Background:systemic sclerosis (SSc) in a chronic autoimmune disease characterized by endothelial dysfunction, diffuse microangiopathy, and fibrosis of skin and visceral organs. Typical cardiac involvement may includes microvascular ischemia, contraction band necrosis, and patchy fibrosis, leading mainly to arrythmias and conduction defects, diastolic dysfunction, or right ventricular failure (secondary to pulmonary arterial hypertension) [1]. Valvular diseases are poorly described and generally not considered a typical sign of SSc [2-4].Objectives:we aimed to describe valvular alterations in a multicentre cohort of SSc patients.Methods:we consecutively recruited 118 SSc patients (M/F: 14/104, mean age 56.7±12.4 years, median disease duration 10 years, limited/diffuse skin subsets: 95/23, anti-centromere/anti-Scl70/others autoantibodies: 35/37/46) in 3 Rheumatology Centres in Sicily, Italy, from January to December 2019.Considering the cardiovascular risk factors, 40 (34%) patients were smokers, 7 (6%) diabetics, 12 (10%) showed hypercholesterolemia, 38 (32%) arterial hypertension, while none was obese. Transthoracic echocardiogram was carried out in all patients during their follow-up.Results:valvular abnormalities were as follow: mitral valve: insufficiency 85 (72%) cases - mild in 77/85, stenosis 2 (2%) - mild in 25/28, sclerosis/tickening 36 (30%), and calcification 9 (8%) patients; aortic valve: insufficiency 28 (24%), stenosis 4 (3%), sclerosis 29 (25%), and calcification 7 (6%) patients; tricuspid valve: insufficiency 91 (77%) cases, no cases of stenosis, sclerosis 5 (4%), and calcification 1 (1%) patients; pulmonary valve: insufficiency in 13 (11%) patients.As expected, tricuspid insufficiency (TI) was associated with pulmonary arterial hypertension (PAH) (moderate TI in 20% of patients with every TI and PAH vs. 4% of patients with TI without PAH, p=0.019).Aortic sclerosis (AS) was associated with the presence of arthritis (AS in 35% of patients with arthritis vs. 16% of patients without, p=0.029).No association was found with age, gender, disease duration, skin subset, autoantibodies, capillaroscopic patterns, presence of digital ulcers, lung, renal, or digestive involvements.Conclusion:in this multicentre SSc cohort study, we found that cardiac valve alterations are very common, even though generally not clinically relevant. The presence of PAH was associated with more severe TI. Finally, AS was associated with arthritis that could be considered sign of chronic inflammatory state, which is often linked with accelerated atherosclerosis and remodeling process of aortic valve [5].References:[1]Lambova S. Cardiac manifestations in systemic sclerosis. World J Cardiol 2014; 6:993-1005.[2]D’Angelo W, Fries JF, Masi AT, Shulman LE. Pathologic observations in systemic sclerosis (scleroderma).A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 1969; 46:428-440.[3]Kazzam E, Caidahl K, Hallgren R, et al. Mitral regurgitation and diastolic flow profile in systemic sclerosis. Int J Cardiol 1990; 29:357-363[4]Wranicz J, Zielińska M, Cygankiewicz I, et al. Early cardiovascular involvement in patients with systemic sclerosis (SSc). Med Sci Monit. 2002; 8:CR78-82.[5]Coté N, Mahmut A, Bosse Y, et al. Inflammation is associated with remodeling of calcific aortic valve disease. Inflammation 2013; 36:573-581.Disclosure of Interests:Michele Colaci: None declared, Claudia Schinocca: None declared, Ylenia Dal Bosco: None declared, Maria Letizia Aprile: None declared, Giuliana Guggino Grant/research support from: Pfizer, Celgene, Speakers bureau: Celgene, Sandoz, Pfizer, Ilenia De Andres: None declared, Alessandra Azzurra Russo: None declared, Domenico Sambataro: None declared, Gianluca Sambataro: None declared, Lorenzo Malatino: None declared

Introduction: We recently evaluated the feasibility and safety of the EpiAccess®System with a novel epicardial access needle in a multicenter study. The pressure monitoring capability identified su...

