Significato clinico della stiffness arteriosa nel Lupus Eritematoso Sistemico: studio prospettico in una coorte di pazienti seguiti presso un unico centro.

Il Lupus Eritematoso Sistemico (LES) è una malattia autoimmune sistemica, con un picco di incidenza fra i 15 e i 40 anni e un rapporto femmine-maschi di 6-10:1. Il LES è associato ad un aumento della morbidità e della mortalità. Quest’ultima appare attribuibile particolarmente al verificarsi di eventi cardiovascolari (CV). Numerose evidenze in Letteratura hanno mostrato che la Aterosclerosi (ATS) si verifica più precocemente in corso di LES rispetto ai controlli ed evolve con velocità pari a circa il doppio rispetto a quella della popolazione generale, indipendentemente dai fattori di rischio (CV) tradizionali. La ATS comprende sia l’aterosi (degenerazione grassa), che la sclerosi (irrigidimento della parete arteriosa); quest’ultimo processo può essere definito come Stiffness Arteriosa (SA). Entrambe queste condizioni possono essere valutate tramite tecniche di imaging ecografico non invasive. La SA è valutata misurando la Pulse Wave Velocity (PWV) e l’Augmentation Index (AI). Studi longitudinali hanno dimostrato che PWV e AI, parametri di valutazione del danno CV subclinico, sono da considerare predittori affidabili del rischio di eventi CV futuri e di mortalità CV, indipendentemente dai fattori di rischio CV tradizionali. Studi clinici hanno mostrato come la PWV e l’AI siano aumentati in giovani donne con LES in assenza di eventi CV e di danno organico severo, rispetto a controlli sani della stessa età. Il presente studio si propone di approfondire il significato clinico della PWV e dell’AI in una coorte di donne affette da LES seguite presso la U.O. di Reumatologia della Azienda Ospedaliera Universitaria Pisana, indagando le eventuali associazioni con parametri specificamente correlati con la malattia di base. Sono state arruolate consecutivamente 31 donne con diagnosi di LES in base ai criteri dell’American College of Rheumatology (ACR). Attività e danno di malattia sono stati misurati rispettivamente con l’European Consensus Lupus Activity Measurement Index (ECLAM) e con il Systemic Lupus International Collaborating Clinics damage index (SLICC/DI). In tutte le pazienti partecipanti allo studio è stata indagata la presenza dei fattori di rischio CV tradizionali e sono stati valutati parametri specifici di attività e danno della malattia di base. In tutte le pazienti sono stati valutati i valori i PWV e AI mediante tonometria arteriosa (Sphygmocor, Atcor Medical). Le valutazioni statistiche sono state eseguite tramite analisi ANOVA, ANCOVA e tramite test non parametrici. L’analisi univariata ha mostrato una correlazione statisticamente significativa fra PWV ed età (r=0,52, p=0,0002), SLICC (r=0,43, p=0,01) e PAS (r=0,61, p=0,000008) e fra AI e età (r=0,57, p=0,00003), SLICC (r=0,59, p=0,0003), PAS (r=0,43, p=0,003) e dose totale di GC (r=0,40, p=0,03). Nella analisi multivariata le correlazioni che si sono mantenute significative sono state quella della PWV con la PAS (r2=0,58, p=0,002) e quelle dell’AI con la durata di malattia (r2=0,55, p=0,004) e SLICC (r2=0,55, p=0,04). Pertanto, da questa prima valutazione del significato clinico dei parametri della SA, emerge che l’AI potrebbe essere interpretabile come parametro di danno vascolare LES-specifico, valido anche in pazienti con malattia di lunga durata, mentre la PWV appare maggiormente influenzabile da fattori di rischio tradizionali come l’età e la PAS. In conclusione, la semplice valutazione della PWV e dell’AI tramite la tonometria arteriosa, potrebbe diventare parte integrante della valutazione clinica dei pazienti con LES, allo scopo di definire il rischio CV individuale e di programmare eventuali strategie preventive e/o terapeutiche

Observer mediation as a function of serial or simultaneous exposure to a model\u27s behavior and intructions concerning the test of learning.

In past research concerning spontaneous motoric and symbolic mediation in observational learning (Berger, et al . , 1979), familiar observers who had symbolic codes for the model\u27s behavior benefited from the use of these codes; unfamiliar observers who had no available symbolic codes benefited from the use of motor mimicry. Familiar observers, however, still engaged in a considerable amount of mimicry. This study examined two hypotheses concerning why familiar subjects continued to mimic: that mimicry acts as a temporary coding device when observers do not have enough time to think of familiar symbolic codes for a model\u27s behavior and that observers increase their use of mimicry when they expect to have to perform the model\u27s behavior as a test of their learning. The results showed that there was no difference in mimicry between groups of observers who did have enough time to think of symbolic codes and those who did not. Observers who expected to have to perform the model\u27s behavior engaged in more mimicry than those who expected a recognition test. In addition, some observers reported engaging in unintentional mimicry. The results suggest that mimicry in past research may have occurred automatically and unintentionally or in preparation for a performance test

Parenteral amino acids v. dextrose infusion: an anabolic strategy to minimise the catabolic response to surgery while maintaining normoglycaemia in diabetes mellitus type 2 patients

