SOX-10 and TRP-1 expression in feline ocular and nonocular melanomas

In felines, ocular and nonocular melanomas are uncommon tumors that represent a diagnostic challenge for pathologists, especially when amelanotic. To date, the immunohistochemical diagnostic panel in cats is based on specific melanocytic markers (Melan-A and PNL2) and a nonspecific but sensitive marker (S100). In human medicine, SOX-10 is reported to be a sensitive antibody for the detection of melanoma micrometastasis in the lymph node. TRP-1, an enzyme involved in melanogenesis, has recently been used in humans and dogs as a specific melanocyte marker. The aim of this study was to evaluate the cross-reactivity and the expression of SOX-10 and TRP-1 antibodies in feline normal tissue and melanocytic tumors. Thirty-one cases of ocular, cutaneous, and oral melanomas were retrospectively evaluated and confirmed by histopathological examination and by immunolabeling with Melan-A and/or PNL2. SOX-10 nuclear expression in normal tissues was localized in epidermal, subepidermal, hair bulb, and iridal stromal melanocytes and dermal nerves. In melanomas, nuclear expression of SOX-10 was detected in ocular (11/12; 92%), oral (6/7; 86%), and cutaneous sites (12/12; 100%). TRP-1 cytoplasmic immunolabeling in normal tissue was observed in epidermal and bulbar melanocytes and in the lining pigmented epithelium of the iris and in its stroma. Its expression was positively correlated to the degree of pigmentation in the tumor and was observed in 75% of ocular (9/12), 43% of oral (3/7), and 33% of cutaneous melanomas (4/12). This study demonstrated the cross-reactivity of SOX-10 and TRP-1 antibodies in feline non-neoplastic melanocytes and their expression in ocular and nonocular melanomas.

The role of lung biopsy for diagnosis and prognosis of interstitial lung disease in systemic sclerosis: a systematic literature review

BACKGROUND

The prognostic and theragnostic role of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) have been largely neglected due to the paucity of treatment options and the risks associated with surgical lung biopsy. The novel drugs for the treatment of ILDs and the availability of transbronchial cryobiopsy provide a new clinical scenario making lung biopsy more feasible and a pivotal guide for treatment. The aim of our study was to investigate the usefulness of lung biopsy in SSc ILD with a systematic literature review (SLR).

METHODS

PubMed, Embase and Cochrane databases were searched up to June 30, 2023. Search terms included both database-specific controlled vocabulary terms and free-text terms relating to lung biopsy and SSc-ILD diagnostic and prognosis. The SLR was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Studies were selected according to the PEO (population, exposure, and outcomes) framework and Quality assessment of diagnostic accuracy studies (QUADAS) were reported.

RESULTS

We selected 14 articles (comprising 364 SSc-ILD patients). The paucity and heterogeneity of the studies prevented a systematic analysis. Diffuse cutaneous SSc was present in 30-100% of cases. Female predominance was observed in all studies (ranging from 64 to 100%). Mean age ranged from 42 to 64 years. Mean FVC was 73.98 (+/-17.3), mean DLCO was 59.49 (+/-16.1). Anti-Scl70 antibodies positivity was detected in 33% of cases (range: 0-69.6). All patients underwent surgical lung biopsies, and multiple lobes were biopsied in a minority of studies (4/14). Poor HRCT-pathologic correlation was reported with HRCT-NSIP showing histopathologic UIP in up to 1/3 of cases. Limited data suggest that SSc-UIP patients may have a worse prognosis and response to immunosuppressive treatment compared to other histopathologic patterns.

CONCLUSIONS

The data from this SLR clearly show the paucity and heterogeneity of the studies reporting lung biopsy in SSc ILD. Moreover, they highlight the need for further research to address whether the lung biopsy can be helpful to refine prognostic prediction and guide therapeutic choices.

CT evaluation of interstitial lung disease related to systemic sclerosis: visual versus automated assessment. A systematic review

AIM

To identify similarities and differences between visual (VA) and automated assessment (AA) of systemic sclerosis-related interstitial lung disease (SSc-ILD) at chest computed tomography (CT) in terms of clinical applicability.

MATERIALS AND METHODS

Medline, Embase, and Web of Science were searched to identify all studies investigating VA and AA for SSc-ILD assessment, from inception to 31 July 2022. Exclusion criteria were manuscripts not in English, absence of full-text, reviews, diseases other than ILD in SSc, CT not analysed with both VA and AA, VA and AA not adopted for the same purpose or not compared, overlap syndromes, SSc-ILD data not extractable, and studies with <10 patients.

RESULTS

Ten full-text studies (804 patients) were included. The most adopted VAs were the Warrick or Goh score (four studies each), while densitometry (eight studies) or lung texture analysis (LTA, two studies) were utilised as AAs. The main field of investigation was the correlation with baseline pulmonary function tests (PFT, six studies). Warrick VA showed lower correlations compared to densitometry, while Goh VA demonstrated more heterogeneous results. Compared to LTA, Goh VA obtained lower correlations with lung volumes but similar or stronger coefficients with alveolar diffusibility.

CONCLUSIONS

VA and AA may show heterogeneous results comparing their correlations with PFT, probably depending on the specific analysis adopted for each method. More data are needed on VA versus LTA. Comparisons between VA and AA regarding correlation with PFT follow-up and as prognostic elements, or for disease monitoring, are lacking. AAs in progressive fibrosis diagnosis remain to be tested.

Genetic variability of Dirofilaria repens isolates from humans and dogs in Italy

Dirofilaria repens is a paradigmatic example of an emerging vector-borne pathogen (VBP) in both human and veterinary fields. The spatial expansion and the increasing zoonotic impact of this VBP can be related to several drivers including the genetic structure of parasite populations. Italy is one of the European countries traditionally endemic with the highest incidence of canine and human cases of subcutaneous dirofilariosis. The present study aimed to assess the genetic identity and variability of D. repens isolates of human and canine origin from areas of Central Italy, compared with those isolated from different areas of Europe by sequence analysis of mtDNA genes (i.e., 12 S rDNA and cox1). A total of twenty isolates of D. repens were obtained from biopsies of subcutaneous and ocular cases of dirofilariosis occurring in 10 dogs and 10 humans. The sequence analysis of 12 S rDNA showed that all the sequences obtained clustered as a monophyletic group with a strong nodal support, indicating that all sequence types represented D. repens. The cox1 and the 12 S sequence analysis did not show host-related polymorphisms between human and dog-derived specimens. The sequence analysis of cox1 was performed including 8 additional sequences previously obtained from human and canine isolates in the same areas. Out of the 28 sequences analyzed, 20 were grouped in a haplogroup comprising 15 haplotypes (i.e., DR1, DR2, DR4, DR5, DR7, DR8, DR10-DR18), 2 sequences matched to DR9, reported for the first time in Italy, and 6 showed peculiar polymorphisms that were not previously described. The results obtained have implications for a better understanding of the epidemiology and phylogeography of this emerging vector-borne zoonotic parasite.

