AB0160 CARDIAC AUTONOMIC NEUROPATHY PREVALENCE IN A COHORT OF SYSTEMIC SCLEROSIS (SSC) PATIENTS

Background:Systemic sclerosis is a rare disease determining a damage to the connective tissue and, consequently, an involvement of several organs. Besides the damage of the connective tissue, preminent is also the small vessels injury, detectable by videocapillaroscopy. Some authors report that the vascular damage may be also responsible of a cardiovascular impairment as cardiac autonomic disease (CAN) and heart rate variability [1].Objectives:Our study aims to assess the presence and entity of CAN in patients with systemic sclerosis (SSc).Methods:This is a pilot prospective cohort study. We enrolled 28 patients in a period of six months, from May 2019 to November 2019, afferent to the outpatient clinic of internal medicine and immunology of the Primo Policlinico of Naples, with definite SSc diagnosis in absence of other comorbidities. All patients underwent diagnostic tests for autonomic cardiac neuropathy (NAC) and videocapillaroscopy. In particular, four test were performed to search for the presence of NAC: orthostatic hypotension, deep breathing, lying to standing and Valsalva maneuver. Each test was corrected for age and diagnosis was made in the case at least two tests resulted positive. Primary endpoint of the study was the assessment of the prevalence of autonomic cardiac neuropathy in the study population.Results:Our cohort was mainly characterized by females (92.9%), with a median age of 58.5 years [IQR: 49-64.8 yrs.] and a median duration of the disease of 4 years [IQR 2-13 yrs.]. The observed prevalence of NAC was equal to the 46.4% (13 cases). In addition, we evaluated the potential association of NAC with age, duration of disease, gastrointestinal dysmotility, sicca syndrome, cutaneous involvement and type of videocapillaroscopy pattern, from which no statistically significant result emerged. Hence, a further analysis, by using a time-dependent Cox regression model (with the duration of disease as time covariate), was performed on the same variables. From this model a significant association emerged in particular between the presence of NAC and the active videocapillaroscopy pattern (OR 6.23; 95% CI: 1.058-36.71, p=0.043).Conclusion:Though current data in the literature on this topic are poor, cardiac autonomic neuropathy is among the clinical manifestations of SSc. In our study population, though the limited sample size, we observed a high percentage of patients with autonomic cardiac neuropathy, which seems much more frequent with the increase in the duration of disease and based on the type of videocapillaroscopy pattern.References:[1]Ferri C, Emdin M, Giuggioli D, Carpeggiani C, Maielli M, Varga A, Michelassi C, Pasero G, L'Abbate A. Autonomic dysfunction in systemic sclerosis: time and frequency domain 24 hour heart rate variability analysis. Br J Rheumatol. 1997[2]Adler BL, Russell JW, Hummers LK, McMahan ZH. Symptoms of Autonomic Dysfunction in Systemic Sclerosis Assessed by the COMPASS-31 Questionnaire. J Rheumatol. 2018 Aug;45(8):1145-1152. doi: 10.3899/jrheum.170868. Epub 2018 JunDisclosure of Interests:None declare

Experimental results from a stepped frequency GPR

In the framework of a nationally funded project, a Ground Penetrating Radar (GPR) has been developed by the Italian Consortium for Research on Advanced Remote Sensing Systems (CO.RI.S.T.A.). The system was described in a previous paper (Alberti et al., 2002). As new aspects, the system is a stepped frequency GPR that can work both in gated and ungated mode, and the antennas can be moved automatically in a controlled fashion. As aspects of geophysical interest, the system is exploitable in situations wherein a high resolution and a shallow penetration in the soil (a few meters) are required. Possibly, this is an example of probing a landscape. This paper completes the results of Alberti et al. (2002), wherein laboratory tests where described, by providing the main results obtained during an outdoor experimental campaign, performed fi rst in a controlled site and then in an archaeological site

Different non-structural carbohydrates/crude proteins (NCS/CP) ratios in diet shape the gastrointestinal microbiota of water buffalo

The microbiota of the gastrointestinal tract (GIT) are crucial for host health and production efficiency in ruminants. Its microbial composition can be influenced by several endogenous and exogenous factors. In the beef and dairy industry, the possibility to manipulate gut microbiota by diet and management can have important health and economic implications. The aims of this study were to characterize the different GIT site microbiota in water buffalo and evaluate the influence of diet on GIT microbiota in this animal species. We characterized and compared the microbiota of the rumen, large intestine and feces of water buffaloes fed two different diets with different non-structural carbohydrates/crude proteins (NSC/CP) ratios. Our results indicated that Bacteroidetes, Firmicutes and Proteobacteria were the most abundant phyla in all the GIT sites, with significant differences in microbiota composition between body sites both within and between groups. This result was particularly evident in the large intestine, where beta diversity analysis displayed clear clustering of samples depending on the diet. Moreover, we found a difference in diet digestibility linked to microbiota modification at the GIT level conditioned by NSC/CP levels. Diet strongly influences GIT microbiota and can therefore modulate specific GIT microorganisms able to affect the health status and performance efficiency of adult animals

