Subclinical atherosclerosis in systemic sclerosis: Different risk profiles among patients according to clinical manifestations.

INTRODUCTION: Like other autoimmune diseases, systemic sclerosis (SSc) has been described to be associated with accelerated atherosclerosis (ATS). Before clinical manifestations of cardiovascular disease (CVD) occur, subclinical ATS can be investigated in different ways. AIM: To evaluate the presence of subclinical ATS in a group of patients with SSc, and to identify different risk profiles among patients. METHODS: Subclinical ATS was reviewed in 43 SSc patients and 27 healthy controls, using 2 methods: carotid ultrasound and flow mediated dilation (FMD) of the brachial artery. RESULTS: Plaques were statistically more frequent in SSc patients than in controls (65% vs 30%, P = .006); intima-media thickness of common carotid artery (CCA-IMT) resulted in statistically higher (median value 0.8 mm vs 0.55 mm; P < .0001) while FMD was significantly lower (median value 9% vs 14%; P = .0086) in patients compared to healthy controls. Among the SSc patients, thickening of CCA-IMT was significantly associated with the presence of diastolic dysfunction of left ventricle (absence of diastolic dysfunction: odds ratio [OR] 0.2, 95% CI 0.04-0.92, P = .038) and with a higher Framingham score (OR 1.3, 95% CI 1.03-1.6], P = .024). The diffuse cutaneous form was slightly protective against pathological FMD (OR 0.12, 95% CI 0.022-0.71, P = .019). CONCLUSIONS: This study confirms the involvement of macrocirculation in SSc patients, detecting the presence of subclinical ATS markers more frequently in patients compared to healthy controls. Framingham score, diastolic dysfunction of left ventricle and limited cutaneous form of the disease appeared to be associated with a higher risk of developing ATS.

Definition, symptoms and risk of techno-stress: a systematic review.

PURPOSE: Techno-stress (TS) is an emergent phenomenon closely related to the pervasive use of information and communication technologies in modern society. Despite numerous studies existing in the literature, only few comprehensive reviews have been performed, which has led to fragmented information about TS. This systematic review aimed to clarify the definition, the symptoms, and the risk factors of TS, focusing on the differences between work-related and non-work-related sources of TS. METHODS: A comprehensive literature review of three electronic databases was performed according to the PRISMA statement. 'Technostress' was used as the only keyword. RESULTS: In the qualitative synthesis, 105 studies were included: 84 cross-sectional studies, 8 experimental studies and 13 reviews (11 narrative and 2 systematic reviews). 70 studies (67%) addressed work-related TS, 26 (25%) addressed non-work-related TS, while 8 (8%) did not differentiate between work and non-work fields. The presence and level of TS among individuals was described in 38 studies (29%), whilst the techno-stressors, and the consequences of TS, were described in 53 studies (51%). The antecedents of TS were reported in 47 studies (45%), its moderators in 40 studies (38%), whilst its symptoms in only 11 studies (10%). CONCLUSIONS: TS affects both professional and private life. It can determine a reduction in job and life satisfaction and in productivity, and is often associated to the occurrence of psychological and behavioral disorders. Efforts should be made to recognize situations with a high risk of causing TS, to prevent its progressive development in a prospective way using mainly cohort studies.

From VEDOSS to established systemic sclerosis diagnosis according to ACR/EULAR 2013 classification criteria: a French-Italian capillaroscopic survey.

OBJECTIVES: Nailfold capillaroscopy (NC) shows microcirculatory abnormalities in systemic sclerosis (SSc). The inclusion of NC specific abnormalities increases the sensitivity of both 2013 ACR/EULAR and VEDOSS (Very Early Diagnosis of Systemic Sclerosis) classification criteria. We aimed to detect NC features able to predict progression toward established SSc in VEDOSS patients. METHODS: Sixty-six VEDOSS patients were enrolled. They had a clinical follow-up and underwent NC once a year, considering morphological parameters, appropriate pattern and semi- quantitative rating scale. RESULTS: In a mean follow-up time of 31 months, 21 patients progressed into SSc (P = Progressors), while 45 were "Non Progressor" (NP). Comparing NC basal features of both groups, significantly larger loop diameter and apex width, higher haemorrhage and NC scores were found in P respect to NP patients. When comparing NC features of P patients who progressed within one year (FP = Fast progressor), loop diameter and apex width were significantly higher compared to all VEDOSS subjects. Each unit increase of apex width was associated with an increasing risk of 1% for developing SSc and the cut-off value of 103 µm showed a positive predictive value of 56% and a negative predictive value of 71%. CONCLUSIONS: We describe NC findings in VEDOSS patients, identifying those suggesting a progression into established disease. These findings must be regarded as possible predictive risk factor to develop SSc and can also be of relevance in the detection of those cases with a faster development. Thus NC seems to have a diagnostic and prognostic role in VEDOSS cases.

[The elimination of measles and rubella in Italy]. / L'eliminazione del morbillo e della rosolia in Italia.

Despite the WHO target for measles and rubella elimination in 2015, outbreaks still occur in all WHO Regions. After a description of the epidemiological situation of measles and rubella worldwide and especially in Europe, this paper aims to provide a detailed analysis of the current epidemiological context of Italy. The surge in the number of measles cases since the beginning of 2017, together with vaccination coverage still far from the 95% target, requires priority actions to be taken to achieve the elimination goals. Alongside the recently approved decree reintroducing compulsory vaccinations for school admissions, further measures are needed and should include the increase in the commitment of the 21 Regions; the implementation of supplemental immunization activities; improving the communication skills of health care workers; ensuring an effective communication with citizens; the enhancement of the surveillance network.