Clinical, histopathological, and molecular characterization of canine pigmented viral plaques

Canine pigmented viral plaques (PVPs) are proliferative epidermal lesions caused by canine papillomaviruses (CPVs). Although the lesions are benign, neoplastic transformation has been reported. Cases reported in the literature are few and mainly focused on genome sequencing. The aim of this study was to collect data on the epidemiology, clinicopathological features, and genotyping of PVPs. Fifty-five canine PVPs were retrospectively retrieved and histologically evaluated. Follow-up was available for 33 cases. The median age was 6.5 years and pugs were the most represented breed (25%). There were 4 clinical presentations: a single lesion (24%), multiple lesions (75%) in one (41%) or different sites (34%), and generalized lesions all over the body (24%). The abdomen and axillae were the most common sites. In single lesions, no recurrence was observed after conventional surgery, whereas different medical treatments reported for multiple lesions were not successful. Spontaneous regression was reported in 3 cases. Neoplasia in contiguity with PVPs was seen in 5 of 55 lesions (9%), and 1 dog was euthanized due to invasive squamous cell carcinoma (SCC). The most useful histopathological features for diagnosis were scalloped profile, epidermal spikes, hypergranulosis, and hyperpigmentation. L1 immunolabeling was present in 14 of 16 cases (87%). Sequencing revealed that 10 of 16 cases were associated with CPV-9 (71%), 2 cases were associated with CPV-4 (14%), and 2 cases were associated with CPV-8 (14%). In conclusion, this represents a large cohort study on canine PVPs reporting data on clinicopathological features, therapy, outcome, and the type of CPV involved for the first time in Italy.

Canine melanocytes: Immunohistochemical expression of melanocytic markers in different somatic areas

BACKGROUND

Melanoblasts originate in the neural crest from where they migrate to peripheral tissues and differentiate into melanocytes. Alteration during melanocyte development and life can cause different diseases, ranging from pigmentary disorders and decreased visual and auditory functions, to tumours such as melanoma. Location and phenotypical features of melanocytes have been characterised in different species, yet data on dogs are lacking.

OBJECTIVE

This study investigates the expression of melanocytic markers Melan A, PNL2, TRP1, TRP2, SOX-10 and MITF in melanocytes of selected cutaneous and mucosal surfaces of dogs.

ANIMALS

At necropsy, samples from five dogs were harvested from oral mucosa, mucocutaneous junction, eyelid, nose and haired skin (abdomen, back, pinna, head).

MATERIALS AND METHODS

Immunohistochemical and immunofluorescence analyses were performed to assess marker expression.

RESULTS

Results showed variable expression of melanocytic markers in different anatomical sites, particularly within epidermis of haired skin and dermal melanocytes. Melan A and SOX-10 were the most specific and sensitive melanocytic markers. PNL2 was less sensitive, while TRP1 and TRP2 were seldomly expressed by intraepidermal melanocytes in haired skin. MITF had a good sensitivity, yet the expression often was weak.

CONCLUSIONS AND CLINICAL RELEVANCE

Our results indicate a variable expression of melanocytic markers in different sites, suggesting the presence of subpopulations of melanocytes. These preliminary results pave the way to understanding the pathogenetic mechanisms involved in degenerative melanocytic disorders and melanoma. Furthermore, the possible different expression of melanocyte markers in different anatomical sites could influence their sensitivity and specificity when used for diagnostic purposes.

Inclusion Body Disease and Columbid Alphaherpesvirus 1 Infection in a Eurasian Eagle-Owl (Bubo bubo) of Central Italy

Hepatosplenitis or inclusion body disease is a fatal disease in owls caused by Columbid alphaherpesvirus 1 (CoHV-1). A few old case reports describe it worldwide. In Italy, knowledge regarding virus circulation and disease development is lacking. Four Eurasian eagle-owls (Bubo bubo), two adults and two juveniles, were submitted for postmortem examination showing aspecific clinical signs a few hours before death. Grossly disseminated petechial hemorrhages on serosal surfaces (n = 4), hepatic and splenic necrosis (n = 3), bilateral and symmetric necrosis of pharyngeal tonsils (n = 2), and diffuse and bilateral dark-red discoloration and firmness in lungs (n = 2) were seen. Tissues were sampled for histology, bacteriology, molecular testing, and transmission electron microscopy (TEM). On histology, disseminated petechial hemorrhages (n = 4) and necrosis of liver (n = 3) and spleen (n = 3) were seen, as well as lympho-histiocytic interstitial pneumonia and meningoencephalitis (n = 2). Intranuclear inclusion bodies (INIBs) were detected in one case. A panherpesviral PCR led to positive results in one case, identified in sequencing as CoHV-1. On TEM, intranuclear and intracytoplasmic virions with herpesviral morphology were seen in the same case. For the other three birds, the lack of PCR positivity, INIBs, and TEM detection could be linked to a possible reduction of the virus to undetectable levels. Death possibly occurred secondarily to bacterial infections, supposedly established during the acute phase of CoHV-1 infection. This paper reports the presence of CoHV-1in Italy and the development of a fatal form of the disease in a Eurasian eagle-owl.

Assessing Family Functioning Before and After an Integrated Multidisciplinary Family Treatment for Adolescents With Restrictive Eating Disorders

Introduction

Previous studies applying the Lausanne Trilogue Play (LTPc), a semi-structured method for observing family dynamics, highlighted dysfunctional interaction patterns in the families of individuals affected by restrictive eating disorders (REDs). Family-centered approaches are considered the first-line treatment for severe cases of REDs in adolescence.

Objectives

To investigate family functioning in the families of adolescents with severe REDs assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention and triadic or family-centered intervention.

Methods

Sixty-seven families of adolescent patients diagnosed with REDs were assessed for eligibility between July 2017 and October 2020. Family functioning was assessed using the clinical version of LTPc. Nutritional counseling and neuropsychiatric monitoring were also provided.

Results

We observed a significant change in the family functioning score for the LTPc phase 2, in which the father interacts with his daughter while the mother acts as a silent observer. This suggests that the fathers, when playing an active role, could improve dyadic family functioning. The treatment was not found to change triadic functioning: a 6-month treatment may not be long enough to modify interactions at the triadic level.

Conclusions

A brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, our study reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.

Disclosure

The authors declare that they do not have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstrac.

Neurocognitive Functioning of Adolescents with Clinical High Risk for Psychosis, other Psychiatric Symptoms, and Psychosis

Introduction

Clinical High Risk of Psychosis (CHR-P) condition and the clinical validity of at-risk criteria are still little studied in child and adolescent population.

Objectives

This study aimed to discover neurocognitive profiles of adolescents with CHR-P, compared with adolescents with psychosis and youth with other psychiatric symptoms that do not meet CHR-P criteria.

Methods

We divided 116 adolescents (12-18 years old) in three groups according to the semi-structured interview Comprehensive Assessment of At-Risk Mental States (CAARMS): psychosis, attenuated psychosis syndrome (APS), non-APS. Moreover, we administered Wechsler scales to assess the IQ, Wisconsin Card Sorting Test to assess abstract reasoning and flexibility, Rey-Osterrieth complex figure to assess planning and attention, and Trail Making Test to assess psychomotor speed, visual attention and task switching. We administered BVN 12-18 subtests to assess lexical denomination, verbal and nonverbal working memory, selective auditory, visual attention, phonemic and categorial fluency, reasoning and problem solving.

