Computational Investigations of the Detailed Mechanism of Reverse Intersystem Crossing in Inverted Singlet-Triplet Gap Molecules

Inverted singlet-triplet gap (INVEST) materials have promising photophysical properties for optoelectronic applications due to an inversion of their lowest singlet (S1) and triplet (T1) excited states. This results in an exothermic reverse intersystem crossing (rISC) process that potentially enhances triplet harvesting, compared to thermally activated delayed fluorescence (TADF) emitters with endothermic rISCs. However, the processes and phenomena that facilitate conversion between excited states for INVEST materials are underexplored. We investigate the complex potential energy surfaces (PESs) of the excited states of three heavily studied azaphenalene INVEST compounds, namely, cyclazine, pentazine, and heptazine using two state-of-the-art computational methodologies, namely, RMS-CASPT2 and SCS-ADC(2) methods. Our findings suggest that ISC and rISC processes take place directly between the S1 and T1 electronic states in all three compounds through a minimum-energy crossing point (MECP) with an activation energy barrier between 0.11 to 0.58 eV above the S1 state for ISC and between 0.06 and 0.36 eV above the T1 state for rISC. We predict that higher-lying triplet states are not populated, since the crossing point structures to these states are not energetically accessible. Furthermore, the conical intersection (CI) between the ground and S1 states is high in energy for all compounds (between 0.4 to 2.0 eV) which makes nonradiative decay back to the ground state a relatively slow process. We demonstrate that the spin-orbit coupling (SOC) driving the S1-T1 conversion is enhanced by vibronic coupling with higher-lying singlet and triplet states possessing vibrational modes of proper symmetry. We also rationalize that the experimentally observed anti-Kasha emission of cyclazine is due to the energetically inaccessible CI between the bright S2 and the dark S1 states, hindering internal conversion. Finally, we show that SCS-ADC(2) is able to qualitatively reproduce excited state features, but consistently overpredict relative energies of excited state structural minima compared to RMS-CASPT2. The identification of these excited state features elaborates design rules for new INVEST emitters with improved emission quantum yields.

Correlation vs. exchange competition drives the singlet-triplet excited-state inversion in non-alternant hydrocarbons

In this work, we focus on the understanding of the driving force behind the S1-T1 excited-state energy inversion (which would thus violate Hund's rule, making the S1 state lower in energy than the T1 state) of two non-benzenoid non-alternant hydrocarbons, composed of odd-membered rings. The molecules considered here have identical chemical composition but different atomic configuration in space. The delicate interplay between structural and electronic factors that might induce inversion and its energy extension, only by a few meV, is systematically investigated here by state-of-the-art calculations. Qualitative and quantitative accurate predictions are obtained employing post-HF methods, thanks to the balanced and careful inclusion of electron correlation effects. The obtained results might guide and rationalize new searches for molecules violating Hund's rule, concomitantly demonstrating the importance of key contributions from the theoretical method of choice.

Reversible spin-optical interface in luminescent organic radicals

Molecules present a versatile platform for quantum information science1,2 and are candidates for sensing and computation applications3,4. Robust spin-optical interfaces are key to harnessing the quantum resources of materials5. To date, carbon-based candidates have been non-luminescent6,7, which prevents optical readout via emission. Here we report organic molecules showing both efficient luminescence and near-unity generation yield of excited states with spin multiplicity S > 1. This was achieved by designing an energy resonance between emissive doublet and triplet levels, here on covalently coupled tris(2,4,6-trichlorophenyl) methyl-carbazole radicals and anthracene. We observed that the doublet photoexcitation delocalized onto the linked acene within a few picoseconds and subsequently evolved to a pure high-spin state (quartet for monoradical, quintet for biradical) of mixed radical-triplet character near 1.8 eV. These high-spin states are coherently addressable with microwaves even at 295 K, with optical readout enabled by reverse intersystem crossing to emissive states. Furthermore, for the biradical, on return to the ground state the previously uncorrelated radical spins either side of the anthracene shows strong spin correlation. Our approach simultaneously supports a high efficiency of initialization, spin manipulations and light-based readout at room temperature. The integration of luminescence and high-spin states creates an organic materials platform for emerging quantum technologies.

Judicious Heteroatom Doping Produces High-Performance Deep-Blue/Near-UV Multiresonant Thermally Activated Delayed Fluorescence OLEDs

Two multiresonant thermally activated delayed fluorescence (MR-TADF) emitters are presented and it is shown how further borylation of a deep-blue MR-TADF emitter, DIDOBNA-N, both blueshifts and narrows the emission producing a new near-UV MR-TADF emitter, MesB-DIDOBNA-N, are shown. DIDOBNA-N emits bright blue light (ΦPL = 444 nm, FWHM = 64 nm, ΦPL = 81%, τd = 23 ms, 1.5 wt% in TSPO1). The deep-blue organic light-emitting diode (OLED) based on this twisted MR-TADF compound shows a very high maximum external quantum efficiency (EQEmax ) of 15.3% for a device with CIEy of 0.073. The fused planar MR-TADF emitter, MesB-DIDOBNA-N shows efficient and narrowband near-UV emission (λPL = 402 nm, FWHM = 19 nm, ΦPL = 74.7%, τd = 133 ms, 1.5 wt% in TSPO1). The best OLED with MesB-DIDOBNA-N, doped in a co-host, shows the highest efficiency reported for a near-UV OLED at 16.2%. With a CIEy coordinate of 0.049, this device also shows the bluest EL reported for a MR-TADF OLED to date.

A Deep-Blue-Emitting Heteroatom-Doped MR-TADF Nonacene for High-Performance Organic Light-Emitting Diodes

We present a p- and n-doped nonacene compound, NOBNacene, that represents a rare example of a linearly extended ladder-type multiresonant thermally activated delayed fluorescence (MR-TADF) emitter. This compound shows efficient narrow deep blue emission, with a λ_PL of 410 nm, full width at half maximum, FWHM, of 38 nm, photoluminescence quantum yield, Φ_PL of 71 %, and a delayed lifetime, τ_d of 1.18 ms in 1.5 wt % TSPO1 thin film. The organic light-emitting diode (OLED) using this compound as the emitter shows a comparable electroluminescence spectrum peaked at 409 nm (FWHM=37 nm) and a maximum external quantum efficiency (EQE_max ) of 8.5 % at Commission Internationale de l'Éclairage (CIE) coordinates of (0.173, 0.055). The EQE_max values were increased to 11.2 % at 3 wt % doping of the emitter within the emissive layer of the device. At this concentration, the electroluminescence spectrum broadened slightly, leading to CIE coordinates of (0.176, 0.068).

Modeling of Multiresonant Thermally Activated Delayed Fluorescence Emitters─Properly Accounting for Electron Correlation Is Key!

