Levodopa-carbidopa intestinal gel infusion (LCIG) in Parkinson disease with genetic mutations

BACKGROUND

Levodopa-carbidopa intestinal gel infusion (LCIG) is a therapeutic option for advanced Parkinson disease (PD) patients with troublesome motor complications, unresponsive to conventional oral treatment. There is some evidence to suggest that the genetic background may influence the clinical presentation and rate of progression of PD. Whether the genetic background influences the outcome of device-assisted therapies is currently debated. Some studies have investigated the effectiveness of deep brain stimulation (DBS) in PD patients with different genetic background, while evidence is lacking regarding LCIG.

METHODS

A cohort of LCIG patients underwent genetic testing. The motor and neuropsychological outcomes of LCIG were retrospectively analyzed.

RESULTS

Fifty-six patients were analyzed, nine of them (15%) had at least one mutation/variant in a PD-associated gene: five GBA1, two SNCA, one LRRK2, one PRKN; 13 (23%) carried the BDNF Val66Met polymorphism. The mean duration of follow-up was 4.9 ± 2.6 years. There were no significant differences in motor or neuropsychological outcomes between patients with and without these gene mutations/variants. No cognitive worsening was observed at follow-up among GBA-PD patients, and they responded well to LCIG in terms of motor symptoms.

CONCLUSIONS

Overall, we observed a significant benefit in terms of motor complications in our cohort, including patients carrying genetic mutations/variants. Due to the small sample and limited number of patients carrying genetic mutations/variants, no definitive conclusions can be drawn yet on the genotype impact on LCIG outcome. A careful selection of patients, regardless of the genetic background, is pivotal for an optimal outcome of LCIG.

Vertical Mental Timeline Is Not Influenced by VisuoSpatial Processing

The results examining the direction (bottom-to-top vs. top-to-bottom) of the mental vertical timeline are not conclusive. The visuospatial processing of temporal stimuli along vertical space could influence this time representation. This study aimed to investigate whether and how the visuospatial processing stage modulated the vertical timeline in an online temporal categorization task. In three studies, Italian university students (N = 150) responded more quickly to words expressing the past with a down arrow key, and more quickly to words expressing the future with an up arrow key, irrespective of whether the words were located in the top, middle, or bottom space (Experiment 1), or were presented downward (from top to bottom; Experiment 2A) or upward (from bottom to top Experiment 2B). These results suggest that the representation of time was not influenced by the visuospatial processing. The daily experience with verticality (e.g., to reach the attic, the lift goes up) could explain the bottom-to-top direction of the mental timeline.

An overview on pure autonomic failure

Pure autonomic failure (PAF) is a neurodegenerative disease affecting the sympathetic component of the autonomic nervous system and presenting as orthostatic hypotension (OH). It is a rare, sporadic disease of adults. Although OH is the primary symptom, the autonomic dysfunction may be more generalised, leading to genitourinary and intestinal dysfunction and sweating disorders. Autonomic symptoms in PAF may be similar to those observed in other autonomic neuropathies that need to be ruled out. PAF belongs to the group of α synucleinopathies and is characterised by predominant peripheral deposition of α-synuclein in autonomic ganglia and nerves. However, in a significant number of cases, PAF may convert into another synucleinopathy with central nervous system involvement with varying prognosis: Parkinson's disease (PD), multiple system atrophy (MSA), or dementia with Lewy bodies (DLB). The clinical features, the main differential diagnoses, the risk factors for "phenoconversion" to another synucleinopathy as well as an overview of treatment will be discussed.

The Mechanisms of Sleep Function and Regulation for Health and Cognitive Performance

Although we spend about one third of our life sleeping, the function and regulation of sleep remain scientific enigmas [...].