Results

Nineteen adolescents met criteria for psychosis, 47 for APS, and 50 did not meet criteria neither for psychosis nor for APS. APS group performed better than psychosis group and similar to non-APS group in processing speed, planning, visual attention, and categorial fluency. APS did not show a significant difference from the other groups in working memory and backward digit span, showing an intermediate profile; non-APS and psychosis groups still differed significantly in these functions.

Conclusions

Identifying typical neurocognitive profiles leads to more accurate diagnoses and early intervention that can lead to better patient outcomes.

Disclosure

The authors declare that they do not have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstrac.

POS0384 ULTRA SHORT ECHO TIME MRI (UTE) SEQUENCE IN THE ASSESSMENT OF INTERSTITIAL DISEASE IN PATIENTS WITH SYSTEMIC SCLEROSIS: CORRELATION WITH DISEASE EXTENSION AT CT AND WITH PULMONARY LUNG FUNCTION TESTS

Background

Interstitial lung disease (ILD) is the major cause of death in Systemic sclerosis (SSc). Computed tomography (CT) is the gold standard imaging technique to diagnose ILD and to assess ILD prognosis. ILD extent assessment at lung CT has shown to correlate with functional lung capacity: extensive lung disease (> 20%) correlate with significant lung capacity decline (forced vital capacity ((FVC) <70%) that is, in fact, associated with a higher mortality. Unfortunately, it is burdened by exposure to ionizing radiations that limits its use for the follow-up. For this reason, new MRI sequences were recently investigated, and Ultra Short Echo Time (UTE) emerged promising for ILD assessment.

Objectives

The aim of the study is to evaluate the reliability of an MRI-UTE sequence in the assessment of ILD extent in patients with SS in comparison with standard high-resolution CT images and to correlate the extension with pulmonary function tests (PFT).

Methods

Patients with SSc and ILD underwent a CT and UTE-MRI (1.5 T) acquisition on the same day. In the same week, they carried out PFT, with FVC and the diffusion capacity of carbon monoxide (DLCo) evaluation. Two thoracic radiologists assessed in consensus, on CT and UTE-MRI, the extent of ILD. Extensions were calculated as the mean percentage of lung involvement, evaluated at five levels, with an approximation of 5%. ILD extension were classified as limited (<20%) or extensive (> 20% or 20% with FVC <70%). The ANOVA test was adopted to compare the CT and MRI extensions of the ILD. Correlations of the extent of CT and UTE-MRI alterations with FVC and DLCo were calculated with Pearson’s correlation coefficient r. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (VPN) of UTE-MRI were also calculated for UTE-MRI in determining ILD extension.

Results

The mean ILD extension was 20.9% in CT and 17.9 % in UTE-MRI (p-value=0.64). The correlation of ILD extension in CT with FVC and DLCo were significant (r=-0.66 (p<0.0001) and r=-0.59 (p<0.0008), respectively). The correlation of ILD extension in UTE-MRI with FVC and DLCo were significant (-0.68 (p<0.0001) and -0.57 (p<0.002), respectively) too. The UTE-MRI assessments agreed with CT in identifying limited or extensive ILD in 25/29 patients (19 limited and 6 extended) and discordant in 4 (1 limited and 3 extended to CT). UTE-MRI sensitivity and specificity in identifying extended ILD were high (86.4% (65.1% -97.1%) and 85.7% (42.1% -99.6%), respectively). PPV and NPV were 95.0% (75.4% -99.2%) and 66.7% (40.7% -85.7%), respectively.

Conclusion

UTE-MRI sequence, compared to CT, has shown high correlation with PFR and comparable ability in identifying patients with extensive ILD. Therefore, UTE-MRI seems new promising imaging sequence for the evaluation of ILD extension in SSc patients.

References

[1]Orlandi M, Landini N, Cerinic MM, Colagrande S. Pulmonary magnetic resonance imaging in systemic sclerosis: a jump in the future to unravel inflammation in interstitial lung disease. Clin Rheumatol. 2021 Sep;40(9):3461-3464. doi: 10.1007/s10067-021-05869-3. Epub 2021 Jul 30. PMID: 34328571.

[2]Romei C, Turturici L, Tavanti L, et al. The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review. Eur Respir Rev. 2018;27(150):180062. Doi:10.1183/16000617.0062-2018

[3]Pinal-Fernandez I, Pineda-Sanchez V, Pallisa-Nuñez E, et al. Fast 1.5 T chest MRI for the assessment of interstitial lung disease extent secondary to systemic sclerosis. Clin Rheumatol. 2016;35(9):2339-2345. doi:10.1007/s10067-016-3267-0

Disclosure of Interests

None declared

Rapid mode in novel generation visually guided laser balloon system: feasibility, safety, and impact on procedural outcomes

Funding Acknowledgements

Type of funding sources: None.

Background

Laser balloon (LB) systems are increasingly used for pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation (AF). The novel generation of the visually guided LB system includes a rapid mode (RM) feature, which potentially allows a continuous circumferential lesion for PVI. Nevertheless, data on its practicability and on its impact on procedural outcomes are lacking.

Purpose

To analyse the applicability of RM and its effect on procedural and fluoroscopic time in a cohort of patients who underwent catheter ablation of AF using a LB system.

Methods

Between September 2020 and December 2021, we prospectively included all consecutive patients who underwent PVI with LB at our centre. All the procedures were performed by the same two operators. For each pulmonary vein (PV), we firstly attempted to obtain a complete circumferential lesion at 13 W using the RM. If its application was not possible or incomplete, we performed additional single lesions at 5.5, 8.5 or 13 W to achieve complete visual PVI. Finally, we calculated the percentage of singular and total circumferential lesions made with RM for every procedure and evaluated its influence on procedural outcomes.

Results

75 patients were enrolled. We identified and successfully isolated 289 PVs, with mean procedural and fluoroscopic time of 171±51 and 38±15 min, respectively. Use of RM for more than 70% of the circumferential lesion was possible in 185 veins (64%), while we obtained complete isolation using only RM in 90 veins (31%). Reasons for interruption of RM were unfavourable anatomy, imperfect visualization of the ostium of the PV and presence of blood between the balloon and the anatomic substrate. For each vein, we observed a significantly shorter ablation (13±8 vs 23±12 min, p&lt;0.001) and fluoroscopic time (3±3 vs 5±4 min, p&lt;0.01) if &gt;70% of the circumferential lesion was made through RM. Further, total procedural (157 ±52 vs 192±42 min, p&lt;0.01), ablation (53±17 vs 88±27, p &gt;0.001) and fluoroscopic time (30±15 vs 36.9±14 min, p 0.025) were significantly shorter if more than 70% of total circumferential lesion was achieved through rapid mode. There were five pinhole balloon ruptures during application of RM. No major complication occurred.

