions from June 2019 to August 2020. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), the Overactive Bladder Questionnaire-Short Form (OAB-q SF) score, the International Index of Erectile Function (IIEF-5) and questions 9 and 10 to assess ejaculatory dysfunction were recorded.

Election criteria were age > 18, no prior prostate interventions, IPSS ≥ 13, post-void residual ≤ 250 mL, prostate volume between 30 and 120 cc.

Results

The median operative time was 10.5 (IQR 8.7–15) min. All patients were dismissed few hours after surgery with indwelling urinary catheter that was removed after a median of 7 (IQR 7–10) days. A significantly decrease of IPSS from baseline at first (p = 0.001) and third (p < 0.0001) month after surgery was reported. No difference was reported in terms of ICIQ-UI SF score postoperatively. A mild reduction of the OAB-q SF score was reported at 1 month from surgery (p = 0.06) that turned significant at 3 months postoperatively (p < 0.0001). A slight but statistically significant increase of the IIEF-5 score was reported from baseline at 6 months (p = 0.04). Postoperatively, patients reported a significantly decrease of ejaculatory dysfunction after alpha-blocker interruption.

Conclusion

Rezūm treatment is a feasible minimally invasive option for patients with BPH symptoms and showed optimal early functional outcomes.

Body composition and bone status in relation to microvascular damage in systemic sclerosis patients

AIM

To evaluate, in Systemic sclerosis (SSc) patients, the body composition and the bone status according to the peripheral microcirculatory condition, assessed and scored by nailfold videocapillaroscopy (NVC, "Early", "Active", "Late" patterns).

METHODS

Body composition and bone mineral density (BMD) were assessed by Dual X-ray absorptiometry and dedicated software (GE Lunar USA) in 37 female SSc patients classified according to the 2013 EULAR/ACR criteria and 40 sex-matched healthy subjects. Clinical, laboratory, body composition and bone parameters were analyzed according to the different NVC patterns. Means were compared by the Student's t test or one-way analysis of variance; medians were compared by the Kruskal-Wallis test; and frequencies by the chi-square test.

RESULTS

Higher prevalence of vertebral (21% vs 7%) and femoral (35% vs 7%) osteoporosis (OP) was found in SSc. Particularly SSc patients with "Late" NVC pattern showed a significantly higher prevalence of vertebral (p = 0.018) and femoral OP (p = 0.016). Regional assessment of bone mass (BM) in seven different body areas showed a significantly lower BMD only at the total spine (p = 0.008) and femoral neck (p = 0.027) in advanced microvascular damage. Patients with "Late" NVC pattern showed a lower whole-body lean mass (LM) compared to "Early" and "Active" NVC patterns, particularly at upper limbs. To note, in all body sites, BMD correlates with LM and BMC according to NVC pattern severity.

CONCLUSIONS

SSc patients with most severe microvascular damage show a significantly altered body composition and bone status suggesting a strong link between microvascular failure and associated muscle/bone sufferance.

Impedance-based Real-time Monitoring of Neural Stem Cell Differentiation

We present here the first impedance-based characterization of the differentiation process of two human mesencephalic fetal neural stem lines. The two dopaminergic neural stem cell lines used in this study, Lund human mesencephalic (LUHMES) and human ventral mesencephalic (hVM1 Bcl-X_L), have been developed for the study of Parkinsonian pathogenesis and its treatment using cell replacement therapy. We show that if only relying on impedance magnitude analysis, which is by far the most usual approach in, e.g., cytotoxicity evaluation and drug screening applications, one may not be able to distinguish whether the neural stem cells in a population are proliferating or differentiating. However, the presented results highlight that equivalent circuit analysis can provide detailed information on cellular behavior, e.g. simultaneous changes in cell morphology, cell-cell contacts, and cell adhesion during formation of neural projections, which are the fundamental behavioral differences between proliferating and differentiating neural stem cells. Moreover, our work also demonstrates the sensitivity of impedance-based monitoring with capability to provide information on changes in cellular behavior in relation to proliferation and differentiation. For both of the studied cell lines, in already two days (one day after induction of differentiation) equivalent circuit analysis was able to show distinction between proliferation and differentiation conditions, which is significantly earlier than by microscopic imaging. This study demonstrates the potential of impedance-based monitoring as a technique of choice in the study of stem cell behavior, laying the foundation for screening assays to characterize stem cell lines and testing the efficacy epigenetic control.

