SSc Groups Research Articles

Long-term outcomes of anterior latissimus dorsi tendon transfer for irreparable subscapularis tears.

Favourable short-term outcomes have been reported following latissimus dorsi tendon transfer for patients with an irreparable subscapularis (SSC) tendon tear. The aim of this study was to investigate the long-term outcomes of this transfer in these patients. This was a retrospective study involving 30 patients with an irreparable SSC tear and those with a SSC tear combined with a reparable supraspinatus tear, who underwent a latissimus dorsi tendon transfer. Clinical scores and active range of motion (aROM), SSC-specific physical examination and the rate of return to work were assessed. Radiological assessment included recording the acromiohumeral distance (AHD), the Hamada grade of cuff tear arthropathy and the integrity of the transferred tendon. Statistical analysis compared preoperative, short-term (two years), and final follow-up at a mean of 8.7 years (7 to 10). There were significant improvements in clinical scores, in the range and strength of internal rotation and aROM compared with the preoperative values in the 26 patients (87%) who were available for long-term follow-up. These improvements were maintained between short- and long-term follow-ups. Although there was a decreased mean AHD of 7.3 mm (SD 1.5) and an increased mean Hamada grade of 1.7 (SD 0.5) at final follow-up, the rate of progression of cuff tear arthropathy remained low-grade. Comparison between the isolated SSC and combined SSC and reparable supraspinatus tear groups showed no significant differences. At final follow-up, one patient (3.8%) had undergone revision surgery to a reverse shoulder arthroplasty (RSA). No neurological complications were associated with the procedure. Latissimus dorsi transfer for an irreparable SSC tendon tear resulted in a significant clinical improvement, particularly in pain, range and strength of internal rotation and aROM, which were maintained over a mean of 8.7 years following surgery. Given that this was a long-term outcome study, there was a low-grade progression in the rate of cuff tear arthropathy. Thus, the long-term clinical efficacy of latissimus dorsi tendon transfer in patients with irreparable SSC was confirmed as a joint-preserving procedure for these patients, suggesting it as an effective alternative to RSA in young, active patients without degenerative changes of the glenohumeral joint.

The cancer-associated glycan polysialic acid is dysregulated in systemic sclerosis and is associated with fibrosis

ObjectiveSystemic sclerosis (SSc) is a rare but deadly disease characterized by autoimmunity, vasculopathy, and fibrosis. Fibrotic complications associated with SSc correlate with severe morbidity and mortality. Previous studies in SSc have identified fibroblasts as the primary drivers of fibrosis; however, the mechanism(s) promoting this are not well understood. Aberrant glycosylation, particularly polysialylation (polySia), has been described as a prominent feature of aggressive cancers. Inspired by this observation, we aimed to determine if polySia is dysregulated in various forms of SSc. MethodsAll patients with SSc met the 2013 ACR/EULAR. Patients were sub-classified into limited cutaneous (lSSc, N = 5 or 46 patients for polySia quantification in the dermis or serum; respectively), diffuse cutaneous (dSSc, N = 11 or 18 patients for polySia quantification in the dermis or serum; respectively), or patients with dSSc treated with an autologous stem cell transplantation (post-ASCT, N = 4 patients for quantification in the dermis). Dermal polySia levels were measured via immunofluorescence microscopy in 10 μm dermal sections, quantified in each group (healthy volunteers (HC), lSSc, dSSc, and post-ASCT) and correlated with skin fibrosis (via the modified Rodnan skin score (mRSS)). Similarly, serum polySia was quantified in each group, and correlated with the mRSS. ResultsDermal polySia levels were highest in patients with dSSc (compared to HC < 0.001), and correlated with the degree of fibrosis in all of the groups (P = 0.008). Serum polySia was higher in all SSc groups (p < 0.001) and correlated with the severity of mRSS (p < 0.0001). ConclusionPolysia is more abundant in the skin and sera from patients with SSc and correlates with the degree of skin fibrosis. The aberrant expression of polySia highlights its potential use as a biomarker in patients with progressive forms of SSc. Dysregulated polySia levels in SSc further emphasizes the cancer-like phenotype present in SSc, which may promote fibrosis and immune dysregulation.

Silk-in-Silk Nerve Guidance Conduits Enhance Regeneration in a Rat Sciatic Nerve Injury Model.

