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Objectives The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. Results Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed ( Discussion Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

Background:Systemic Sclerosis (SSc) is a chronic rheumatic disease characterized by an autoimmune disorder with vasculopathy that leads to an excess in collagen and other extracellular matrix proteins deposition. This process results in progressive fibrotic and vascular damage of skin and visceral organs. According to observational studies conducted in last decades, mean survival of SSc patients had improved with significant changes in causes of death.Objectives:To assess the 10-years survival in a large Italian multicentre cohort of SSc patients in the last decade compared to previous periods published since the 1980s, and to identify features that can justify any change.Methods:We retrospectively analysed all medical records of our longitudinal SSc cohorts, fulfilling 1980 ARA and/or 2013 EULAR/ACR Classification Criteria, with a median (IQR) follow-up of 91.5 (51-120) months from 4 Scleroderma Units since January 2009. All clinical, laboratory and instrumental findings have been recorded and analysed. Survival rate was calculated with Kaplan-Meier curves and log-rank tests, and Cox proportional hazards models were used to identify any predictor. Then, observed SSc survival was compared to those previously published and to that expected in the general population, calculated using official data published on the website United Nation World Population Prospects (www.macrotrends.net/countries/ITA/italy/death-rate).Results:Of 912 SSc patients (91.6% female; mean (SD) age at first non-Raynaud symptom (RS) 51 (15.4) years; median (IQR) disease duration from non-RS 24 (0-84.7) months) diffuse cutaneous involvement was defined in 182 (20%) patients. Anti-centromere and anti-topoisomerase-I were detected in 390 (42.8%) and 302 (33.1%) patients, respectively, while 220 (24.1%) presented antibodies for other extractible nuclear antigens. Prevalent non-Raynaud manifestations were interstitial lung disease detected in 459 (50.3%), digital ulcers in 395 (43.3%) and oesophagopathy in 371 (40.7%) patients, respectively, while other gastrointestinal manifestations were reported in 234 (25.7%) patients. Chronic renal failure was observed in 61 (6.7%) patients and pulmonary arterial hypertension (PAH) was confirmed at right heart catheterization in 38 (4.2%) patients. Three hundred twenty-two (35.3%) patients received immunosuppressant, 215 (23.5%) assumed an endothelin receptor antagonist and/or a 5-phosphodiesterase inhibitor, and 72 (7.9%) were treated with a biologic agent. The global 10-years survival was 89.4%; female gender (HR 0.33, CI95% 0.17-0.67), diffuse cutaneous involvement (HR 2.14, CI95% 1.17-3.91), presence of pulmonary hypertension (HR 2.61, CI95%1.31-5.16) and older age at non-RS (HR 1.1, CI95% 1.06-1.12) affected survival. Furthermore, as compared to previous Italian studies, our cohort showed a significant improvement in rate (see Figure 1).Conclusion:Survival in SSc patients has improved in last 5 decades but still reduced compared to that expected in general population above all 5 years after diagnosis. Early diagnosis, with reduced renal involvement, along with better screening and innovative therapeutic strategies may explain these achievements.Figure 1.Ten-years survival in SSc patients since 2009 (left); comparison of survival across different Italian SSc cohorts (box: current analysis) (right).References:[1]Giordano M, et al. The Journal of Rheumatology. 1986; 13:911-916.[2]Ferri C, et al. Medicine. 2002; 81:139-53.[3]Vettori S, et al. Reumatismo. 2010; 62(3):202-209.[4]Ferri C, et al. Autoimmun Rev. 2014; 13(10):1026-34.Disclosure of Interests:None declared

Background:Systemic sclerosis (SSc) is one of the connective tissue diseases with the poorer prognosis and disease-related causes, particularly pulmonary fibrosis, PAH and cardiac involvement, accounting the most deaths.Objectives:This multicentre study aimed to evaluate the global survival and any predictor of mortality in a large multicentric cohort of SSc patients.Methods:We performed a retrospective analysis examining the medical records of our longitudinal SSc cohorts with a median (IQR) follow-up of 11 (6-18) years from 3 Scleroderma Units since January 2009. All clinical, laboratory and instrumental findings have been recorded and analyzed using Chi-squared tests, Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models.Results:Data from 750 SSc patients (91.9% female; mean (SD) age at first Non-Raynaud symptom 48.4 (15.3) years, median (IQR) disease duration 3 (0-8) years; diffuse cutaneous involvement 162 (21.6%) patients) fulfilling the 1980 ARA and/or 2013 ACR/EULAR classification criteria, were collected. All patients were positive for ANA, anti-Topo-I Abs were found in 235 (31.3%) and Cenp-B Abs in 300 (40%) patients. 98 (13.1%) patients were positive to other Abs (Anti-RNA polymerase III, anti-Pm/Scl) and anti-ENA were negative/unknown for 117 (15.6%) patients. Interstitial lung disease (ILD) was present in 202 (26.9%), pulmonary arterial hypertension (PAH) was found in 29 (3.9%), and 50/750 (6.7%) patients presented pulmonary hypertension combined with ILD (PH-ILD). The overall 10-years survival was 93.1% and, it was significantly impaired by the presence of ILD, PAH or PH-ILD [Figure]. The univariate analysis showed that female gender, higher age at first Non-Raynaud symptom, earlier referral to a tertiary Scleroderma center, absence of any ENA antibodies, and PH-ILD presence were survival predictors. After multivariate analysis the significance of PH-ILD was lost [Table]. Disease duration, basal Rodnan skin score, smoking, renal or gastrointestinal comorbidities, NYHA functional class, steroid or immune-suppressive treatments did not reach the statistically significance.Conclusion:Our study demonstrated a global 10-years survival rate over 93%. Male patients and rapid evolution of Non-Raynaud symptoms represent the main death predictors in our SSc cohort. A rapid referral to a tertiary rheumatological centre and early treatment with effective agents are associated to a better prognosis.Figure.Kaplan-Meier curves for 5-years survival in SSc patients (Log-rank 8.96, p=0.03).Table.Prognostic factors for 10-years survival at univariate and multivariate analysis.UNIVARIATE ANALYSISMULTIVARIATE ANALYSISHR95%ICPHR95%ICPFemale gender0.350.15-0.810.010.310.15-0.660.002Age at first Non-Raynaud symptom1.071.04-1.10.0011.081.05-1.110.001Time referral to a tertiary SSc centre0.830.76-0.920.0010.840.77-0.930.001Absence of any ENA antibodies0.080.01-0.620.010.090.01-0.710.02PH-ILD presence2.61.01-6.820.042.40.93-6.10.069Disclosure of Interests:Fabio Cacciapaglia Speakers bureau: BMS; Roche; Pfizer; Abbvie, Enrico De Lorenzis: None declared, Addolorata Corrado: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Marco Fornaro: None declared, Fabio Montini: None declared, Livio Urso: None declared, Lucrezia Verardi: None declared, Alberto Altomare: None declared, Francesco Paolo Cantatore: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD

Background High-grade inflammation in patients affected with Rheumatoid Arthritis (RA) leads to an imbalanced body composition characterised by increased fat mass and decreased lean mass, with stable or increased body weight, resulting in little or no change in body mass index (BMI).1 This condition, known as rheumatoid cachexia, is proven to be reversible once inflammatory process has been shut down. BMI and waist-to-hip ratio (WHR) are used as indirect measurements of visceral fat even if not capable of discriminating it from subcutaneous fat tissue. An alternative method proposed for assessment of fat composition, indicating nutritional status, is bioelectrical impedance analysis (BIA). Objectives To analyse body fat composition of patients with RA assessed using either BIA and anthropometric measures, investigating relationships between the related indices, serum adipokines and disease activity. Methods The body composition of 87 consecutive patients (72 female, 82.76%) affected with RA according to 2010 ACR/EULAR classification criteria, mean age of 52.42±13.29, mean disease duration of 10.71±8.58 years, treated with DMARDs and/or biologics, was assessed during their visit to our outpatient department. Data including demographic characteristics clinical manifestations, disease activity indices (DAS28-ESR, DAS28-CRP, CDAI, SDAI), Health Assessment Questionnaire (HAQ), lipid profile, as well as radiological findings were collected. Patients underwent to anthropometric measures (WHR and BMI) and BIA for the evaluation of fat-free mass (FFM), fat mass (FM) and the derived indices (fat-free mass index (FFMI) and fat mass index (FMI)). In addition for each patient blood samples were collected to determine serum levels of several adipokines (leptin, adiponectin, visfatin, resistin). Statistical tests as well as linear and logistic regression analysis were carried out. Results DAS28-ESR was found to be related to FMI (p=0.02; r=0.22) and to BMI (p=0.03; r=0.22). In addition, in patients in whom DAS28-ESR remission was not achieved, FMI but not BMI was found to be related to the latter disease activity index (p=0.007, r=0.37). FMI was shown to correlate to HAQ (p=0.01, r=0.31). Higher serum levels of leptin were found to predict higher FMI and BMI (p Conclusions Either body fat composition assessed with BIA-related indices and serum leptin have been noticed to predict disease activity. Moreover nutritional status of patients in remission according to DAS28-ESR may be better assessed by determining indices brought by BIA along with BMI, in order to rule out rheumatoid cachexia on the basis of FMI and FFMI. Reference [1] Ferraz-Amaro I, Gonzalez-Juanatey C, Lopez-Mejias R, Riancho-Zarrabeitia L, Gonzalez Gay MA. Metabolic syndrome in rheumatoid arthritis. Mediators Inflamm2013. Disclosure of Interest None declared

The object of this study is to investigate whether: (1) phosphorylated α -synuclein (p-syn) deposits in peripheral nerves might represent a useful biomarker in dementia Lewy Body (DLB) helping to differentiate DLB from other forms of dementia; (2) small fiber neuropathy (SFN) may be part of DLB pathological picture contributing to autonomic dysfunctions. 20 well-characterized DLB patients (11 of them complaining autonomic symptoms particularly orthostatic hypotension) were studied together with 23 patients with dementia of different pathogenesis (Dementia without synuclein- DWS) including 13 patients fulfilling diagnostic criteria for Alzheimer’s disease, 6 with Frontotemporal Dementia and 4 with vascular dementia. Twenty-five age-matched healthy subjects served as controls. Subjects underwent: nerve conduction velocities from the leg to evaluate large nerve fibers; skin biopsy from proximal (i.e. cervical) and distal (i.e. thigh and distal leg) sites to study small nerve fibers and deposits of phosphorylated α -synuclein, considered the pathological form of α -synuclein. P-syn was not found in any skin sample in DWS patients and controls but it was found in all DLB patients with a proximal-distal gradient with all patients positive in the cervical site. Patients complaining of autonomic symptoms showed higher widespread positivity of analyzed skin samples than patients without autonomic symptoms. Furthermore DLB patients showed a length-dependent SFN particularly important in patients complaining autonomic symptoms. Conclusions: (1) p-syn in peripheral nerves is a sensitive biomarker for DLB diagnosis helping to differentiate DLB from other forms of dementia; (2) SFN was part of DLB pathological picture contributing to induce autonomic symptoms.