Conclusions

RM is a novel feature in the latest generation of LB system. In our cohort, it showed good applicability and safety, while significantly reducing procedural times. Further studies are needed to understand its possible impact on clinical outcomes.

Localization and genotyping of canine papillomavirus in canine inverted papillomas

Numerous canine papillomaviruses (CPVs) have been identified (CPV1-23). CPV1, 2, and 6 have been associated with inverted papillomas (IPs). We retrieved 19 IPs from 3 histopathology archives, and evaluated and scored koilocytes, inclusion bodies, giant keratohyalin granules, cytoplasmic pallor, ballooning degeneration, and parakeratosis. IHC targeting major capsid proteins of PV was performed, and CPV genotyping was achieved by PCR testing. Tissue localization of CPV DNA and RNA was studied by chromogenic and RNAscope in situ hybridization (DNA-CISH, RNA-ISH, respectively). IPs were localized to the limbs (50%), trunk (30%), and head (20%), mainly as single nodules (16 of 19). In 15 of 19 cases, immunopositivity was detected within the nuclei in corneal and subcorneal epidermal layers. PCR revealed CPV1 in 11 IPs and CPV2 DNA in 3 IPs. Overall, 14 of 17 cases were positive by both DNA-CISH and RNA-ISH, in accord with PCR results. A histologic score >5 was always obtained in cases in which the viral etiology was demonstrated by IHC, DNA-CISH, and RNA-ISH. IHC and molecular approaches were useful to ascertain the viral etiology of IPs. Although IHC is the first choice for diagnostic purposes, ISH testing allows identification of PV type and the infection phase. RNA-ISH seems a promising tool to deepen our understanding of the pathogenesis of different PV types in animal species.

AB0334 THE FIRST 1000 DAYS OF LIFE AND REPRODUCTIVE DISORDERS IN WOMAN WITH RHEUMATIC DISEASE (RDS)

Background:

Gynaecological problems are often ignored by rheumatologist and have a negative impact on quality of life of RDs patients.

Objectives:

The aim of this study was to describe gynaecological, reproductive and sexual problems in premenopausal woman with RDs.

Methods:

A monocentric, cross-sectional observational study was conducted in the Rheumatology Department of Careggi Hospital in Florence. Inclusion criteria: female gender, premenopausal age (and≥18 years old), diagnosis of rheumatic diseases. All patients have been investigated about gynaecological anamnesis and symptoms and subjected to a self-administered validated questionnaire.

Results:

From May 4 th to November 30th, 2020, 200 patients were enrolled (mean age 39.1± 8.7 years (M±SD)): 58% arthritis, 40% connective tissue disease and 1.5% systemic vasculitis. In the history, spontaneous, full-term birth in 91% and 93% of patients, respectively, was observed and pre-term birth was reported in 8.1%. 63% of patients were breastfed. In family history, menorrhagia, dysmenorrhea, or chronic pelvic pain were reported in 59%, 55 and 7% of patients, respectively. The first menstruation was at 12.3±2.0 years (M±DS) and mostly woman reported menstrual disorders during adolescence (56% experienced dysmenorrhea and 52% menorrhagia). Menstrual disorders and abnormal bleeding were frequently reported also in adulthood: 71% had dysmenorrhea, 38% heavy menstrual cycles and 9% metrorrhagia. Moreover, 26% of patients referred non- menstrual pelvic pain, 19% urinary pain and 18% pain during defecation. Vaginal symptoms were frequently reported: 36% of patients referred vaginal dryness, 29% burning, 19% recurrent vaginal infections and dyspareunia in 39% of patients. Uterine fibroma was present in 23% and endometriosis in 10% of patients. Fertility problems were reported by 10% of patients in a time frame of 7.5±6.4 years and 30% of patients experienced at least one miscarriage; otherwise, 56% of patients have had at least one full-term pregnancy.

Conclusion:

RDs patients show a high prevalence of various gynaecological problems affecting their quality of life. The management of female RDs patients is a challenge for the clinician and should include an accurate evaluation of the gynaecological aspects (menstruation, fertility, maternity, sexuality) as well as a multidisciplinary teamwork (rheumatologist and gynaecologists).

References:

[1]Critchley H., Babayev E., Bulun E., et al. Menstruation: Science and society | Elsevier Enhanced Reader. (s.d.). https://doi.org/10.1016/j. American Journal of Obstetrics & Gynecology 2020.06.004

[2]Østensen M, Andreoli L, Brucato A,et al. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev. 2015 May;14(5):376-86. doi: 10.1016/j.autrev.2014.12.011. Epub 2014 Dec 30. PMID: 25555818.

[3]Marder W, Johnson TRB. Rheumatic diseases and maternal-fetal medicine. Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:1-2. doi: 10.1016/j.bpobgyn.2019.11.007. Epub 2019 Dec 17. PMID: 31983554.

[4]Sammaritano LR, Bermas BL, Chakravarty EE,et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Apr;72(4):529-556. doi: 10.1002/art.41191. Epub 2020 Feb 23. PMID: 32090480.

Disclosure of Interests:

None declared

POS1228 THE ROLE OF CHEST CT IN UNDERSTANDING INTERSTITIAL LUNG DISEASE (ILD): SYSTEMIC SCLEROSIS (SSc). VERSUS COVID-19

Background:

COVID-19 pandemic is a global emergency which may overlap on the clinical and radiological scenario of ILD in SSc. In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 superinfection from a progression of SSc-ILD.

Objectives:

The aim of our study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia.

Methods:

22 international readers were included and divided in the radiologist group (RAD) and non-radiologist group (nRAD). The RAD group included non-chest RAD and chest-RAD. A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.

Results:

Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT parameters most frequently associated with SSc-ILD. The CT parameters most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p <0.0001) and signs of fibrosis in GGO in the lower lobes (p <0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. These two variables were combined in a predictive score which resulted positively associated with the COVID-19 diagnosis, with 96.1% sensitivity and 83.3% specificity: 3 different risk class for COVID-19 pneumonia may be identified: high risk for COVID-19 pneumonia (5-9 points); probable overlap COVID-19 pneumonia in SSc-ILD (4 points); low risk for COVID-19 pneumonia (0-3 points).

Conclusion:

The CT differential diagnosis between COVID-19 Pneumonia and SSc-ILD is possible and may be fostered in practice by the use of a radiological score. In the case where an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.

References:

[1]Orlandi M, Landini N, Bruni C, et al. Infection or autoimmunity? The clinical challenge of interstitial lung disease in systemic sclerosis during COVID 19 pandemic. J Rheumatol. 2020 Dec 1: jrheum.200832

[2]Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA [published online ahead of print, 2020 Apr 28]. J Thorac Imaging. 2020;10.1097/RTI.0000000000000524.

[3]Cheng C, Li C, Zhao T, et al. COVID-19 with rheumatic diseases: a report of 5 cases. Clin Rheumatol. 2020;39(7):2025-2029.

[4]Mariano RZ, Rio APTD, Reis F. Covid-19 overlapping with systemic sclerosis. Rev Soc Bras Med Trop. 2020 Sep 21;53:e20200450.