Advanced nerve guidance conduits can provide an off-the-shelf alternative to autografts for the rehabilitation of segmental peripheral nerve injuries. In this study, the excellent processing ability of silk fibroin and the outstanding cell adhesion quality of spider dragline silk are combined to generate a silk-in-silk conduit for nerve repair. Fibroin-based silk conduits (SC) are characterized, and Schwann cells are seeded on the conduits and spider silk. Rat sciatic nerve (10mm) defects are treated with an autograft (A), an empty SC, or a SC filled with longitudinally aligned spider silk fibers (SSC) for 14weeks. Functional recovery, axonal re-growth, and re-myelination are assessed. The material characterizations determine a porous nature of the conduit. Schwann cells accept the conduit and spider silk as growth substrate. The in vivo results show a significantly faster functional regeneration of the A and SSC group compared to the SC group. In line with the functional results, the histomorphometrical analysis determines a comparable axon density of the A and SSC groups, which is significantly higher than the SC group. These findings demonstrate that the here introduced silk-in-silk nerve conduit achieves a similar regenerative performance as autografts largely due to the favorable guiding properties of spider dragline silk.

Bite force evaluation at maximal intercuspal position: An in vivo comparative study between stainless steel and zirconia crowns on primary molar teeth.

The objective of this study was to clinically evaluate and compare the mean bite force changes at maximum intercuspal position, along with parental satisfaction following full crown restoration using stainless steel crown/zirconia crown on primary molar teeth using digital occlusal analysis system T-Scan III (Tekscan Corp, Boston, Mass., USA). Thirty-six primary molars of children aged 6-9 years with pulpal involvement were selected for the study. The selected teeth were allocated to either of the two groups using simple random sampling technique: Group A = stainless steel crowned teeth and Group B = zirconia crowned teeth. The mean bite force was recorded before the placement of the crown, after the placement of the crown, and after 1 month-follow-up. The inter-group and intra-group comparison was done among the groups. After the placement of the crown, parents were asked to fill out a questionnaire for assessing parental satisfaction. A significant result in the bite force on crowned tooth, vertical dimension was seen from baseline to 1-month follow-up between the SSC and zirconia groups. In the zirconia crown group, the mean bite force was more compared to the stainless steel crown group. Parents' satisfaction was higher with zirconia crown in terms of color and esthetics. SSC is more acceptable than zirconia crown since occlusal re-equilibration was attained better in SSC as compared to zirconia crown.

Clinical outcomes and temporal changes in the range of motion following superior capsular reconstruction for irreparable rotator cuff tears: comparison based on the Hamada classification, presence or absence of shoulder pseudoparalysis, and status of the subscapularis tendon.

Superior capsular reconstruction (SCR) has recently gained popularity as a surgical solution for patients with massive rotator cuff tears or shoulder pseudoparalysis (PPS). Good clinical outcomes have been reported after SCR; however, the factors that influence its clinical outcomes remain unclear. Therefore, in this study, we aimed to clarify the factors influencing postoperative outcomes after SCR using tensor fascia lata graft, for which we evaluated the Hamada grade, patients with or without PPS, and the status of the subscapularis tendon (SSC). In total, 54 consecutive patients with irreparable rotator cuff tears or PPS who underwent SCR between June 2014 and October 2018 were included. The enrolled patients were grouped and compared as follows: (1) Hamada grade 2 (11 patients) and Hamada grade 3 (43 patients) and (2) non-PPS (22 patients), moderate PPS (16 patients), and severe PPS (16 patients). For subanalysis, the 32 PPS patients were divided into 3 groups: intact SSC (11 patients), repairable SSC (16 patients), and irreparable SSC (5 patients). To assess shoulder function, the American Shoulder and Elbow Surgeons (ASES) score was evaluated before surgery and at 24 months postoperatively; shoulder range of motion was evaluated at 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively. No significant differences in postoperative ASES scores and shoulder range of motion were observed between the Hamada grade 2 and grade 3 groups or between the non-PPS, moderate PPS, and severe PPS groups. However, significant differences in postoperative shoulder elevation and ASES scores were observed between the intact SSC and irreparable SSC groups (P = .006) and between the repairable SSC and irreparable SSC groups (P = .003). This study demonstrated that the status of the SSC, rather than the Hamada grade or the presence or absence of PPS, influences the clinical outcomes after SCR. Therefore, reparability or intactness of the SSC is an important factor in considering the surgical indication for SCR.