With the surge of interest in multiresonant thermally activated delayed fluorescent (MR-TADF) materials, it is important that there exist computational methods to accurately model their excited states. Here, building on our previous work, we demonstrate how the spin-component scaling second-order approximate coupled-cluster (SCS-CC2), a wavefunction-based method, is robust at predicting the ΔE_ST (i.e., the energy difference between the lowest singlet S₁ and triplet T₁ excited states) of a large number of MR-TADF materials, with a mean average deviation (MAD) of 0.04 eV compared to experimental data. Time-dependent density functional theory calculations with the most common DFT functionals as well as the consideration of the Tamm-Dancoff approximation (TDA) consistently predict a much larger ΔE_ST as a result of a poorer account of Coulomb correlation as compared to SCS-CC2. Very interestingly, the use of a metric to assess the importance of higher order excitations in the SCS-CC2 wavefunctions shows that Coulomb correlation effects are substantially larger in the lowest singlet compared to the corresponding triplet and need to be accounted for a balanced description of the relevant electronic excited states. This is further highlighted with coupled cluster singles-only calculations, which predict very different S₁ energies as compared to SCS-CC2 while T₁ energies remain similar, leading to very large ΔE_ST, in complete disagreement with the experiments. We compared our SCS-CC2/cc-pVDZ with other wavefunction approaches, namely, CC2/cc-pVDZ and SOS-CC2/cc-pVDZ leading to similar performances. Using SCS-CC2, we investigate the excited-state properties of MR-TADF emitters showcasing large ΔE_T2T1 for the majority of emitters, while π-electron extension emerges as the best strategy to minimize ΔE_ST. We also employed SCS-CC2 to evaluate donor-acceptor systems that contain a MR-TADF moiety acting as the acceptor and show that the broad emission observed for some of these compounds arises from the solvent-promoted stabilization of a higher-lying charge-transfer singlet state (S₂). This work highlights the importance of using wavefunction methods in relation to MR-TADF emitter design and associated photophysics.

P-760 Monozygotic twin rate among IVF centers: A multicenter analysis of data from 18 Italian units

Study question

Could factors inherent to individual centers, related to local clinical or laboratory variables, play a role in the increased incidence of monozygotic twins in IVF?

Summary answer

The rate of MZT did not significantly vary among IVF centers

What is known already

The risk of monozygotic twins (MZT) is increased in couples undergoing in vitro fertilization (IVF). Several systematic reviews have investigated the possible determinants linked to IVF, but results obtained have been inconclusive. Associations have been identified with the prolonged culture at blastocyst stage and young female age. Conventional IVF compared to ICSI, and assisted hatching emerged as possible additional risk factors, but evidence is controversial. Meta-analyses, however, cannot provide robust evidence because of the difficulty in performing multivariate analyses. Moreover, available investigations were retrospective and involved relatively small sample sizes hampering the quality of the collected data.

Study design, size, duration

This is a multicenter retrospective cohort study using the Italian ART National Registry database and involving the Centers reporting data from individual IVF cycles from 2015 to 2019. Eighteen IVF centers were included with a total of 87,076 IVF cycles reported during the study period. The primary aim of the study was to investigate whether the incidence of MZT differed among centers.

Participants/materials, setting, methods

Only single embryo transfer cycles were considered. Women who had sex-discordant twin deliveries were excluded. MZT rate was calculated as the number of multiple pregnancies out of the total number of clinical pregnancies. A binomial distribution model was used to determine the 95% CI of the frequency of MZT. The rates among centers were deemed heterogeneous if the 95% CI in at least one center did not include the mean MZT rate.

Main results and the role of chance

Ten centers reported data from 2015 to 2019, eight from 2017 to 2019. An analysis of the main characteristics of the centers revealed considerable variability. The total number of clinical pregnancies fulfilling our inclusion criteria were 10,440. Of these, 7 were found to be twin pregnancies with discordant gender and were excluded, leaving 10,433 for data analyses. The number of cases included per center varied between 11 and 2,823. Overall, 162 pregnancies were found to be multiple: 48 ended in a miscarriage, 28 spontaneously reduced to singletons and 86 women delivered two or more newborns. The vast majority were twins (n = 160), one was triplet, and one was quadruplet. Considering the denominator of 10,433 pregnancies, the rate of MZT was thus 1.5% (95%CI: 1.3 - 1.8%). The MZT rate among centers varied between 0% (95%CI: 0.0 - 25.9%) and 3.2% (95%CI: 1.3 - 8.1%). All the 95%CIs of the rates of MZT include the 1.5% common rate, thus rejecting the hypothesis that this incidence significantly differed among centers. Spearman correlations between the rate of MZT and variables associated with individual center policies could not identify any significant association. Even when restricting the analyses only to the largest centers, no association emerged.

Limitations, reasons for caution

Our study was limited by its retrospective nature. Furthermore, some centers provided less than 100 cases for data analysis and were therefore poorly informative. External confirmation from larger registries is therefore required.

Wider implications of the findings

This study provides evidences that the rate of MZT did not differ among IVF centers. Furthermore, no clinical and laboratory variables inherent to individual centers were identified in the determinism of IVF-associated MZT. Further studies are needed to identify the causes of increased risk of MZT in IVF practice.

Trial registration number

not applicable

C23 HOW TO IMPROVE ADHERENCE TO ESC HF GUIDELINES THE PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) PROJECT

Background

A careful and integrated follow up after hospitalization for heart failure (HF) may represent a feasible strategy to optimize the adherence to ESC guidelines and reduce the occurrence of adverse events (mortality, re–hospitalizations).

Methods

A strict integration between hospital and local health district proximity office cardiologist through an integrated clinical data sharing software has been implemented in Apulia region, Italy, in order to optimize the management of the HF patient after an hospitalization: the PONTE (PDTA FOR INTEGRATED FOLLOW–UP TERRITORY HOSPITAL OF THE PATIENT WITH CARDIAC HEART FAILURE) (bridge) project. As until December 2021, 1200 patients with HF have been enrolled in the project, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). Adherence to ESC HF guidelines in HFrEF patients before vs after December 2020 was compared.

Results

In the HFrEF population (56%) the mean age was 63 years, 38% were hypertensive, 15% diabetic, 40% had ischemic heart disease, 42% were previously treated with coronary angioplasty, 56% had an ICD/CRT, 22% had atrial fibrillation. Mean NYHA class was 2.2, mean LVEF 30%, mean NT–proBNP values 4027 pg/mL, mean serum creatinine 1 mg/dL, 91% were taking beta–blockers (BB), 86% mineral corticoid receptor antagonists (MRA), 98% ACE–inhibitors/angiotensin–receptor–antagonists/neprilysin and angiotensin receptor antagonists (ACE/ARB/ARNI), and 13% ARNI. Compared to patients enrolled before 2020, ARNI prescription increased in 2021 (60% vs 13%, p < 0.001); in 30% ARNI were prescribed in hospital before discharge. Furthermore, in 10% of the population (most diabetics), sodium glucose cotransporter type 2 inhibitors (SGLT2i) have been prescribed as indicated by the latest ESC 2021 guidelines.

