Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention

This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.

Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics

Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.

Is it a complication or a consequence - a new perspective on adverse outcomes in Interventional Radiology

The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.For the first time, we are trying to introduce the term "consequence"; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an "adverse event" despite correct technical execution.

Contrast-Enhanced Mammography (CEM) compared to Breast Magnetic Resonance (MRI) in the evaluation of breast lobular neoplasia

PURPOSE

To compare the diagnostic performance (detection, assessment of correct disease extent and multifocality/centricity) of Contrast-Enhanced Mammography (CEM) Versus Breast Magnetic Resonance (MRI) in the study of lobular neoplasms.

METHODS

We retrospectively selected all the patients who underwent surgery for a lobular breast neoplasm, either an in situ or an invasive tumor, and had undergone both breast CEM and MRI examinations during the pre-surgical planning. Wilcoxon Signed Rank test was performed to assess the differences between size measurements using the different methods and the post-surgical pathological measurements, considered the gold standard. The agreement in identifying multifocality/multicentricity among the different methods and the pathology was assessed using the Kappa statistics.

RESULTS

We selected 19 patients, of which one presented a bilateral neoplasm. Then, the images of these 19 patients were analyzed, for a total of 52 malignant breast lesions. We found no significant differences between the post-surgical pathological size of the lesions and the calculated size with CEM and MRI (p-value of the difference respectively 0.71 and 0.47). In all 20 cases, neoplasm detection was possible both with CEM and MRI. CEM and MRI showed an excellent ability to identify multifocal and multicentric cases (K statistic equal to 0.93 for both the procedures), while K statistic was 0.11 and 0.59 for FFDM and US, respectively.

CONCLUSION

The findings of this study suggest that CEM is a reliable imaging technique in the preoperative setting of patients with lobular neoplasm, with comparable results to breast MRI.

Advances in breast cancer risk modeling: integrating clinics, imaging, pathology and artificial intelligence for personalized risk assessment

Breast cancer risk models represent the likelihood of developing breast cancer based on risk factors. They enable personalized interventions to improve screening programs. Radiologists identify mammographic density as a significant risk factor and test new imaging techniques. Pathologists provide data for risk assessment. Clinicians conduct individual risk assessments and adopt prevention strategies for high-risk subjects. Tumor genetic testing guides personalized screening and treatment decisions. Artificial intelligence in mammography integrates imaging, clinical, genetic and pathological data to develop risk models. Emerging imaging technologies, genetic testing and molecular profiling improve risk model accuracy. The complexity of the disease, limited data availability and model inputs are discussed. A multidisciplinary approach is essential for earlier detection and improved outcomes.

Performance and Safety of a Reflux-Control Microcatheter Used to Perform DEB-TACE with LUMITM Beads in HCC Patients: Preliminary Experience

PURPOSE

The present study aims to evaluate the effectiveness and safety of the anti-reflux microcatheter during DEB-TACE with DC Bead LUMITM (radiopaque beads) for the treatment of hepatocellular carcinoma (HCC).

METHODS

We performed an observational longitudinal prospective monocentric study to analyze all patients with HCC who underwent to DEB-TACE with DC Bead LUMITM and anti-reflux microcatheter. Technical success, the presence of residual disease, and clinical success were evaluated. The performance of the anti-reflux microcatheter on the basis of the percentage of tumor covered and the non-target embolization (NTE) was also evaluated.

RESULTS

Twenty patients underwent DEB-TACE with DC Bead LUMITM and an anti-reflux microcatheter. Technical success was achieved in all cases. Residual disease in the target tumor was observed in 11/20 (55%) of cases and no residual disease was found in 9/20 (45%) of cases. The clinical response at 1-month follow-up was of PD 4/20 (20%), SD 7/20 (35%), and CR 9/20 (45%). No major complications were recorded, and 10% of cases had minor complications. The distribution of beads on post-procedural CBCT, classified according to the percentage of target nodule coverage, was ≥50% in 70% (14/20) of cases and between 30-50% in 30% of cases (6/20). NTE was never registered.

Pollination mechanism in Serapias with no pollinaria reconfiguration

Orchidaceae, one of the most numerous families in the world's flora, have evolved various pollination strategies to favour cross-pollination, such as deceptive pollination and pollinarium reconfiguration. Among the terrestrial orchids of the Mediterranean, only species belonging to the genus Serapias show a strategy defined as shelter imitation. The floral elements form a tubular structure that insects use during their resting phases. The purpose of this article was to clarify the mechanisms that guarantee pollination with particular attention to the morphological interactions between orchids and pollinators and whether pollinaria reconfiguration is necessary in the promotion of cross-pollination in Serapias. Breeding system experiments and hand-pollination treatments indicated that Serapias was highly self-compatible, shows low value of natural fruit set and is pollinator limited. Time-lapse photos showed that the pollinarium had no refolding of the stipe or caudicle after its removal from the flower. The morphology of the flower determined the attack of the pollinarium on the occiput/vertex of insect. When the insect left the flower, the pollinarium was unable to encounter the stigma. When the insect made a second visit to another flower, the pollen masses of the first pollinarium ended up on the stigma and at the same time, the insect picked up a second pollinarium. Our observations and analyses suggested that morphological interactions between flower and pollinator are crucial to the success of pollination and to prevent self-pollination and thus that pollinarium reconfiguration is unnecessary in shelter deceptive orchids, such as Serapias species, for the promotion of cross-pollination. Serapias represent a case of interactions between plant and pollinator; the formation of the tubular shape of the flower is an essential preadaptation for the development of resting site mimicry originating exclusively in Serapias among Mediterranean orchids.

History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century

Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.

The effect of inflorescence display size and flower position on pollination success in two deceptive and one rewarding orchid

Inflorescence display size and flower position on the inflorescence play important roles in plant reproduction, in the formation of fruits and are primarily linked to pollinator behaviour. We used three orchids to determine how visitation rates and choice of pollinator depend on number and position of the flowers along the inflorescence. We measured reproductive success in (1) natural conditions, (2) hand-pollination experiments and (3) an experimental design, by modifying composition of inflorescences in populations of two deceptive orchids, Orchis anthropophora and O. italica, and one rewarding orchid, Anacamptis coriophora subsp. fragrans. There were no differences in natural fruit production in relation to flower position on the inflorescence (i.e. upper versus lower part), suggesting no preference of pollinators for different parts of the inflorescence. Hand-pollination experiments highlighted low pollen limitation in A. coriophora subsp. fragrans but high limitation in O. italica and O. anthropophora. Reproductive success of deceptive orchids in experimental plots decreased significantly when flowers on the upper half of the inflorescence were removed leading to reduced floral display, while reproductive success of the nectariferous species did not differ significantly. Our data highlight that in the examined orchids there is no clear relationship between fruit formation and flower position along inflorescences. Thus we can affirm that, for orchids, the entire inflorescence plays a dominant role in insect attraction but the part of the flower spike does not influence the choice of the insect. This implies that all flowers have the same possibility of receiving visits from pollinators, and therefore each flower has the same opportunity to set fruit.

Ablative Therapies for Breast Cancer: State of Art

Breast cancer (BC) is the most frequently diagnosed malignancy among women. In the past two decades, new technologies and BC screening have led to the diagnosis of smaller and earlier-stage BC (ESBC). Therefore, percutaneous minimally invasive techniques (PMIT) were adopted to treat patients unfit for surgery, women who refuse it, or elderly patients with comorbidities that could make surgery a difficult and life-threatening treatment. The target of PMIT is small-size ESBC with the scope of obtaining similar efficacy as surgery. Minimally invasive treatments are convenient alternatives with promising effectiveness, lower morbidity, less cost, less scarring and pain, and more satisfying cosmetic results. Ablative techniques used in BC are cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound (US), and laser ablation. The aim of our study is to discuss the current status of percutaneous management of BC, evaluate the clinical outcomes of PMIT in BC, and analyze future perspectives regarding ablation therapy in BC.

Minimally Invasive Treatment in Benign Prostatic Hyperplasia (BPH)

Review efficacy and safety of minimally-invasive treatments for Low Urinary Tract Symptoms (LUTS) in patients affected by Benign Prostate Hyperplasia (BPH). We performed a systematic review of the literature from 1993 to 2022 leveraging original research articles, reviews, and case-studies published in peer-reviewed journals and stored in public repositories. Prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), high intensity focused ultrasound (HIFU), laser treatments and Cryoablation are valid and safe alternatives to the gold standard (surgery) in the treatment of LUTS in patients affected by BPH, with fewer undesired effects being reported.

Artificial Intelligence in Emergency Radiology: Where Are We Going?

Emergency Radiology is a unique branch of imaging, as rapidity in the diagnosis and management of different pathologies is essential to saving patients' lives. Artificial Intelligence (AI) has many potential applications in emergency radiology: firstly, image acquisition can be facilitated by reducing acquisition times through automatic positioning and minimizing artifacts with AI-based reconstruction systems to optimize image quality, even in critical patients; secondly, it enables an efficient workflow (AI algorithms integrated with RIS-PACS workflow), by analyzing the characteristics and images of patients, detecting high-priority examinations and patients with emergent critical findings. Different machine and deep learning algorithms have been trained for the automated detection of different types of emergency disorders (e.g., intracranial hemorrhage, bone fractures, pneumonia), to help radiologists to detect relevant findings. AI-based smart reporting, summarizing patients' clinical data, and analyzing the grading of the imaging abnormalities, can provide an objective indicator of the disease's severity, resulting in quick and optimized treatment planning. In this review, we provide an overview of the different AI tools available in emergency radiology, to keep radiologists up to date on the current technological evolution in this field.