Occupational therapy integrated with a self-administered stretching program on systemic sclerosis patients with hand involvement.

OBJECTIVES: To evaluate the effect of occupational therapy (OT) intervention, integrated with a self-administered stretching program on the hands of patients with SSc, after one and three months of treatment. METHODS: We enrolled 31 patients with SSc, randomly allocated to the occupational group (15 patients) or to the control group (16 patients). Each patient received specific outcome measures: Canadian Occupational Performance Measure (COPM), HAQ, Short-Form Health Survey (SF-36), Duruoz Hand Index (DHI), reassessed after 1 (T1) and three months (T2). RESULTS: At T1 and T2 we found a statistically significant improvement from baseline values of COPM Performance and COPM Satisfaction in the OT group compared to baseline. At T2 HAQ values and Mental SF36 were also significantly improved. In the control group we found a statistically significant improvement of HAQ values and Mental SF36 at T1, confirmed at T2. COPM Performance was also significantly improved. The comparison between the two groups showed a greater improvement in the OT group concerning COPM Performance at T1 and T2. Mental SF-36 score greater improved in the control group at T1. CONCLUSIONS: Our results indicate that a rehabilitation program including OT and self-administered stretching exercises may be effective to improve and maintain hand function in patients with SSc.

Systemic sclerosis patients with and without pulmonary arterial hypertension: a nailfold capillaroscopy study.

OBJECTIVE: Pulmonary arterial hypertension (PAH) is a complication of SSc due to increased vascular resistance, and abnormal vascularity is a well-known feature of the disease as shown by nailfold videocapillaroscopy (NVC). This study investigated for specific NVC changes in SSc patients with and without PAH to assess any useful difference. METHODS: Twenty-four SSc patients, 12 with PAH and 12 without, entered the study. Evidence of PAH was defined as increased systolic pulmonary artery pressure (PAP) (≥35 mmHg), indirectly assessed by echocardiography and confirmed by right heart catheterization (mPAP > 25 mmHg). NVC was performed, and a semi-quantitative rating scale, a rating system for avascular areas and a specific NVC pattern evaluation, namely early, active and late, were used. RESULTS: An NVC score >1 was more frequently found in patients with PAH than those without, 11 cases (92%) vs 5 cases (42%) (P = 0.03); an avascular areas grade >1 was present in 10 (83%) and 2 (17%) cases, respectively (P = 0.003); and a more severe NC pattern (active/late) was described in 11 (92%) and 5 (42%) patients, respectively (P = 0.03). When we compared the mPAP with NVC parameters, we found significant correlations between mPAP values and the NVC score (P < 0.005) and with the avascular areas score (P < 0.001). CONCLUSION: Our results underline the relevance of early microvascular assessment in patients at risk of developing a severe complication such as PAH that can amplify the systemic microvascular impairment in SSc. More severe NVC abnormalities should lead to strict cardiopulmonary surveillance and a complete NVC study is indicated.

Abnormal plasma levels of different angiogenic molecules are associated with different clinical manifestations in patients with systemic sclerosis.

OBJECTIVES: Systemic Sclerosis (SSc) is characterized by a microvascular damage due to an impairment of different angiogenic and angiostatic factors. Aim of this study was to measure plasma levels of nine molecules involved in these vascular processes in a group of SSc patients, respect to healthy controls (NC). METHODS: Sixty-five patients (M/F = 2/63; mean age = 57.29 yrs; mean disease duration = 9,63 yrs) with established SSc according to ARA criteria, and sixteen age- and sex-matched NC were enrolled. Plasma levels of vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), platelet derived growth factor- bb (PDGF-BB), platelet endothelial cellular adhesion molecule-1 (PECAM-1), leptin, hepathocyte growth factor (HGF), follistatin, granulocyte-colony stimulating factor (G-CSF) and interleukin 8 (IL-8) were measured using commercially available immunoassay kits (Human Angiogenesis 9-Plex Panel, Bio-Rad Laboratories). RESULTS: We detected a significant increase of Ang-2 (median value 1315.4 pg/ml vs 538.73 pg/ml; p=0.0292), HGF (median value 2886.16 pg/ml vs 1296.16 pg/ml; p=0.0001), IL-8 (median value 32.22 pg/ml vs 16.86 pg/ml; p=0.02), leptin (median value 32589,1 pg/mg vs 10679.61 pg/ml; p=0.0065), PDGF-BB (median value 7258.6 pg/ml vs 2913.44 pg/ml; p=0.0005), PECAM-1(median value 21681.81 pg/ml vs 10354.53 pg/ml; p=0.0003) and VEGF (median value 236.72 pg/ml vs 122.905 pg/ml; p=0.0073) in patients with SSc respect to NC. Higher levels of PDGF-BB (p=0.03) and PECAM-1 (p=0.05) were found in patients with digital ulcers while lower levels of PECAM-1 were found in patients with pulmonary hypertension (PH). Besides levels of IL-8 were higher in patients with PH (p=0.04) and lower in those with pulmonary fibrosis (p=0.5), while levels of Ang-2 were higher in those with a 'late' nailfold video-capillaroscopy (NVC) pattern respect to those with an 'early/active' one (p=0.05). Moreover, plasma levels of VEGF (p=0.02) and PDGF-BB (p= 0.04) were significantly higher in those patients positive for anti-topoisomerase 1 antibodies. CONCLUSIONS: Our findings show significantly higher circulating levels of seven angiogenic parameters in SSc patients, thus reflecting the disregulation of endothelium in this disease. Abnormal levels of these molecules may be considered an attempt for compensatory although ineffective mechanisms of vascular function, leading to the development of the main clinical manifestations of SSc.