Asymptomatic hypertension-mediated organ damage in patients with or without moderate to severe chronic kidney disease

Introduction

Moderate or severe chronic kidney disease (CKD) is regarded as high or very high risk factor in the Systematic COronary Risk Evaluation (SCORE) system, as stated in the ESC guidelines on arterial hypertension. Assessment of cardiovascular (CV) risk should be completed evaluating hypertension-mediated organ damage (HMOD).

Purpose

The aim of our study was to find out differences in HMOD in patients with or without moderate to severe chronic kidney disease (CKD).

Methods

We enrolled 80 consecutive non-diabetic hypertensive patients, divided into two groups according to the presence of impaired renal function, evaluated by estimated glomerular filtration rate (eGFR): moderate to severe CKD group (n=26 patients, eGFR &lt;60 mL/min/1.73 m2) and mild CKD - normal renal function group (n=54 patients, eGFR ≥60 mL/min/1.73 m2). A transthoracic echocardiogram was performed to evaluate cardiac HMOD. Small and large vessel damage was assessed by means of non-mydriatic digital fundus oculi examination in order to detect arteriolar narrowing using arteriolar-venular ratio (AVr), applanation tonometry to measure carotid-femoral pulse wave velocity (cfPWV) and carotid ultrasound to quantify intima-media tickness (IMT).

Results

Moderate to severe CKD patients appeared to be older (mean age 75.54±8.06 vs 63.38±9.62, p=0.001) and showed lower level of total and LDL cholesterol. Both groups showed abnormal values of cfPWV, but these were significantly higher in the presence of moderate to severe CKD (14.12±7.93 m/s vs 10.94±5.81 m/s, p=0.03). Abnormal AVr values were found in patients with higher grade of CKD, with statistically significant differences in the two groups (0.75±0.015 vs 0.81±0.06, p=0.00001). Carotid IMT resulted to be at the upper limit of normality in both groups (0.95±0.15 vs 0.90±0.18, p=0.35). With regard to echocardiography evaluation, left ventricular mass index (LVMi: 105.04±0.4 vs 96.35±1.7, p=0.06) and relative wall thickness (RWT: 0.43±0.02 vs 0.42±0.05, p=0.41) did not differ significantly in the two groups, with a mild trend for LVMi. Both groups showed abnormal diastolic dysfunction on average, but no differences emerged in the presence of more severe renal impairment (deceleration time 281.74±0.37 vs 256.30±0.54, p=0.08; E/A 0.86±0.03 vs 0.95±0.25, p=0.20; E/e' 7.89±2.93 vs 7.60±2.46, p=0.66).

Conclusions

Our study showed significant differences in HMOD in presence of moderate to severe renal impairment. Moderate to severe CKD seemed to be associated to vascular damage (hypertensive retinopathy and arterial stiffness), while no significant differences in echocardiographic markers of cardiac remodeling were found, suggesting that systemic vascular damage is more closely linked to CKD than cardiac damage. Therefore, the use of fundus oculi examination and PWV should always be considered to properly assess the target organ damage in hypertensive patients with CKD.

Funding Acknowledgement

Type of funding source: None

Measurement of the Canonical Equation of State of a Weakly Interacting 3D Bose Gas

Using a multiple-image reconstruction method applied to a harmonically trapped Bose gas, we determine the equation of state of uniform matter across the critical transition point, within the local density approximation. Our experimental results provide the canonical description of pressure as a function of the specific volume, emphasizing the dramatic deviations from the ideal Bose gas behavior caused by interactions. They also provide clear evidence for the nonmonotonic behavior with temperature of the chemical potential, which is a consequence of superfluidity and Bose-Einstein condensation. The measured thermodynamic quantities are compared to mean-field predictions available for the interacting Bose gas. The limits of applicability of the local density approximation near the critical point are also discussed, focusing on the behavior of the isothermal compressibility.