Disclosure of Interests:

None declared

POS0317 THE PERFORMANCE OF DIFFUSING CAPACITY FOR MONOXIDE CARBON (DLCO) AND FORCED VITAL CAPACITY (FVC) IN PREDICTING THE ONSET OF SYSTEMIC SCLEROSIS (SSc)-INTERSTITIAL LUNG DISEASE (ILD) IN THE EUROPEAN SCLERODERMA TRIALS AND RESEARCH (EUSTAR) DATABASE

Background:

In SSc, ILD is a major cause of morbidity and mortality. High resolution computed tomography (HRCT) is the gold standard for the diagnosis. Predictors of ILD onset are eagerly awaited to improve SSc-ILD management. Pulmonary function test (PFTs) are routinely performed to measure lung function changes.

Objectives:

Our aim was to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) in predicting the development of SSc-ILD.

Methods:

The longitudinal data of DLCO, FVC and ILD on HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t0), after 12 (±4) (t1) and 24 (±4) (t2) months. Patients with negative HRCT for any sign of ILD both at t0 and t1 were included. Patients who presented or developed pulmonary hypertension during the study period were excluded. At baseline, demographic data, disease duration from Raynaud’s onset, disease subsets, autoantibodies and other laboratory and instrumental data were recorded.

Results:

474/17805 patients were eligible for the study (403 females, 71 males): 26.0% dcSSc, 58.3% lcSSc, 220 (48.0%) patients with positive anticentromere antibodies (ACA) and 117 (25.4%) with positive antitopoisomerase I antibodies (Topo-I abs). Among all enrolled patients, 46 (9.7%) developed HRCT signs of ILD at t2. Patients with Topo-I abs showed an association with ILD development at t2 (16.7% vs 7.8%, p=0.0031), contrarily ACA positive patients were negatively associated with ILD appearance after 2 years of follow-up (4.4% vs 14.4%, p=0.0001). Positive t2 HRCT patients had a significant lower value of DLCO and FVC at all three assessments when compared to patients with a negative HRCT at t2 (Table 1) and both t0 DLCO and FVC values negatively correlated with ILD development (Table 1). The mean t0 to t1 change (Δ) of DLCO in patients with negative t2 HRTC and positive t2 HRCT were -0.5 (±12.6) and -1.0 (±15.1), respectively. The mean t0 to t1 ΔFVC in patients with negative t2 HRTC and positive t2 HRCT were -0.2 (±10.6) and 0.1 (±11.5), respectively. None of them predicted the appearance of ILD at t2 (ΔDLCO: OR (IC) 0.997 (0.97-1.02), p=0.8024; ΔFVC OR (IC) 1.002 (0.97-1.03), p=0.8664). The data showed an association between t0 DLCO value<80% and ILD appearance after 2 years of follow-up [OR(IC): 3.09(1.49-6.40), p=0.0023]. Such association was not observed for t0 FVC value<80% [OR(IC): 1.95(0.81-4.68), p=0.1329]. The predictive capability of t0 DLCO<80% was moderate but stronger than FVC<80% [AU ROC: 0.62 (0.56-0.69), 0.53 (0.48-0.59) respectively, p=0.0205].

Conclusion:

Our data suggest that an impaired baseline DLCO (<80%) may have a predictive value for the development of ILD on HRCT after 2 years of follow-up. Further rigorous prospective studies are warranted to understand the role of DLCO evaluation in the course of SSc.

Table 1.

DLCO and FVC values at t0, t1 and t2 values in patients with positive or negative HRCT for ILD at t2 and their statistical differences.

Patients without ILD at t2 (mean±SD)Patients with ILD at t2 (mean±SD)OR (95%CL)p-valueDLCO at t079.0 ± 16.669.9 ± 17.40.97 (0.95 - 0.99)0.0006DLCO at t178.4 ± 16.868.9 ± 18.60.97 (0.95 - 0.98)0.0005DLCO at t278.0 ± 17.065.1 ± 19.10.95 (0.93 - 0.97)<0.0001FVC at t0102.2 ± 17.394.6 ± 16.20.97 (0.96 - 0.99)0.0052FVC at t1101.9 ± 17.994.7 ± 16.50.98 (0.96 - 0.99)0.0092FVC at t2101.6 ± 17.694.5 ± 20.00.98 (0.96 - 1)0.0126

Disclosure of Interests:

Gemma Lepri: None declared, Cosimo Bruni Speakers bureau: CB reports personal fees from Actelion, personal fees from Eli Lilly, Grant/research support from: CB reports personal fees from Actelion, personal fees from Eli Lilly, grants from European Scleroderma Trial and Research (EUSTAR) group, grants from New Horizon Fellowship, grants from Foundation for Research in Rheumatology (FOREUM), grants from Fondazione Italiana per la Ricerca sull’Artrite (FIRA), outside the submitted work, Lorenzo Tofani: None declared, Alberto Moggi Pignone: None declared, Martina Orlandi: None declared, Tomasetti Sara Speakers bureau: Speaker’s fees for Roche and Boehringer Ingelheim, Mike Hughes: None declared, Francesco Del Galdo: None declared, Rosaria Irace: None declared, Oliver Distler Grant/research support from: OD (last three years) has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Valeria Riccieri: None declared, Yannick Allanore Speakers bureau: YA received personal fees from Boehringer, Sanofi, Menarini and Medsenic and grants from Alpine with regards to the management of systemic sclerosis, Grant/research support from: YA received personal fees from Boehringer, Sanofi, Menarini and Medsenic and grants from Alpine with regards to the management of systemic sclerosis, Ana Maria Gheorghiu: None declared, Elise Siegert: None declared, Jeska de Vries-Bouwstra: None declared, Eric Hachulla: None declared, Mohammed Tikly: None declared, Nemanja Damjanov: None declared, Francois Spertini: None declared, Luc Mouthon: None declared, Anna-Maria Hoffmann-Vold Speakers bureau: AMHV: received consulting fees from Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche; and grants from Boehringer Ingelheim., Consultant of: AMHV: received consulting fees from Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche; and grants from Boehringer Ingelheim., Grant/research support from: AMHV: received consulting fees from Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme and Roche; and grants from Boehringer Ingelheim., Armando Gabrielli: None declared, Serena Guiducci: None declared, Marco Matucci-Cerinic Speakers bureau: has received consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: has received consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Daniel Furst: None declared, Silvia Bellando Randone: None declared

POS0264 THE EMERGING ROLE OF MAGNETIC RESONANCE IMAGING IN INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS: EVIDENCE FOR ULTRA SHORT TE AND COMPRESSED SENSING VIBE ACQUISITIONS AS PROMISING TOOLS FOR THE EVALUATION OF PARENCHYMAL ALTERATIONS

Background:

Interstitial lung disease (ILD) is a frequent complication and the major cause of death in Systemic sclerosis (SSc). Computed tomography (CT) is the gold standard imaging technique to assess ILD but is burdened by exposure to ionizing radiations that limits its use for the follow-up. MRI sequences with Ultra Short Echo Time (UTE) are promising for ILD.