Conclusions

The implementation the PONTE project shows an improved adherence to ESC HF guidelines.

C57 DUAL ANTIPLATELET THERAPY DID NOT PREDICT ALL–CAUSE BLEEDING AT LONG–TERM FOLLOW–UP AFTER ACS: A SUBANALYSIS FROM THE APULIA PONTE ACS STUDY

Background

Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. Nevertheless, the risk for bleeding often impact on the long–term administration of DAPT. The aim of this study was to evaluate the determinants of bleeding risk after ACS.

Methods

This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. Data were computed in order to evaluate the major determinants of all–cause bleeding at one–year follow–up.

Results

We finally enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 years). Pharmacological treatments were optimized during the follow–up visits. According to anti–thrombotic therapies, 92.1% of patients persisted on DAPT at one–year follow–up. The number of patients on DAPT+anticoagulant were: 4.4%. All–cause bleeding occurred in 2.2% of patients. Anthropometric characteristics (height [β: –0.04594 ± 0.01610, p = 0.0044] and weight [β: –0.03043 ± 0.01035, p = 0.033]), male gender [β: –0.7008 ± 0.2818, p = 0.0129], and age [β: 0.02535 ± 0.01219, p = 0.0376] were the major determinants of all–cause bleeding at univariate regression analysis but they were not confirmed at multivariate regression analysis (p=ns). Kaplan Meier curve points out the impact of age on all–cause bleeding (Figure 1). Nor DAPT or triple therapy remained associated with all–cause bleeding at one year follow–up.

Conclusions

Long–term DAPT is not a predictor of all–cause bleeding in patients who suffered ACS and/or coronary revascularization.

C29 SEEING BEYOND APPEARANCES: INTRACORONARY IMAGING TECHNIQUES IN SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD)

Over recent years, mainly due to a broad use of coronary angiography and intracoronary imaging techniques (IIT), SCAD has emerged as a no longer rare cause of acute coronary syndrome (ACS). Early diagnosis is extremely important to avoid potentially lethal complications; nevertheless, considerable uncertainty remains about optimal acute and post–discharge management. Current endorsed therapeutic strategy lean towards an initial conservative approach, relegating percutaneous or surgical coronary intervention to high–risk coronary anatomy or in case of hemodynamic instability. We report our experience in the field by presenting a clinical case of a 36–year–old woman admitted to emergency department with acute, anginal pain started 24 hours earlier, referring no medical history, except for a syncopal episode occurred four days earlier, in correspondence of a mournful event. She was hemodynamically stable, with work–up significant only for elevated troponin level of 3649.5 ng/ml (n.v. <11). Coronary angiogram showed atherosclerotic–like changes limited to right coronary artery (RCA), with focal subcritical stenosis at its proximal segment (Fig 1). In the absence of major precipitating factors for atherosclerotic coronary disease, SCAD was suspected. IVUS and OCT were performed, with evidence of dissection and intra–mural haematoma (Fig. 2), extending from proximal RCA to posterior descending branch take–off, compressing the true lumen. Considering both anatomical (coronary ostium not involved) and clinical (patient asymptomatic and hemodynamically stable) factors, conservative treatment with low dose aspirin and beta blocker was prescribed. After three days of hospitalization occurred a single episode, lasted 5 minutes, of anginal pain associated with ST elevation in inferior leads, managed with nitrates administration; subsequent cardiac computed tomography angiography excluded disease progression (Fig.2). On the 23rd day, due to angiographic evidence of SCAD partial healing (Fig.3), the patient was discharged. This case highlights the importance of keeping in mind the possibility of SCAD, especially when healthy young women with prior emotional stress present with ACS. IIT allow to shed light on the true mechanism of ACS without significant obstructive coronary disease. Finally, in case of conservative approach, close in–hospital monitoring is mandatory, given the highest probability of complications in the first days after clinical onset.

P311 TAKOTSUBO CARDIOMYOPATHY RELATED TO MRNA SARS–COV2 VACCINE

54–year–old woman with a family history of systemic sclerosis, with no significant cardiological history. She underwent anti–Covid vaccination in February and March 2021 with Spikevax (Moderna) and a booster dose (Spikevax) on 09/12/21. A few hours after this last administration, the patient presented with palpitations, asthenia, and intermittent chest tightness. In the following days, because of dyspnea for mild exertion, she went to the emergency department. ECG showed low QRS voltages in the peripheral leads, poor septal r wave growth and negative T waves in inferior leads and from V3 to V6. Echocardiography showed akinesia of apical and middle segments, LVEF 40%, mitral obstructive systolic anterior motion, moderate mitral regurgitation and mild pericardial effusion. In blood tests: increase in myocardiospecific enzymes and NTproBNP, modest increase in indices of inflammation. The patient was admitted to Cardiology Unit, where coronary angiography showed coronary arteries free from stenosing lesions and Takotsubo–like appearance on ventriculography. Cardiac MRI confirmed alterations in parietal kinetics, hyperintensity in the STIR sequences referable to apical and middle segments edema compatible with Takotsubo cardiomyopathy (CMT). Capillaroscopy excluded scleroderma pattern. The patient presented a progressive reduction of troponins and, the echocardiogram before discharge showed improved LV systolic function, regression of mitral obstructive systolic anterior motion with reduction of mitral regurgitation. Rare case reports of CMT after influenza vaccination [1] and a similar case to the one we described after Spikevax vaccine [2] and ChAdOx1 nCov–19 (AstraZeneca) [3] have been presented in the literature. The underlying pathophysiological mechanism appears to be related to a stress–induced systemic reaction with a predominantly adrenergic sympatho–vagal imbalance [4]. In this clinical setting, cardiac MRI can offer added value in the diagnostic process, especially to exclude post–vaccine myocarditis, which in our case seemed unlikely given the immediate onset of symptoms.

Role of meteorological factors in the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic in Italy

OBJECTIVE

Understanding the evolutionary dynamics of the Coronavirus disease 2019 (COVID-19) pandemic in the coming months is a matter of great importance and urgency for governments worldwide, making fundamental decisions based on what is known about the transmission mechanisms of the virus and its survival in the environment. The present study aimed to evaluate the impact of demographic variables, solar radiation and relative humidity on the spread of the COVID-19 pandemic of the various regions in Italy.

MATERIALS AND METHODS

The retrospective longitudinal study was conducted, and data used in this study was obtained from the Italian Health Ministry. Descriptive statistics included mean, frequency, and percentage, and results presented by graphs were calculated.

RESULTS

The infection trend was investigated by comparing it with the demographic situation and the irradiation indices of solar ultraviolet light that are detected with the changing seasons. The present study reported that the geographic areas with higher population density and lower solar radiation during the autumn and winter months were most affected by SARS-CoV-2.

CONCLUSIONS

The analysis carried out can provide a predictive model for the future phases of the COVID-19 pandemic in Italy, regardless of the adoption of lockdown measures and behavioral factors.