KNEE PERIPROSTHETIC FRACTURES IN THE ELDERLY: CURRENT CONCEPT

Periprosthetic fractures around total knee arthroplasty in elderly represent an emerging cause of implant revision and their incidence seems destined to further increase in the upcoming years, considering the ever-increasing number of implanted prostheses. These are complex injuries with very high complication rates. It has been estimated that the incidence of femoral periprosthetic fractures after T.K.A. ranged between 0,3 to 2,5%, but increases up to 38% when considering revision T.K.A. Patient-related risk factors for T.K.A. periprosthetic fracture (T.K.A.P.F.) include osteoporosis, age, female sex, revision arthroplasty and peri-implant osteolysis. The grate debate concerns the choice of the most appropriate fixation device for T.K.A.P.F.: closed or open reduction with internal fixation with either locked plate or intramedullary nail is the most commonly used for treating these fractures. Success of these methods depends on the fracture pattern, the stability of implants, and the patient’s bone quality which is often poor in elderly, thus resulting in high complication rates. Conversely, a revision of T.K.A. (R.T.K.A.) should be considered in case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture (that precludes a good fixation), previous treatments failure and severe malalignment of T.K.A. Instead megaprosthesis and allograft-prosthesis composite are necessary in case of sever bone loss. Considering the variability of the clinical scenario of T.K.A.P.F., this complex injury requires and experienced and comprehensive approach based on both facture fixation and/or revision arthroplasty.

Pain perception in paediatric patients: evaluation of computerised anaesthesia delivery system vs conventional infiltration anaesthesia in paediatric patients

AIM

The aim of the present study is to compare the effectiveness of a computerised system (QuickSleeper) compared to traditional syringe in injection of local anaesthetic focusing on the perception of anxiety and pain in paediatric patients.

METHODS

Study design: 100 children aged between 3 and 15 years in need of two dental treatments that required local anaesthesia were selected and treated randomly but alternately with computerised and traditional local anaesthesia. After each anaesthetic injection, patient's anxiety was measured using the Venham test.

RESULTS

Electronic anaesthesia showed statistically significant better results than traditional anaesthesia according to the Venham pain scale, in both mandibular and maxillary sites. Statistics: Data were analysed using the paired Wilcoxon test.

CONCLUSION

The computer-assisted anaesthesia system resulted in a significantly lower pain perception score and yielded to helpful, cooperative behaviour. For this reason, it is an advantageous alternative to traditional injection anaesthesia and can avoid invasive treatments and trauma for young patients.

POS0475 ROLE OF IL-33/ST2 AXIS IN SYSTEMIC SCLEROSIS PATIENTS WITH ELECTROCARDIOGRAPHIC ABNORMALITIES

Background

Electrocardiographic (EKG) abnormalities are described in 25-75% Systemic Sclerosis (SSc) patients and they are associated with other systemic manifestations1 as well as with a worse prognosis.2 There is an increasing need for clinical and laboratory biomarkers to ameliorate the diagnostic approaches to patients with EKG abnormalities.3

In the last decade, many studies focused on the components of the interleukin (IL)-33/ST2 axis. Under physiological conditions, IL-33 is released by apoptotic cardiac cells, promoting a protective mechanism of cell survival, thanks to the binding with its transmembrane receptor ST2.4 During pathological cardiovascular events, an abnormal secretion of the IL-33 soluble receptor (sST2) by Th2 cells occurs. It binds IL-33 not allowing the physiological mechanism driven by the IL-33/ST2 binding previously described.4 For these reasons, sST2 has been proposed as a biomarker of cardiac injury in a variety of diseases.5

Objectives

Aim of this study was to analyse clinical and demographical parameters in a group of SSc patients, trying to define any possible feature associated with EKG abnormalities. Furthermore, the role of IL-33/ST2 axis components as biomarkers of cardiac injury in patients with SSc-related EKG abnormalities was evaluated, also assessing the possible correlation with serum concentration of NT-pro-BNP, a well-known cardiac injury biomarker in SSc.

Methods

Data from 277 SSc patients, fulfilling the 2013 ACR/EULAR classification criteria,6 attending our Scleroderma Clinic were retrospectively analysed. We selected patients with EKG trace and a blood sample available, collected after the SSc diagnosis. The sera levels of sST2 (ELISA Kit, Abcam), IL-33 (ELISA kit, RayBiotech) and NT-pro-BNP (ELISA Kit, Abcam) were measured. Patients with a history of heart diseases occurring before the diagnosis of SSc or features of secondary cardiac involvement (pulmonary arterial hypertension, severe interstitial lung disease or renal disease) were excluded.

Results

Forty-six SSc patients showed significant EKG abnormalities (rhythm and conduction disorders). Thirty-one SSc patients without pathologic finding at EKG traces were recruited as the control group.

From the analysis of the clinical characteristic of the disease at the moment of serum collection, patients with EKG anomalies have more frequently both a diffuse form of disease (n°-%: 23-50 vs 7-23; p 0.01), with a mean value of mRSS higher than controls (11±9 vs 6±6; p 0.01), and a scleroderma “late” pattern at the nailfold capillaroscopy (n°-% 23-50 vs 6-19; p 0.027).

Significantly higher median values of serum levels of sST2 in SSc patients with EKG disorders compared to the control group (4289pg/mL, IQR 2383 vs 2560 pg/mL, IQR 1455; p 0.0002) were detected, while opposite results were found analyzing serum levels of IL-33 (2.89 pg/mL IQR 101 vs 9 pg/mL IQR 277; p 0.032) (Graph 1). Serum NT-pro-BNP median values were significantly higher in the group of patients with EKG abnormalities than in the control group (149 pg/mL, IQR 354 vs 26 pg/mL, IQR 62; p 0.0007). These values correlated with sST2 serum levels (rho Spearman correlation 0.37; p 0.0006).

Conclusion

SSc patients with EKG abnormalities showed an increased skin and vascular involvement with respect to the control group. These associations could help clinicians in clinically stratifying SSc patients at risk of EKG abnormalities. To our knowledge, this is the first report evaluating the serum concentration of sST2 in SSc patients. Based on these results, we can speculate on the role of this molecule as potential biomarkers of early cardiac injury during SSc, although further studies involving a larger cohort of patients are needed.

References

[1]Vacca et al. Rheumatol 2014

[2]Tyndall et al. Ann Rheum Dis 2010

[3]Muresan et al. Clin Rheumatol 2018

[4]Vianello et al. Int J Biochem Cell Biol 2019

[5]Dudek et al. Adv Clin Exp Med 2020

[6]van den Hoogen et al. Arthritis Rheum 2013

Figure 1:

Graph 1. Serum sST2 (a) and IL-33 (b) concentrations in patients with EKG abnormalities (EKG+) vs control group (EKG)

Disclosure of Interests

None declared.

POS0410 THE ROLE OF IL-6 IN ENDOTHELIAL DYSFUNCTION: RHEUMATOID ARTHRITIS AND COVID-19, TWO PATHOGENIC MODELS IN COMPARISON

Background

Rheumatoid arthritis (RA) is the most common systemic autoimmune disease that primarily affects joints but is also often characterized by extra-articular involvement1. Cardiovascular diseases are the most important causes of sudden death in these patients, which present a risk of developing cardiovascular events increased by 48%2. The causes of increased cardiovascular risk are several and not completely understood, but recent evidence supports the key role of endothelial dysfunction in pathogenesis. In this complex scenario, it is known that IL-6 receptors are present at the endothelial level and can be activated leading to endothelial dysfunction. SARS-Cov-2 is a coronavirus responsible for the disease called ‘coronavirus disease 2019’ (CoViD-19) characterized by clinical manifestations ranging from a flu-like syndrome up to severe lung damage associated with systemic hyper cytokine syndrome that can lead to multiple organ failure and death. Therefore, both RA and Covid-19 are associated with an increased pro-thrombotic and cardiovascular risk and IL-6 might be crucial in the pathophysiological mechanisms of both diseases.

Objectives

The main hypothesis of this study was to evaluate the possible role of IL-6 as a promoter of endothelial dysfunction in RA and CoViD-19.

Methods

In vitro experiments were conducted on the endothelial cell line EA. hy926. Cells were treated for 24 h with fetal bovine serum (FBS), a pool of RA patients’ sera or a pool of CoViD-19 patients’ sera. The expression levels of adhesion molecules (V-CAM1/CD-106, I-CAM/CD-54, p-selectine/CD-62, tissue factor/CD-142) and apoptosis were analyzed using cytofluorimetric technique. In addition, the autophagy level, using the autophagy markers p62 and LC3II, were evaluated through a western-blot analysis. The same experiments were conducted co-treating cells with the same pool of sera in addition to tocilizumab (TCZ), an anti-IL-6 drug, to verify the reversibility of the process and test the role of the aforementioned cytokine. Data are reported as interquartile median values. The Kruskal Wallis test was used for unpaired samples and the Mann-Whitney test for paired samples. P<0.05 values were considered statistically significant.

Results

EA. hy926 cells, when treated with both RA and CoViD-19 patients’ sera, showed increased levels of activation molecules and apoptosis compared to FBS treated cells. In addition, we observed increased levels of both p62 and LC3 proteins after both rheumatoid arthritis and CoViD-19 patients’ sera treatment. All these findings were reversible in the presence of TCZ. The results are presented in Figure 1.

Figure 1.

Figures show the adhesion molecules levels (A), apoptosis levels (B), p62 and LC3II levels (C), in all experimental conditions. FBS 10% (cells treated with FBS at 10% concentration), S AR (cells treated with a pool of RA patients’ sera); S Covid (cells treated with a pool of COVID-19 patients’ sera); FBS 10%+toci (cells co-treated with FBS at 10% concentration and TCZ); S AR+toci (cells co-treated with a pool of RA patients’ sera and TCZ); S Covid+toci (cells co-treated with a pool of CoViD-19 patients’ sera and TCZ).