Objectives This study aimed to assess the responsiveness of ultrasonography (US)-7 in patients with psoriasic arthritis (RA) non responders at only MTX terapy recruided with baseline ecographic positivity per disease activity. Sixty-two RA patients were recruited and followed up for 24 weeks. Methods The clinical, laboratory, and X-ray assessments, along with grayscale US (GSUS) and power Doppler US (PDUS) examinations were performed at baseline, 6, 14, and 24 weeks after adalimumab treatment GSUS for synovitis and PDUS for synovitis and paratendinitis/tenosynovitis were assessed by a semi-quantitative (0 to 3) score, while GSUS for paratendinitis/tenosynovitis and bone erosion was qualitatively assessed as absent or present (0 or 1). US scores in both 7-joint (US7) and 12-joint (US12) systems were evaluated. Results After 6, 14, and 24weeks of treatment with adalimumab, indices such as US scores in both 7-joint (US7) and 12-joint (US12) systems were evaluated. After 6, 14, and 24 weeks of treatment with adalimumab indices such as US scores, 28-joint disease activity (DAS28) score, and tender and swelling joint count were all significantly improved compared to baseline. US7 scores were significantly correlated with that of US12. Strong correlations were identified between most US7 scores with DAS28, health assessment questionnaire (HAQ), and C-reactive protein (CRP) levels. When DAS28 was used as a reference, the US7 cutoff for disease remission was less than 35 for GS+PD and also less than 29 for GS and 1 for PD, respectively Conclusions Additionally, the positive percent agreement, negative percent agreement, and overall percent agreement for GS+PD were 77.78, 76.19, and 76.67%, respectively, which were all higher than that of GS or PD. US7 may be a feasible tool to assess the therapeutic response in RA patients. References Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Naredo E, Moller I, Cruz A, Carmona L, Garido J. Arthritis Rheum. 2008 Aug;58(8):2248–56. doi: 10.1002/art.23682 Skeletal Radiol. 2010 May;39(5):457–65. doi: 10.1007/s00256-009-0824-5. Epub 2009 Nov 20. Semi-quantitative analysis of rheumatoid finger joint synovitis using power Doppler ultrasonography: when to perform follow-up study after treatment consisting mainly of antitumor necrosis factor alpha agent. Kamishima T, Sagawa A, Tanimura K, Shimizu M, Matsuhashi M, Shinohara M, Hagiwara H, Henmi M, Narita A, Terae S, Shirato H. Skeletal Radiol. 2010 May;39(5):457–65. doi: 10.1007/s00256-009-0824-5. Epub 2009 Nov 20. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study.Ribbens C, André B, Marcelis S, Kaye O, Mathy L, Bonnet V, Beckers C, Malaise MG.Radiology. 2003 Nov;229(2):562–9. Epub 2003 Sep 11 Disclosure of Interest None declared

Background Interstitial involvement is a common manifestation in patient with connective tissue disorders, Objectives The aim of our study is to investigate the utility of modified TTUS scoring system compared con HRCT findings of in patients with connective tissue disease with pulmonary involvement in treatment with cyclophosphamide Methods 21 patients with a diagnosis of connective lung involvement in treatment with cyclophosphamide were examined with high resolution transthoracic ultrasonography for detecting of ultrasonography comet tail signe as a ultrasonographyc marker of lung involvement in interstitial in connective disease at time 0 and after 6 and 12 months after initiation of treatment with cyclophosphamide and the results of them were compared with high resolution computed tomography as gold standard method for diagnosis of lung involvemeant in this patients Results In comparation with HRCT as gold standard method, the sensitivity, specificity, positive and negative predictive value of TTUS was 75%, 89%, 95% and 52% respectively. Conclusions Modified TTUS can be useful imaging modality in the evalutation of even early stages of pulmonary involvement in connective lung disaease References Diagnostic Perfomance of lung ultrasound in the diagnosis of pneumonia: a bivariate meta-analysis Qian-Jing Hu*, Yong-Chun Shen*, Liu-Qun Jia, Shu-Jin Guo, Hong-Yu Long, Cai-Shuang Pang, Ting Yang, Fu-Qiang Wen Int J Clin Exp Med 2014;7(1):115-121 Guidelines for the diagnosis and treatment of pulmonary hypertension Nazzareno Galiè (Chairperson) (Italy)*; Marius M. Hoeper (Germany); Marc Humbert (France); Adam Torbicki (Poland); Jean-Luc Vachiery (France); Joan Albert Barbera (Spain); Maurice Beghetti (Switzerland); Paul Corris (UK); Sean Gaine (Ireland); J. Simon Gibbs (UK); Miguel Angel Gomez-Sanchez (Spain); Guillaume Jondeau (France); Walter Klepetko (Austria)Christian Opitz (Germany); Andrew Peacock (UK); Lewis Rubin (USA); Michael Zellweger (Switzerland); Gerald Simonneau (France) Disclosure of Interest None declared

Objectives: Aim of our study was to investigate gut microbiota composition in 9 months old patient with chronic liver disease undergoing liver transplantation colonized by multiresistent germs, due to the high infective risk linked to the surgical procedure and the immunosuppressive post transplant therapy. In the literature there are no clear indication to a preventive antibiotic treatment of gut decontamination, nor for the management of these patients.