The combination of the horizontal and vertical dimensions in mental time representation: the existence of a spatial mental map of time

Horizontal and vertical representations of time (past-left or down and future-right or top) have been demonstrated. However, only a few studies have investigated the existence of a spatial map of time, considering it as the interaction of different spatial dimensions in space. The aim of this study was to investigate the existence of a mental time representation along the diagonal axes, intended as the combination of the horizontal and the vertical dimensions. Seventy-nine Italian participants (85% females; mean age = 25.11 ± 4.86 years; 77 right-handed) performed an online temporal judgment task using 20 Italian temporal expressions presented either always in the center (Experiment 1) or in the four corners of the screen (Experiment 2) and two pairs of response keys ("C" and "U" for the positive diagonal; "R" and "N" for the negative diagonal). Results showed spatial-temporal associations in positive (i.e., time was represented from left-bottom to right-top) and negative (i.e., time was represented from left-top to right-bottom) diagonals, although in Experiment 2 these associations were weak for the negative diagonal. These spatial-temporal associations along both diagonals were confirmed even when participants were free to place different temporal stimuli along a diagonally drawn line, in a Time-to-Position task, indicating that the temporal expressions could be ordered linearly along the diagonal spaces. Finally, these data indicated that the horizontal information was mainly used for determining the spatial-temporal associations along both diagonals, whereas the vertical information was flexible with a bottom-to-top (for positive diagonal) and top-to-bottom (for negative diagonal) temporal representation.

Mindfulness, Subjective Cognitive Functioning, Sleep Timing and Time Expansion during COVID-19 Lockdown: A Longitudinal Study in Italy

During the COVID-19 lockdown, a distortion of time passage has been widely reported in association with a change in daily rhythm. However, several variables related to these changes have not been considered. The purpose of the present study was to assess the changes in dispositional mindfulness, time experience, sleep timing and subjective memory functioning. A longitudinal study was conducted on 39 Italian adults (53.85% males; 35.03 ± 14.02 years) assessing mindfulness, ad hoc questions of sleep habits during workdays and free days, chronotypes, subjective time experience, and memory functioning before (December 2019-March 2020) and during (April 2020-May 2020) the first Italian COVID-19 lockdown. Participants reported delayed sleep timing, a slowdown in the perception of the present time, a decrease of time pressure, and an increase in the feeling of time expansion/boredom. In addition to correlations between mindfulness, memory functioning, and subjective sleep duration during workdays, a mediation model showed that changes in the dispositional mindfulness determined a delay of bedtime during workdays through the mediation effect of increased feeling of time expansion/boredom. This finding highlighted the role of mindfulness in reducing the feeling of time expansion/boredom for regulating the sleep timing. The theoretical and practical implications of the findings are discussed.

The Italian Validation of the Zimbardo Time Perspective Inventory and Its Comparison with Three Time Perspective Inventories

The Zimbardo time perspective inventory (ZTPI) is the most well-known and widely used measure of time perspective. However, the assessment of the psychometric properties of the ZTPI reveals several problems, and various short versions have been proposed to overcome these problems. In a large Italian sample (N = 2295; 1326 women; age range 18-74 years), the present study aimed to test a short version of the ZTPI (ZTPI-16) defined by high frequency items (i.e., "good" items), reviewing the items composition of previous alternative short versions of the scale. Beyond the assessment of the factorial structure of this new short ZTPI, we compared the ZTPI-16 to the original ZTPI (ZTPI-56) and another already validated version of the ZTPI in the Italian context, such as Zimbardo's Stanford time perspective inventory (ZTPI-22), the short version of the ZTPI (ZTPI-30), and the ZTPI-36 proposed analyzing the data from 24 countries. The results confirmed the psychometric problems of the ZTPI-56, whereas the ZTPI-16 reported adequate structural validity and reliability. Moderate-to-strong correlations between same temporal subscales in different ZTPI versions were also found. These data suggest that the review of the "good" items is a new direction in the development of ZTPI versions with good psychometric properties and comparable data among cultures.