Conclusion

Our data showed that treatment with RA and CoViD-19 patients’ sera increase the activation and death of endothelial cells in vitro. The increased level of cells death is possibly due to a block of autophagy. The reversibility of the process after blocking IL-6 with TCZ co-treatment confirms the hypothesis that IL-6 can play a key role in the pathogenesis of endothelial damage in patients with RA and CoViD-19.

References

[1]Bordy R et al. Microvascular endothelial dysfunction in rheumatoid arthritis. Nat Rev Rheumatol. 2018 Jul;14(7):404-420.

[2]Avina-Zubieta et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann. Rheum. Dis. 2012; 71:1524–1529.

Disclosure of Interests

None declared.

AB1355 NAILFOLD CAPILLAROSCOPY CHANGES IN PATIENTS WITH PSORIATIC ARTHRITIS AND RHEUMATOID ARTHRITIS

Background

In psoriatic arthritis (PsA) and rheumatoid arthritis (RA) systemic inflammation is known to cause endothelial dysfunction(1). Nailfold videocapillaroscopy (NVC) analyzes in vivo blood vessels, looking for alterations due to microvascular damage, and its application in these pathologies often highlights interesting abnormalities. PsA is characterized by lower mean capillary length and density and abnormal morphology, such as tight terminal convolutions. In RA typically elongated and dilated capillaries and prominent subpapillary plexus are described(2, 3). Differences between RA and PsA NCV patterns are known but not well defined yet(3).

Objectives

Aim of our study was to evaluate the microvascular features circulation by NVC in patients affected by PsA and RA, looking for possible differences that may characterize the two diseases.

Methods

We recruited outpatients affected by PsA or RA classified according to standard criteria(4, 5) referring to the Rheumatology Unit at Sapienza University of Rome. Healthy controls (HCs) without known risk factors for nailfold capillary alterations(6) were also recruited. Patients and HCs underwent NVC with a 200x magnification lens. The following morphological parameters were considered: number of capillaries per square millimeter, alterations in length, dimension, morphology and distribution of the capillary; presence of ectatic loops, hemorrhages, flux abnormalities(7, 8). A semi-quantitative rating scale was adopted to score these changes, according to previous studies(9). The mean score for each subject was obtained by analyzing all fingers, except the thumbs.

For the statistical analysis, Chi-square and Mann-Whitney tests were used. All tests were two-sided with a significance level set at p<0.05.

Results

We recruited 34 patients (20 with PsA and 14 with RA) and 30 HCs. For patients, the mean age was 61,7 years (SD 15,4), median disease duration was 184 months (SD 204) and males were 18 (53%). Active or past smokers were 11 (18%), 9 (15%) suffered from arterial hypertension and 2 (0.03%) from type 2 diabetes mellitus. Raynaud’s phenomenon was present in 4 patients with PsA (20%) and 6 with RA (43%).

The most frequent morphological changes were tortuous capillaries (90% in PsA and 100% in RA), single-crossing shape (90% and 86%) and bizarre capillaries (30% in both groups) while multiple crossing and ramified capillaries were present in 50% and 21 % RA patients only.

With respect to HCs, we found significantly more frequent changes concerning morphology, ectatic loops, presence of hemorrhages and capillary plexus visibility in both PsA and RA patients. Moreover, patients with RA showed significantly more frequent abnormalities of the blood flow with respect to HCs. These results are shown in Table 1.

Table 1.

Comparison of the main NVC changes in patients and HCs.

NVC ChangesHCPsARAN (%)N (%)P value vs HCsN (%)P value vs HCsMorphology3 (10%)14 (70%)p<0.000112 (86%)p<0.0001Ectatic loops0 (0%)11 (55%)p<0.00018 (57%)p<0.0001Hemorrhages2 (0.07%)1 (5%)p<0.016 (43%)p<0.0058Plexus19 (63%)10 (50%)p<0.027 (50%)p<0.02Flux abnormalities3 (10%)6 (30%)p>0.055 (36%)p<0.026

The presence of hemorrhages was significantly higher in RA rather than in PsA patients (p<0.01). No significant differences were found in number, length, and distribution of capillaries between PsA/RA cases and HCs.

Conclusion

Our study confirms and completes the frame of NCV alterations in PsA and RA. We described for the first time alterations in the capillary morphology and the presence of hemorrhages in both groups of patients with respect to HCs. It remains to evaluate how these findings can reflect the microvascular environment of chronic arthritis.

References

[1]Fromm, S et al. Arthritis Res Ther 2019

[2]Lambova SN, Müller-Ladner U. Microvasc Res 2012

[3]Graceffa D, et al. Arthritis 2013

[4]Taylor W, et al. Arthritis Rheum 2006

[5]Aletaha D, et al. Ann Rheum Dis 2010

[6]Ciaffi J, et al. Microvasc Res 2020

[7]Maricq HR. Arthritis Rheum 1981

[8]Smith V, et al. Autoimmun Rev. 2020

[9]Cutolo M, et al. J Rheumatol 2000

Disclosure of Interests

None declared

POS1267 LONG-TERM SURVEY STUDY OF THE IMPACT OF COVID-19 ON SYSTEMIC AUTOIMMUNE DISEASES. LOW DEATH RATE DESPITE THE INCREASED PREVALENCE OF SYMPTOMATIC INFECTION. ROLE OF PRE-EXISTING INTERSTITIAL LUNG DISEASE AND ONGOING TREATMENTS

Background

Patients with autoimmune systemic diseases (ASDs) can be counted among frail populations as regards the predisposition to COVID-19 due to the frequent visceral organ involvement and comorbidities, as well as the ongoing immunomodulating treatments.

Objectives

Our long-term multicenter telephone survey prospectively investigated the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients during the first 3 pandemic waves.

Methods

A large series of 3,918 ASD patients (815 M, 3103 F; mean age 59±12SD years) was consecutively recruited at the 36 referral centers of COVID-19 & ASD Italian Study Group. In particular, ASD series encompassed the following conditions: rheumatoid arthritis (n: 981), psoriatic arthritis (n: 471), ankylosing spondylitis (n: 159), systemic sclerosis (n: 1,738), systemic lupus (172), systemic vasculitis (n: 219), and a miscellany of other ASDs (n: 178). The development of COVID-19 was recorded by means of telephone survey using standardized symptom-assessment questionnaire (1).

Results

A significantly increased prevalence of COVID-19 (8.37% vs 6.49%; p<0.0001) was observed in our ASD patients, while the cumulative death rate revealed statistically comparable to the Italian general population (3.65% vs 2.95%; p: ns). In particular, among the 328 ASD patients complicated by COVID-19, 57 (17%) needed hospitalization, while mild-moderate manifestations were observed in the large majority of individuals (83%). In addition, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular manifestations.

Interestingly, a significantly higher COVID-19-related death rate was observed in systemic sclerosis patients compared to the Italian general population (6.29% vs 2.95%; p=0.018). Other adverse prognostic factors to develop COVID-19 were the patients’ older age, male gender, pre-existing ASD-related interstitial lung involvement, and chronic steroid treatment. Conversely, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%; p=0.000), as well as the chronic administration of low dose aspirin in a subgroup of SSc patients (with 5.57% vs without 27.84%; p=0.000).

Conclusion

The cumulative impact of COVID-19 on ASD patients after the first 3 pandemic waves revealed less severe than that observed during the first phase of pandemic (1), especially with regards to the death rate that was comparable to the Italian general population in spite of the increased prevalence of complicating COVID-19 in the same ASD series.

Ongoing long-term treatments, mainly csDMARDs, might usefully contribute to generally positive outcomes of in this frail patients’ population.

Of note, a significantly increased COVID-19-related mortality was recorded in only SSc patients’ subgroup, possibly favored by pre-existing lung fibrosis. Among different ASD, SSc deserves special attention, since it shares the main pathological alterations with COVID-19, namely the interstitial lung involvement and the endothelial injury responsible for diffuse microangiopathy.

Besides SSc, the patients’ subgroups characterized by older age, chronic steroid treatment, pre-existing interstitial lung disease, and/or impaired COVID-19 vaccine response (1-3), may deserve well-designed prevention and management strategies.

References

[1]Ferri C, et al. Ann Rheum Dis. 2020 Oct 14 doi: 10.1136/annrheumdis-2020-219113.

[2]Ferri C et al. J Autoimmun. 2021 Dec;125:102744. doi: 10.1016/j.jaut.2021.102744.

[3]Visentini M et al. Ann Rheum Dis. 2021 Nov 24. doi: 10.1136/annrheumdis-2021-221248

Disclosure of Interests

None declared

POS0879 LUNG ULTRASOUND FOR INTERSTITIAL LUNG DISEASE DETECTION IN A COHORT OF SYSTEMIC SCLEROSIS PATIENTS: ROLE OF B-LINE AND PLEURAL LINE MODIFICATIONS

Background

Lung ultrasound (LUS) is a technique that showed a high diagnostic accuracy for interstitial lung disease (ILD) detection in systemic sclerosis (SSc) patients and currently in progress of standardization. Traditionally, B-lines represented the finding of ILD, with the ≥10 total cut-off reported by Tardella et al. resulting to be closely related to moderate ILD detected on high resolution chest computed tomography (HRCT). Recently, Fairchild et al. proposed novel LUS criteria for the evaluation of pleural line, disclosing high accuracy and reproducibility.

Objectives

To compare B lines cut-off with novel pleural line criteria and the respectively associated variables.

