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BackgroundThe COVID-19 pandemic shifted most healthcare to remote delivery methods (telehealth technologies including clinical video televisit) to protect patients, clinicians, and hospital staff. Telerheumatology visits were found to be noninferior to in-person visits and are often more time and cost effective for patients.1ObjectivesDescription of an initial integration of video televisit in regular follow-up.MethodsIn cooperation with the ALTEMS Operational Telemedicine Observatory, we built a procedural manual for televisit, whose phases were as much as possible similar to the usual visit scenario. Patients in remission or in mild disease activity at the time of enrolling visit were involved. Clinical characteristics, treatments and televisits’ features were considered for all patients (Table 1). Patient overall satisfaction was evaluated (rating 1 to 5).Table 1.Patients (n.)74M/F27/47Age (y) median46.2±13.5RA n. (%)19 (25.6)PsA n. (%)21 (28.3)SpA (%)13 (17.5)CTD n. (%)8 (10,4)Vasculitis n. (%)7 (9.4)Other n. (%)6 (8.1)b or tsDMARDs n. (%)20 (62.5)Televisits n.86Mean duration (min.)17±3.5Satisfaction (1-5)4.68Device (PC/smartphone) %62.5/37.5Distance saved, mean (km)77,5Time travel saved, mean (min.)66CO2 saved (kg)866.71€ saved (per patient)44,37Working visit n. (%)5 (15.6)Results86 televisits were performed in 74 consecutive patients, with a mean age of 46.2 ± 13.5 years, diagnosed with the most common rheumatic diseases and on chronic immunosuppressive therapy (c-b-ts DMARDs mono or combination therapy). In 5 cases, in-person visit after televisit was required. the average duration of the televisit was 17 ± 3.5 minutes and the average overall satisfaction was 4.68 / 5. The average distance saved (round trip) was 77,5 km, equal to an avoided travel time of 66 minutes and with a total reduction in CO2 production of approximately 866 kg. 5 patients performed video visit from workplace, de facto inventing the “working visit”.ConclusionTelemedicine is going to become an essential element of clinical practice in rheumatology,2 especially for active, young, and working patients, helping to minimize the overall impact of the disease on QoL, as far as they are properly selected for clinical characteristics and informatic skills. The possibility to attend to televisit from the workplace will reduce the lost working-hours and the need of travel, thus acquiring undoubted social utility. In the near future, the use of televisit should be also extended to vulnerable patients lacking basic informatic resources, with the help of care-givers or dedicated territorial services.References[1]Matsumoto R, Barton JL. Curr Opin Rheum 2021 May; 1;33(3):262-269. doi:0.1097/BOR.0000000000000790.[2]https://www.salute.gov.it/imgs/C_17_pubblicazioni_2129_allegato.pdfALTEMS = Alta Scuola di Economia e Management dei Sistemi SanitariDisclosure of InterestsNone declared

BackgroundSystemic Sclerosis (SSc) is a complex autoimmune disease characterized by vascular damage, immune activation and fibrosis of skin and internal organs 1. Raynaud phenomenon (RP) is frequently the first symptom of the disease and growing evidences are supporting the hypothesis the SSc may be a vascular disease, with a pivotal role of endothelial cells, particularly in the very early phase2,3. Robust data support the use of vascular active drug to treat RP and to prevent vascular complication4–7.ObjectivesThe use of prostacyclin analog (PA) is evertything but standardized, with different regimen used all around the Country. We report data on the use of PA in a multicentric regional reality to understand which regimen are prevalent (and why) and if there is the opportunity to standardized them.MethodsWe collected data from an online survey exploring different items related to the use of PA.ResultsSurvey was fullfilled by 12 sites: 5 university hospital and 7 local hospitals, 7 driven by Rheumatologist and 5 from internal medicine specialists with/without concomitant rheumatologists. PA are ubiquitarly used for SSc-related digital ulcers (SSc-DU) and secondary RP but only a half of sites use it for primary RP. Seventy-five percent of