Spontaneous exciton dissociation enables spin state interconversion in delayed fluorescence organic semiconductors

Engineering a low singlet-triplet energy gap (ΔEST) is necessary for efficient reverse intersystem crossing (rISC) in delayed fluorescence (DF) organic semiconductors but results in a small radiative rate that limits performance in LEDs. Here, we study a model DF material, BF2, that exhibits a strong optical absorption (absorption coefficient = 3.8 × 105 cm-1) and a relatively large ΔEST of 0.2 eV. In isolated BF2 molecules, intramolecular rISC is slow (delayed lifetime = 260 μs), but in aggregated films, BF2 generates intermolecular charge transfer (inter-CT) states on picosecond timescales. In contrast to the microsecond intramolecular rISC that is promoted by spin-orbit interactions in most isolated DF molecules, photoluminescence-detected magnetic resonance shows that these inter-CT states undergo rISC mediated by hyperfine interactions on a ~24 ns timescale and have an average electron-hole separation of ≥1.5 nm. Transfer back to the emissive singlet exciton then enables efficient DF and LED operation. Thus, access to these inter-CT states, which is possible even at low BF2 doping concentrations of 4 wt%, resolves the conflicting requirements of fast radiative emission and low ΔEST in organic DF emitters.

peri-Acenoacene molecules: tuning of the singlet and triplet excitation energies by modifying their radical character

The energy difference between singlet and triplet excitons, or ΔE_ST, is a key parameter for novel light-emission mechanisms (i.e., TADF or thermally activated delayed fluorescence) or other photoactivated processes. We have studied a set of conjugated molecules (peri-acenoacenes and their heteroatom-doped analogues) to observe the evolution of their excited-state properties upon increasing the system size with and without substitution with a pair of N atoms. Since these molecules exhibit a (ground-state) diradicaloid character, together with marked correlation effects influencing the excited-states formed, we have applied a variety of theoretical methods (FT-DFT, TD-DFT, SF-TD-DFT, CIS, CIS(D), SCS-CC2, SA-CASSCF, and SC-NEVPT2) to bracket the accuracy of the results while concomitantly providing insights into electronic structure. The results show how this chemical strategy (N-doping) largely modifies not only the excited-state energies but also the oscillator strengths and the ΔE_ST values, constituting versatile platforms for fine-tuned photophysical applications.

Hypsochromic Shift of Multiple-Resonance-Induced Thermally Activated Delayed Fluorescence by Oxygen Atom Incorporation

Herein, we reported an ultrapure blue multiple-resonance-induced thermally activated delayed fluorescence (MR-TADF) material (ν-DABNA-O-Me) with a high photoluminescence quantum yield and a large rate constant for reverse intersystem crossing. Because of restricted π-conjugation of the HOMO rather than the LUMO induced by oxygen atom incorporation, ν-DABNA-O-Me shows a hypsochromic shift compared to the parent MR-TADF material (ν-DABNA). An organic light-emitting diode based on this material exhibits an emission at 465 nm, with a small full-width at half-maximum of 23 nm and Commission Internationale de l'Eclairage coordinates of (0.13, 0.10), and a high maximum external quantum efficiency of 29.5 %. Moreover, ν-DABNA-O-Me facilitates a drastically improved efficiency roll-off and a device lifetime compared to ν-DABNA, which demonstrates significant potential of the oxygen atom incorporation strategy.

O-156 Fertilization rate as a novel indicator for cumulative live birth rate: multicenter retrospective cohort study of 9,394 complete IVF cycles

Study question

Does fertilization rate (FR) affect cumulative success rates in assisted reproduction cycles?

Summary answer

These data indicate a positive association between FR with CLBR suggesting the predictive clinical relevance of this parameter and its adoption as Key Performance Indicator(KPI).

What is known already

Numerous studies have aimed at characterizing outcome predictors. Maternal age is historically and correctly recognized as the single most important factor impacting on the clinical outcome of ART. More recently ovarian response has also gained interest in this respect. However, the quest for novel, more comprehensive predictive factors is not over; new relevant evidence is starting to emerge. FR is a noteworthy parameter because expressing a fundamental aspect of both oocyte and sperm developmental competence. In fact it has been adopted as a key performance indicator of the IVF laboratory, to assess laboratory, operator, and gamete competence.

Study design, size, duration

Reported data concern a retrospective cohort study carried out between 2015 to 2017 involving 7,968 couples undergoing 9,394 complete ICSI cycles, i.e. whose all embryos were transferred or disposed.All women aged between 18-42 years were included.We excluded from analysis: surgical sperm retrieval cases, cycles resulting in neither fresh or frozen–thawed embryo transfers,cycles in which live birth were not achieved, but with remaining cryopreserved embryos,cycles of PGT, cycle with fertilization failure and standard IVF cycles.

Participants/materials, setting, methods

The cohort was groupped according to fertilization rate intervals based on recommendations of the Vienna Consensus (<65% - Group 1; 65%-80% - Group 2; >80% - Group 3). Harnessing the large size of the original dataset, further cycle stratifications were carried out based on female age (<34, 35-38, 39-42 years) and number of oocytes retrieved (5-7, 8-10, >10 oocytes).

Main results and the role of chance

No significant difference in female age was observed between fertilization rate groups (p = 0.640). CLBR was progressively higher in relation fertilization rate in Groups 1, 2 and 3 (20.1%, 34.7%, 41.3%, P < 0.001, respectively). Number of recovered oocytes, embryo number per cycle, cumulative pregnancy rate followed the same trend (p < 0.001). The decrease in CLBR with increasing female age was significantly correlated with fertilization rate and CLBR in all three female age groups (P < 0.001). Finally, to further control for possible patient-specific confounding factors, maternal age, number of retrieved oocytes, percent of inseminated oocytes and fertilization rate were evaluated in a multivariate logistic regression analysis. From this assessment, fertilization rate emerged as a factor independently associated with cumulative live birth rate, to a degree equivalent or higher compared with the number or retrieved oocytes.

Limitations, reasons for caution

The study design is retrospective and requires further refinement to control for factors that may impact clinical outcome.

Wider implications of the findings

These data indicate a positive association of FR with CLBR, thereby suggesting that fertilization, in addition to representing an assay for gamete quality and laboratory performance,has an independent clinical significance.Irrespective of the number of retrieved oocytes and female age, we observed that, rates of FR are positively associated with CLBR.

Trial registration number

None

The new generation PFAS C6O4 does not produce adverse effects on thyroid cells in vitro

PURPOSE

Per- and poly-fluoroalkyl-substances (PFASs) are synthetic compounds that raised concern due to their potential adverse effects on human health. Long-chain PFAS were banned by government rules in many states, and thus, new emerging PFAS were recently introduced as substitutes. Among these, Perfluoro{acetic acid, 2-[(5-methoxy-1,3-dioxolan-4-yl)oxy]}, ammonium salt (C6O4) was recently introduced to produce a range of food contact articles and literature data about this compound are scanty. The aim of this study was to evaluate the in vitro effects of exposure to C6O4, compared with PFOA and PFOS on thyroid cells.