Methods

We enrolled 55 consecutive patients affected by SSc according to ACR/EULAR 2013 criteria who underwent respiratory functional tests (RFTs) during 2021, excluding smokers and those with arterial pulmonary hypertension. Twenty-four of them carried out a HRCT during a ± 6-months’ time. In the same day of RFTs, two certified blinded operators performed LUS for each patient applying the 14-areas technique proposed by Gutierrez et al., looking for the presence of total ≥10 cumulative B lines and the fulfilling of Fairchild’s criteria for pleural line. A 3-13 MHz operating linear probe was used. Clinical-demographic data and ongoing therapies were collected.

Results

Among 55 total SSc patients, the agreement between the two operators for Fairchild’s criteria was almost perfect (Cohen’s kappa (k) =0.81) and substantial for ≥10 cumulative B-lines count (k=0.74). Fairchild’s criteria showed a higher diagnostic accuracy compared with ILD detected on HRCT, with an overall specificity (SP) and a positive predicted value (PPV) of 100% (Table 1). A negative correlation emerged between total lung capacity values (TLC%) and both B lines cut-off [first operator (IO): p 0.04, r -0.27; second operator (IIO): p 0.042, r-0.28] and pleural line criteria (IO: p 0.009, r -0.35; IIO: p 0.08, r – 0.36), but only the latter negatively correlated also with forced vital capacity values (FVC%) (IO: p 0.04, r – 0.27; IIO p 0.03, r -0.28). The ≥10 total B lines amount correlated positively with concurrent mycophenolate therapy (IO: p 0.09, r 0.28; IIO: p 0.005, r 0.37) and negatively with anti-centromere antibodies (IO: p 0.002, r -0.3; IIO p 0.009, r -0.34). The presence of digital ulcers showed a positive correlation with pleural line criteria (IO: p 0.03, r 0.29; IIO: p 0.005, r 0.37), with a significant association on multivariate analysis (IO: p 0.03, IIO: p 0.01).

Table 1.

Overall sensitivity, specificity, positive predictive value, negative predictive value of LUS compared to ILD detected on HRCT. C.I. 95% confidence interval.

SE (C.I.)SP (C.I.)PPV (C.I.)NPV (C.I.)Fairchild’s criteria fulfilling0.91 (0.76 - 0,97)1 (0.78 – 1.000)1 (0.88 -1.00)0.82 (0,59 – 0.94)≥10 cumulative B-lines count0.73 (0.56 – 0.85)0.8 (0.55 – 0.93)0.89 (0.72 – 0.96)0.57 (0.36 – 0.75)

Conclusion

We confirmed the feasibility and reliability of Fairchild’s recently proposed pleural line LUS criteria, that showed a higher diagnostic accuracy versus ≥10 cumulative B-lines count for ILD detected on HRCT, presenting SP and PPV values of 100% in SSc. Furthermore, these LUS features seem to differently associate with other aspects of the disease such as autoantibody specificity and vascular lesions, thus deserving future deeper evaluations. For the first time, we found that Fairchild’s criteria were associated with a clinical variable such as digital ulcers. Our results highlight the relevance of pleural line evaluation for ILD detection in SSc on LUS and its possible role towards a standardization of this diagnostic technique.

References

[1]Gutierrez M et al., Radiol Med, 2019.

[2]Xie, H.Q et al. Arthritis Res Ther, 2019.

[3]Tardella M et al., Medicine (Baltimore), 2018.

[4]Fairchild R et al. Arthritis Care Res, 2021.

Disclosure of Interests

None declared

Pollinaria Reconfiguration Mechanism of Widespread Euro-Mediterranean Orchids: The Effects of Increasing Air Temperature

Orchids are fascinating for many reasons: their reproductive strategies, their pollination systems and the various morphological adaptations they have evolved, including the presence of pollen grains agglomerated into two masses, called pollinia, which form a structure known as a pollinarium. After withdrawal from a flower, the pollinarium undergoes a bending movement such that the pollen masses become correctly orientated to strike the stigma. We evaluated the duration of pollinator visits to inflorescences and the effects of temperature on pollinaria reconfiguration in eight orchid species in order to analyze the effects of increasing air temperature on the changes in bending time, and thus on geitonogamy levels. The impact of temperature on insect behavior was not assessed because our priority was to understand the effects of temperature on the process of pollinaria reconfiguration. All the examined species showed natural reconfiguration times that were 1.7-3.0 times longer than the pollinator residency times. A higher temperature showed a reduction in bending time regardless of the species tested. However, the bending time was never shorter than the residence time of the insects on the flower. Our data showed that high temperatures had a limited effect on the pollinarium reconfiguration time, thus indicating that high temperatures had a limited effect on folding compared to the effect that it had on the viability of the pollen.

In silico framework to inform the design of repair constructs for peripheral nerve injury repair

Peripheral nerve injuries affect millions of people per year and cause loss of sensation and muscle control alongside chronic pain. The most severe injuries are treated through a nerve autograft; however, donor site morbidity and poor outcomes mean alternatives are required. One option is to engineer nerve replacement tissues to provide a supportive microenvironment to encourage nerve regeneration as an alternative to nerve grafts. Currently, progress is hampered due to a lack of consensus on how to arrange materials and cells in space to maximize rate of regeneration. This is compounded by a reliance on experimental testing, which precludes extensive investigations of multiple parameters due to time and cost limitations. Here, a computational framework is proposed to simulate the growth of repairing neurites, captured using a random walk approach and parameterized against literature data. The framework is applied to a specific scenario where the engineered tissue comprises a collagen hydrogel with embedded biomaterial fibres. The size and number of fibres are optimized to maximize neurite regrowth, and the robustness of model predictions is tested through sensitivity analyses. The approach provides an in silico tool to inform the design of engineered replacement tissues, with the opportunity for further development to multi-cue environments.

Development and Validation of an AI-driven Mammographic Breast Density Classification Tool Based on Radiologist Consensus

Mammographic breast density (BD) is commonly visually assessed using the Breast Imaging Reporting and Data System (BI-RADS) four-category scale. To overcome inter- and intraobserver variability of visual assessment, the authors retrospectively developed and externally validated a software for BD classification based on convolutional neural networks from mammograms obtained between 2017 and 2020. The tool was trained using the majority BD category determined by seven board-certified radiologists who independently visually assessed 760 mediolateral oblique (MLO) images in 380 women (mean age, 57 years ± 6 [SD]) from center 1; this process mimicked training from a consensus of several human readers. External validation of the model was performed by the three radiologists whose BD assessment was closest to the majority (consensus) of the initial seven on a dataset of 384 MLO images in 197 women (mean age, 56 years ± 13) obtained from center 2. The model achieved an accuracy of 89.3% in distinguishing BI-RADS a or b (nondense breasts) versus c or d (dense breasts) categories, with an agreement of 90.4% (178 of 197 mammograms) and a reliability of 0.807 (Cohen κ) compared with the mode of the three readers. This study demonstrates accuracy and reliability of a fully automated software for BD classification. Keywords: Mammography, Breast, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms Supplemental material is available for this article. © RSNA, 2022.

Fluid-dynamic control microcatheter used with glue: preliminary experience on its feasibility and safety

Purpose

To evaluate feasibility, safety, and success of peripheral embolization procedures carried out using anti-reflux microcatheter with N-butyl-cyanoacrylate (NBCA) as an embolic agent.

Methods

We retrospectively described 11 patients that suffered from active bleeding in different body districts, who underwent embolization procedure using SeQure microcatheter (Guerbet, France) with NBCA glue (Glubran II, GEM Italy) as an embolic agent. The treatments required NBCA volumes ranged from 0.1 to 0.6 mL, with different dilutions with ethiodized oil (Lipiodol, Guerbet, France), depending on the entity of the bleeding. Technical success, clinical success, and complications were evaluated.

Results

The procedures were successfully concluded in the totality of the patients, achieving full technical and clinical success. In one patient (9.1%), a small upstream of embolic material was encountered, without any consequence.

Conclusion

This preliminary experience shows that the use of SeQure is feasible and safe with NBCA.

Cetacean presence and distribution in the central Mediterranean Sea and potential risks deriving from plastic pollution

The Sardinian and Sicilian Channels are considered hotspots of biodiversity and key ecological passages between Mediterranean sub-basins, but with significant knowledge gaps about marine mammal presence and potential threats they face. Using data collected between 2013 and 2019 along fixed transects, inter and intra-annual cetacean index of abundance was assessed. Habitat suitability, seasonal hot spots, and risk exposure for plastic were performed using the Kernel analysis and the Biomod2 R-package. 661 sightings of 8 cetacean species were recorded, with bottlenose and striped dolphins as the most sighted species. The north-eastern pelagic sector, the coastal waters and areas near ridges resulted the most suitable habitats for these species. The risk analysis identified the Tunis, Palermo, and Castellammare gulfs and the Egadi Island as areas of particular risk of plastic exposure. The study represents a great improvement for cetacean knowledge in this region and contributes to the development of effective conservation strategies.

POS1185 IMPACT OF LOCKDOWN DURING COVID-19 PANDEMIC ON THE ONSET OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN SYSTEMIC SCLEROSIS PATIENTS: A CASE-CONTROL STUDY

Background:

Social distancing due to COVID-19 pandemic had a major impact on the mental health of general population, with a high prevalence of post-traumatic stress disorder (PTSD) related symptoms1, 2. Psychological repercussions were notably found in people with chronic diseases, including systemic sclerosis (SSc) patients, where an increasing of anxiety symptoms, related also to low financial resources, emerged3.

Objectives:

To evaluate the impact of COVID-19 lockdown on the onset of PTSD in patients with SSc, firstly during the total confinement period (March-April 2020) and then at the time of less restrictive government measures, following the RT index lowering (June-July 2020)4.