Fiberoptic bronchoscopy (FBO) in Community-Acquired Pneumonia (CAP) is indicated in Intensive Care settings, in Immunocompromised patients and in CAP not responsive to antibiotic treatment. The FBO has a dual role to allow a targeted bacterial isolation and a more accurate toilet of tracheobronchial secretions in the airways. Aim and Methods : 98 pts (81 M, mean age 68 yrs, BMI 25) with diagnosis of CAP, from 2010 to 2011, were evaluated by performing a FBO. All patients were selected according to the values of pH, PaO2/FiO2, PaCO2 mmHg and evaluation of APACHE III score, Kelly-Matthay score and CURB-65 score. View this table: Caracheristics of both group in admission Results: In 47 out of 58 patients, those undergoing FBO, were identified pathogenic species on bronchial mucus aspirated, with a higher prevalence of Pseudomonas aeruginosa and Entero-bacteracee. The improvement of respiratory symptoms and laboratory parameters, at a mean of 4 days from the execution of the FBO, was obtained. Moreover, we observed a reduction in the average time of hospitalization (9 vs 14 gg). Conclusions: In this study, is evident that the routine application of FBO may lead to the identification of a high percentage of pathogens (81% in our patients), significantly reduce the time of hospitalization and limit the costs associated with complications.

PH can be present in 37% to 59% of patients with IPF and is a predictor of mortality, which appears to be the cause of additional burden of exercise capacity. The aim of study was to investigate the role of oral dual ERA therapy in 2 groups of patients with PH associate to IPF with or without Bosentan therapy during 24 months. The primary endpoint was the change of exercise capacity up to month 24, measured by a modified 6MWT.We evaluated retrospectively 16 patients: 8 pts (6 M; mean age of 72 yrs old) with moderate-severe PH and IPF (mPAP measured by RCH estimated as a mean value of 38 ± 4.8 mmHg), treated with Bosentan (PH-IPF ERA group); 8 pts (5 M; mean age of 70 yrs old) with moderate PH and IPF not treated with Bosentan (PH-IPF control group).At baseline, there were differences about hemodynamic and pulmonary functional test profile between two groups of pts. At T 24, the 6MWT increased in PH-IPF ERA group showing a mean increase of +150 mt, while in the PH-IPF control group we observed a reduction of 41% compared to the 6MWT values baseline ( p 0,0003 ).In PH-PID group treated with ERA, FVC% and DLCO% were reduced of 8% and 32%, respectively, while in PH-IPF control group were reduced of 6,6% and 22% compared to the baseline ( p 0,009 ).The NYHA functional class was decreased in group treated with ERA (3,5 vs 2; p 0,009 ) and improved in control group (2,12 vs 3,25; p 0,007 ). In patients with moderate-severe PH and idiophatic pulmonary fibrosis, treated by Bosentan, there was a clinical improvement, measured by a six minute-walk test and a change in NYHA functional class, without affecting pulmonary functional test.

A pituitary adenoma(PA) causes different symptoms, depending on its size and location and on the type of hormone that is being made. SDB and OSA are atypical presentation of PA secreting ACTH and GH. However, the non-secreting adenomas may cause alterations of sleep architecture. The aim of the study was to evaluate clinical and sleep characteristics in a group of patients with functioning (FPA) and non-functioning pituitary adenomas (NFP). We recruited 6 pts with SDB and PA. Physical and anthropometric examination were performed ES score and BMQ modified has been used to diagnose sleep disorders symptoms. SDB were studied by means of overnight polysomnographic study in our sleep lab.The scoring criteria were according to event definition by AASM. SDB were documented in 6 pts (3 M, mean age 50.8 yrs and mean BMI 35), with PA. Three NFPA, two patients with FPA and one with acromegaly, were diagnosed after neurosurgery resection. ESS mean reported were 10, mean SaO 2 was 93 ± 5% and AH index were 6.7 ±1.7, with a prevalence of obstructive events. ODI mean 7.8 ± 1.2., REM sleep duration mean 15.4±6.8% of total sleep time and SWS mean was 22.4±11.1%. In acromegaly patient, was found a worsening of sleep parameters compared to other patients (AHI 18.4; AHI supine 29.6; ODI 12.7), successfully treated with CPAP therapy.SDB in patients with FPAand NFPA are underdiagnosed. Although the patients with NFPA and Cushing9s syndrome were affected by a mild OSA, they reported sleepiness symptoms.Expert consultation and a multidisciplinary approach to sleep disordered are needed in patients with PA.