METHODS

FRTL5 rat-thyroid cell lines and normal human thyroid cells (NHT) were incubated with increasing concentrations of C6O4 for 24, 48, 72, and 144 h to assess cell viability by WST-1. Cell viability was confirmed by AnnexinV/PI staining. Long-chain PFAS (PFOA and PFOS) were used at same concentrations as positive controls. The proliferation of cells exposed to C6O4, PFOA, and PFOS was measured by staining with crystal violet and evaluation of optical density after incubation with SDS. Changes in ROS production by FRTL5 and NHT after exposure to C6O4 at short (10, 20, and 30 min) and long-time points (24 h) were evaluated by cytofluorimetry.

RESULTS

C6O4 exposure did not modify FRTL5 and NHT cell viability at any concentration and/or time points with no induction of necrosis/apoptosis. At difference, PFOS exposure reduced cell viability of FRTL5 while and NHT, while PFOA only in FRTL5. FRTL5 and NHT cell proliferation was reduced by incubation with by PFOA and PFOS, but not with C6O4. ROS production by NHT and FRTL5 cells was not modified after C6O4 exposure, at any time/concentration tested.

CONCLUSIONS

The present in vitro study constitutes the first evaluation of the potential adverse effects of the new emerging PFAS C6O4 in cultured rat and human thyroid cells, suggesting its safety for thyroid cells in vitro.

Cardiac magnetic resonance findings in patients with type 1 myotonic dystrophy

Funding Acknowledgements

Type of funding sources: None.

Background

Heart disease is a major determinant of prognosis in type 1 myotonic dystrophy (DM1), second only to respiratory complications. Cardiac imaging, possibly including cardiac magnetic resonance (CMR), is recommended in patients with DM1. However, limited information is available on CMR findings and their prognostic significance in DM1.

Methods

We identified all patients with DM1 evaluated from 2009 to 2020 in a CMR laboratory with an established collaboration with a Neuromuscular Disorder Unit.

Results

Thirty-four patients were retrieved (21 males, aged 45 ± 12). At the time of CMR examination, 97% had neuromuscular symptoms (mean duration 16 ± 13 years), 12 (35%) presented with atrioventricular block (n = 11 1st degree, n = 1 2nd degree type 1), 15 (44%) with intraventricular conduction disturbances (n = 5 left bundle branch block, n = 5 right bundle branch block, n = 3 left anterior fascicular block, n = 2 other non-specific intraventricular conduction delay), 4 (12%) with atrial fibrillation or flutter. No patient had a device. At CMR, 5 (15%) patients had left ventricular (LV) systolic dysfunction (LV ejection fraction [LVEF] <50%) and 5 (15%) a depressed right ventricular (RV) function (RVEF <50%). Compared to age- and sex-specific reference values for our laboratory, 12 (35%) patients showed a decreased LV end-diastolic volume index (LVEDVi), 7 (21%) a decreased LV mass index (LVMi), and 29 (83%) a decreased LVMi/LVEDVi ratio. Nine (26%) patients had mid-wall late gadolinium enhancement (LGE, mean extent 4.5 ± 2.0% of LVM; n = 8 septal, n = 4 inferolateral, n = 2 inferior, n = 1 anterolateral), and 14 (40%) some areas of fatty infiltration (n = 9 involving the LV, n = 13 the RV). Native T1 in the interventricular septum (1,041 ± 53 ms) approached the upper reference limit (1,089 ms), and the extracellular volume was slightly increased (33 ± 2%, reference values <30%). Over a median follow-up of 3.3 years (interquartile interval 1.6-4.7), 2 (6%) patients died, one for infectious and respiratory complications and the other for unknown causes, 5 (15%) patients underwent pacemaker implantation for conduction disturbances, and 4 (12%) had a documentation of high-risk (Lown class ≥4) ventricular ectopic beats (VEBs). Among all CMR variables collected, higher values of LVMi/LVEDVi ratio emerged as univariate predictor of all-cause death (p = 0.044). At logistic regression analysis, anteroseptal wall thickness was associated with the need for pacemaker implantation (p = 0.028), while LGE mass was associated with high-risk VEBs (p = 0.026).

Conclusions

Patients with DM1 display several structural and functional cardiac abnormalities, with variable degrees of cardiac muscle hypotrophy, fibrosis and fatty infiltration. The possibility to predict the need for pacemaker implantation, ventricular arrhythmias and all-cause or cardiovascular mortality should be verified in larger cohorts.

Impact of Fluoroalkylation on the n-Type Charge Transport of Two Naphthodithiophene Diimide Derivatives

In this work, we investigate two recently synthesized naphthodithiophene diimide (NDTI) derivatives featuring promising n-type charge transport properties. We analyze the charge transport pathways and model charge mobility with the non-adiabatic hopping mechanism using the Marcus-Levich-Jortner rate constant formulation, highlighting the role of fluoroalkylated substitution in α (α-NDTI) and at the imide nitrogen (N-NDTI) position. In contrast with the experimental results, similar charge mobilities are computed for the two derivatives. However, while α-NDTI displays remarkably anisotropic mobilities with an almost one-dimensional directionality, N-NDTI sustains a more isotropic charge percolation pattern. We propose that the strong anisotropic charge transport character of α-NDTI is responsible for the modest measured charge mobility. In addition, when the role of thermally induced transfer integral fluctuations is investigated, the computed electron-phonon couplings for intermolecular sliding modes indicate that dynamic disorder effects are also more detrimental for the charge transport of α-NDTI than N-NDTI. The lower observed mobility of α-NDTI is therefore rationalized in terms of a prominent anisotropic character of the charge percolation pathways, with the additional contribution of dynamic disorder effects.

Detection of SARS-COV-2 receptor ACE-2 mRNA in thyroid cells: a clue for COVID-19-related subacute thyroiditis

PURPOSE

SARS-COV-2 is a pathogenic agent belonging to the coronavirus family, responsible for the current global world pandemic. Angiotensin-converting enzyme 2 (ACE-2) is the receptor for cellular entry of SARS-CoV-2. ACE-2 is a type I transmembrane metallo-carboxypeptidase involved in the Renin-Angiotensin pathway. By analyzing two independent databases, ACE-2 was identified in several human tissues including the thyroid. Although some cases of COVID-19-related subacute thyroiditis were recently described, direct proof for the expression of the ACE-2 mRNA in thyroid cells is still lacking. Aim of the present study was to investigate by RT-PCR whether the mRNA encoding for ACE-2 is present in human thyroid cells.

METHODS

RT-PCR was performed on in vitro ex vivo study on thyroid tissue samples (15 patients undergoing thyroidectomy for benign thyroid nodules) and primary thyroid cell cultures.