Study of antibiotic resistance in freshwater ecosystems with low anthropogenic impact

This study aimed to investigate the bacterial diversity and the background level of antibiotic resistance in two freshwater ecosystems with low anthropogenic impact in order to evaluate the presence of natural antimicrobial resistance in these areas and its potential to spread downstream. Water samples from a pre-Alpine and an Apennine river (Variola and Tiber, respectively) were collected in three different sampling campaigns and bacterial diversity was assessed by 16S sequencing, while the presence of bacteria resistant to five antibiotics was screened using a culturable approach. Overall bacterial load was higher in the Tiber River compared with the Variola River. Furthermore, the study revealed the presence of resistant bacteria, especially the Tiber River showed, for each sampling, the presence of resistance to all antibiotics tested, while for the Variola River, the detected resistance was variable, comprising two or more antibiotics. Screening of two resistance genes on a total of one hundred eighteen bacterial isolates from the two rivers showed that bla_TEM, conferring resistance to β-lactam antibiotics, was dominant and present in ~58 % of isolates compared to only ~9 % for mefA/E conferring resistance to macrolides. Moreover, β-lactam resistance was detected in various isolates showing also resistance to additional antibiotics such as macrolides, aminoglycosides and tetracyclines. These observations would suggest the presence of co-resistant bacteria even in non-anthropogenic environments and this resistance may spread from the environment to humans and/or animals.

Gender composition of pairs influences joint action effect

Research on joint action has demonstrated that individuals are sensitive to a coactor's attentional relation to jointly attend stimuli. It has also been suggested that some features are necessary to resolve the discrimination problem (i.e., self-own and other-own actions). In the present study, we aimed to test whether the gender composition of interacting pairs modulated the joint action effect. Same- (female-female or male-male) and mixed- (female-male) gender pairs performed a joint version of flanker tasks in Experiment 1 (90 participants, 50% males), while in Experiment 2 (154 participants, 50% males) Navon tasks were performed. In Experiment 1, a higher joint flanker effect in same-gender pairs than in mixed-gender pairs, and this joint effect was similar to the classical flanker effect reported by males and females in a classical procedure of the task (70 participants, 50% males). In Experiment 2, the same-gender pairs reported a joint Navon effect, which was reversed in mixed-gender pairs. In conclusion, our findings support how the gender composition of interacting pairs plays a role in joint attentional tasks.

Attentional Bias for Sleep-Related Words as a Function of Severity of Insomnia Symptoms

Attentional bias to sleep-related information is thought to be a core feature for developing and/or maintaining insomnia. This study used a hallmark measure of attentional bias, the dot-probe task, to determine whether this bias toward sleep-related stimuli was a function of the severity of insomnia symptoms. A sample of 231 volunteers (175 females; mean age of 26.91 ± 8.05 years) participated in this online study, filling out the Insomnia Severity Index (ISI) and performing a visual dot-probe task. After categorizing individuals based on the ISI score into normal, subclinical, and moderate/severe sleep groups, we only found a marginally significant interaction between sleep groups and the type of stimuli on RTs, suggesting that subclinical and moderate/severe sleep groups reported slower RTs for sleep-related words than for neutral words. When we calculated the attentional bias score (ABS), we found that ABS significantly differed from zero in the moderate/severe sleep group only, suggesting a disengagement for sleep-related information as a function of the severity of insomnia symptoms. This finding seems to suggest that insomnia is related to greater difficulties in shifting away from sleep-related stimuli.

BORN study: a multicenter randomized trial investigating cord blood red blood cell transfusions to reduce the severity of retinopathy of prematurity in extremely low gestational age neonates

BACKGROUND

Extremely low gestational age neonates (ELGANs, i.e., neonates born before 28 weeks of gestation) are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP.

METHODS/DESIGN

BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent, and randomization take place at 10 neonatology intensive care units (NICUs) of 8 Italian tertiary hospitals. ELGANs with gestational age at birth comprised between 24+0 and 27+6 weeks are randomly allocated into two groups: (1) standard RBC transfusions (adult-RBCs) (control arm) and (2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of postmenstrual age, which occurs first.

DISCUSSION

BORN is a groundbreaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would become the preferential blood product to be used in severely preterm neonates.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05100212. Registered on October 29, 2021.