Objectives:

We tested two MRI sequences, UTE Spiral VIBE and Compressing Sensing (CS) VIBE, in SSc-ILD, in comparison to chest CT.

Methods:

SSc patients with suspected-ascertained ILD were evaluated for undergoing CT-MRI examinations in the same day. Two radiologists visually scored the extent of ground glass opacities (GGO), reticulations, honeycombing and consolidations on CT-MRI. The sum of alteration was assumed as ILD extent. A quantitative texture analysis (qCT) was also performed on CT. Cohen’s k was adopted for interreader concordance in ILD detection. MRI sensitivity and specificity in ILD detection were evaluated. Lin’s concordance was adopted to compare extent analysis between readers and between CT (visual and qCT analysis) and MRI sequences.

Results:

54 patients performed both CT and MRI. MRI interreader concordance was moderate in ILD detection, while ILD and GGO extent analysis showed good or very good concordance. UTE Spiral VIBE had a sensitivity and specificity in ILD detection of 95.8% and 77.8%, while alterations extent analysis obtained a very good concordance with CT for ILD and GGO. CS VIBE showed a sensitivity and specificity in ILD detection of 46.7% and 95.0%, but a slight or fair concordance with CT in all alterations’ extent analysis.

Conclusion:

MRI UTE Spiral VIBE sequences are helpful in the evaluation of SSc-ILD. Larger cohorts of patients will be needed to confirm that MRI may be useful in clinical practice, reducing the radiological load of chest CT

References:

[1]Romei C, Turturici L, Tavanti L, et al. The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review. Eur Respir Rev. 2018;27(150):180062. Doi:10.1183/16000617.0062-2018

[2]Miller GW, Mugler JP, Sá RC, Altes TA, Prisk GK, Hopkins SR. Advances in functional and structural imaging of the human lung using proton MRI. NMR Biomed. 2014;27(12):1542-1556. doi:10.1002/nbm.3156

[3]Pinal-Fernandez I, Pineda-Sanchez V, Pallisa-Nuñez E, et al. Fast 1.5 T chest MRI for the assessment of interstitial lung disease extent secondary to systemic sclerosis. Clin Rheumatol. 2016;35(9):2339-2345. doi:10.1007/s10067-016-3267-0

[4]Ohno Y, Koyama H, Yoshikawa T, et al. Pulmonary high-resolution ultrashort TE MR imaging: Comparison with thin-section standard- and low-dose computed tomography for the assessment of pulmonary parenchyma diseases: Pulmonary MRI with UTE in Pulmonary Disease. J Magn Reson Imaging. 2016;43(2):512-532. doi:10.1002/jmri.25008

Disclosure of Interests:

None declared

POS0322 CORRELATION BETWEEN QUANTITATIVE COMPUTED TOMOGRAPHY AND DISEASE ACTIVITY IN SYSTEMIC SCLEROSIS

Background:

High Resolution Computed Tomography (HRCT) is the gold standard to evaluate Interstitial Lung Diseases (ILDs) extent and severity. Quantitative Computed Tomography (QCT) is a promising tool as it provides an operator-independent assessment of ILD extent. Even if there are emerging data on QCT in Systemic Sclerosis (SSc), its correlation with disease activity (DA) has not been yet studied.

Objectives:

To evaluate the correlation between QCT score and DA in an Italian cohort of SSc patients.

Methods:

A multicentric, observational study was conducted in three Italian rheumatological centers.

Adult SSc patients classified according to the ACR/EULAR 2013 criteria [1] were assessed with pulmonary function tests, HRCT and for DA. CT images were analyzed quantitatively with the densitometric radiomic data obtained through a free open software – Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume. DA assessment was conducted according to EUSTAR index [2]: a score ≥2.5 was considered indicative of high disease activity.

Age below 18 and pregnancy were considered exclusion criteria. We used Student’s T test to evaluate the means of the parameters, Pearson’s r test for correlations, receiver operating characteristics curve to define the cutoff values of the significant details, and linear regression with collinearity test to define the role of the details. P value <0.05 was considered statistically significant.

Results:

Sixty patients were enrolled (male 8, female 52), with mean age 53.2 years (SD 15.6) and mean disease duration 5.3 years (SD 4.2). QCT indexes distribution was different in high DA vs low DA SSc patients. In particular mean lung attenuation (MLA, -834.7 vs -812.1, p =0.03), standard deviation (95.9 vs 102, p =0.03), skewness (2.2 vs 1.7, P =0.006) and kurtosis (5.5 vs 3.3, p =0.009) of the parenchymal lung and skewness (3.1 vs 2.8, p =0.03) of the whole lung were statistically different. DA correlates with MLA (r =0.28, p =0.003), standard deviation (r =0.21, p =0.02), skewness (r =-0.32, p =0.001) and kurtosis (r =-0.29, p =0.001) of the parenchymal lung and MLA (r =0.25, p =0.006), skewness (R =-0.27, p =0.003), kurtosis (r =-0.21, P =0.02) of the whole lung. The skewness of the parenchymal lung was the QCT index with the best performance in identifying high DA SSc patients (cutoff value ≤1.85; area under the curve 0.74, p =0.005; sensitivity 79.5%, specificity 68.7% accuracy 76.6%).

Conclusion:

To our knowledge, this is the first study which correlate the QCT score with DA in SSc patients. Our results suggest that QCT can identify SSc patients with high DA score. This could open a scenario of new applications as an operator-independent contribution in DA scores with a potential role in clinical practice. Further studies are needed to confirm the data and to better identify the most suitable parameters for the purpose.

References:

[1]Van den Hoogen F, et al. 2013 classification criteria for Systemic Sclerosis: and American college of rheumatology / European league against rheumatism collaborative initiative. Ann Rheum Dis 2013;72:1747-1755.

[2]Valentini G, et al. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis 2017;76:270-276.

Disclosure of Interests:

None declared

POS0842 LUNG ULTRASOUND TO ASSESS THE SEVERITY OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS

Background:

Interstitial lung disease (ILD) is one of the most common complications and one of the main causes of morbidity and mortality in Systemic Sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for the diagnosis of ILD and it allows its quantification. Among semi-quantitative methods, Goh et al proposed a semi-quantitative scoring system to visually quantify ILD extent, with categorical cut-off of 20% to distinguish limited and extensive parenchymal involvement with prognostic implications. More recently, the use of radiomics has allowed the objective quantification of ILD through the use of dedicated software, which calculate different parameters of lung density.

Given the exposure to ionizing radiation that the procedure entails, other methods of ILD evaluation are being studied, among which lung ultrasound (LUS) identifies the B-lines as a main feature of ILD. So far, different evidences have proposed the use of LUS for the screening of ILD, even in the early phases of the disease and in subclinical lung involvement.

Objectives:

the aim of this study is to test the role of LUS in quantifying the severity of SSc-ILD, evaluated with both semi-quantitative visual radiological and quantitative radiomic scores.