RESULTS

The ACE-2 mRNA was detected in all surgical thyroid tissue samples (n = 15). Compared with two reporter genes (GAPDH: 0.052 ± 0.0026 Cycles^-1; β-actin: 0.044 ± 0.0025 Cycles^-1; ACE-2: 0.035 ± 0.0024 Cycles^-1), the mean level of transcript expression for ACE-2 mRNA was abundant. The expression of ACE-2 mRNA in follicular cells was confirmed by analyzing primary cultures of thyroid cells, which expressed the ACE-2 mRNA at levels similar to tissues.

CONCLUSIONS

The results of the present study demonstrate that the mRNA encoding for the ACE-2 receptor is expressed in thyroid follicular cells, making them a potential target for SARS-COV-2 entry. Future clinical studies in patients with COVID-19 will be required for increase our understanding of the thyroid repercussions of SARS-CoV-2 infection.

Addressing the Frenkel and charge transfer character of exciton states with a model Hamiltonian based on dimer calculations: Application to large aggregates of perylene bisimide

To understand the influence of interchromophoric arrangements on photo-induced processes and optical properties of aggregates, it is fundamental to assess the contribution of local excitations [charge transfer (CT) and Frenkel (FE)] to exciton states. Here, we apply a general procedure to analyze the adiabatic exciton states derived from time-dependent density functional theory calculations, in terms of diabatic states chosen to coincide with local excitations within a restricted orbital space. In parallel, motivated by the need of cost-effective approaches to afford the study of larger aggregates, we propose to build a model Hamiltonian based on calculations carried out on dimers composing the aggregate. Both approaches are applied to study excitation energy profiles and CT character modulation induced by interchromophore rearrangements in perylene bisimide aggregates up to a tetramer. The dimer-based approach closely reproduces the results of full-aggregate calculations, and an analysis in terms of symmetry-adapted diabatic states discloses the effects of CT/FE interactions on the interchange of the H-/J-character for small longitudinal shifts of the chromophores.

Gestational diabetes mellitus: Prevention, diagnosis and treatment. A fresh look to a busy corner

BACKGROUND

Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by hyperglycaemia with onset or first recognition during pregnancy. Risk factors include family history of diabetes, previous GDM, genetic predisposition for GDM/type 2 diabetes, insulin resistance conditions such as overweight, obesity and ethnicity. Women with GDM are at high risk for fetal macrosomia, small for gestational age, neonatal hypoglycaemia, operative delivery and caesarean delivery. The aim of this narrative review is to summarize the most recent findings of diagnosis and treatment of GDM in order to underline the importance to promote adequate prevention of this disease, especially through lifestyle interventions such as diet and physical activity.

METHODS

The research was conducted using the following electronic databases, MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library, including all published randomized and non-randomized studies as well as narrative and systematic reviews.

RESULTS

The lack of universally accepted criteria makes the definition of diagnosis and prognosis of this condition difficult. Early diagnosis and glucose blood level control may improve maternal and fetal short and long-term outcomes. Treatment strategies include nutritional interventions and exercise. Medical treatment can be necessary if these strategies are not effective. Moreover, novel non-pharmacologic agents such as myo-inositol seem to be effective and safe both in the prevention and the treatment of GDM.

CONCLUSIONS

It is important to promote adequate prevention of GDM. Further studies are needed in order to better define the most appropriate strategies for the clinical management of women affected by GDM.

The effects of oral supplements with Sambucus nigra, Zinc, Tyndallized Lactobacillus acidophilus (HA122), Arabinogalactans, vitamin D, vitamin E and vitamin C in otitis media with effusion in children: a randomized controlled trial

OBJECTIVE

To evaluate the ability of oral supplements with immune-stimulating molecules (Sambucus nigra, Zinc, Tyndallized Lactobacillus acidophilus (HA122), Arabinogalactans, vitamin D, vitamin E and vitamin C) to reduce the inflammation of the upper airway tract and improve the outcome of otitis media with effusion (OME) in children.

PATIENTS AND METHODS

Randomized controlled trial. One-hundred ninety-eight children (CI 95%: 12-96 months) were divided into four groups. Group 1 (48 subjects) received 10 ml of oral supplements (OS) with immune-stimulating molecules for three months (20 days consecutively, then 10 days of suspension - the therapeutic scheme was repeated three times); Group 2 (54 children) underwent treatment with 10 ml of OS for 90 consecutive days; Group 3 (48 subjects) received 15 ml of OS for 45 consecutive days; a control group (48 children) underwent the standard treatment for rhinitis and OME. Outcome measures included otoscopy, tympanometry, fibroendoscopy, and the pure tone audiometry (PTA) at T0 (before treatment), T1 (45 days after treatment), and T2 (90 days after treatment).

RESULTS

All children treated with OS showed a reduction of Upper Airway Infection (UAI) episodes and OME compared to the control group independent of the administration method and posology. The three groups treated with OS showed statistically significant differences between T0 and T2 for otoscopy, tympanometry, fibroendoscopy, and PTA. In Group 2, the otoscopy and the tympanometry scores improved at T1. Group 2 and 3 had better PTA results than Group 1.

CONCLUSIONS

OS with immune-stimulating molecules should be considered as a supporting therapy in children affected by recurrent episodes of UAI associated with OME due to their capacity to improve the immune response and reduce the inflammatory phenomena. OS can improve the fibroendoscopic findings by restoring middle ear ventilation, in addition to their ability to reduce inflammation in the middle ear.

Nutraceuticals as immune-stimulating therapy to fight COVID-19. Combination of elements to improve the efficacy

COVID-19 pandemic has underlined that unknown viral infections, which jump from animals to humans, can be extremely dangerous. In case of new viruses as SARS-CoV2, available drugs can fail to contrast the virus aggressiveness leading patients to death. Long time is necessary to create a vaccine, but immediate solutions are necessary to stop the mortality COVID-19 related. We have learned that the immune-system is the key to reduce the severity of COVID-19 and, through its modulation, it has been possible saving people's life. In this short communication, we discuss the use of nutraceuticals to modulate and stimulate the immune answer for reducing the severity of COVID-19 symptoms. The nutraceuticals are safe and can be administered to all ages. In addition, combination of natural anti-viral elements and immune-stimulating molecules already successfully tested against others upper-respiratory tract infections-could be efficient against SARS-CoV2. We believe that these natural molecules could really be a valid ally against COVID-19, especially in this moment in which a SARS-CoV2 vaccine is still not available.

Use of cognitive enhancers: methylphenidate and analogs

OBJECTIVE

In the last decades, several cognitive-enhancing drugs have been sold onto the drug market. Methylphenidate and analogs represent a sub-class of these new psychoactive substances (NPS). We aimed to review the use and misuse of methylphenidate and analogs, and the risk associated. Moreover, we exhaustively reviewed the scientific data on the most recent methylphenidate analogs (methylphenidate and ethylphenidate excluded).