Methods:

We carried out a case-control study on 57 SSc patients, according to the ACR/EULAR 2013 criteria, and on 57 healthy subjects as control group (HC), matched by sex and age. At T0 (March-April) and T1 (June-July) both populations received the “Impact of Event Scale Revised” questionnaire (IES-R) by e-mail, with a cut-off of ≥ 33 defining probable diagnosis of PTSD5. A multivariate analysis of possible factors influencing IES-R score, such as age, number of cohabitating people and weekly outings count, was performed in SSc patients at both times of the survey.

Results:

At T0 we found a significantly greater number of SSc patients with IES-R score ≥ 33 compared to HC (26/45.6% vs 13/22.8%; median value [quartiles] 31 [19.5;42.5] vs 24 [15.5; 32]; p-value 0.046). At T1, we obtained data from 44 SSc patients and 35 HC but no significant difference was noticed (18 / 40.9% vs 8 / 23.5%; 26 [15.25; 38] vs 26.5 [20.75; 32.5]; p> 0.05). SSc patients also had significantly fewer weekly outings than HC, both at T0 (p <0.001) and T1 (p <0.001) (Table 1). The multivariate analysis performed at T0 on SSc patients showed a significant association of IES-R ≥33 score with age (p 0.025) and with a lower count of weekly outings (p 0.002). The latter data negatively correlated with an IES-R ≥33 score in SSc patients (r -0.267, p 0.004).

Conclusion:

We found a significantly higher prevalence of PTSD in SSc patients compared to HC at the strictest lockdown time, turning into comparable when government measures were less restrictive, due to the minimum RT index values recorded in Italy. Older age and lower count of weekly outings were associated with PTSD in SSc patients during the lockdown, whereas the count of weekly outings was lower than in HC during both the examined periods. The results of this study indicate that COVID-19 lockdown had a worse impact in SSc patients, where the fewer weekly outings may depend on their clinical condition and on a greater concern about their health6. These findings strengthen the World Scleroderma Foundation recommendations regarding care to the psychological frailty of SSc patients7.

References:

[1]Wang C, Brain Behav Immun. 2020.

[2]Dubey S, Psychiatr Pol. 2020.

[3]Thombs BD, J Psychosom Res. 2020 Dec.

[4]https://covid19.infn.it/grafici/?chart=italia,rt,covidstat

[5]Weiss, D. S., & Marmar, C. R. (1996). The Impact of Event Scale - Revised, Assessing. psychological trauma and PTSD (pp. 399-411).

[6]Orlandi M, Clin Rheumatol. 2020

[7]Matucci-Cerinic M, Ann Rheum Dis. 2020

Table 1.

Descriptive analysis of study population: T0 (Time 0), T1 (Time 1), SD (Standard Deviation), IES-R (Impact of Event Scale-Revised).

SSc patient groupHS groupFemale:male ratio at T046:746:7Mean age ± SD at T059±12.851±8.7IES-R ≥33 score n°/% at T026/45.6%*13/22.8%IES-R ≥33 score n°/% at T118/40.9%8/23.5%IES-R score at T0, median value [quartiles]31 [19.5;42.5]24 [15.5;32]IES-R score at T1, median value [quartiles]26 [15.25; 38]26.5 [20.75; 32.5]N° of weekly outings at T0, median value [quartiles]2 [1;3.5]4 [2;10]**N° of weekly outings at T1, median value [quartiles]5 [3;6]14 [6.75;15]**

*p<0.046; **p<0.001

Disclosure of Interests:

None declared.

POS0433 CAN INTERLEUKIN 33 (IL-33) BE CONSIDERED A VALUABLE BIOMARKER IN THE EARLY STAGES OF SYSTEMIC SCLEROSIS? ANALYSIS OF A MONOCENTRIC COHORT

Background:

The ScS approach has changed considerably in recent years especially concerning the very early diagnosis of the disease (VEDOSS) at the time when the patient is still in an undifferentiated form (UCTD) at risk of developing SSc (1, 2). Of great value are different clinical, instrumental and laboratory findings, such as specific autoantibodies and Nailfold VideoCapillaroscopy (NVC), able to identify those cases progressing into overt SSc. IL-33 cytokine is known to exert pro-fibrotic effects through its membrane receptor ST2 on immune cells and myofibroblasts and recent studies suggest that it can be released following endothelial cell activation at the onset of SSc (3, 4).

Objectives:

Our aim has been to evaluate IL-33 serum levels in a monocentric cohort of VEDOSS patients, looking for the possible association with clinical phenotype and disease progression, focusing on the microvascular capillaroscopic changes.

Methods:

Fourty-seven VEDOSS patients underwent a complete clinical, instrumental and laboratory evaluation, including NVC and specific SSc autoantibodies. At baseline serum IL-33 levels were measured using an ELISA assay. In 32 of them we also had a second serum sample at a follow-up time of at least 24 months (range 24 to 96 months).

Results:

During the follow-up time, 17 patients were subsequently reclassified as having ScS whereas 30 remained VEDOSS. The “progressor” subjects positively correlated with the presence of anti-Topoisomerase I antibodies (p>0,004). IL-33 concentrations had a median value of 427.2 pg/ml (IQR 967.9 pg/ml) at baseline and of 130.4 pg/ml (IQR 399 pg/ml) at the follow up, showing a statistically significant difference independently from the progression of the disease (p=0.03). Besides significantly higher levels were detected in those patients with more severe NVC changes, defined as “active” pattern (p<0.05). Among the 47 VEDOSS patients, 12 started some kind of vascular therapy. In these patients serum IL-33 concentrations significantly lowered during the follow-up respect to those without any treatment (p<0.03)

Conclusion:

The analysis of our data confirms previous report (5) on higher IL-33 serum levels in the very early stages of UCTD patients at risk for SSc, regardless of their progression in established SSc, although related to more severe microvascular NVC involvement. The lowering of IL-33 serum levels that we detected in the follow up of our patients, may be linked to the well-known endothelial changes during the progression of the SSc and seems also to be partially affected by treatments. Investigation on a greater number of patients are needed to better understand our findings.

References:

[1]J. Avouac et al. Ann Rheum Dis 2011

[2]G Valentini et al. Clin Exp Med 2017

[3]Manetti M, et al. Ann Rheum Dis 2010

[4]Terras S et al. Ann Rheum Dis 2013

[5]Vettori S, et al. J Clin Immunol 2014

Disclosure of Interests:

None declared

POS1246 COVID-19 IN ITALIAN PATIENTS WITH RHEUMATIC AUTOIMMUNE SYSTEMIC DISEASES: RESULTS OF A NATIONWIDE SURVEY STUDY

Background:

SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement.

Objectives:

To evaluate the impact of Covid-19 pandemic in a large series of Italian patients with ASD.

Methods:

Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, Covid-19 was classified as definite Covid-19 (signs or symptoms of Covid-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected Covid-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis.

Results:

The main findings of the survey study revealed a significantly increased prevalence of Covid-19 in:

a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%; p=0.0007;

definite Covid-19 plus highly suspected Covid-19: 74/2,994, 2.47%; p<0.0001) when compared to Italian general population of Covid-19 infected individuals (349/100000 = 0.34%; data from Italian Superior Institute of Health;

https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-national-surveillance-system).

b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%; p=0.036; definite Covid-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%; p<0.0001)

c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%; p=0.0015; definite Covid-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%; p<0.0001).

Of interest, the prevalence of Covid-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs; while patients treated with conventional DMARDs showed a significantly lower prevalence of Covid-19 compared to those without. Covid-19 was more frequently observed in the patients’ populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate; 4/9 individuals requiring hospital admission died for severe pneumonia.

Conclusion:

The prevalence of Covid-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population; moreover, the actual prevalence of Covid-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as ‘frail patients’ during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection.

The statistically significant association of Covid-19 with connective tissue diseases/systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients’ vulnerability to SARS-CoV-2 infection.

Disclosure of Interests:

None declared

POS1219 SARS-COV-2 VACCINE HESITANCY AMONG PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES: A MESSAGE FOR RHEUMATOLOGISTS

Background:

Conflicting results have been published regarding the risk of infection with SARS-CoV-2 and development of severe COVID-19 among patients affected by rheumatic musculoskeletal diseases (RMDs). [1-4] Taking into account the lack of effective drugs to treat the COVID-19 and despite the burdensome and costly lockdown measures adopted to counteract the spread of SARS-CoV-2, effective and safe vaccines appear reasonably to be the best strategy for fighting the virus. [6] Before vaccines availability, several reports showed that a non-negligible proportion of subjects, among the general population or within specific categories, would have refused vaccination against COVID-19 once possible;[6, 7] data on vaccination hesitation among patients with RMD are not available yet.

Objectives:

This study aimed to evaluate the attitude of patients with RMDs to vaccination against SARS-CoV-2 and explore the factors which may influence it.

Methods:

During the first weeks of Europe vaccination campaign, we proposed an online survey to Italian adult patients with RMDs followed up in the Rheumatology Unit. All patients fulfilled the most recent classification criteria for each disease. HCs were recruited using a “best friend” system. The informed consent was collected for all participants. The questionnaires included the following items: demographic features, presence of comorbidities, educational level, and ongoing therapy. The individual’s perception of the COVID-19 vaccination, as well as the willingness to receive a COVID-19 vaccination with targeted questions was properly assessed.

For the statistical analyses, Mann-Whitney and Chi-square tests were used. To account for baseline clinical differences among RMD-patients and controls, multivariable logistic regression analysis was used; covariates were selected according to a clinical criterion. The hypothesis that willingness for COVID-19 vaccine varied in specific subgroups of patients was tested using interaction terms at logistic regression analysis. All statistical tests were performed using the RStudio graphical interface and all tests were two-sided with a significance level set at p<0.05.