Methods:

Adult SSc patients classified according to the ACR/EULAR 2013 criteria patients were assessed with pulmonary function test (PFTs), lung ultrasound and HRCT over 60 days. CT images were analysed qualitatively (by presence/absence of ILD), semi-quantitatively (categorical Goh score <20% vs> 20% of extent and the continuous extent Goh score made from 5 levels’ assessment– 0 to 100%) and quantitatively [with the densitometric radiomic data obtained through the Horos software - Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume (LV)]. LUS was used to quantify the B-lines detected in each patient by scanning a total of 13 intercostal spaces, on both anterior and posterior chest wall.

Results:

Among 59 SSc patients (81% women, mean age 48±14 years, 45% anti-Scl70 positive), 23 (39%) presented ILD on HRCT, of which 14 limited and 9 extensive. The mean visual semi-quantitative score was 6%, ranging from 0 to 66%. Our data showed a significantly different number of B-Lines in ILD vs non-ILD patients (median 38 vs 9, p <.005), a result which was further confirmed among non-ILD vs ILD> 20% (median 47 vs 9, p=.001) and ILD <20% (median 36 vs 9, p=.001) patients. Conversely, the number of B-lines was not statistically different between patients with ILD <20% and >20% (median 47 vs 36, p=.78). We observed a significant negative correlation between the number of B-lines and FVC (r=-.472, p<.05) TLC (r=-.436, p=.003), DLco (r=-.515, p<.001), DLCO/VA (r=.-306, p=.03). Finally, the number of B-lines showed a statistically significant correlation with the Goh score on 5 levels (r=.437, p=.001), MLA (r=.571, p<.001), kurtosis (r=-.285, p=.028), skewness (r=-.370, p = .004) and LV (r=-.277, p=.033). All data were confirmed analysing anterior and posterior B-Lines separately.

Conclusion:

Our study confirms that LUS represents a useful tool for the identification of SSc-ILD. In addition, we showed that LUS may be useful also for the quantification of the severity of SSc-ILD, by correlating with PFT parameters, radiomics parameters and visual radiological evaluation. Together with the PFTs, LUS could be used to increase the accuracy of the screening and, potentially, of the follow-up of SSc-ILD patients.

Disclosure of Interests:

Cosimo Bruni: None declared, Lavinia Mattolini: None declared, Lorenzo Tofani: None declared, Luna Gargani Consultant of: GE Healthcare, Philips Healthcare and Caption Health, Nicholas Landini: None declared, Gemma Lepri: None declared, Martina Orlandi: None declared, Serena Guiducci: None declared, Silvia Bellando Randone: None declared, Marco Matucci-Cerinic: None declared

Linear arrector pili muscle hamartoma on the tail of a sphynx cat

Arrector pili muscle (APM) hamartoma is reported in humans and dogs. We describe a linear APM hamartoma in a sphynx cat. The lesion was characterized by multiple nodules distributed linearly along the tail, made of randomly arranged hypertrophic smooth muscles, the size of which tended to wax-and-wane during a one year follow-up.

Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population-based surveys

OBJECTIVE

The primary objective was to investigate the relationship between periodontitis and hypertension in two independent large surveys. The secondary objective was to ascertain whether systemic inflammation had a mediation effect in the association.

METHODS

This cross-sectional study analysed representative samples of the US (n = 3460; NHANES 2009/10) and Korean (n = 4539; 2015 KNHANES VI-3) populations. The association between periodontitis (exposure), hypertension (outcome) and inflammatory markers [C-reactive protein (CRP) and white blood cell counts (WBC)] (mediators) was assessed using multivariate linear and logistic regression models and mediation analysis.

RESULTS

Participants with periodontitis were more likely to have hypertension (NHANES: OR = 1.3, 95% CI: 1.0-1.6, P = 0.025; KNHANES: OR = 1.2, 95% CI: 1.0-1.4, P = 0.041) and actual systolic blood pressure ≥ 140 mmHg (NHANES: OR = 1.6, 95% CI: 1.1-2.3, P < 0.001; KNHANES: OR = 1.3, 95% CI :1.0-1.6, P < 0.031) than those without the disease. These associations were independent of age, gender, BMI, education level, smoking, alcohol consumption, creatinine, physical activity, presence of other comorbidities and confirmed in participants not taking antihypertensive medications. Diagnosis of periodontitis was directly associated with WBC (in both surveys: NHANES: β ± SE = 0.3 ± 0.1, P < 0.004; KNHANES: β ± SE = 0.3 ± 0.1, P < 0.001) and with CRP levels (in one survey: NHANES: β ± SE = 0.1 ± 0.03, P < 0.007; KNHANES: β ± SE = 0.1 ± 0.04, P > 0.213). Mediation analyses confirmed that CRP acted as a mediator in the association between periodontitis and hypertension in both populations (mediated effect: NHANES: β ± SE = 0.010 ± 0.003, P < 0.001; KNHANES: β ± SE = 0.003 ± 0.001, P = 0.015). WBC acted as a mediator in the KNHANES (mediated effect: β ± SE = 0.004 ± 0.001, P = 0.004) whilst in the NHANES, its effect was dependent of CRP inclusion in the model (mediated effect WBC + CRP: β ± SE = 0.002 ± 0.001, P = 0.001).

CONCLUSIONS

These findings suggest that periodontitis is closely linked to hypertension and systemic inflammation is, in part, a mediator of this association.

Celocentesis for early prenatal diagnosis of hemoglobinopathy

OBJECTIVE

Celocentesis is an invasive technique that can provide prenatal diagnosis of single-gene disorders, from as early as 7 weeks' gestation. The objective of this study was to examine the safety of celocentesis.

METHODS

In this prospective study, celocentesis was performed for prenatal diagnosis of hemoglobinopathy in 402 singleton pregnancies in which both parents were carriers of β-thalassemia or sickle cell disease trait. We assessed procedure-related maternal discomfort or pain, success of sampling and obtaining results, pregnancy outcome and postnatal follow-up.

RESULTS

First, celocentesis was carried out at a median gestational age of 8.6 (range, 6.9-9.9) weeks and celomic fluid was successfully aspirated in 99.8% of cases. Second, 67% of women had no or only mild discomfort, 18% had moderate discomfort, 12% had mild-to-moderate pain and 3% had severe pain. Third, prenatal diagnosis from analysis of the celomic fluid was successful in 93.8% cases, and in the last 121 cases, it was always successful. Fourth, in all cases of successful sampling and analysis of celomic fluid, the diagnosis was concordant with results obtained from additional prenatal or postnatal testing. Fifth, in addition to diagnosis of hemoglobinopathy, quantitative fluorescence polymerase chain reaction analysis, which was performed to evaluate maternal contamination using several markers for chromosomes X, Y, 21, 18 and 13, led to the accurate diagnosis of chromosomal aneuploidy. Sixth, in all cases of an affected fetus diagnosed by celocentesis in which the parents chose termination of pregnancy, this was carried out < 10 weeks' gestation. Seventh, in 97.1% (298/307) of the continuing pregnancies there was live birth, in seven (2.3%) there was miscarriage and in two (0.7%) there was loss to follow-up. Eighth, fetal abnormalities were diagnosed in three (1%) cases, including unilateral transverse amputation of the forearm, unilateral moderate hydronephrosis and small-bowel duplication. All neonates were examined by a pediatrician and were found to be phenotypically normal, except for the three cases with a prenatally diagnosed defect.