Single-shot reconstruction of the density profile of a dense atomic gas

Partial transfer absorption imaging (PTAI) of ultracold atoms allows for repeated and minimally-destructive measurements of an atomic ensemble. Here, we present a reconstruction technique based on PTAI that can be used to piece together the non-uniform spatial profile of high-density atomic samples using multiple measurements. We achieved a thirty-fold increase of the effective dynamic range of our imaging, and were able to image otherwise saturated samples with unprecedented accuracy of both low- and high-density features.

Continuity of care and chronicity in medical students' education: 'adopt' a chronic patient

Purpose: Nowadays chronicity is one of the most frequent aspects of care doctors have to deal with. Students need to know and learn clinical, relational, social and managerial elements of chronicity and changes that disease causes in patients, families and doctors themselves. Methods: Students are supervised by a family doctor, in taking care of 'their' patient and of his/her family. They are asked to keep an updated diary, participate in the periodical revision of the medical history and write an end-report. Two focus groups were conducted, adopting a constructive qualitative approach in order to analyse results. Results: The focus groups and the SWOT analysis show common themes such as innovative learning and multidisciplinary approach. Clinical evolution of the disease, mental and body changes and the diagnostic and therapeutic future planning were also revealed. Conclusions: The main goal of this innovation was understanding the importance of a continuous clinical relationship and of the role of the doctor as 'therapy itself'. The project was demonstrated to be able to teach the future physicians how to practice more empathetic medicine and to improve the skills needed in a complex relational environment including that of chronic disease.

Progression of nailfold capillaroscopic patterns and correlation with organ involvement in systemic sclerosis: a 12 year study

OBJECTIVE

The aim of this observational study was to investigate the evolution of scleroderma microangiopathy throughout different nailfold videocapillaroscopy (NVC) patterns ('early', 'active', 'late') as well as the prevalence of organ involvement in SSc patients during a 12-year follow-up.

METHODS

Thirty-four SSc patients showing at baseline (first capillaroscopic analysis) the 'early' NVC pattern of microangiopathy were enrolled and followed for 12 years (s.d. 2). Complete NVC analysis and clinical and serological findings were collected. Patients were in a standard therapeutic care setting. Statistical analysis was carried out by non-parametric tests.

RESULTS

After a 12-year follow-up, the 'early' NVC pattern changed from baseline in 76% of the patients. The NVC pattern was found to be 'active' in 9 patients (26%), 'late' in 13 (38%) and characterized by non-specific capillary abnormalities in 4 (12%). In the subgroup whose microangiopathy progressed from the 'early' to the 'late' NVC pattern, the median time of progression from the 'early' to the 'active' pattern was significantly shorter (11 months) when compared with patients who progressed from the 'early' to the 'active' NVC pattern (55 months) (P = 0.002). The median time of progression between NVC patterns was significantly shorter in SSc patients showing either a nucleolar ANA pattern or Scl70 autoantibodies (P = 0.048). Organ involvement was progressively greater in SSc patients with 'early', 'active' and 'late' NVC patterns, respectively.

CONCLUSIONS

This longitudinal study confirms over a 12-year follow-up the evolution of specific NVC patterns associated with the progressive severity of organ involvement in SSc patients in a standard clinical care setting.

Observation of Magnetic Solitons in Two-Component Bose-Einstein Condensates

We experimentally investigate the dynamics of spin solitary waves (magnetic solitons) in a harmonically trapped, binary superfluid mixture. We measure the in situ density of each pseudospin component and their relative local phase via an interferometric technique we developed and as such, fully characterize the magnetic solitons while they undergo oscillatory motion in the trap. Magnetic solitons exhibit nondispersive, dissipationless longtime dynamics. By imprinting multiple magnetic solitons in our ultracold gas sample, we engineer binary collisions between solitons of either the same or opposite magnetization and map out their trajectories.