MATERIALS AND METHODS

Literature search was performed on methylphenidate and analogs, using specialized search engines accessing scientific databases. Additional reports were retrieved from international agencies, institutional websites, and drug user forums.

RESULTS

Methylphenidate/Ritalin has been used for decades to treat attention deficit disorders and narcolepsy. More recently, it has been used as a cognitive enhancer and a recreational drug. Acute intoxications and fatalities involving methylphenidate were reported. Methylphenidate was scheduled as an illegal drug in many countries, but NPS circumventing the ban and mimicking the psychostimulant effects of methylphenidate started being available: ethylphenidate, 3,4-dichloromethylphenidate, 3,4-dichloroethylphenidate, 4-fluoromethylphenidate, 4-fluoroethylphenidate, methylnaphthidate, ethylnaphthidate, isopropylphenidate, propylphenidate, 4-methylmethylphenidate, and N-benzylethylphenidate have been available in the past few years. Only little data is currently available for these substances. Many intoxications involving methylphenidate analogs were reported. To date, ethylphenidate was involved in 28 fatalities, although it was reportedly directly related to the cause of death in only 7 cases; 3,4-dichloroethylphenidate was involved in 1 death.

CONCLUSIONS

The rapid expansion of methylphenidate analogs onto the drug market in the past few years makes likely the occurrence of intoxications and fatalities in the next years. Careful monitoring and systematic control of methylphenidate analogs should be undertaken to reduce the uprising threat, and education efforts should be made among high-risk populations.

Microbial consortia involved in fermented spelt sourdoughs: dynamics and characterization of yeasts and lactic acid bacteria

This study aims to describe the native microbiota of fermented spelt, taking into consideration both lactic acid bacteria (LAB) and yeasts, for which little data are available. Five samples of commercial spelt flour were subjected to spontaneous fermentation to obtain a type I sourdough. A total of 186 LAB and 174 yeast isolates were selected at different refreshment steps and subjected to further analyses. Within LAB, coccal isolates constituted 78·5% of the total LAB, with the dominance of Pediococcus pentosaceus. Although documented before as a component, this is the first report of a spelt sourdough fermentation dominated by this homofermentative LAB, characterized by a high acidification rate, ability to utilize a wide range of carbon sources and to grow in high osmolarity conditions. Yeast communities resulted in four dominant species, Saccharomyces cerevisiae, Wickerhamomyces anomalus, Pichia fermentans and Clavispora lusitaniae. This study highlights for the first time the biodiversity and dynamics of yeast communities involved in sourdough fermentation of spelt. Compared to commercial baker's yeast, autochthonous W. anomalus, P. fermentans and S. cerevisiae isolates show a good performance, and their use could be an advantage for their acquired adaptation to the environment, providing stability to the fermentation process. SIGNIFICANCE AND IMPACT OF THE STUDY: Nowadays, there is a renewed interest in products based on spelt. This 'ancient grain' is a highly nutritional grain; however, its use is limited to bread-making processes, which are not standardized. The low baking and sensory quality of spelt can be overcome through fermentation processes. However, the autochthonous microbiota of spelt sourdough is poorly known. This study highlights the dynamics of microbial communities involved in sourdough fermentation of spelt and provides the basis for the selection of autochthonous cultures, with the aim of improving the nutritional potential of spelt and its rheology and bread-making properties.

Obesity in the European region: social aspects, epidemiology and preventive strategies

Obesity related to metabolic syndrome is gaining an increasing importance as the main risk factor for diseases and disability in the European region. We herein review the increasing trend of obesity and overweight in males and females from Europe, preventive programs addressed to children, youngsters, adult population and subjects with particular diseases which can profit from healthy nutrition. The main feature is that some European countries have implemented programs on World Health Organization (WHO) proposals, while some others have focused attention only on some aspects. Based on the reported obesity increase over the last twenty years, prevention programs seem to have been ineffective. Most likely, the effects will be observed later on. In this concern, it will be fundamental to continue and finance the countries of the European region, where those programs have been extensively applied, to obtain even better results in terms of obesity prevention.

Evaluation of medical prescriptions and off-label use on board ships to improve healthcare quality

OBJECTIVE

This study analyzed the appropriateness of drug therapies prescribed for a particular category of patients: the seafarers. We investigated an important problem of this area: the off-label use of drugs, which resulted to be a consequence of major shortcomings in the on-board pharmacies of ships. The off-label use of drugs is allowed, but can lead to some not negligible ethical and health problems, compromising the quality of provided healthcare.

MATERIALS AND METHODS

The analysis was performed on electronic health records of patients onboard ships without physicians, and assisted by the CIRM from 2011 to 2015. This work is divided into two phases: in the first one, we classified the diagnoses registered onboard on the basis of the ICD-10 classification proposed by the WHO. In the second phase, we evaluated the congruence of the pharmacological therapies prescribed by CIRM physicians, according to the MICROMEDEX Database, which provides comprehensive information about drugs and their use.

RESULTS

From the analysis emerged that prescribed drugs were not always corresponded to their primary indication of use. In particular, in 2011 off-label drug use was widely spread (more than 30%) in some ICD-10 classes. In the following years (2012-2015) a decrease of off-label use of drugs was noticed.

CONCLUSIONS

The results suggest that a standardization of onboard pharmacies is crucial, in order to have a complete on-board pharmacy that will allow preventing and counteracting any situation of health danger, which may occur onboard, ensuring high quality healthcare to seafarers all over the world.

A polyphasic approach to characterize Weissella cibaria and Weissella confusa strains

AIM

To study Weissella cibaria and Weissella confusa strains, lactic acid bacteria (LAB) members naturally present in food products, but not yet included in Qualified Presumption of Safety (QPS) list of European Food Safety Authority (EFSA).

METHODS AND RESULTS

We carried out a comparative genome analysis of 23 sequenced W. cibaria and 7 W. confusa genomes, in parallel with a physiological and functional characterization of several strains previously isolated from sourdough-like maize bran fermentation. The genome analysis revealed the absence of dedicated pathogenicity factors. Some putative virulence genes found in Weissella genomes were also present in other LAB strains, considered safe by EFSA and commonly used as probiotics. The physiological tests carried out on our strains corroborated the genomic results. Moreover, the following functional traits of interest to application in the food sector were identified: the majority of tested strains displayed high acidification rate, high reducing ability, production of exopolysaccharides (EPS), arabinoxylan degradation ability, growth in the presence of fructo-oligosaccharides (FOS), bile and gastric juice tolerance, and antifungal activity.

CONCLUSIONS

These results provide evidence for the possible use of selected strains of W. cibaria and W. confusa in the food sector.

SIGNIFICANCE AND IMPACT OF THE STUDY

This polyphasic study adds to the body of knowledge on the functional and applicable characteristics of these controversial species of LAB. This knowledge contributes to design new selected cultures included in the QPS list required for food applications.

Correction to: Contribution of cryopreservation to the cumulative live birth rate: a large multicentric cycle-based data analysis from the Italian National Registry

The original article unfortunately contained a mistake. The names of the collaborators were captured as authors of the article.