Results:

We provided an online survey to 830 adult RMD-patients and 370 healthy controls (HCs). Overall, 626 RMD-patients and 345 HCs completed the survey. Patients with RMDs were less willing to receive a COVID-19 vaccination compared to HCs (Odds Ratio (OR) 0.24, 95% CI 0.17 – 0.34, p<0.0001) despite they perceived themselves as at higher risk both to get infected (OR 11.3, 95% CI 8 – 15.9, p<0.0001) and develop a severe COVID-19 (OR 11.06, 95% CI 7.8 – 15.6, p<0.0001) and even if they had been vaccinated for influenza and pneumococcus more frequently than controls (OR 1.60 95% CI 1.18 – 2.16, p=0.002; OR 2.23, 95% CI 1.34 – 3.73, p=0.002). However, our results reveal that RMD-patients are more willing to change their minds if properly informed by the rheumatologist (OR 3.08, 95% CI 2.19 – 4.34, p<0.0001) in comparison to controls.

Conclusion:

The results of our study indicate for the first time that patients with RMDs are less willing to receive COVID-19 vaccination compared to the general population, despite perceiving themselves as at higher risk of getting infected with SARS-CoV-2 and develop severe COVID-19. However, our data underscored a meaningful aspect: patients with RMDs may change their attitude to COVID-19 vaccination if properly informed about risks and benefits by their trusted specialist.

The results of this study encourage the entire rheumatologist community to become more committed to patient education, increasing their willingness to COVID-19 vaccine, which is the most promising strategy to protect them from the virus.

References:

1]Favalli EG et al. Arthritis Rheumatol, 2020

[2]Fredi M, et al. Lancet Rheumatol, 2020.

[3]Giardina F et al. Rheumatol Int 2021.

[4]Pellegrino G et al. Clin Rheumatol 2020.

[5]Frederiksen LSF, et al. Front Immunol, 2020.

[6]La Vecchia C et al. Med Lav 2020.

[7]Qiao S, et al. medRxiv 2020.

Disclosure of Interests:

None declared

OP0246 PREDICTIVE VALUE OF LABORATORY AND INSTRUMENTAL FINDINGS IN THE VERY EARLY DIAGNOSIS OF SYSTEMIC SCLEROSIS. ROLE FOR CXCL4 CHEMOKINE

Background:

Systemic sclerosis (SSc) is a rare and progressive autoimmune disease, whose diagnosis is difficult in the early stages because of the lack of specific signs and symptoms. Criteria for a Very Early Diagnosis of SSc (VEDOSS) have been proposed to identify those patients affected by undifferentiated connective tissue disease (UCTD) at risk to develop SSc [1]. For the diagnosis of SSc a strict clinical and laboratory follow up is mandatory [2]. CXCL4 chemokine recently proved to be higher in early SSc [3][4][5].

Objectives:

Aim of our study was to evaluate at baseline the main clinical-demographic and laboratory parameters in a group of VEDOSS patients, comparing these features during the follow-up, to detect any difference between progressors (P) and non-progressors (NP) into SSc. Furthermore, we dosed plasma levels of CXCL4.

Methods:

We included 27 VEDOSS patients, defined by EUSTAR 2011 Criteria and not fulfilling the 2013 ACR/EULAR classification criteria of SSc, attending the Rheumatology Unit of Policlinico Umberto I in Rome from 2009 to 2020. Demographic, laboratory and instrumental features were analyzed, and, after a mean follow-up of 5.7±1,7 years, we compared the P to NP patients. Having obtained written informed consent, blood samples were taken at baseline to measure plasma levels of CXCL4 chemokine using an ELISA assay.

Results:

At baseline the 27 VEDOSS patients (mean age 53.2±13.5 years, all females) had ANA positivity in 25 (93%) cases and Raynaud’s phenomenon in 25 (93%) cases. In a mean follow-up time of 43.5 ± 23.1 weeks from the first clinical examination, 15 (55%) patients were classified as P into SSc. These P patients showed a significant association with SSc specific antibodies such as anti-Centromere, anti-Scl70 and anti-RNAPIII (p=0.014) as well as with a specific “Scleroderma pattern” at the nailfold capillaroscopy (p=0.022) respect to those NP into SSc. A group of 6 P patients evolved in less than 24 months (mean 19,6 ± 6,8 weeks) and were defined “Fast Progressor”. They were also significantly associated with those autoantibodies considered as having a worse prognosis such as anti-Scl70 and anti-RNAPIII (p=0.005), and had a shorter duration of RP (88 vs 189.3 months) and a younger mean age (49.5 vs 55.4 years) respect to “Slow Progressor” (SSc evolving in >24 months). At baseline we detected significantly higher median plasma levels of CXCL4 in the 27 VEDOSS patients compared to 10 healthy subjects (9024±10559 pg/ml versus 348,5±684,3 pg/ml; p=0.0047). We also noticed a trend for lower CXCL4 levels in the “Fast Progressor” than in the “Slow Progressor” (3303 ± 6065 pg/ml vs 13300 ± 10308 pg/ml; p=0.052) without reaching a significant value, due probably to the low number of cases.

Conclusion:

Our study confirms that the presence of specific autoantibodies and capillaroscopic abnormalities correlate to an increased risk of developing SSc in patients with UCTD [6]. Beside we found significantly higher levels of CXCL4 in our 27 VEDOSS patients respect to controls, in agreement with other authors showing the association of this chemokine with early stages and specific organ involvement [4][5][7]. The finding of CXCL4 lower levels in “fast progressor” cases is consistent with our recent report of anti-CXCL4 antibodies in patients with early SSc, determining lower levels of this antigen [7]. We need deeper investigations to better evaluate the role of CXCL4 in the different stages of SSc.

References:

[1]J. Avouac et al., Ann. Rheum. Dis., 2011.

[2]F. van den Hoogen et al., Ann. Rheum. Dis., 2013.

[3]G. Valentini et al., Clin. Exp. Med., 2017.

[4]R. Lande et al., Nat. Commun., 2019.

[5]L. van Bon et al., N. Engl. J. Med., 2014.

[6]M. Vasile et al., Clin. Exp. Rheumatol., 2018.

[7]R. Lande et al., Int. J. Mol. Sci., 2020.

Disclosure of Interests:

None declared

Chromatographic Fingerprinting Strategy to Delineate Chemical Patterns Correlated to Coffee Odor and Taste Attributes

Coffee cupping includes both aroma and taste, and its evaluation considers several different attributes simultaneously to define flavor quality and therefore requires complementary data from aroma and taste. This study investigates the potential and limits of a data-driven approach to describe the sensory quality of coffee using complementary analytical techniques usually available in routine quality control laboratories. Coffee flavor chemical data from 155 samples were obtained by analyzing volatile (headspace-solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS)) and nonvolatile (liquid chromatography-ultraviolet/diode array detector (LC-UV/DAD)) fractions, as well as from sensory data. Chemometric tools were used to explore the data sets, select relevant features, predict sensory scores, and investigate the networks between features. A comparison of the Q model parameter and root-mean-squared error prediction (RMSEP) highlights the variable influence that the nonvolatile fraction has on prediction, showing that it has a higher impact on describing acid, bitter, and woody notes than on flowery and fruity. The data fusion emphasized the aroma contribution to driving sensory perceptions, although the correlative networks highlighted from the volatile and nonvolatile data deserve a thorough investigation to verify the potential of odor-taste integration.

Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones

OBJECTIVES

To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones.

METHODS

We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an endoscopic approach, treated with PTL. Both procedures were conducted using the same protocol, with two different accesses. The treatments were performed using a 10 Fr flexible choledoscopy SpyGlass DSTM for visualization and an EH system for lithotripsy.

RESULTS

Technical success, clinical success and complications were evaluated. The two procedures were successfully concluded in both patients without any residual stones in the biliary tree. For both patients, a short follow-up period of six months was available, during which they remained asymptomatic. Neither major nor minor complications were registered.

CONCLUSION

PTL was determined to be an effective and safe technique. This procedure allows a direct visualization of the stone, reducing fluoroscopy time and permitting a less invasive and less traumatic method for the percutaneous management of difficult bile stones. Advances in knowledge: The direct visualization, the high quality of the digital view, the adequate length of the device and the less traumatic approach of EH systems represent advantages compared with other available technologies.

Pollen viability of Euro-Mediterranean orchids under different storage conditions: The possible effects of climate change

The future impact of climate change and a warmer world is a matter of great concern. We therefore aimed to evaluate the effects of temperature on pollen viability and fruit set of Mediterranean orchids. The in vitro and controlled pollination experiments were performed to evaluate the ability of pollinia stored at lower and higher temperatures to germinate and produce fruits and seeds containing viable embryos. In all of the examined orchids, pollen stored at -20 °C remained fully viable for up to 3 years, reducing its percentage germination from year 4 onwards. Pollinia stored at higher temperatures had a drastic reduction in vitality after 2 days at 41-44 °C, while pollinia stored at 47-50 °C did not show any pollen tube growth. The different levels of pollen viability duration among the examined orchids can be related to their peculiar reproductive biology and pollination ecology. The germinability of pollinia stored at lower temperatures for long periods suggests that orchid pollinia can be conserved ex situ. In contrast, higher temperatures can have harmful effects on the vitality of pollen and consequently on reproductive success of the plants. To our knowledge, this is the first report demonstrating the effects of global change on orchid pollen, and on pollen ability to tolerate, or not, higher air temperatures. Although vegetative reproduction allows orchids to survive a few consecutive warm years, higher temperatures for several consecutive years can have dramatic effects on reproductive success of orchids.