sites (9/12) dispense PA at least once a month, but some other (1 each one respectively) on weekly basis, every other month or every 7 weeks. Drug administration may last from 2 to 5 consecutive days (mean 1.91+/- 1.5SD) with drug dose ranging from 0.5 to 2 ng/Kg/min with a minimum variability from site to site. Our regional hospitals may count on overall 68 spots, some available as beds (outpatient or inpatient), some as reclining chair or chair (outpatients only). University centers have usually more assigned personnel than local hospital (on average: 2 versus 1.5 physicians, 2 versus 1.2 nurse). Sites are able to offer meals (except one) and are able to accomodate from 1 to 12 patients at the same time (mean 3.45, +/- 3.2SD).ConclusionPA has known benefit in vascular involvement in SSc patients. Despite a multicenter palcebo-control study8 defining time and dose of this drugs and subsequent data based on the same regimen9, there is no homogeneity in treatment administration. The unequal treatment, based on our data, seems due to limited resources and personnel. High variability has been found in regimen duration and administration frequency.References[1]Ferri, C. et al. Systemic sclerosis evolution of disease pathomorphosis and survival. Our experience on Italian patients’ population and review of the literature. Autoimmunity Reviews vol. 13 1026–1034 (2014).[2]Mulligan-Kehoe, M. J. et al. Antiangiogenic plasma activity in patients with systemic sclerosis. Arthritis Rheum.56, 3448–58 (2007).[3]Wigley, F. M. Vascular disease in scleroderma. Clin. Rev. Allergy Immunol.36, 150–75 (2009).[4]Brueckner, C. S. et al. Effect of sildenafil on digital ulcers in systemic sclerosis: Analysis from a single centre pilot study. Ann. Rheum. Dis.69, 1475–1478 (2010).[5]Kowal-Bielecka, O. et al. EULAR recommendations for the treatment of systemic sclerosis: A report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann. Rheum. Dis.68, 620–628 (2009).[6]Matucci-Cerinic, M. et al. Bosentan treatment of digital ulcers related to systemic sclerosis: Results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann. Rheum. Dis.70, 32–38 (2011).[7]Herrick, A. L. & Wigley, F. M. Raynaud’s phenomenon. Best Practice and Research: Clinical Rheumatology (2020) doi:10.1016/j.berh.2019.101474.[8]Wigley, F. M. et al. Intravenous iloprost infusion in patients with Raynaud phenomenon secondary to systemic sclerosis: A multicenter, placebo-controlled, double- blind study. Ann. Intern. Med.120, 199–206 (1994).[9]Cappelli, L. & Wigley, F. M. Management of Raynaud Phenomenon and Digital Ulcers in Scleroderma. Rheumatic Disease Clinics of North America vol. 41 419–438 (2015).Disclosure of InterestsNone declared

The objective of the study was to investigate the expression of p53 and p16INK4ain cervical intraepithelial neoplasia (CIN) and their relation with disease severity and high-risk human papillomavirus (HR-HPV) status. A series of 125 women with previous positive Pap smear were selected for this cross-sectional study. All patients underwent gynecological examination, including colposcopy. Specimens for Pap smears, Hybrid Capture 2 (HC2) test, and pathologic analysis were obtained. After evaluation of CIN grade, immunohistochemical detection of proteins p53 and p16INK4awas performed on paraffin-embedded sections. The extent of immunoexpression of both proteins was analyzed in relation to CIN grade and HR-HPV status. CIN was graded as 1 in 21, 2 in 17, and 3 in 87 specimens. p16INK4apositivity (at least 5% of epithelial cells stained) was found in 99 of 125 cases (79.2%) and was significantly higher in high-grade lesions as compared to low-grade CIN (P< 0.001). The expression of p53 did not differ across histologic strata. Protein expression neither of p16INK4anor of p53 correlated with HR-HPV status. Expression of p16INK4awas not related with that of p53. Our study gives further support to previous findings of strong association of p16INK4aimmunostaining with severity of epithelial atypia, but this protein may not be considered a predictor of HR-HPV status determined with HC2. By contrast, immunoexpression of p53 was related neither to CIN grade nor to HR-HPV status.