In the field of waste management, thermal disposal is a treatment option able to recover resources from "end of life" products. Pyrolysis and gasification are emerging thermal treatments that work under less drastic conditions in comparison with classic direct combustion, providing for reduced gaseous emissions of heavy metals. Moreover, they allow better recovery efficiency since the process by-products can be used as fuels (gas, oils), for both conventional (classic engines and heaters) and high efficiency apparatus (gas turbines and fuel cells), or alternatively as chemical sources or as raw materials for other processes. This paper presents a comparative study of a steam gasification process applied to three different waste types (refuse-derived fuel, poplar wood and scrap tyres), with the aim of comparing the corresponding yields and product compositions and exploring the most valuable uses of the by-products.

Background and aim. We have previously observed that gliadin peptide P31-43 can induce proliferation of NIH3T3 cells and of enterocytes of untreated celiac mucosa due to an interference of this peptide with the degradation of the ligand loaded EGF receptor [ [1] Barone et al. Growth factor-like activity of gliadin, an alimentary protein: implications for coeliac disease. Gut. 2007; 56 (Epub 2006 Aug 4): 480-488 Crossref PubMed Scopus (90) Google Scholar ]. We have also shown that in presence of P31-43 the EGF receptor stays longer activated as a consequence of a delay of the endocytic maturation. Aim of our study was to investigate whether proliferative effects induced by gliadin peptide P31-43 could be mediated also by activation of innate immunity. In particular we tested P31-43 effects on IL15 induction at level of transcription, translation, intracellular trafficking and role in P31-43 induced proliferation of both Caco2 cells and celiac enterocytes.

www.gimle.fsm.it The effects of low-dose lead occupational exposure on neurobehavioral functions are still not well defined by international literature. The objective of this study is to assess by psychometric testing the presence of possible neuropsychological impairment in a group of male Italian workers with low blood lead levels in comparison to an adequate non exposed worker group. Given informed consent to take part to the study, all workers were interviewed about their working and clinical history and underwent determination of blood lead levels (PbB). An internationally validated computerized battery of psychometric tests and a standardized paper-and-pencil version of mood self-rating scale and WAIS-R Vocabulary subtest were also administered to the workers. Exposed workers had a geometric mean of PbB significantly higher than non exposed workers, but rather low (16,4±1,7µg/dl). The results of psychometric tests were not significantly different between the two worker groups, even after adjusting for the main confounding factors. In workers exposed to low lead doses no neurobehavioral abnormalities were demonstrated by the administered psychometric test battery.

The association between sitting posture and degenerative alterations of intervertebral disks has been widely studied, while the possible relationship between sitting posture and thoracic hyperkyphosis has not been investigated sufficiently. The objective of this study, therefore, is to verify the possible association between video display terminal (VDT) use, which needs a sitting prolonged posture, and thoracic hyperkyphosis. 63 VDT workers and 71 telephone line maintenance workers (control group) have been examined. The two groups were different for the postural load required by the two jobs. A questionnaire about job and clinical history has been administered to workers included in the study. A complete orthopedical examination has been performed for all workers, while radiographic exams have been performed only in the cases requiring of further diagnostic investigations. The two groups have resulted homogenous for age, while were different for working age and body mass index (BMI). The frequency of subjects with rachialgia has resulted higher in VDT users than in maintenance workers. The prevalence of thoracic hyperkyphosis observed in VDT users has been higher than in maintenance workers, with a difference near to be statistically significant, and significantly associated with age in VDT users. The hyperkyphosis of the dorsolumbar tract have resulted significantly more frequent in VDT users than in maintenance workers (p<0.05). Preliminary results of this study suggest that fixed and prolonged sitting working posture would be able to determine thoracic hyperkyphosis, although constitutional factors and age could have a role in its determination. Preventive measures should be proposed for an adequate ergonomic training of VDT users.

The effects of low-dose lead occupational exposure on neurobehavioral functions are still not well defined by international literature. The objective of this study is to assess by psychometric testing the presence of possible neuropsychological impairment in a group of male Italian workers with low blood lead levels in comparison to an adequate non exposed worker group. Given informed consent to take part to the study, all workers were interviewed about their working and clinical history and underwent determination of blood lead levels (PbB). An internationally validated computerized battery of psychometric tests and a standardized paper-and-pencil version of mood self-rating scale and WAIS-R Vocabulary subtest were also administered to the workers. Exposed workers had a geometric mean of PbB significantly higher than non exposed workers, but rather low (16.4 +/- 1.7 microg/dl). The results of psychometric tests were not significantly different between the two worker groups, even after adjusting for the main confounding factors. In workers exposed to low lead doses no neurobehavioral abnormalities were demonstrated by the administered psychometric test battery.