Capillaroscopy in 2016 : new perspectives in systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune disorder of unknown etiology characterized by early impairment of the microvascular system. Nailfold microangiopathy and decreased peripheral blood perfusion are typical clinical aspects of SSc. The best method to evaluate vascular injury is nailfold videocapillaroscopy, which detects peripheral capillary morphology, and classifies and scores the abnormalities into different patterns of microangiopathy. Microangiopathy appears to be the best evaluable predictor of the disease development and has been observed to precede the other symptoms by many years. Peripheral blood perfusion is also impaired in SSc, and there are different methods to assess it: laser Doppler and laser speckle techniques, thermography and other emerging techniques

Factors related to swallowing oral phase

Introduction: Efficacy of swallowing oral phase is often impaired in dysphagic patients and may impact on pharyngeal stage, meal consumption, nutritional status and quality of life. However, factors related to oral phase of swallowing have been little studied. Matherial & Methods: Thirty-nine adult patients with dysphagia of different etiology were enrolled. FEES and the Test of Mastication and Swallowing Solids (TOMASS) were performed. The Penetration-Aspiration scale, the Yale Pharyngeal Residue Severity Rating Scale and the Dysphagia Outcome and Severity Scale (DOSS) were used to assess the FEES. Tongue strength was assessed using the Iowa Oral Performance Instrument. Patients completed the Eating Assessment Tool-10. The time the patients needed to consume a meal, the Functional Oral Intake Scale score and the body mass index (BMI) were recorded. Correlations between the TOMASS and other variables were studied using Spearman\u2019s correlation coefficient. TOMASS scores were compared between patients with complete denture and those with partial edentulism through Mann-Whitney test. Results: The number of discrete bites correlated only with the BMI (r=-0.38; p=0.01). Statistically significant correlations were found between the number of masticatory cycles and tongue strength (r=-0.47; p<0.01), pharyngeal residue (r=0.42; p<0.01), DOSS (r=-0.38; p=0.01). The total time of the TOMASS correlated with tongue strength (r=-0.45; p<0.01), pharyngeal residue (r=0.48; p<0.01), time needed to consume a meal (r=0.41; p=0.01) and DOSS (r=-0.36; p=0.02). A significant difference was found between patients with complete denture and patients with partial edentulism for the number of masticatory cycles (p=0.02) and total time (p=0.03). Conclusions: Swallowing oral phase seems to correlate with tongue strength, denture, pharyngeal residue, overall dysphagia severity, duration of meals and BMI. Further studies involving a larger sample size are necessary to confirm present data

A Response Surface Methodology Approach to Improve Adhesive Bonding of Pulsed Laser Treated CFRP Composites

In this work, a response surface-designed experiment approach was used to determine the optimal settings of laser treatment as a method of surface preparation for CFRP prior to bonding. A nanosecond pulsed Ytterbium-doped-fiber laser source was used in combination with a scanning system. A Face-centered Central Composite Design was used to model the tensile shear strength (TSS) of adhesive bonded joints and investigate the effects of varying three parameters, namely, power, pitch, and lateral overlap. The analysis was carried out considering different focal distances. For each set of joints, shear strength values were modeled using Response Surface Methodology (RSM) to identify the set-up parameters that gave the best performance, determining any equivalent conditions from a statistical point of view. The regression models also allow the prediction of the behavior of the joints for not experimentally tested parameter settings, within the operating domain of investigation. This aspect is particularly important in consideration of the process optimization of the manufacturing cycle since it allows the maximization of joint efficiency by limiting the energy consumption for treatment

Assessment of treatment effects on digital ulcer and blood perfusion by laser speckle contrast analysis in a patient affected by systemic sclerosis

Laser speckle contrast analysis (LASCA) is a good tool to evaluate the variation in peripheral blood perfu-sion during long-term follow-up andis able to safely monitor digital ulcer evolution inscleroderma patients. It evaluates blood perfusion in different areas within the skin lesions and surrounding them during standard treatment

Low-pressure plasma treatment of CFRP substrates for epoxy-adhesive bonding: an investigation of the effect of various process gases

This work reports a systematic and quantitative evaluation of the effects induced on the adhesive properties of carbon fiber reinforced polymer (CFRP) substrates by various vacuum cold-plasma treatments. In particular, surface activation of the CFRP substrates was performed using several combinations of exposure time, plasma power, and processing gas (air, O 2 , Ar and N 2 ). By comparing these plasma treatments with conventional techniques of abrasion and peel ply, it was possible to substantially increase the performance of the adhesively bonded joints made by overlapping the CFRP substrates with a structural epoxy resin. On each differently treated surface, measurements of roughness and of wettability were performed, allowing the evaluation of the increase in surface energy after the plasma treatment. XPS analyses allowed the identification of the chemical state of the substrates and showed an in-depth functionalization of the outer layer of the CFRP material. The experimental results show that an engineered plasma treatment of the CFRP substrates allows one to modify the surface morphology and both wetting and chemical activation properties of the treated surfaces, resulting in an increased mechanical shear strength of the joints

Imaging and rheumatic diseases: correlation between fingertip blood perfusion and nailfold capillary impairment in systemic sclerosis

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The role of nailfold videocapillaroscopy in Raynaud's phenomenon monitoring and early diagnosis of systemic sclerosis

Several connective tissue diseases, in particular systemic sclerosis (SSc), have Raynaud's phenomenon (RP) as their first clinical manifestation. Primary RP represents a benign condition often observed in otherwise healthy subjects, especially women: it is due to an exaggerated response to the physiological cold-induced vasospasm, whereas the secondary form of RP is typically associated with connective tissue diseases, especially SSc. Nailfold videocapillaroscopy (NVC), particulary after the recent technological advances, is a safe and reliable method to observe the microvascular structure and its early changes, especially during the transition from primary to secondary RP. In case of SSc, by considering validated patterns and scoring systems, NVC is the main tool that rheumatologists can rely on, besides the presence of specific auto-antibodies, to perform a very early diagnosis of the disease. This implies the possibility of early treatment of SSc, with an eye of predicting and preventing its major clinical complications

Subclinical dermal involvement is detectable by high frequency ultrasound even in patients with limited cutaneous systemic sclerosis.