3D planning of ear prosthesis and navigated flapless surgery for craniofacial implants: A pilot study

New 3D digital technologies can be applied to implant-supported ear prostheses to restore anatomical structures damaged by cancer, dysplasia, or trauma. However, several factors influence the accuracy of implant positioning using a cranial template. This pilot study describes an innovative navigated flapless surgery for craniofacial implants, prosthetically guided by 3D planning of the ear prosthesis. Laser surface scanning of the face allowed for mapping of the healthy ear onto the defect site, and projection of the volume and position of the final prosthesis. The projected ear volume was superimposed on the skull bone image obtained by cone-beam computed tomography (CBCT), performed with the navigation system marker plate positioned in the patient's mouth. The craniofacial implants were fitted optimally to the ear prosthesis. After system calibration, real-time navigated implant placement based on the virtual planning was performed with minimally invasive flapless surgery under local anesthesia. After 3 months of healing, digital impressions of the implants were made, and the digital manufacturing workflow was completed to manufacture the ear prosthesis anchored to the craniofacial implants. The proposed digital method facilitated implant positioning during flapless surgery, improving the ear prosthesis manufacturing process and reducing operation time, patient morbidity, and related costs. This protocol avoids the need for a reference tool fixed in the cranial bone, as is usually required for maxillofacial surgery, and confirmed that surgical navigation is useful for guiding the insertion of craniofacial implants during flapless surgery.

Comparison of Three Nutritional Screening Tools with the New Glim Criteria for Malnutrition and Association with Sarcopenia in Hospitalized Older Patients

The integrated assessment of nutritional status and presence of sarcopenia would help improve clinical outcomes of in-hospital aged patients. We compared three common nutritional screening tools with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria among hospitalized older patients. To this, 152 older patients were assessed consecutively at hospital admission by the Malnutrition Universal Screening Tool (MUST), the Subjective Global Assessment (SGA), and the Nutritional Risk Screening 2002 (NRS-2002). A 46% prevalence of malnutrition was reported according to GLIM. Sensitivity was 64%, 96% and 47%, and specificity was 82%, 15% and 76% with the MUST, SGA, and NRS-2002, respectively. The concordance with GLIM criteria was 89%, 53% and 62% for the MUST, SGA, and NRS-2002, respectively. All the screening tools had a moderate value to diagnose malnutrition. Moreover, patients at high nutritional risk by MUST were more likely to present with sarcopenia than those at low risk (OR 2.5, CI 1.3-3.6). To conclude, MUST is better than SGA and NRS-2002 at detecting malnutrition in hospitalized older patients diagnosed by the new GLIM criteria. Furthermore, hospitalized older patients at high risk of malnutrition according to MUST are at high risk of presenting with sarcopenia. Nutritional status should be determined by MUST in older patients at hospital admission, followed by both GLIM and the European Working Group on Sarcopenia in Older People (EWGSOP2) assessment.

AB0170 PHENOTYPIC CHARACTERIZATION OF ENDOTHELIAL PROGENITORS CELLS OF SYSTEMIC SCLEROSIS (SSC) PATIENTS: ROLE IN ENDOTHELIAL-TO-MESENCHIMAL TRANSITION PROCESS

Background:

Endothelial-to-mesenchymal transition (EndoMT), a newly recognized type of cellular transdifferentiation, seems to be involved in Systemic Sclerosis (SSc) pathogenesis. In this process endothelial cells lose their specific markers, and acquire a mesenchymal phenotype, thus expressing cell products such as alpha smooth muscle actin (α-SMA) (1,2).Circulating endothelial progenitors cells (EPCs) derive from bone marrow stem cells and contribute tode novovessels formation. Several studies, although with conflicting results, have shown that EPCs in the peripheral blood of patients with SSc are impaired in their number and function (3).

Objectives:

to assess phenotypic characteristics of EPCs fromSSc patients and from patients with Very Early Diagnosis of SSc (VEDOSS) compared with healthy controls (HC). In particular we want to evaluate the expression of α-SMA, as marker of a pro-mesenchymal switch (EndoMT) in:

Methods:

we enrolled 11 patients (6 SSc and 5 VEDOSS), classified according to the classification criteria for SSc (4) and for VEDOSS not fulfilling SSc criteria (5), and 5 HC. Phenotypic characterization was performed as previously described by Vasa et al. using a FACS Calibur (BD Immunocytometry Systems). EPCs number was expressed as a percentage of cells within the lymphocyte gate. 5*106 PBMCs were plated on human fibronectin-precoated (10 μg/ml Sigma-Aldrich) 6-well plates and cultured for 7-12 days to obtain EPCs. PBMCs from one HC were also cultured with 20% SSc patient serum. Collected EPCs were lysed and a Western blot analysis for α-SMA detection was performed.

Results:

we found a significant higher percentage of α-SMA positive Early EPCs in all patients respect to HC (0,06% ±0,03 vs 0,03% ± 0,01; p=0,0149) particularly in VEDOSS patients (0,07%±0,01 vs 0,03%±0,01 p=0,008). Similarly we found a significant higher expression of α-SMA protein in all patients and VEDOSS patients respect to HC (0,1895±0,16 vs 0,07± 0,06 p= 0,0342; 0,3075 ± 0,14 vs 0,07± 0,06 p=0,0159). After the incubation of HC PBMCs with SSc serum, the α-SMA protein expression seems to be increased respect to its expression in thePBMCs of the same HC cultured without SSc serum (0,33 vs 0,1).

Conclusion:

we found higher percentage of Early α-SMA positive EPCs and a higher expression of α-SMA protein in cultured EPCs in patients group (SSc and VEDOSS) than in HC. So we hypothesized a predominant pro-mesenchymal phenotype of this kind of EPCs. This could be considered the expression of the involvement of EPCs in the EndoMT process and it better explain the controversial role of EPCs in SSc pathogenesis. Moreover the modified expression of α-SMA in HC EPCs co-cultured with 20% SSc serum could suggest the presence of a factor inducing the EndoMT process in the disease.

References:

[1]Corallo C et al Arthritis Res Ther 2016;

[2]Manetti M et al AnnRheumDis 2017;

[3]Del Papa N et al Front. Immunol 2018;

[4]Van den Hoogen F et al AnnRheumDis 2013.

[5]Avouac J et al Ann Rheum Dis 2011;

Disclosure of Interests:

Katia Stefanantoni Consultant of: Italfarmaco

Boehringer Ingelheim, cristiana barbati: None declared, Tania Colasanti: None declared, Carlotta Angelelli: None declared, Greta Pellegrino: None declared, cristiano alessandri Grant/research support from: Pfizer, Guido Valesini: None declared, Valeria Riccieri: None declared

SAT0296 SERUM LEPTIN LEVELS IN SYSTEMIC SCLEROSIS PATIENTS WITH ELECTROCARDIOGRAPHIC ABNORMALITIES

Background:

Electrocardiographic (ECG) abnormalities are described in 25-75% Systemic Sclerosis (SSc) cases and they are associated with other systemic manifestations as well as with a worse prognosis. There is an increasing need for clinical and laboratory biomarkers to ameliorate the diagnostic and therapeutic approaches to patients with ECG abnormalities, due to their actual low sensitivity and specificity. Adipokines are circulating proteins that appear dysregulated in SSc and leptin in particular is synthesized in response to inflammatory conditions and seems to play a proinflammatory and pro-fibrotic action in SSc. Interesting, many studies in the last years have underlined its role in the cardiac remodeling mechanisms and in the development of cardiac fibrosis in other chronic diseases.

Objectives:

Aim of our study is to evaluate the role of leptin in the development of cardiac rhythm disorders (CRD) during SSc. Furthermore, by the analysis of the clinical and demographical parameters of our SSc patients, we tried to define other possible features associated with increased serum leptin concentration.

Methods:

We included eighty-five SSc patients, fulfilling the 2013 ACR/EULAR classification criteria, attending the Regional Rare Disease Center of Policlinico Umberto I of Rome. Fifty presented significant CRD at non-invasive diagnostic techniques (12 Lead ECG, 24-hour Holter ECG). Demographic, clinical, conventional cardiovascular risk factors were examined; instrumental and laboratory assessments were obtained, together with ECG recordings. Thirty-five SSc patients without pathologic finding at ECG traces, matched for demographic and clinical features, were recruited as the control group. In all cases, after obtaining written informed consent, blood samples were taken to measure serum levels of leptin using an ELISA assay (Life Technologies-Italia).

Results:

The fifty SSc patients with CRD (mean age 51±15 years; F:M 41:9) had pulmonary fibrosis (PF) in 32 cases (64%) and a BMI >25Kg/m2in 22 (44%) while in the control group of thirty-five SSc patients (mean age 49±16 years; F:M 33:2) PF was found in 15 (43%) and a BMI >25Kg/m2in 9 (35%); We detected significantly higher median values of serum leptin in SSc patients with CRD compared to the control group (12027 pg/ml IQR 12314 versus 6392 pg/ml IQR 7103;p 0,0009). Additionally, SSc patients with a BMI> 25 kg/m2(31 cases) as well as those with PF (47 cases) showed a significantly higher median serum leptin levels compared to those with BMI <25 kg/m2(13161 pg/ml IQR 13610 versus 8187 pg/ml IQR 8255;p 0,0008) and those without PF (11740 pg/ml IQR 11940 versus 7616 pg/ml IQR 7855;p 0,0079).

Conclusion:

To our knowledge this is the first report on high serum levels of leptin in SSc patients with CRD that also confirms its increase in those cases with a BMI >25 kg/m2and with PF, according to scientific literature data. The role of leptin in the pathogenesis of SSc remains unclear although it is already known its involvement in the development of cardiac fibrosis during other chronic diseases. On the basis of these results we speculate on leptin involvement in the pathogenesis of CRD during SSc, although further studies are needed with larger cohort of patients.