Loss of body protein and hyperglycaemia represent typical features of the stress response to surgery and anaesthesia. This appears to be particularly pronounced in patients with diabetes mellitus type 2. The aim of the present study was to highlight the greater benefit of amino acids (AA) as represented by positive protein balance and maintenance of blood glucose homoeostasis compared with dextrose (DEX) in diabetic patients after colorectal surgery. A total of thirteen patients underwent a 5h stable isotope infusion study (2h fasted, 3h fed with an infusion of AA (n 6) or DEX (n 7)) on the second post-operative day. Glucose and protein kinetics were assessed by using the stable isotopes l-[1-13C]leucine and [6,6-2H2]glucose. The transition from fasted to fed state decreased endogenous glucose production (P<0·001) in both groups, with a more profound effect in the DEX group (P=0·031). In contrast, total glucose production was increased by the provision of DEX while being lowered by AA (P=0·021). Feeding decreased protein oxidation (P=0·009) and protein synthesis in the AA group, whereas DEX infusion did not affect oxidation and even decreased protein synthesis. Therefore, only AA shifted protein balance to a positive value, while patients in the DEX group remained in a catabolic state (P<0·001). Parenteral nutritional support with AA rather than with DEX is an effective strategy to achieve a positive protein balance while maintaining normoglycaemia in diabetic patients after colorectal surger

Occurrence of hashimoto thyroiditis among the first- and second-degree relatives of systemic lupus erythematosus patients with Hashimoto thyroiditis

Occurrence of Hashimoto thyroiditis among the first- and second-degree relatives of systemic lupus erythematosus patients with Hashimoto thyroiditis

Early treatment with hydroxychloroquine prevents the development of endothelial dysfunction in a murine model of systemic lupus erythematosus

INTRODUCTION: Accelerated atherosclerosis is one of the major causes of morbidity in patients with systemic lupus erythematosus (SLE). Endothelial dysfunction (ED) is considered an early marker of atherosclerosis. It is a reversible alteration, thus representing an attractive target for prevention strategies against cardiovascular disease. Studies have shown that ED occurs in patients with SLE even in the absence of severe, active disease. Hydroxychloroquine (HCQ) is widely used in SLE to control disease activity, but its use is also associated with an improvement in long-term prognosis. Beyond the beneficial effect in well-established disease, our hypothesis is that treatment with HCQ might have a beneficial impact on ED prevention in SLE. The aim of this study was to assess the impact of early treatment with HCQ on ED in a murine model of SLE. METHODS: Twelve-week-old NZB/W F1 (NZ) and C57BL/6 J mice (controls) were allocated to receive HCQ or vehicle for 6, 12, or 18 weeks. Proteinuria and anti-double-stranded DNA autoantibodies were determined. ED was assessed in mesenteric arteries (pressurized myography). Nitric oxide (NO) availability and reactive oxygen species (ROS) production were evaluated. Vascular ROS production was measured with dihydroethidium (DHE) fluorescent dye. RESULTS: Starting from 18 weeks of age, NZ mice showed a progressive reduction in NO availability, which was normalized by ascorbic acid and apocynin in the up to 24-week-old group, and partly ameliorated in older animals. HCQ administration normalized the NO availability in the up to 24-week-old group, with a partial amelioration in the 30-week-old group. DHE analysis revealed a progressive increment of vascular ROS generation among NZ groups, which was prevented by apocynin. Similarly, in the NZ HCQ-treated group, vascular ROS production was abrogated. CONCLUSIONS: The ED that characterizes this mouse model of SLE is caused by the nicotinamide adenine dinucleotide phosphate oxidase-driven ROS excess. Very early treatment with HCQ is able to exert vascular protection via an antioxidant effect

184 Patient perception of SLE burden: the role of disease activity, comorbidities and treatment

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270 The discordance between patient and physician perception of the disease: the paradigm of SLE

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Reporting quality of randomized controlled trials in prehabilitation: a scoping review.

BACKGROUND Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists. METHODS Eligibility criteria: RCTs of unimodal or multimodal prehabilitation interventions. SOURCES OF EVIDENCE search was conducted in March 2022 using MEDLINE, Embase, PsychINFO, Web of Science, CINAHL, and Cochrane. CHARTING METHODS identified studies were compared to CONSORT, CERT & Modified CERT, TIDieR, PRESENT, and CONSORT-SPI. An agreement ratio (AR) was defined to evaluate if applicable guideline items were correctly reported. Data were analyzed as frequency (n, %) and mean with standard deviation (SD). RESULTS We identified 935 unique articles and included 70 trials published from 1994 to 2022. Most prehabilitation programs comprised exercise-only interventions (n = 40, 57%) and were applied before oncologic surgery (n = 32, 46%). The overall mean AR was 57% (SD: 20.9%). The specific mean ARs were as follows: CONSORT: 71% (SD: 16.3%); TIDieR: 62% (SD:17.7%); CERT: 54% (SD: 16.6%); Modified-CERT: 40% (SD:17.8%); PRESENT: 78% (SD: 8.9); and CONSORT-SPI: 47% (SD: 22.1). CONCLUSION Altogether, existing prehabilitation trials report approximately half of the checklist items recommended by methodological and intervention reporting guidelines. Reporting practices may improve with the development of a reporting checklist specific to prehabilitation interventions

O13 Remission and LLDAS as a target for pregnancy planning in SLE?

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