CXCR4 pos circulating progenitor cells coexpressing monocytic and endothelial markers correlating with fibrotic clinical features are present in the peripheral blood of patients affected by systemic sclerosis

There is still controversy regarding the role of circulating endothelial and progenitor cells (CECs/CEPs) in the pathogenesis of systemic sclerosis (SSc). Using a sequential Boolean gating strategy based on a 4-color flow cytometric protocol, an increased number of CD31(pos)/CD184(pos)(CXCR4)/CD34(pos)/CD45(pos) and CD31(pos)/CD117(pos) (c-kit-R) /CD34(pos)/ CD45(pos) hematopoietic circulating progenitor cells (HCPCs) was detected in SSc patients compared with healthy subjects. In SSc, no circulating mature and progenitor endothelial cells were observed, while an enhanced generation of erythroid progenitor cells was found to be correlated with the presence of CD117+ HCPCs. The presence of freshly detected CXCR4posHCPC was correlated either to the in vitro cultured spindle-shaped endothelial like cells (SELC) with an endo/myelomonocytic profile or to SDF-1 and VEGF serum level. These data are related to more fibrotic clinical features of the disease, thus supporting a possible role of these cells in fibrosis

Bronchoalveolar lavage in systemic sclerosis with lung involvement: role and correlations with functional, radiological and scintigraphic parameters

To evaluate the role and the prognostic value of bronchoalveolar lavage (BAL) in scleroderma patients withinterstitial lung disease. We reviewed the records of 79 patients with systemic sclerosis (SSc) who had dyspnea and pulmonary involvement and underwent BAL study. Sixty-two patients were prospectively followed up for 12–36 months and re-evaluated by pulmonary function tests (PFTs). Seventy-nine SSc patients were enrolled (71 F and 8 M), 55 with limited and 24 with a diVuse form; mean age55 +/- 13 years; mean disease duration 55.2 +/- 59 months. All patients were ANA positive, of these 30 were anti-topoisomerase-1 positive (anti-Topo1) and 22 were anti-centromere positive (ACA). Thirty-one patients had alveolitis (39.2%) that was neutrophilic in 12 patients, eosinophilic in 3 and mixed (neutrophilic and eosinophilic) in 16 patients. Compared to patients without alveolitis, those with alveolitis had a significant reduction of carbon monoxide diffusing capacity (DLCO), forced vital capacity (FVC) and more elevated lung high-resolution computed tomography (HRCT) scores. Furthermore, alveolar clearance was signiWcantly accelerated. No differences were found between patients with and without alveolitis regarding disease subsets (diffuse vs limited-SSc); a significant predominance of anti-Topo1 antibodies was foundin the alveolitis group and of ACA antibodies in the non-alveolitiscohort. During the follow-up, (range: 12–36 months) 62patients, 26 with and 36 without alveolitis were re-evaluated with PFTs. In the alveolitis group, 12 patients (46.1%)showed stable lung function parameters and 14 had worsened (53.8%). In this group, 20 patients (77%) received cyclophosphamide (CYC): 11 (55%) worsened (5 of them died of cardio-pulmonary complications) and 9 (45%) remained stable. Six patients could not be treated; of these 3 remained stableand 3 worsened. Among 36 patients with normal BAL, 11 (30.5%) showed stable lung function parameters, 13 improved (36.1%) and 12 worsened (33.3%); in this last group, 2 patients died of extra-pulmonary complications. Six patients, with progression of lung fibrosis, were treated with CYC: 3 of them improved and 3 remained stable. Our study revealed a trend toward a more severe course in the SSc patients with BAL alveolitis; probably the non-significant result is related to the low number of the examined subjects and to the selection criteria. However, BAL remains the only tool to exclude lung infections and, in our experience, a useful instrument to evaluate interstitial lung disease in SSc patients

3ronchial hyperreactivity in systemic sclerosis patients: influence of associated Sjogren's syndrome

Abstract Objective-To determine the frequency and relative risk of bronchial hyperreactivity to methacholine in systemic sclerosis patients with or without associate

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Le manifestazioni neurologiche della malattia di Behçet

Rassegna sulle manifestazioni neurologiche del morbo di Behçe

Bronchial hyperresponsiveness to methacholine in primary Sjogren's syndrome.

none4---noneLA CORTE R.; BAJOCCHI G.; F. TROTTA; POTENA A.LA CORTE, Renato; Bajocchi, G.; Trotta, Francesco; Potena, Alfred

Comment on: Sarcoid-like granulomatosis in patients treated with tumour necrosis factor blockers: 10 cases

none4As the use of TNF-a antagonists has increased, a variety of possible adverse events, including noninfectious granuloma formation, have been reported. A recent large series adds to a growing number of reports about this unusual and paradoxical adverse event. Following 2 own cases recently published, a comment on this paradoxical aspect is purposed.noneA. Massara; L. Cavazzini; R. La Corte; F. TrottaMassara, Alfonso; Cavazzini, Luigi; LA CORTE, Renato; Trotta, Francesc

Helicobacter pylori and nonsteroidal anti-inflammatory drugs.

none4---noneLa Corte R.; Caselli M.; Castellino G.; Trotta F.LA CORTE, Renato; Caselli, Michele; Castellino, G.; Trotta, Francesc

Helicobacter pylori and Non-Steroidal Anti-Inflammatory Drugs.

The relationship between H.pylori and NSAID use are under discussion. Susceptibility to H.pylori is not increased in NSAIDs users nevertheless an already mucosa damaged by H.pylori may be more susceptible to NSAIDs toxic effects

L'interessamento polmonare in corso di polimisite/dermatomiosite e di connettivite mista.

L'interessamento polmonare è una importante causa di morbilitàù e moratalità nelle poli-dermatomiositi e nellaconnettivite mista. L'interstiziopatia polmonare rappresenta la complicanza più importante e potenzialmente più grave. E' nota l'associazione dell'interstiziopatia con gli anticorpi anti-sintetasi. Nella MCTD la complicanza più grave èp rapprersentata dalla ipertensione polmonare