References:

[1]Vacca A et al. Rheumatology, 2014

[2]Tyndall AJ et al. Ann Rheum Dis, 2010

[3]Muresan L et al. Iran J Pub Health, 2017

[4]Sanna T et al. Indian Pacing Electrophysiol J, 2009

[5]Riccieri V et al. Clin Exp Rheumatol, 2011

[6]Żółkiewicz J et al. Arch Dermatol Res, 2019

[7]Huby AC et al. Circulation, 2015

[8]Shulze PC et al. Clin Chim Acta, 2005

[9]Van de Hoogen F et al. Arthritis Rheum, 2013

[10]Gui X et al. Biochem Biophys Res Commun, 2018

Disclosure of Interests:

Greta Pellegrino: None declared, Katia Stefanantoni Consultant of: Italfarmaco

Boehringer Ingelheim, Fausta Facioni: None declared, Carlotta Angelelli: None declared, Antonietta Gigante: None declared, Roberto Badagliacca: None declared, Carmine Dario Vizza: None declared, Sergio Morelli: None declared, Edoardo Rosato: None declared, Valeria Riccieri: None declared

Corrigendum: Sicoli G, Passalacqua NG, De Giuseppe AB, Palermo AM, Pellegrino G (2019) A new species of Psathyrella (Psathyrellaceae, Agaricales) from Italy. MycoKeys 52: 89-102. https://doi.org/10.3897/mycokeys.52.31415

Not required

A new species of Psathyrella (Psathyrellaceae, Agaricales) from Italy

Sporophores of a new Psathyrella species have been reported for the first time as growing at the base of Cladiummariscus culms in the Botanical Garden of the University of Calabria, Rende, Cosenza, southern Italy. The fungus was initially identified as P.thujina (= P.almerensis) by means of both ecology and macro- and microscopic characteristics of the basidiomes, then referred to P.cladii-marisci sp. nov. after extraction, amplification, purification and analysis of the rDNA ITS region. We came to this conclusion after comparing our specimen with the descriptions of the taxa available in the literature for the genus Psathyrella.

ROLE of IGF-1 System in the Modulation of Longevity: Controversies and New Insights From a Centenarians' Perspective

Human aging is currently defined as a physiological decline of biological functions in the body with a continual adaptation to internal and external damaging. The endocrine system plays a major role in orchestrating cellular interactions, metabolism, growth, and aging. Several in vivo studies from worms to mice showed that downregulated activity of the GH/IGF-1/insulin pathway could be beneficial for the extension of human life span, whereas results are contradictory in humans. In the present review, we discuss the potential role of the IGF-1 system in modulation of longevity, hypothesizing that the endocrine and metabolic adaptation observed in centenarians and in mammals during caloric restriction may be a physiological strategy for extending lifespan through a slower cell growing/metabolism, a better physiologic reserve capacity, a shift of cellular metabolism from cell proliferation to repair activities and a decrease in accumulation of senescent cells. Therefore, understanding of the link between IGF-1/insulin system and longevity may have future clinical applications in promoting healthy aging and in Rehabilitation Medicine.

Transport of trace organic compounds through novel forward osmosis membranes: Role of membrane properties and the draw solution

Forward osmosis (FO) offers to be a very promising technology for the removal of trace organic compounds (TrOCs) from contaminated wastewater, and with the recent developments in FO membranes, the effect of both a higher water flux and reverse salt flux on the rejection of TrOCs needs to be explored. In this study two novel thin-film composite (TFC) membranes with greater water permeability and selectivity than the benchmark cellulose tri-acetate (CTA) membrane were compared at bench-scale in terms of TrOCs permeability. By probing the solute-membrane interactions that dictate the transport of TrOCs through the two membranes in the absence and presence of a draw solution, several conclusions were drawn. Firstly, steric hindrance is the main TrOCs transport -limiting mechanism through TFC membranes unless the negative membrane surface charge is significant, in which case, electrostatic interactions can dominate over steric hindrance. Secondly, the increase in ionic strength induced by the draw solution in the vicinity of and perhaps inside the membrane seems to favour the rejection of TrOCs by "shrinking" the membrane pores or by "shielding" the negative surface charge. Lastly, during FO operation, solute concentration polarisation becomes detrimental when working at high water fluxes, whereas the reverse solute flux has no direct impact on the transport of TrOCs through the membrane.

Optimal positioning of optodes on the scalp for personalized functional near-infrared spectroscopy investigations

BACKGROUND

Application of functional Near InfraRed Spectroscopy (fNIRS) in neurology is still limited as a good optical coupling and optimized optode coverage of specific brain regions remains challenging, notably for prolonged monitoring.

METHODS

We propose to evaluate a new procedure allowing accurate investigation of specific brain regions. The procedure consists in: (i) A priori maximization of spatial sensitivity of fNIRS measurements targeting specific brain regions, while reducing the number of applied optodes in order to decrease installation time and improve subject comfort. (ii) Utilization of a 3D neuronavigation device and usage of collodion to glue optodes on the scalp, ensuring good optical contact for prolonged investigations. (iii) Local reconstruction of the hemodynamic activity along the cortical surface using inverse modelling.

RESULTS

Using realistic simulations, we demonstrated that maps derived from optimal montage acquisitions showed, after reconstruction, spatial resolution only slightly lower to that of ultra high density montages while significantly reducing the number of optodes. The optimal montages provided overall good quantitative accuracy especially at the peak of the spatially reconstructed map. We also evaluated real motor responses in two healthy subjects and obtained reproducible motor responses over different sessions.

COMPARISON WITH EXISTING METHODS

We are among the first to propose a mathematical optimization strategy, allowing high sensitivity measurements.

CONCLUSIONS

Our results support that using personalized optimal montages should allow to conduct accurate fNIRS studies in clinical settings and realistic lifestyle conditions.

Enhanced sensitivity in non-enzymatic glucose detection by improved growth kinetics of Ni-based nanostructures

Ni-based nanostructures are attractive catalytic materials for many electrochemical applications, among which are non-enzymatic sensing, charge storage, and water splitting. In this work, we clarify the synthesis kinetics of Ni(OH)₂/NiOOH nanowalls grown by chemical bath deposition at room temperature and at 50 °C. We applied the results to non-enzymatic glucose sensing, reaching a highest sensitivity of 31 mA cm^-2mM^-1. Using scanning electron microscopy, x-ray diffraction analysis and Rutherford backscattering spectrometry we found that the growth occurs through two regimes: first, a quick random growth leading to disordered sheets of Ni oxy-hydroxide, followed by a slower growth of well-aligned sheets of Ni hydroxide. A high growth temperature (50 °C), leading mainly to well-aligned sheets, offers superior electrochemical properties in terms of charge storage, charge carrier transport and catalytic action, as confirmed by cyclic voltammetry and electrochemical impedance spectroscopy analyses. The reported results on the optimization and application of low-cost synthesis of these Ni-based nanostructures have a large potential for application in catalysis, (bio)sensing, and supercapacitors areas.

Footprint of the eastern euroasian past in Italian populations of Cryptotaenia thomasii (Ten.) DC

BACKGROUND

The knowledge of the genetic architecture of closely related species and/or populations of a single species can be very useful to shed light on the processes that led to their current distributions. The present study provides a preliminary evaluation of the conservation status of the populations of Cryptotaenia thomasii, a very narrow endemic species occurring in southern Italy. Previous studies showed that C. thomasii was phylogenetically closely related to C. flahaultii, endemic species of Caucasus, and to evaluate its conservation status and the genetic variability of plant species the internal transcribed spacers (ITSs) of nuclear ribosomal DNA were sequenced and the SNPs were analyzed.

RESULTS

The restriction analysis of nrDNA with the restriction enzymes allowed to detect the presence of two single mutations (SNPs) among the sequences of two species. Our molecular analysis pointed out that C. thomasii and C. flahaultii, in spite of their geographical disjunction, show a sign of an ancient contact as an extreme case of geographical disjunction Italian-Caucasus.

CONCLUSION

From the evolutionary history of the species and its distribution pattern one can reconstruct a possible scenario with some hypotheses that explain the hypothetical ancestral area where the two species were in contact. We speculate the two species may have originated from fragmentation of a common ancestor widespread in the Western Palearctic zone and have survived in two separated refuge areas limited by important mountain systems. This hypothesis is supported by our molecular analysis, in fact, the analysis of SNPs showed that some C. thomasii populations retain the signs of an ancient link with C. flahaultii.

Functional differentiation in pollination processes among floral traits in Serapias species (Orchidaceae)

Floral displays, influencing attractiveness to insects, increase the number of pollinator visits and the efficiency of each visit in terms of pollen exchange and thus affect the plant reproductive success. Here, we conducted an in situ manipulation experiment to investigate whether the floral modifications affect reproductive success in natural orchid populations of Serapias lingua and Serapias vomeracea. We estimated male and female reproductive success of three treatment groups, disassembly of floral tube, cutting of lip, and painting of the callus surface, in terms of pollinaria removed/deposited and fruit production. Results revealed that phenotypic modification had opposite effects on reproductive success of two examine species. Indeed, reproductive success was significantly increased by the detached of the petals and sepals, and decreased, due to callus painting and lip removal, in S. lingua. On the contrary, unmanipulated plants of S. vomeracea showed significantly higher value of pollinaria removed and deposited and fruit set than manipulated ones. The differences between S. lingua and S. vomeracea agree to the different pollination strategy of examined species. S. vomeracea shows shelter imitation strategy, and thus, the disassembly of tunnel-like corolla does not allow the insects to use the flower as a refuge, while S. lingua is a sexually deceptive orchid and therefore the opening of the flower made more visible callus (visible at a greater distance) increasing the pollinators attraction. This study provides evidence that pollinators were largely sensitive to the experimental modification of the flower phenotype, which is consistent with the presence of significant selection on individual floral characters. Our experimental investigations of the effects of variation in display on pollinator visitation provide insights into the evolution of floral morphology in orchid with shelter imitation strategy.