CONCLUSIONS

Celocentesis can be used for early prenatal diagnosis of genetic abnormalities, and the procedure-related risk of pregnancy complications appears to be low. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Prognostic Value of Serum Alkaline Phosphatase in Osteosarcoma

In 163 patients with osteosarcoma of the extremities treated with adjuvant chemotherapy, serum alkaline phosphatase (SAP) levels were evaluated before treatment and successively closely monitored in an attempt to determine whether serum levels of this enzyme had clinical value in predicting the course of the disease. Of 121 patients with elevated preoperative SAP levels, 78 (64%) recurred. Of 42 patients with normal preoperative SAP levels, only 8 (19%) recurred (P < 0.00001). Of the 140 patients locally treated with amputation, SAP returned to normal values in 77 patients; 46 of these (59%) relapsed. Of the 21 patients whose SAP remained elevated after amputation, all but 2 relapsed (90%). Among 119 patients with normal postoperative values of SAP, at the time of relapse SAP resulted elevated in 22 of 41 patients (53%). These data confirm that in osteosarcoma, preoperative SAP levels have a definite value in establishing the prognosis and that posttreatment follow-up examination should include SAP determination, since persistent elevated or increasing values herald the appearance of a recurrence.

Serum Lactate Dehydrogenase (LDH) as a Tumor Marker in Ewing's Sarcoma

The pretreatment serum lactic acid dehydrogenase (LDH) level of 246 patients with Ewing's sarcoma of bone (47 metastatic and 199 localized at presentation) was examined to evaluate the use of LDH as a tumor marker. The percentage of patients with increased serum LDH levels was significantly higher in the metastatic group than in the group of patients with localized disease (83 % vs 41 %; p < 0.01). In the latter group the relapse rate after treatment with combined therapy was significantly higher in patients with an elevated serum LDH at admission than in those with normal serum levels (68.2 % vs 39.3 %; p < 0.01). After local treatment, in 73 out of 82 patients with an elevated serum LDH at admission the enzyme level normalized whereas in 9 it fell but never reached a normal value. The rate of relapse in these two groups was respectively 64 % and 100 %. The value of serum LDH at the time of recurrence, determined in 62 patients, was elevated in 50 (80.7 %). These data demonstrate that in Ewing's sarcoma of bone pretreatment serum LDH levels have a definitive value in establishing the prognosis and could also be used in evaluating the response to therapy. A persistent elevated value of serum LDH, or an increasing value after a transient normalization, is usually followed by relapse.

Kinetics versus thermodynamics in the proline catalyzed aldol reaction

In this paper the equilibrium properties of the proline catalyzed aldol reaction was studied. The use of well-established methodologies, like reaction progress kinetic analysis and linear free energy relationship analysis, led to the quantification of the reaction reversibility and to its correlation with the substrate electronic activation. Due to these experimental observations, common computational approaches based on a one way transition state analysis become unsuitable. Therefore, a computational model based on the integration of a system of kinetic differential equations associated to the multiple equilibrium reactions was proposed. Such a model was found to successfully rationalize the chemical and stereochemical outcomes of this paradigmatic reaction for the first time.

One year in review 2015: spondyloarthritis

Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. Recently, novel insights into the epidemiology, pathogenesis and treatment of these diseases have been provided. Herewith, we provide an overview of the most significant literature contributions published over the year.

Breast-conservative surgery with and without radiotherapy in patients aged 55-75 years with early-stage breast cancer: a prospective, randomized, multicenter trial analysis after 108 months of median follow-up

OBJECTIVES

Breast-conserving therapy (BCT), including postoperative whole breast irradiation (WBI), is generally accepted as the treatment of choice for most patients with early-stage breast cancer. The question whether WBI is mandatory in all patients remains one of the most controversial issues in BCT. To answer this question, a randomized, prospective, multicentre study was launched in January 2001. Primary endpoints of the study were to assess the cumulative incidence of in-breast-recurrences (IBR) and overall survival (OAS) after conservative surgery (BCS) with or without WBI.

METHODS

From January 2001 until December 2005, 749 patients with unifocal infiltrating breast cancer up to 25 mm, 0-3 positive axillary lymph nodes, no extensive intraductal component or lymphvascular invasion from 11 centres in Italy, were randomly assigned to BCS+WBI (arm 1:373 patients) or BCS alone (arm 2:376 patients). Treatment arms were well balanced in terms of baseline characteristics. Systemic adjuvant therapy was administered according to the institutional policies. Kaplan-Meier method was used for survival analysis and log-rank test to evaluate the difference between the two arms. RESULTS (Last analysis 31.12.2012): After median follow-up of 108 months, 12 (3.4%) IBR were observed in arm 1 and 16 (4.4%) in arm 2. OAS was 81.4% in arm 1 and 83.7% in arm 2. There was no statistically significant difference regarding IBR and death in the two treatment groups.

CONCLUSIONS

These data are promising and suggest that WBI after BCS can be omitted in selected patients with early stage breast cancer without exposing them to an increased risk of local recurrence and death. Longer follow-up is needed to further consolidate these results.

Disease-related nutritional risk and mortality in systemic sclerosis

BACKGROUND & AIMS

To evaluate the relationship between mortality and nutritional risk associated with disease activity in Systemic Sclerosis (SSc).

METHODS

A single-centre prospective cohort study involving 160 SSc outpatients (median age, 62 years [25th-75th, 54-68]). Nutritional risk was assessed by the Malnutrition Universal Screening Tool (MUST), a screening tool that combines anthropometric parameters of nutritional status (body mass index [BMI] and percentage of unintentional weight loss [WL]) with the presence of an "acute disease" (as defined by a disease activity score ≥3 according to Valentini's criteria).

RESULTS

Prevalence of high nutritional risk (MUST score ≥2) was 24.4% [95%CI, 17.4-31.3]. A low nutritional risk (MUST = 1) was detected in 30% of our study sample. In hazard analysis (median follow-up duration = 46 months [25th-75th percentile, 31-54]), high nutritional risk was significantly associated with mortality (HR = 8.3 [95%CI, 2.1-32.1]). The performance of the model based on nutritional risk including disease activity (Harrell's c = 0.74 [95%CI, 0.59-0.89]) was superior to that based on active disease alone (HR = 6.3 [95%CI, 1.8-21.7]; Harrell's c = 0.68 [95%CI, 0.53-0.84]). Risk scored only by anthropometric parameters (prevalence, 9.4% [95%CI, 4.6-14.2]) was not associated with mortality: HR = 2.8 [95%CI, 0.6-13.2].

CONCLUSIONS

In SSc outpatients MUST significantly predicts mortality. The combined assessment of nutritional parameters and disease activity significantly improves the evaluation of mortality risk. Disease-related nutritional risk screening should be systematically included in the clinical workup of every SSc patient.