Background: The aim of the study was to detect by skin high-frequency ultrasound (US) possible subclinical skin involvement in patients affected by limited cutaneous systemic sclerosis (lcSSc), in those skin areas apparently not affected by the disease on the basis of a normal modified Rodnan skin score (mRSS). Differences in dermal thickness (DT) in comparison with healthy subjects were investigated. Methods: Fifty patients with lcSSc (age 62 \ub1 13 years (mean \ub1 SD), disease duration 5 \ub1 5 years) and 50 sex-matched and age-matched healthy subjects (age 62 \ub1 11 years) were enrolled. DT was evaluated by both mRSS and US at the usual 17 skin areas (zygoma, fingers, dorsum of the hands, forearms, upper arms, chest, abdomen, thighs, lower legs and feet). Non-parametric tests were used for the statistical analysis. Results: Subclinical dermal involvement was detected by US even in the skin areas in patients with lcSSc, who had a normal local mRSS. In addition, statistically significantly higher mean DT was found in almost all skin areas, when compared to healthy subjects (p < 0.0001 for all areas). In particular, DT was significantly greater in patients with lcSSc than in healthy subjects in four out of six skin areas with a normal mRSS (score = 0) (upper arm, chest and abdomen), despite the clinical classification of lcSSc. Conclusions: This study strongly suggests that subclinical dermal involvement may be detectable by US even in skin areas with a normal mRSS in patients classified as having lcSSc. This should be taken into account during SSc subset classification in clinical studies/trial

Microvascular damage evaluation in systemic sclerosis : the role of nailfold videocapillaroscopy and laser techniques

Microvascular damage and a decrease in peripheral blood perfusion are typical features of systemic sclerosis (SSc) with serious clinical implications, not only for a very early diagnosis, but also for disease progression. Nailfold videocapillaroscopy is a validated and safe imaging technique able to detect peripheral capillary morphology, as well as to classify and to score any nailfold abnormalities into different microangiopathy patterns. Capillaroscopic analysis is now included in the ACR/EULAR classification criteria for SSc. The decrease in peripheral blood perfusion is usually associated with microvascular damage in SSc, which may be studied by different methods. Several of these make use of safe laser technologies. This paper focuses on these new clinical aspects to assess SSc microvascular impairment

The importance of meal assessment in ALS patients

Background: the importance of instrumental evaluation of swallowing in ALS patients is highly recognized in order to assess swallowing safety and prevent pulmonary complications. However, swallowing performance during instrumental assessment may not be representative of what happens when consuming meals in everyday life. Indeed, as fatigue is a common feature in ALS patients, swallowing efficacy may progressively decline during mealtime consumption and food and liquid oral intake may not be sufficient. Objectives: to investigate the relationship between the performance during mealtime consumption and the efficacy of oral and pharyngeal phase of swallowing in ALS patients. Methods: thirteen ALS patients, 7 males and 6 females with a median age of 68.5 years (range 51-78) were enrolled in the study. Fiberoptic endoscopic evaluation of swallowing (FEES) was conducted testing liquids, semisolids and, whether possible, solids. The Penetration-Aspiration Scale (PAS) and the Dysphagia Outcome and Severity Scale (DOSS) were used to assess the FEES. The Test of Mastication and Swallowing Solids (TOMASS) was performed. Tongue strength and resistance were assessed through the Iowa Oral Performance Instrument (IOPI). Patients completed the Eating Assessment Tool-10, a self-reported questionnaire. Typical oral intake was recorded using the Functional Oral Intake Scale (FOIS). Meal consumption was observed and scored through the Mealtime Assessment Scale (MAS); the time the patients needed to consume a meal was recorded. Correlations between MAS total score or time and PAS, DOSS, EAT-10, FOIS, TOMASS and IOPI measures were studied using Spearman\u2019s correlation coefficient. Results: a statistically significant correlation was found between MAS total scores and FOIS (r=0.755, p=0.007), EAT-10 (r=-0.724, p=0.012), tongue strength (r=0.718, p=0.019) and TOMASS total time (r=-0.709, p=0.046). Time needed to consume a meal significantly correlated with tongue resistance (r=0.675, p=0.032) and number of discrete bites during TOMASS (r=-0.793, p=0.033). No statistically significant correlations were found between MAS and PAS or DOSS. Discussion and conclusion: these preliminary results suggest that instrumental assessment of swallowing, especially FEES, may not be exhaustive in ALS patients as it does not predict patient\u2019s performance during meals. Efficacy of swallowing oral phase seems to be related to meal consumption more than pharyngeal phase. Therefore, our data stress the need of a comprehensive swallowing evaluation in ALS patients, including instrumental, oral phase and mealtime assessment, in order to estimate the risk of both pulmonary and nutritional complications related to dysphagia