Contribution of cryopreservation to the cumulative live birth rate: a large multicentric cycle-based data analysis from the Italian National Registry

PURPOSE

To estimate the contribution of cryopreservation to the cumulative live birth rate (CLBR) after law modification in Italy in the era of vitrification and freeze-all.

METHODS

The Italian National Registry performed a cycle-based data collection. Nine Italian IVF clinics were involved incorporating a total of 10,260 fresh cycles performed between January 2015 and April 2016 resulting in 9273 oocyte retrievals and 3266 subsequent warming cycles from the same oocyte retrievals performed up to December 2016. Mean female age was 37 ± 4.3 years. Primary outcome measure was CLBR per oocyte retrieval. Confounding factors were tested in multivariate regression analysis, and the relative impact of cryopreservation to the CLBR in different patient categories was calculated.

RESULTS

CLBR per oocyte retrieval was 32.6%, 26.5%, 18.7%, 13.0%, and 5.5% for women younger than 36, aged 36-39, 40-41, and older than 41 years, respectively. The total relative contribution of oocyte/embryo cryopreservation was 40.6% (95% CI 38.41-42.75). An association between maternal age, number of oocytes retrieved, fertilization rate, cryopreservation, and cumulative live birth was shown. When adjusted for confounders, a 2.3-fold increase was observed in the chance of live birth when cryopreservation was performed (OR 2.3; 95% CI 1.99-2.56). In high responder patients (> 15 oocytes retrieved) where freeze-all was applied in 67.6% of cycles to avoid the risk of hyper stimulation syndrome, the relative contribution of vitrification to the CLBR was 80.6%.

CONCLUSIONS

Cryopreservation is essential in IVF and should always be available to patients to optimize success rates. Multicentric, cycle-based data analyses are crucial to provide infertile couples, clinicians, and regulatory bodies with accurate information on IVF effectiveness including fresh and cryopreserved cycles.

Cough and airway clearance in Duchenne muscular dystrophy

People with Duchenne muscular dystrophy (DMD), develop a respiratory muscle weakness that results in weakened cough, airway clearance impairment and over time respiratory failure and death. Assessment of cough effectiveness through vital capacity, peak cough flow and maximal inspiratory and expiratory pressures has been used to identify the optimal timing of cough augmentation techniques initiation. The choice of therapies depends on physician knowledge, and patient/care giver abilities. The purpose of this review is to clarify mechanisms of action, benefits and disadvantages of available techniques, such as manual cough-assisting manoeuvres, glossopharyngeal breathing, air stacking by resuscitator bag or by volume-cycle ventilator, and mechanical insufflator-exsufflator. Mechanisms of mucus mobilization, like intrapulmonary percussive ventilation, may have a therapeutic role in the case of persistent atelectasis. It is also crucial to recognize the initial phase of an acute respiratory exacerbation, increase the use of these techniques which may reduce morbidity and mortality.

Overview of procalcitonin in pregnancy and in pre-eclampsia

Procalcitonin (PCT), a precursor for calcitonin, is a prohormone involved in the inflammatory processes, which has been poorly studied in the context of pregnancy. During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. In normal pregnancy, PCT is basally expressed at very low level by decidual cells, even if decidual macrophages, which in normal pregnancy are skewed to M2 macrophages, are resistant to lipopolysaccharide (LPS)-induced production of PCT. As PCT increase is associated with an inflammatory state, several research groups investigated whether PCT can be considered a marker of pre-eclampsia, a pregnancy disease characterized by systemic inflammation. The first aim of this review is to summarize what is already known about the tissues synthesizing PCT, about the stimuli that cause the increase of circulating PCT levels and how PCT acts as a proinflammatory stimulus by itself. Secondly, we will describe the role of this prohormone in normal pregnancy and in pregnancies complicated by pre-eclampsia, highlighting the involvement of the decidual macrophages and the proinflammatory cytokine tumor necrosis factor-α in the modulation of PCT expression in the decidual microenvironment.

The human embryo, subjectivity and legal capacity. Notes in the light of art. 1 of the Italian law on "medically assisted procreation"

AIM

This paper aims to examine the legal status of the human embryo taking into consideration Article 1 of the Italian law on medically assisted procreation, which protects the human embryo, which is recognised as an individual holding the same rights as already born children. The progressive increase in legal decisions regarding reproductive technologies requires a re-examination of the traditional legal categories of "subjectivity" and legal capacity, and a deeper understanding of the status of the human embryo as a subject, or individua.

MATERIALS AND METHODS

The following sources were searched: Institutional websites, Research Centre for Social Investments reports, updated jurisprudence and Rulings of Italian Constitutional Court and European Court of Human Rights. In addition, also the following databases were searched: PubMed and Scopus, using the following keywords: medically assisted procreation (MAP) and embryo.

RESULTS

The authors believe that the best orientation is the modern principle of equality (non-discrimination); according to them, the need to protect unborn life requires therefore the consideration of interests which can no longer be confined to the solely patrimonial ones held by the embryo. The paper draws attention to a series of non-patrimonial interests, for whose protection the legal expert has to adopt innovative safeguarding techniques. In this context, there emerge some rights worthy of protection whose potential holders are as yet unborn.

The unethicality of doping in sports

Performance enhancing drug use in sport arguably constitutes a crisis, and as such, targeted measures are needed in order to stem it. Substance abuse in professional sports and competitions has besmirched many world-class athletes' reputations and standing, in addition to jeopardizing their health. Furthermore, there are many instances of amateur athletes and school-aged competitors who have taken to using such substances as well, significantly exacerbating the overall picture. The widespread acknowledgement of the potentially life-threatening consequences of performance-enhancing drug use has prodded sports organizations and governments into cooperating on many different levels to preserve the ethical grounding and soundness of sport competitions; unlawful substance abuse is in fact liable to undermine the very core of fairness in competition. Doping, along with various forms of cheating, has been recorded throughout the history of sport: prohibition in itself is all but ineffective without reliable and systematic detection strategies and enforcement of sanctions.

Current therapeutic paradigm in pediatric atopic dermatitis: Practical guidance from a national expert panel

INTRODUCTION AND OBJECTIVES

Atopic dermatitis (AD) is the most common cutaneous inflammatory disease in both adults and children. Although emerging therapeutic approaches are being investigated for the management of pediatric AD, it still needs to be managed with conventional treatments. This consensus document is aimed at providing an update on general management and therapies of pediatric AD, defining practical recommendations for using both topical and systemic agents.

MATERIAL AND METHODS

A panel of experts consisting of dermatologists and pediatricians were convened in order to define statements, through a Delphi process, standardizing the management of AD in pediatric subjects in a real-world setting.

RESULTS

A set of practical recommendations obtaining an at least 75% agreement was presented.

CONCLUSIONS

This set of practical recommendations represents a simple and fast snapshot on the pediatric use of common anti-AD therapeutics.