The Role of Neuropathy Screening Tools in Patients Affected by Fibromyalgia

Fibromyalgia syndrome (sFM) is one of the most common causes of chronic pain. This study aimed to assess the presence of small and large fiber impairment in fibromyalgic patients by applying validated scores used in the screening for diabetic neuropathy. The endpoints for the study were the assessment of neuropathy prevalence in sFM patients using the NerveCheck Master (NCM), the Michigan Neuropathy Screening Instrument (MNSI), the Diabetic Neuropathy Symptom (DNS) and the Douleur Neuropathique 4 Questions (DN4). The sample was composed of 46 subjects: subjects with sFM (n = 23) and healthy controls (HC) (n = 23). The positivity rates in each group for DN4 were significantly different (p < 0.001), with a prevalence in symptomatic subjects of 56.3% (n = 9) among sFM individuals. A similar difference was also observed with the DNS total score (p < 0.001). NCM and MNSI did not disclose significant differences between the two groups. This finding seems to confirm the data regarding the prevalence of a neuropathic pain in sFM patients

The Diabetic Cardiomyopathy: The Contributing Pathophysiological Mechanisms

Individuals with diabetes mellitus (DM) disclose a higher incidence and a poorer prognosis of heart failure (HF) than non-diabetic people, even in the absence of other HF risk factors. The adverse impact of diabetes on HF likely reflects an underlying “diabetic cardiomyopathy” (DM–CMP), which may by exacerbated by left ventricular hypertrophy and coronary artery disease (CAD). The pathogenesis of DM-CMP has been a hot topic of research since its first description and is still under active investigation, as a complex interplay among multiple mechanisms may play a role at systemic, myocardial, and cellular/molecular levels. Among these, metabolic abnormalities such as lipotoxicity and glucotoxicity, mitochondrial damage and dysfunction, oxidative stress, abnormal calcium signaling, inflammation, epigenetic factors, and others. These disturbances predispose the diabetic heart to extracellular remodeling and hypertrophy, thus leading to left ventricular diastolic and systolic dysfunction. This Review aims to outline the major pathophysiological changes and the underlying mechanisms leading to myocardial remodeling and cardiac functional derangement in DM-CMP

An Overview of the Cardiorenal Protective Mechanisms of SGLT2 Inhibitors

Sodium-glucose co-transporter 2 (SGLT2) inhibitors block glucose reabsorption in the renal proximal tubule, an insulin-independent mechanism that plays a critical role in glycemic regulation in diabetes. In addition to their glucose-lowering effects, SGLT2 inhibitors prevent both renal damage and the onset of chronic kidney disease and cardiovascular events, in particular heart failure with both reduced and preserved ejection fraction. These unexpected benefits prompted changes in treatment guidelines and scientific interest in the underlying mechanisms. Aside from the target effects of SGLT2 inhibition, a wide spectrum of beneficial actions is described for the kidney and the heart, even though the cardiac tissue does not express SGLT2 channels. Correction of cardiorenal risk factors, metabolic adjustments ameliorating myocardial substrate utilization, and optimization of ventricular loading conditions through effects on diuresis, natriuresis, and vascular function appear to be the main underlying mechanisms for the observed cardiorenal protection. Additional clinical advantages associated with using SGLT2 inhibitors are antifibrotic effects due to correction of inflammation and oxidative stress, modulation of mitochondrial function, and autophagy. Much research is required to understand the numerous and complex pathways involved in SGLT2 inhibition. This review summarizes the current known mechanisms of SGLT2-mediated cardiorenal protection

Efficacy of COVID-19 vaccination in patients with immune system disorders and cancer

This is an editorial on the efficacy of COVID-19 vaccines in immune system disorders and cancer

Current hepatocellular carcinoma systemic pharmacological treatment options

Liver cancer is the sixth common cancer and the second leading cause of cancer death worldwide. Hepatocellular carcinoma (HCC) accounts for ~90% of cases of liver cancer and is the fourth most common cause of cancer-related death in the world. Up to now, 4 oral multityrosine kinase inhibitors (sorafenib, lenvatinib, regorafenib and cabozantinib), 1 anti-angiogenic antibody (ramucirumab) and 5 immune checkpoint inhibitors, alone or in combination (atezolizumab in combination with bevacizumab, ipilimumab in combination with nivolumab, tremelimumab in combination with durvalumab, nivolumab and pembrolizumab in monotherapy) have been commercialized for advanced HCC patients’ treatment. The aim of this editorial is to provide an insight in current hepatocellular carcinoma systemic pharmacological treatment options

Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study

Background Italy has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory. Objectives Aim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy). Methods COVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission. Results Among 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42–4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39–14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21–5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings. Conclusion Mortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage