Effect of Interfacial SiOx Defects on the Functional Properties of Si-Transition Metal Oxide Photoanodes for Water Splitting

The transfer of photogenerated charges through interfaces in heterojunction photoanodes is a key process that controls the efficiency of solar water splitting. Considering Co3O4/SiOx/Si photoanodes prepared by physical vapor deposition as a representative case study, it is shown that defects normally present in the native SiOx layer dramatically affect the onset of the photocurrent. Electron paramagnetic resonance indicates that the signal of defects located in dangling bonds of trivalent Si atoms at the Si/SiOx interface vanishes upon vacuum annealing at 850 °C. Correspondingly, the photovoltage of the photoanode increases to ≈500 mV. Similar results are obtained for NiO/SiOx/Si photoanodes. Photoelectrochemical analysis and impedance spectroscopy (in solution and in the solid state) indicate how the defect annealing modifies the Co3O4/SiOx/Si junction. This work shows that defect annealing at the solid-solid interface in composite photoanodes strongly improves the efficiency of charge transfer through interfaces, which is the basis for effective solar-to-chemical energy conversion.

Improved clinical utility of preimplantation genetic testing through the integration of ploidy and common pathogenic microdeletions analyses

STUDY QUESTION

Can chromosomal abnormalities beyond copy-number aneuploidies (i.e. ploidy level and microdeletions (MDs)) be detected using a preimplantation genetic testing (PGT) platform?

SUMMARY ANSWER

The proposed integrated approach accurately assesses ploidy level and the most common pathogenic microdeletions causative of genomic disorders, expanding the clinical utility of PGT.

WHAT IS KNOWN ALREADY

Standard methodologies employed in preimplantation genetic testing for aneuploidy (PGT-A) identify chromosomal aneuploidies but cannot determine ploidy level nor the presence of recurrent pathogenic MDs responsible for genomic disorders. Transferring embryos carrying these abnormalities can result in miscarriage, molar pregnancy, and intellectual disabilities and developmental delay in offspring. The development of a testing strategy that integrates their assessment can resolve current limitations and add valuable information regarding the genetic constitution of embryos, which is not evaluated in PGT providing new level of clinical utility and valuable knowledge for further understanding of the genomic causes of implantation failure and early pregnancy loss. To the best of our knowledge, MDs have never been studied in preimplantation human embryos up to date.

STUDY DESIGN, SIZE, DURATION

This is a retrospective cohort analysis including blastocyst biopsies collected between February 2018 and November 2021 at multiple collaborating IVF clinics from prospective parents of European ancestry below the age of 45, using autologous gametes and undergoing ICSI for all oocytes. Ploidy level determination was validated using 164 embryonic samples of known ploidy status (147 diploids, 9 triploids, and 8 haploids). Detection of nine common MD syndromes (-4p=Wolf-Hirschhorn, -8q=Langer-Giedion, -1p=1p36 deletion, -22q=DiGeorge, -5p=Cri-du-Chat, -15q=Prader-Willi/Angelman, -11q=Jacobsen, -17p=Smith-Magenis) was developed and tested using 28 positive controls and 97 negative controls. Later, the methodology was blindly applied in the analysis of: (i) 100 two pronuclei (2PN)-derived blastocysts that were previously defined as uniformly euploid by standard PGT-A; (ii) 99 euploid embryos whose transfer resulted in pregnancy loss.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The methodology is based on targeted next-generation sequencing of selected polymorphisms across the genome and enriched within critical regions of included MD syndromes. Sequencing data (i.e. allelic frequencies) were analyzed by a probabilistic model which estimated the likelihood of ploidy level and MD presence, accounting for both sequencing noise and population genetics patterns (i.e. linkage disequilibrium, LD, correlations) observed in 2504 whole-genome sequencing data from the 1000 Genome Project database. Analysis of phased parental haplotypes obtained by single-nucleotide polymorphism (SNP)-array genotyping was performed to confirm the presence of MD.

MAIN RESULTS AND THE ROLE OF CHANCE

In the analytical validation phase, this strategy showed extremely high accuracy both in ploidy classification (100%, CI: 98.1-100%) and in the identification of six out of eight MDs (99.2%, CI: 98.5-99.8%). To improve MD detection based on loss of heterozygosity (LOH), common haploblocks were analyzed based on haplotype frequency and LOH occurrence in a reference population, thus developing two further mathematical models. As a result, chr1p36 and chr4p16.3 regions were excluded from MD identification due to their poor reliability, whilst a clinical workflow which incorporated parental DNA information was developed to enhance the identification of MDs. During the clinical application phase, one case of triploidy was detected among 2PN-derived blastocysts (i) and one pathogenic MD (-22q11.21) was retrospectively identified among the biopsy specimens of transferred embryos that resulted in miscarriage (ii). For the latter case, family-based analysis revealed the same MD in different sibling embryos (n = 2/5) from non-carrier parents, suggesting the presence of germline mosaicism in the female partner. When embryos are selected for transfer based on their genetic constitution, this strategy can identify embryos with ploidy abnormalities and/or MDs beyond aneuploidies, with an estimated incidence of 1.5% (n = 3/202, 95% CI: 0.5-4.5%) among euploid embryos.

LIMITATIONS, REASONS FOR CAUTION

Epidemiological studies will be required to accurately assess the incidence of ploidy alterations and MDs in preimplantation embryos and particularly in euploid miscarriages. Despite the high accuracy of the assay developed, the use of parental DNA to support diagnostic calling can further increase the precision of the assay.

WIDER IMPLICATIONS OF THE FINDINGS

This novel assay significantly expands the clinical utility of PGT-A by integrating the most common pathogenic MDs (both de novo and inherited ones) responsible for genomic disorders, which are usually evaluated at a later stage through invasive prenatal testing. From a basic research standpoint, this approach will help to elucidate fundamental biological and clinical questions related to the genetics of implantation failure and pregnancy loss of otherwise euploid embryos.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was used for this study. S.C., M.F., F.C., P.Z., I.P., L.G., C.P., M.P., D.B., J.J.-A., D.B.-J., J.M.-V., and C.R. are employees of Igenomix and C.S. is the head of the scientific board of Igenomix. A.C. and L.P. are employees of JUNO GENETICS. Igenomix and JUNO GENETICS are companies providing reproductive genetic services.

TRIAL REGISTRATION NUMBER

N/A.

P–530 The use of wide thresholds for detecting intermediate chromosomal CNV up to 80% doesn’t improve PGT-A ability to discriminate true mosaic from uniformly aneuploid embryos

Study question

What is the effect of varying diagnostic thresholds on the accuracy of Next Generation Sequencing (NGS)-based preimplantation genetic testing for aneuploidies (PGT-A)?

Summary answer

When single trophectoderm biopsies are tested, the employment of 80% upper threshold increases mosaic calls and false negative aneuploidy results compared to more stringent thresholds.

What is known already

Trophectoderm (TE) biopsy coupled with NGS-based PGT-A technologies are able to accurately predict Inner Cell Mass’ (ICM) constitution when uniform whole chromosome aneuploidies are considered. However, minor technical and biological inconsistencies in NGS procedures and biopsy specimens can result in subtle variability in analytical results. In this context, the stringency of thresholds employed for diagnostic calls can lead to incorrect classification of uniformly aneuploid embryos into the mosaic category, ultimately affecting PGT-A accuracy. In this study, we evaluated the diagnostic predictivity of different aneuploidy classification criteria by employing blinded analysis of chromosome copy number values (CNV) in multifocal blastocyst biopsies.

Study design, size, duration

The accuracy of different aneuploidy diagnostic cut-offs was assessed comparing chromosomal CNV in intra-blastocysts multifocal biopsies. Enrolled embryos were donated for research between June and September 2020. The Institutional Review Board at the Near East University approved the study (project: YDU/20l9/70–849). Embryos diagnosed with uniform chromosomal alterations (single or multiple) in their clinical TE biopsy (n = 27) were disaggregated into 5 portions: the ICM and 4 TE biopsies. Overall, 135 specimens were collected and analysed.

Participants/materials, setting, methods

Twenty-seven donated blastocysts were warmed and disaggregated in TE biopsies and ICM (n = 135 biopsies). PGT-A analysis was performed using Ion ReproSeq PGS kit and Ion S5 sequencer (ThermoFisher). Sequencing data were blindly analysed with Ion-Reporter software. Intra-blastocyst comparison of raw NGS data was performed employing different thresholds commonly used for aneuploidy classification. CNV for each chromosome were reported as aneuploid according to 70% or 80% thresholds. Categorical variables were compared using Fisher’s exact test.

Main results and the role of chance

In this study, a total of 50 aneuploid patterns in 27 disaggregated embryos were explored. Single TE biopsy results were considered as true positive when they displayed the same alteration detected in the ICM at levels above the 70% or 80% thresholds. Alternatively, alterations detected in the euploid or mosaic range were considered as false negative aneuploidy results. When the 70% threshold was applied, aneuploidy findings were confirmed in 94.5% of TE biopsies analyzed (n = 189/200; 95%CI=90.37–37.22), while 5.5% showed a mosaic profile (50–70%) but uniformly abnormal ICM. Positive (PPV) and negative predictive value (NPV) per chromosome were 100.0% (n = 189/189; 95%CI=98.07–100.00) and 99.5% (n = 2192/2203; 95%CI=99.11–99.75) respectively. When the upper cut-off was experimentally placed at 80% of abnormal cells, a significant decrease (p-value=0.0097) in the percentage of confirmed aneuploid calls was observed (86.5%; n = 173/200; 95%CI=80.97–90.91), resulting in mosaicism overcalling, especially in the high range (50–80%). Less stringent thresholds led to extremely high PPV (100.0%; n = 173/173; 95%CI=97.89–100.00), while NPV decreased to 98.8% (n = 2192/2219; 95%CI=98.30–99.23). Furthermore, no additional true mosaic patterns were identified with the use of wide range thresholds for aneuploidy classification.

Limitations, reasons for caution

This approach involved the analysis of aneuploidy CNV thresholds at the embryo level and lacked from genotyping-based confirmation analysis. Moreover, aneuploid embryos with known meiotic partial deletion/duplication were not included.

Wider implications of the findings: The use of wide thresholds for detecting intermediate chromosomal CNV up to 80% doesn’t improve PGT-A ability to discriminate true mosaic from uniformly aneuploid embryos, lowering overall diagnostic accuracy. Hence, a proportion of the embryos diagnosed as mosaic using wide calling thresholds may actually be uniformly aneuploid and inadvertently transferred.

Trial registration number

N/A

P-536 Pre-selected for an award: Validation of a Next Generation Sequencing (NGS) workflow integrating simultaneous analysis of ploidy, microdeletions and de novo monogenic diseases for expanded preimplantation genetic testing (PGT)

Study question

Can major de novo genetic and chromosomal abnormalities (i.e., ploidy, microdeletions) be effectively tested on a single embryo biopsy specimen using an integrated NGS approach?

Summary answer

The integrated NGS workflow provided high accuracy for multilevel chromosome and genetic abnormalities analysis based on single biopsies expanding PGT informativity to de novo conditions.

What is known already

Current NGS-based methodologies employed in PGT for aneuploidy (PGT-A) do not detect embryo ploidy level nor frequent pathogenic de novo microdeletions below resolution limits. Moreover, despite their considerable incidence and adverse pregnancy outcomes, de novo mutations causing severe dominant monogenic fetal structural defects (FSD) are not investigated during PGT. The development of a single biopsy specimen-based PGT-A sequencing strategy that integrates ploidy and de novo microdeletions/mutations assessment would significantly widen PGT-A diagnostic scope and technical capabilities. This comprehensive approach would provide additional valuable genetic information of unquestionable clinical utility to further refine embryo selection process among those showing euploid profiles.

Study design, size, duration

Chromosomal conditions were validated using 24 embryo rebiopsies and 5 cell lines with both known ploidy level and known microdeletions (-4p; -8q; -1p; -22q; -5p; -15q; -11q). Genotyping for monogenic conditions was validated using 5 genomic DNA samples (33pg/µl) carrying known pathogenic Single Nucleotide Variants (SNVs) in COL1A1, SOS1, PTPN11, TSC2 and FGFR2 genes. To assess technical performance across identified SNPs, genotyping accuracy was evaluated on 17 samples from 5 embryos and 2 cell lines.

Participants/materials, setting, methods

Thirty-two de novo dominant monogenic conditions with FSD and strong gene-disease relationship were tested using a multiplex PCR panel with sequencing for the genes’ whole coding region. Eight common microdeletions ( < 10Mb) syndromes (Wolf-Hirshorn, Langer-Geidion, 1p36 deletion, De George, Cri-du-Chat, Prader-Willy/Angelman, Jacobsen) were tested using B-allelic frequency (BAF) of 356 highly polymorphic Single Nucleotide Polymorphisms (SNPs). These SNPs were also used for ploidy assessment. Library preparation and sequencing were performed on the IonTorrent S5 (ThermoFisher).

Main results and the role of chance

Blinded NGS data analysis confirmed the ploidy status in all (19) samples with known constitution (8 diploids, 7 polyploids, 4 haploids). Specifically, the proportion of heterozygote calls (BAF 40%-60%) was 60.9% (95%CI:47.6-72.8) for diploid samples and < 1% for haploid samples(P < 0.001). All polyploid samples showed a typical splitting of BAF among 3 experimental ranges (20-40%,40%-60%,60-80%): 34.1%,18.2% and 47.7%, respectively. For microdeletions, all interstitial SNPs genotyped showed a loss of heterozygosity (LOH) as expected. The analysis of positive controls consisting of 20 blastocyst rebiopsies and 3 cell lines (-4p: n = 3; -8q: n = 4; -1p: n = 5; -22q: n = 3; -5p: n = 2; -15q: n = 4; -11q: n = 2), allowed to accurately characterize 6 out of the 7 microdeletions (18/23 samples). In particular, all interstitial SNPs genotyped showed a LOH, while diploid controls showed an overall heterozygosity of 30.9% (average number of hetSNP x deletion = 9/28). Only the very small telomeric 1p36 region failed to properly amplify. For monogenic conditions, sequencing analysis of 5 positive gDNA controls confirmed the presence of 4 known SNVs, whilst only 1 did not achieve the minimum coverage for variant calling. Moreover, 4 additional de novo SNVs detected by sequencing analysis in the gene panel on 8 blastocyst rebiopsies were all confirmed by qPCR/Taqman assays.

Limitations, reasons for caution

Positive controls were not available for all genes and microdeletions included in the panel. Moreover, inefficient amplification has affected some target regions and further optimization will be required. However, analytical performance on technical and biological replicates were highly promising for the tested conditions both cell lines and trophectoderm biopsies.

Wider implications of the findings

This study demonstrates that the integration of genotyping and chromosomal analyses can be efficiently achieved in the same NGS workflow. This approach can be employed to expand PGT diagnostic scope to conditions undetectable in parents due to their de novo onset, or that are below the standard PGT-A resolution.

Trial registration number

N/A

P–536 Validation of a Next Generation Sequencing (NGS) workflow integrating simultaneous analysis of ploidy, microdeletions and de novo monogenic diseases for expanded preimplantation genetic testing (PGT)

Study question

Can major de novo genetic and chromosomal abnormalities (i.e., ploidy, microdeletions) be effectively tested on a single embryo biopsy specimen using an integrated NGS approach?

Summary answer

The integrated NGS workflow provided high accuracy for multilevel chromosome and genetic abnormalities analysis based on single biopsies expanding PGT informativity to de novo conditions.

What is known already

Current NGS-based methodologies employed in PGT for aneuploidy (PGT-A) do not detect embryo ploidy level nor frequent pathogenic de novo microdeletions below resolution limits. Moreover, despite their considerable incidence and adverse pregnancy outcomes, de novo mutations causing severe dominant monogenic fetal structural defects (FSD) are not investigated during PGT. The development of a single biopsy specimen-based PGT-A sequencing strategy that integrates ploidy and de novo microdeletions/mutations assessment would significantly widen PGT-A diagnostic scope and technical capabilities. This comprehensive approach would provide additional valuable genetic information of unquestionable clinical utility to further refine embryo selection process among those showing euploid profiles.

Study design, size, duration

Chromosomal conditions were validated using 24 embryo rebiopsies and 5 cell lines with both known ploidy level and known microdeletions (–4p; –8q; –1p; –22q; –5p; –15q; –11q). Genotyping for monogenic conditions was validated using 5 genomic DNA samples (33pg/µl) carrying known pathogenic Single Nucleotide Variants (SNVs) in COL1A1, SOS1, PTPN11, TSC2 and FGFR2 genes. To assess technical performance across identified SNPs, genotyping accuracy was evaluated on 17 samples from 5 embryos and 2 cell lines.

Participants/materials, setting, methods

Thirty-two de novo dominant monogenic conditions with FSD and strong gene-disease relationship were tested using a multiplex PCR panel with sequencing for the genes’ whole coding region. Eight common microdeletions (<10Mb) syndromes (Wolf-Hirshorn, Langer-Geidion, 1p36 deletion, De George, Cri-du-Chat, Prader-Willy/Angelman, Jacobsen) were tested using B-allelic frequency (BAF) of 356 highly polymorphic Single Nucleotide Polymorphisms (SNPs). These SNPs were also used for ploidy assessment. Library preparation and sequencing were performed on the IonTorrent S5 (ThermoFisher).

Main results and the role of chance

Blinded NGS data analysis confirmed the ploidy status in all (19) samples with known constitution (8 diploids, 7 polyploids, 4 haploids). Specifically, the proportion of heterozygote calls (BAF 40%–60%) was 60.9% (95%CI:47.6–72.8) for diploid samples and <1% for haploid samples(P < 0.001). All polyploid samples showed a typical splitting of BAF among 3 experimental ranges (20–40%,40%–60%,60–80%): 34.1%,18.2% and 47.7%, respectively. For microdeletions, all interstitial SNPs genotyped showed a loss of heterozygosity (LOH) as expected. The analysis of positive controls consisting of 20 blastocyst rebiopsies and 3 cell lines (–4p: n = 3; –8q: n = 4; –1p: n = 5; –22q: n = 3; –5p: n = 2; –15q: n = 4; –11q: n = 2), allowed to accurately characterize 6 out of the 7 microdeletions (18/23 samples). In particular, all interstitial SNPs genotyped showed a LOH, while diploid controls showed an overall heterozygosity of 30.9% (average number of hetSNP x deletion=9/28). Only the very small telomeric 1p36 region failed to properly amplify. For monogenic conditions, sequencing analysis of 5 positive gDNA controls confirmed the presence of 4 known SNVs, whilst only 1 did not achieve the minimum coverage for variant calling. Moreover, 4 additional de novo SNVs detected by sequencing analysis in the gene panel on 8 blastocyst rebiopsies were all confirmed by qPCR/Taqman assays.

Limitations, reasons for caution

Positive controls were not available for all genes and microdeletions included in the panel. Moreover, inefficient amplification has affected some target regions and further optimization will be required. However, analytical performance on technical and biological replicates were highly promising for the tested conditions both cell lines and trophectoderm biopsies.

Wider implications of the findings: This study demonstrates that the integration of genotyping and chromosomal analyses can be efficiently achieved in the same NGS workflow. This approach can be employed to expand PGT diagnostic scope to conditions undetectable in parents due to their de novo onset, or that are below the standard PGT-A resolution.

Trial registration number

N/A

Clinical validity and utility of preconception expanded carrier screening for the management of reproductive genetic risk in IVF and general population

STUDY QUESTION

What is the clinical validity and utility of preconception Expanded Carrier Screening (ECS) application on the management of prospective parents?

SUMMARY ANSWER

The high detection rate of at-risk couples (ARCs) and the high proportion opting for IVF/preimplantation genetic testing (PGT) treatment demonstrate the clinical utility of ECS in the preconception space in IVF and general population.

WHAT IS KNOWN ALREADY

About 2-4% of couples are at risk of conceiving a child with an autosomal recessive or X-linked genetic disorder. In recent years, the increasing cost-effectiveness of genetic diagnostic techniques has allowed the creation of ECS panels for the simultaneous detection of multiple recessive disorders. Comprehensive preconception genetic screening holds the potential to significantly improve couple's genetic risk assessment and reproductive planning to avoid detectable inheritable genetic offspring.

STUDY DESIGN, SIZE, DURATION

A total of 3877 individuals without a family history of genetic conditions were analyzed between January 2017 and January 2020. Of the enrolled individuals, 1212 were gamete donors and 2665 were patients planning on conceiving from both the IVF and the natural conception group. From the non-donor cohort, 1133 were analyzed as individual patients, while the remaining ones were analyzed as couples, for a total of 766 couples.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A focused ECS panel was developed following American College of Obstetrics and Gynecology ACOG-recommended criteria (prevalence, carrier rate, severity), including highly penetrant severe childhood conditions. Couples were defined at-risk when both partners carried an autosomal recessive pathogenic/likely pathogenic variant (PLP) on the same gene or when the woman was a carrier of an X-linked PLP variant. ARC detection rate defined the clinical validity of the ECS approach. Clinical utility was evaluated by monitoring ARCs reproductive decision making.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 402 individuals (10.4%) showed PLP for at least one of the genes tested. Among the 766 couples tested, 173 showed one carrier partner (22.6%), whereas 20 couples (2.6%) were found to be at increased risk. Interestingly, one ARC was identified as a result of cascade testing in the extended family of an individual carrying a pathogenic variant on the Survival Of Motor Neuron 1SMN1 gene. Of the identified ARCs, 5 (0.7%) were at risk for cystic fibrosis, 5 (0.7%) for fragile X syndrome, 4 (0.5%) for spinal muscular atrophy, 4 (0.5%) for Beta-Thalassemia/Sickle Cell Anemia, 1 (0.1%) for Smith-Lemli-Opitz Syndrome and 1 (0.1%) for Duchenne/Becker Dystrophy. Fifteen ARCs were successfully followed up from both the IVF and the natural conception groups. All of these (15/15) modified their reproductive planning by undergoing ART with Preimplantation Genetic Testing for Monogenic disease and Aneuploidies (PGT-M and PGT-A). To date, 6/15 (40%) couples completed their PGT cycle with euploid/unaffected embryos achieving a pregnancy after embryo transfer and three of them have already had an unaffected baby.

LIMITATIONS, REASONS FOR CAUTION

The use of a limited panel of core gene-disease pairs represents a limitation on the research perspective as it can underestimate the rate of detectable carriers and ARCs in this cohort of prospective parents. Expanding the scope of ECS to a larger panel of conditions is becoming increasingly feasible, thanks to a persistent technological evolution and progressive cataloging of gene-disease associations.

WIDER IMPLICATIONS OF THE FINDINGS

These results highlight the potential clinical validity and utility of ECS in reducing the risk of a pregnancy affected by a detectable inheritable genetic condition. The steady reduction in the costs of genetic analyses enables the expansion of monogenic testing/screening applications at the preimplantation stage, thus, providing valid decisional support and reproductive autonomy to patients, particularly in the context of IVF.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was used for this study. A.C., M.F., S.C., M.P., L.G., and C.P. are employees of Igenomix Italy. C.S. is the head of the scientific board of Igenomix.

TRIAL REGISTRATION NUMBER

N/A.

Alexithymia, recognition of facial emotion and inference in patients with Eating Disorders (ED) or Substance Abuse Disorders (SAD)

Alexythimia is a psychological construct characterized by difficulty describing emotions and distinguishing them from somatic components of the emotional activation. Patients with eating disorders (ED) or substance use disorders (SAD) commonly present also impairment of recognition of facial expressions and deficits in social inference. Patients with ED and SAD may present impulsiveness, difficulty in emotion-focused coping skills, and search for a concrete relief from psychological suffering. The purpose of study is to compare the ED, SAD and healthy controls (HC), in several variables, including Alexythimia, empathy, and ability to recognize emotions, social inference. Thirty-two patients with ED, 27 patients with SAD and 31 HC were recruited between September 2016 and April 2016 at the psychiatric ward of Novara Hospital, nursing home of Nebbiuno and the nursing home of Viverone. We administrated to patients the same battery of tests, composed by Toronto Alexithymia Scale-20 (TAS-20), Facial Emotion Identification Test (FEIT), the awareness of Social Inference Test (TASIT), temperament and Character Inventory (TCI), Interpersonal Reactivity Index (IRI), Symptoms Checklist-90 (SCL-90). The two clinical groups showed differences in TAS, FEIT and TASIT, highlighting Alexythimic tracts, difficulty in recognizing emotions and deficit of social inference, compared to HCs. The TCI and SCL-90 have also highlighted the common psychopathological characteristics and temperamental in patients with ED and SAD. Alexythimia is particularly represented in patients with ED and SAD, and could represent a maintenance factor, together with deficits in emotions recognition and social inference. The similarities between ED and TD seem to suggest the possibility of shared core features.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparison between patients with depressive disorders and healthy controls in resilience and coping skills

Introduction

Resilience in the psychiatric field, it is defined as the ability to recover from perceived adverse or changing situations through a dynamic process of adaptation. This process is influenced by personal characteristics, family and social resources and is expressed by positive coping skills. It is well known that resilience has an inverse relation with depression, however, the specific role of resilience in disorders like depression, personality disorders and psychosis is not fully understood.

Objectives

Compare differences in resilience and coping skills in a sample of patients with depressive disorder in acute phase versus healthy controls.

Methods

We are conducting a cohort study to the date we recruited 82 inpatients admitted in our psychiatric ward. The data have been gathered from the 1st December 2014 and they will continue to be collected until the 1st December 2016, the healthy controls are represented by 67 subjects with similar socio-demographic features.

Inclusion criteria are: diagnosis of depressive disorders or dysthymia according to DSM-IV-TR diagnostic criteria, age > 18 years, proper understanding of Italian language, willingness to give written informed consent. We compared them with healthy controls with similar socio-demographic features.

Patients’ assessment includes the following tests:

– Resilience Scale for Adults (RSA);

– Brief-COPE Scale (Brief-COPE);

– Statistical analysis will be performed using SPSS for Windows, 21.0 (Armonk, NY: IBM Corporation).

Results

Data collection is still ongoing.

Conclusions

From a preliminary analysis of data, we assume that the levels of resilience and coping of our patients is reduced compared with controls, however the recruitment during the acute phase could significantly influence final results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Psycho-geriatric Patient in the Emergency Room (ER) of the Maggiore della Carità Hospital in Novara

Introduction

Due to population aging, the health system will face increasing challenges in the next years. Concerning mental disorders, they are major public health issues in late life, with mood and anxiety disorders being some of the most common mental disorder among the elderly. For this reason, increasing attention has to be paid to the evaluation of the elderly in psychiatry emergency settings.

Objectives

To evaluate the socio-demographic and clinical features of over 65 patients referred to psychiatric consultations in the ER of “Maggiore della Carità” Hospital in Novara, in a 7 years period.

Aims

The analysis of the characteristics of the study sample could be potentially useful in resource planning in order to better serve this important segment of the general population.

Methods

Determinants of ER visits for over 65 patients referred to psychiatric evaluation were studied retrospectively from 2008 to 2015.

Results

Elderly patients made up 14,7% (n = 458) of all psychiatric evaluation in the ER (n = 3124). About two thirds (65,9%) were females and one third were males (34,1%). The mean age of patients recruited was 75.11 years. The majority of subjects (68.6%) presented without a diagnosis of Axis I according to DSM-IV. The other most frequent diagnosis was “cognitive disorders” (11.4%) and “mood disorders” (10.9%).

Conclusions

The large proportion of patients without a diagnosis of Axis I, could be related to the misunderstanding of the psychosocial aspects of aging. Preliminary results highlight the importance of research on this topic, considering population aging and the impact of mental disorders in late-life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Anger Expression, Impulsivity And Expressed Emotion: a Comparison Between Patients With Eating Disorder And Schizophrenia

Introduction

The level of express emotion (EE) is a measure of the attitude of close relatives towards a patient and include dimensions as critical comments, hostility and emotional over-involvement. Anger and impulsivity may lead to self-injurious and aggressive behaviours, and often represent an obstacle to treatment.

Aims

To compare anger expression, impulsivity and expressed emotion in ED and SCHZ, and to explore the different level of caregivers’ EE in the two groups.

Methods

Twenty-five female with ED diagnosis and 25 patients with schizophrenia, were recruited at the Psychiatry Ward and outpatient Service of AOU – Novara, during one year period. Patient's assessment included Global Assessment of Functioning (GAF), Structured Clinical Interview (SCID 1-2), Level of Expressed Emotion Scale (LEE), Paykel scale, State and Trait Anxiety Inventory (STAY 1-2), State-Trait Anger Expression Inventory (STAXY), Barratt Impulsiveness Scale (BIS-11).

Results

Levels of anxiety (both state and trait) are higher in the ED group than in SCHZ. As far as the STAXY is concerned, SCHZ patients score higher than ED ones on control over anger, while general index of anger expression was higher in ED patients. We did not find significant differences in EE between two groups, except for the patient's emotional response of the patient to the disease, which was greater among SCHZ. Both SCHZ and ED patients scored higher on the LEE, Paykel and STAY than their caregivers.

Conclusions

SCHZ and ED patients show different patterns of anxiety and anger, but similar profile as far as EE is concerned. Implications for treatment will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Could whey be responsible for the development of cow's milk allergy in newborns and infants?]

Cow's milk allergy is the most common type of food allergy in infants. Most infants develop symptoms one week after initiating the feeding of cow's milk based formulas though sensitisation in utero and via mother's milk are also possible. We report on three newborns who received whey baths after birth and developed allergic skin reactions. Cow's milk allergy was diagnosed. In our opinion the whey baths could be responsible for the sensitisation via skin and the allergic skin reactions. The risks and benefits of whey baths for newborns and infants should therefore be carefully considered.

Vascular trauma induces rapid but transient mobilization of VEGFR2(+)AC133(+) endothelial precursor cells

Bone marrow (BM)-derived circulating endothelial precursor cells (CEPs) are thought to play a role in postnatal angiogenesis. Emerging evidence suggests that angiogenic stress of vascular trauma may induce mobilization of CEPs to the peripheral circulation. In this regard, we studied the kinetics of CEP mobilization in two groups of patients who experienced acute vascular insult secondary to burns or coronary artery bypass grafting (CABG). In both burn and CABG patients, there was a consistent, rapid increase in the number of CEPs, determined by their surface expression pattern of vascular endothelial growth factor receptor 2 (VEGFR2), vascular endothelial cadherin (VE-cadherin), and AC133. Within the first 6 to 12 hours after injury, the percentage of CEPs in the peripheral blood of burn or CABG patients increased almost 50-fold, returning to basal levels within 48 to 72 hours. Mobilized cells also formed late-outgrowth endothelial colonies (CFU-ECs) in culture, indicating that a small, but significant, number of circulating endothelial cells were BM-derived CEPs. In parallel to the mobilization of CEPs, there was also a rapid elevation of VEGF plasma levels. Maximum VEGF levels were detected within 6 to 12 hours of vascular trauma and decreased to baseline levels after 48 to 72 hours. Acute elevation of VEGF in the mice plasma resulted in a similar kinetics of mobilization of VEGFR2(+) cells. On the basis of these results, we propose that vascular trauma may induce release of chemokines, such as VEGF, that promotes rapid mobilization of CEPs to the peripheral circulation. Strategies to improve the mobilization and incorporation of CEPs may contribute to the acceleration of vascularization of the injured vascular tissue.