Can zirconia crowns be the first restorative choice after endodontic treatment of primary teeth?

Early loss of primary teeth due to caries can cause temporary or permanent problems, such as occlusion disorders, aesthetic problems, nutritional problems, abnormal habits, and speech disorders. Although the development of restorative materials has led to significant improvements, failures are still frequent. The purpose of this study was to evaluate the success rates of zirconia crowns compared to other crowns for the restoration of endodontically treated teeth with excessive loss of material. A total of 45 teeth of patients aged under 10years, including primary molars and anterior teeth, requiring restoration after root canal treatment, were included in this randomized, non-blinded clinical study. Stainless steel (SSC), zirconia (ZC), and strip (SC) crowns were used and compared clinically and radiographically during a six-month follow-up period. Parents were asked to fill out a questionnaire at one week and six months to evaluate the parent and child satisfaction levels. The patients' pain and discomfort levels were assessed using a visual analogue scale. The Mann-Whitney U, Chi-Squared and Friedman and Cochran Q tests were used for statistical comparisons using IBM SPSS Statistics version 23 (IBM, Armonk, NY, USA). The six-month follow-up evaluations revealed no significant differences in clinical outcomes between the SSC, ZC, and SC groups. There were no significant differences between the groups with respect to parent and child satisfaction. The clinical outcomes of ZCs were comparable to those of the other crowns. ZCs could be a choice for aesthetic purposes, with the disadvantage of a higher cost.

Morphological Changes in the Motor Endplate and in the Belly Muscle Induced by Previous Static Stretching to the Climbing Protocol.

Static stretching provides benefits to the range of motion, modulates intramuscular connective tissue, and is incorporated into warm-up exercises. In this study, we present the effects in the motor endplate and belly muscle resulting from previous static stretching to climbing training. Twenty-four adult male Wistar rats were divided into four groups (n = 6 each): Sedentary (Sed), Climbing (Clb), Static stretching (Ss), and Static stretching prior to climbing (Ssc). The animals (Clb, Ss, and Ssc groups) were subjected to a training protocol 3×/week for 8 weeks, and the Ssc group was subjected to the Ss and Clb protocols in the same session. Samples from the animals were processed for immunostaining, histochemistry, and light microscopy. The Clb group presented a higher motor endplate; the Ss group presented no changes in the motor endplate; and the Ssc group demonstrated a higher compactness. We concluded that static stretching prior to the climbing protocol maintained the density of the motor endplate and increased the compactness of the neuromuscular junction structure. Also, there was a reduction in the myofibers’ diameter (Type I and IIa), an increase in myofibrillar densities (Type I and IIx, and total), and the reorganization of the myonuclei and the interstitium.

High frequency ultrasonography: reliable tool to measure skin fibrosis in SSC? A systematic literature review and additional pilot study.

To investigate the reliability of high frequency ultrasound (HFUS) in measuring skin fibrosis in SSc. First, a systematic review (according to PRISMA) was conducted to identify studies that documented HFUS' reliability in SSc as a primary outcome. Then, in an additional pilot study, the inter- and intra-rater reliability of two investigators performing HFUS for dermal thickness (DT) measurements in a standardized manner across all 17 areas of the modified Rodnan Skin Score was evaluated in a group of 59 SSc patients and descriptively in 44 healthy controls (HC). As an external validation, DT measurements by HFUS were performed in a separate group of 30 SSc patients by the same first and another third investigator. The systematic review retained few (4/1719 unique records) small-scale studies, with mixed study populations (combining SSc and HC). The reported data herein are suggestive of the inter-/intra-rater reliability of HFUS (intra-class correlation coefficient [ICCs] ranging 0.65-0.94/0.55-0.96, respectively). Additionally, in our pilot study, inter-/intra-rater reliability was good-to-excellent in both SSc groups and HC (ICCs ranging 0.70-0.97/0.70-0.98 and 0.65-0.95/0.63-0.96, respectively). The identified small-scale studies were not only combining data from SSc and HC, they were also heterogeneous in terms of technical aspects (probes and frequency), image acquisition methods ([number of] areas assessed) and definitions used for skin thickness, which prevents drawing unequivocal conclusions. Despite these limitations, our standardized pilot study corroborated the findings in literature, paving the way for the applicability of HFUS as a reliable (complementary) tool to quantify skin fibrosis in SSc.

Correlation Between Facial Skin Microbiota and Skin Barriers in a Chinese Female Population with Sensitive Skin.

Background and AimThe association of microbiota changes with sensitive skin remains controversial until now. Although a strong correlation is detected between skin microbiota distribution and biophysical parameters, there is little knowledge on the link between sensitive skin and skin microbiota in Chinese women. This study aimed to unravel the correlation between facial skin microbiota distribution and skin barriers in Chinese women with sensitive skin.Materials and MethodsIn total, 34 volunteers were enrolled, including 24 subjects with sensitive skin (SS group) and 10 subjects with non-sensitive skin (NS group). The cuticle moisture content, transepidermal water loss (TEWL), and facial skin sebum secretion were measured, and the facial skin surface morphology was evaluated. Sensitive skin samples were collected from the facial (SS-F group) and chest skin of subjects in the SS group (SS-C group), while non-sensitive skin samples were collected from the facial skin of subjects in the NS group (NS-F group). All skin samples were subjected to 16S rRNA sequencing.Results16S rRNA sequencing detected Actinobacteria, Firmicutes, and Proteobacteria as the three most common microbiota phyla and Propionibacterium, Paracoccus, and Corynebacterium as the three most common microbiota genera, and there were no significant differences in the relative frequency of Actinobacteria, Firmicutes, or Proteobacteria, or Propionibacterium, Paracoccus, or Corynebacterium among the SS-F, SS-C, and NS-F groups (P>0.05). We detected no significant difference in the diversity of bacterial communities among the SS-F, SS-C, and NS-F groups; however, the Shannon’s diversity index was significantly higher in the NS-F group than in the SS-C group. In addition, Spearman correlation analysis showed a correlation between the microbiota genera and skin physiological parameters (P<0.05).ConclusionThis study preliminarily unravels the skin microbiota of sensitive skin using a high-throughput tool, and there are no microbiota genera with strong associations with skin physiological parameters.

Study of MRI brain findings and carotid US features in systemic sclerosis patients, relationship with disease parameters

Background/objectivesSystemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought.MethodsSeventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger’s severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done.ResultsSSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P < 0.05). Significant positive correlations existed between CCA-IMT and Medsger vascular (r = 0.7, P = 0.02). The FLAIR-MRI showed multiple hyperintense lesions in 24 patients (33%), ranging 0–36 lesions. SSc patients with more lesions (positive MRI) had longer disease duration (P = 0.001) and left and right carotid artery atheromata (P = 0.001, and 0.013, respectively) than SSc patients with negative MRIs; Medsger vascular score did not separate the SSc groups (P = 0.08).ConclusionsIn systemic sclerosis patients without central nervous system symptoms, MRI lesion numbers correlated with CCA-IMT. MRI abnormalities were found more frequently if CRP was elevated, if the Medsger SSc Severity Scale was increased, or if there was thickened carotid IMT.

Effect of Trunk Side Shift Exercise on the Trunk Muscle Activation of Patients with Idiopathic Scoliosis

Purpose: This study investigated scoliosis muscle activity after the trunk side shift exercise. Methods: Fifty-eight subjects (control group=30, scoliosis group=28) participated in this study. The patients with idiopathic scoliosis were randomly divided into two groups: the side shift exercise (SSE) group and the trunk stabilization exercise (TSE) group. The SSE group performed SSE with chair training for eight weeks. A one-way ANOVA test was carried out to compare the results within the idiopathic scoliosis patient group prior to and after different exercise methods. Result: The muscle activity differences of the TPS, LPS, and latissimus dorsi muscles significantly decreased in all idiopathic scoliosis exercises groups after training. According to the exercise method, the TPS differed between the control group (CG) and TSE group and between the SSC and TSE groups. The LPS and latissimus dorsi muscles showed differences between the CG and TSE groups. Conclusions: This study found that the side shift exercise effectively improve spine muscles. The side shift exercise was performed using chairs that were designed for this study. Thus, this method is easily accessible for busy students who are exposed to scoliosis or spinal disorders that are caused by a pattern of inactivity.

Circulating Reticulocalbin 1 and Reticulocalbin 3 in Systemic Sclerosis Patients: Results of a Case Control Study

Proteomic candidate biomarkers for systemic sclerosis (Ssc) useful for appropriate patient evaluation and follow-up were identified in mass-spectrometry studies; however, most of these biomarkers were not evaluated and confirmed on independent patient samples. Up-regulation of reticulocalbin 1 (RCN1) and reticulocalbin 3 (RCN3) in the dermal fibroblast secretome originating from Ssc patients was previously described. The aim of the study was to evaluate circulating RCN1 and RCN3 as candidate biomarkers for Ssc clinical expression. 40 consecutive Ssc patients and 20 gender and age matched controls were included. Serum RCN1 and RCN3 was evaluated using commercial ELISA kits. Serum RCN1 and RCN3 were not statistically significant different between Ssc patients and healthy controls. Serum RCN1 and RCN3 were correlated in both Ssc and healthy control groups (p < 0.001). Serum RCN1 was positively correlated with Ssc disease activity score (EUSTAR, p = 0.02) and remained associated with EUSTAR after adjusting for disease duration in multivariate analysis. 6 Ssc patients (15%) had elevated RCN1 values compared to reference values obtained from healthy control samples. These patients had higher prevalence of digital ulcers, higher disease activity scores, and tended to have esophageal hypomotility, calcinosis, telangiectasia, and diffuse Ssc subtype. RCN1 and RCN3 expression was not statistically significantly different to healthy controls. However, RCN1 was associated with disease activity score and could be used as a stratification biomarker for Ssc patients, as patients with high RCN1 shared a particular disease pattern.

Hematological Indices May Be Useful in the Diagnosis of Systemic Lupus Erythematosus and in Determining Disease Activity in Behçet's Disease

Objectives: The aim of this study was to investigate the relationships between clinical features of rheumatic diseases and hematologic indices, including mean platelet volume (MPV), MPV/platelet ratio (MPR), platelet/lymphocyte ratio, and neutrophil/lymphocyte ratio (NLR). Subjects andMethods: Rheumatoid arthritis (RA; n = 91), systemic lupus erythematosus (SLE; n = 51), systemic sclerosis (SSc; n = 39), and Behçet's disease (BD; n = 53) patients, and 55 healthy controls (HC) were enrolled. Hematological indices were calculated and one-way analysis of variance, Mann-Whitney U and χ² tests, and receiver operating characteristic (ROC) analyses were performed. Results: The MPV and MPR were higher in the SLE group than the RA group (p < 0.05 and p < 0.01, respectively). ROC analysis indicated that MPV (area under the curve, AUC, 0.68, 95% CI 0.58-0.77) and MPR (AUC 0.69, 95% CI 0.59-0.78) were sensitive and specific markers for SLE against RA. The NLR was higher in the RA, SLE, and SSc groups compared to the HC group (p < 0.05, p < 0.001, and p < 0.01, respectively). The NLR was higher in the active BD patients than those that were inactive (p = 0.008). Besides, NLR was higher in patients with neuro-BD and patients with active genital ulcers compared to patients without neurological involvement (p < 0.01) and active genital ulcers (p < 0.05). Conclusion: The MPV and MPR were significantly higher in the SLE group than in the RA group. They were also higher in the active than in the inactive BD patients. The MPV and MPR are useful diagnostic tools for SLE, and NLR reflects disease activity in BD. However, further research should be performed to standardize these tools.

Evaluation of techniques to prevent colorectal anastomotic leakage

BackgroundAnastomotic leakage is a major complication after anterior resection for rectal cancer. The double-stapling technique (DST) is the main method for creating a colorectal anastomosis. However, the rate of anastomotic leakage after DST remains high, and the technical risk factors have not been well established. Materials and methodsFive methods of colorectal anastomosis were performed on the porcine rectum and colon: single-stapled double-purse-string (SSDP), DST, side-to-side with a linear stapler (SS-L), side-to-side with a circular stapler (SS-C), and SS-C with hand-sewn reinforcement (n = 6 for each method). In each group, burst pressures were tested, paying special attention to the locations of the first disruptions. The anastomosis line, including staples, was embedded in polyester resin, and polished sections were examined histologically. ResultsBurst pressures were significantly higher in the SS-L and SS-C than those in the SSDP and DST groups (P < 0.001) and were higher in the SS-C with hand-sewn reinforcement than those in the SS-L and SS-C groups (P < 0.001). Remarkably, in the SSDP, DST, and SS-C groups, the first disruptions occurred on the staple line created by the circular stapler. ConclusionsThe experimentally strongest colorectal anastomosis created with instruments currently in use was a SS-C. This anastomosis does not overlap staple lines and does not require a purse-string suture. Hand-sewn reinforcement was effective in increasing the anastomotic strength.

FRI0511 Detection of Anti-Th/To Antibodies in Patients with Various Rheumatic Diseases and their Clinical Features

BackgroundAnti-Th/To were initially reported to be specific for SSc or Raynaud's disease with a short duration. Clinically, anti-Th/To were associated with features like puffy fingers, hypothyroidism and a significantly lower...

Residual salivary secretion ability may be a useful marker for differential diagnosis in autoimmune diseases.

Background. We have elucidated decreased resting salivary flow in approximately 60% of patients with autoimmune diseases not complicated by Sjögren syndrome (SjS). In this study, salivary stimulation tests using capsaicin were performed to examine residual salivary secretion ability in patients with autoimmune diseases. Materials and Methods. Fifty-eight patients were divided into three groups: patients with primary or secondary SjS (SjS group), patients with systemic sclerosis not complicated by SjS (SSc group), and patients with other autoimmune diseases (non-SjS/non-SSc group). Simple filter paper and filter paper containing capsaicin were used to evaluate salivary flow rates. Results. Resting salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group but did not differ significantly between the SjS and SSc groups. Capsaicin-stimulated salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group, but not significantly different between the SjS and SSc groups. In the non-SjS/non-SSc group, salivary flow rates increased after capsaicin stimulation to the threshold level for determination of salivary gland dysfunction, whereas no improvement was observed in the SjS and SSc groups. Conclusion. Residual salivary secretion ability may be a useful marker for differential diagnosis in autoimmune diseases.

THU0379 Comparison of Bone Mineral Density in Patients with Systemic Sclerosis and Rheumatoid Arthritis

BackgroundSystemic sclerosis (SSc) is a rare connective tissue disease characterized by vascular, immune and fibrotic changes in the skin and internal organs. Rheumatoid arthritis (RA) is a chronic inflammatory disease...

THU0595 Adaptation and Validation of the Education Needs Assessment Tool into Polish: A Cross Sectional, Tool Validation Study

BackgroundThe Educational Needs Assessment Tool (ENAT) is a self-completed questionnaire developed in the UK to measure educational needs of patients with rheumatic diseases.ObjectivesThe aim of this study was to adapt...

AB0152 The rs11792633-t allele of il-33 gene is associated with systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a chronic inflammatory disease characterized by widespread fibrosis of the skin and several visceral organs. Its pathogenesis is not fully known. However, T lymphocytes actives fibroblasts...

Heart rate turbulence assessment in systemic sclerosis: the role for the detection of cardiac autonomic nervous system dysfunction

To assess the heart rate turbulence (HRT) in patients with SSc as a method of assessment for cardiac autonomic nervous function. We prospectively studied 68 consecutive patients with SSc before inclusion in the study. After a detailed clinical evaluation, including echocardiography, 45 subjects [aged 54.6 (14.7) years; 40 women] underwent 24-h Holter monitoring for HRT and time- and frequency-domain heart rate variability (HRV) assessment. Results were compared with those in 30 age- and sex-matched healthy controls. As compared with controls, HRT was impaired in SSc patients: the median turbulence onset (TO) was higher (P = 0.0001) and the median turbulence slope (TS) was lower (P = 0.0003). Abnormal HRT (TO > or =0.0% and/or TS < or =2.5 ms/RR) was found in 42% of SSc patients. Moreover, SSc duration correlated negatively with values of TS (r = -0.3; P = 0.045). HRT did not differ between diffuse and limited SSc groups. All estimated time- and the majority of frequency-domain values of HRV parameters in SSc were significantly lower than in controls. Significant correlations were also demonstrated between HRT and HRV parameters. HRT, like HRV assessment, indicates a frequent impairment of the cardiac autonomic nervous system in SSc patients, irrespective of the SSc type.