Effect of heparin, platelets, activated platelets, platelet fragments, and hematocrit on activated clotting time

Activated clotting time (ACT) is the most commonly used laboratory test to control the heparin effect during extracorporeal techniques. The study was undertaken in order to test in vitro the influence of heparin, platelet count, hematocrit, platelet fragmentation, and platelet activation on ACT. Blood was drawn from volunteer donors into syringes containing citrate. Platelet counts and hematocrit were modified. Platelets were fragmented by sonifier or activated by collagen and adenosine diphosphate (ADP). Different heparin final concentrations were created. Increasing concentrations of heparin had a significant effect on ACT. However, it was not predictable in every case in concentrations lower than 1.0 U/ml. Platelet count generally had no significant effect on ACT. The effect of hematocrit was detectable in a group but not in single cases. Fragmented platelets significantly shortened ACT only without addition of heparin, and the effect was only partly predictable. Activation of platelets by collagen and ADP induced no significant changes. Our results show that heparin is reflected by ACT but that effect is not predictable in every specific patient. Our results also show that other variables that may be altered during extracorporeal techniques such as platelet count, hematocrit, activation, and fragmentation of platelets do not severely influence the ACT.

A t(2;19)(p13;p13.2) in a giant invasive cardiac lipoma from a patient with multiple lipomatosis

Cardiac lipomas occur infrequently but account for a significant portion of rare cardiac tumors. Common cutaneous lipomas have previously been associated with rearrangements of chromosome band 12q15, which often disrupt the high-mobility-group protein gene HMGIC. In this report, we describe the cytogenetic analysis of an unusual giant cardiac lipoma that exhibited myocardial invasion in a patient with a history of multiple lipomatosis (cutaneous lipoma, lipomatous gynecomastia, lipomatous hypertrophy of the interatrial septum, and dyslipidemia). Cytogenetic studies of cells derived from the cardiac lipoma demonstrated no abnormalities of chromosome 12, but did reveal a t(2;19)(p13;p13.2). A liposarcoma-derived oncogene (p115-RhoGEF) previously mapped to chromosome 19 and the low-density lipoprotein receptor gene (LDLR) previously mapped to chromosome band 19p13 were evaluated to determine whether they were disrupted by this translocation. Fluorescence in situ hybridization analyses assigned p115-RhoGEF to chromosome 19 in bands q13.2-q13.3 and mapped the LDLR to chromosome arm 19p in segment 13.2, but centromeric to the t(2;19) breakpoint. Thus, these genes are unlikely to be involved in the t(2;19)(p13;p13.2). Further studies of the regions of chromosomes 2 and 19 perturbed by the translocation in this unusual infiltrating cardiac lipoma will identify gene(s) that participate in adipocyte growth and differentiation and may provide insight into syndromes of multiple lipomatosis.

Repair of traumatic aortic valve disruption and descending aortic transection

Traumatic aortic transection after acute deceleration injury remains a highly lethal condition. Concomitant aortic valve disruption is exceedingly rare, and can complicate the timing of surgical management. This report describes the management and outcome of a patient with these types of injuries.

En bloc esophagectomy improves survival for stage III esophageal cancer

OBJECTIVE

The role of en bloc esophagectomy in the surgical treatment of patients with locally advanced esophageal cancer is not well defined. This report attempts to elucidate its impact on survival, in comparison with less extensive resection, among patients with stage III disease.

METHODS

A prospectively established database was retrospectively analyzed.

RESULTS

One hundred twenty-eight patients underwent esophagectomy for carcinoma of the thoracic esophagus between 1988 and 1996 (78 underwent en bloc resection and 50 underwent standard resection). The 30-day and hospital mortality rates were 3.9% and 5.4%, respectively, comparable for the two procedures. Fifty-four patients had stage III disease. Overall 4-year survival was 34.5% after en bloc resection, with a median survival of 27 months (n = 33), and 11% after standard resection (n = 21), with a median survival of 12 months (p = 0.007). Among patients with stage III disease undergoing a complete resection, 4-year survivals were 36.7% and 0% after en bloc and standard resections, respectively (p = 0.001). Eighty-six of 128 patients had nodal metastasis. Three-year survivals for patients with NI disease were 33.9% and 13% after en bloc and standard resections, respectively (p = 0.02).

CONCLUSION

Among patients with stage III esophageal cancer, en bloc resection appears to significantly improve survival compared with lesser resections. This improvement in survival may be attributable to resection of nodal disease.

Squamous cell carcinoma of the esophagus: therapeutic dilemma

Seventy-five patients with squamous cell carcinoma of the esophagus were evaluated over a 5-year period. Most of the patients had advanced-stage cancer when first seen. Only 50% were surgically explored, and 33% underwent resection. Operative mortality was 8%. Despite the immediate and durable palliation provided by surgical resection, survival rates were poor. Early diagnosis and aggressive surgical resection are the main hopes for improved long-term results.

Recurrent systemic embolization caused by aortic thrombi

The aorta is a commonly unrecognized source of systemic embolization. Transesophageal echocardiography is a reliable method for visualization of the intima of the thoracic aorta and identification of aortic thrombi. Balloon embolectomy of the aorta can be used to remove thrombi and prevent further embolic events.