Carboxymethyl Cellulose-Based Hydrogel Film Combined with Umbilical Cord Blood Platelet gel as an Innovative Tool for Chronic Wound Management: A Pilot Clinical Study

Treatment of chronic leg ulcers remains a major challenge and it is a substantial financial burden on individuals, families, caregivers, and health care system. There is increasing evidence on using of autologous Platelet-rich-plasma in wound repair but limited clinical data are available on the efficacy and safety of the use of umbilical cord blood platelet gel (CBPG). In our pilot study, for the first time, we aimed to evaluated the safety and efficacy of the use of umbilical CBPG combined with a hydrogel dressing in 10 patients with chronic venous ulcers (VU). The protocol consisted of application of umbilical cord blood platelet-rich plasma (PRP) combined with a Carboxymethyl cellulose (CMC)-based hydrogel dressing once a week for 4 weeks. The 80% of patients after 4 weeks of treatment had a significantly decrease in wound size. Moreover, we obtained an improvement in terms of mean Wound Bed Score (WBS), numeric rating scale (NRS) value and the EQ-5D index score. This pilot study showed that the topically therapeutic administration of umbilical CBPG associated with a CMC-based hydrogel dressing has the potential to accelerate the healing of chronic lesions without adverse reaction. However, additional studies with larger sample size and longer follow-up periods are required to confirm our findings.

Insomnia, Time Perspective, and Personality Traits: A Cross-Sectional Study in a Non-Clinical Population

Insomnia disorder is considered a public health problem and additional studies should investigate predisposing and perpetuating factors. This study examined the relationship between Big Five personality traits, time perspective, and insomnia. In a cross-sectional study, 400 participants (227 women; age range 18-74 years) were administered the Big Five Inventory-10 items, the Zimbardo Time Perspective Inventory, and the Insomnia Severity Index (ISI). A measure of chronotype was also included for control purposes. The results show that insomniacs reported lower scores for conscientiousness and extraversion, and for past-positive (PP) and future (F) perspectives, whereas they obtained higher scores for past-negative (PN) perspectives and deviation from a balanced time perspective. The correlations confirmed these findings, but negative correlations between present-hedonistic (PH) perspective and ISI score, and between emotional stability and ISI score, were also found. The mediation analyses showed that F played an indirect role in the relationship between consciousness and ISI score, PN had an indirect effect on the relationship between emotional stability and ISI or between extraversion and insomnia, and PH had an indirect effect on the relationship between extraversion and ISI score. The current outcomes shed light on the mechanisms which serve to mediate the relationship between insomnia and personality traits.

Multilevel Hidden Markov Models for Behavioral Data: A Hawk-and-Dove Experiment

Motivated by the analysis of behavioral data taken from an economic experiment based on the Hawk-and-Dove game, this article describes a multilevel hidden Markov model, that includes covariates, autoregression, and endogenous initial conditions under a unified framework. The data at hand are affected by multiple sources of latent heterogeneity, due to multilevel unobserved factors that operate in conjunction with observed covariates at all the levels of the data hierarchy. We fit a multilevel logistic regression model for repeated measurements of player behaviors, nested within groups of interacting players. The model integrates discrete random effects at the group level and Markovian sequences of discrete random effects at the player level. Parameters are estimated by a computationally feasible expectation-maximization algorithm. We model the probability of playing the Hawk strategy, which implies fighting aggressively for controlling an asset, and test the role played by initial possession, property, and other player-specific characteristics in driving hawkish behaviors. The results from our study suggest that crucial factors in determining hawkish behavior are both the way possession is achieved - which depends on our treatment manipulation- and possession itself. Furthermore, a clear time-dependence is observed in the data at the player level as accounted for by the Markovian random effects.

The role of circadian typology in the relationship between perfectionism and workaholism

Workaholism is a work-related addiction, and the study of its antecedents has a strong individual and social impact. Several studies reported high trait perfectionism in individuals exhibiting workaholism. Although the relationship between perfectionism and workaholism is quite consistent in the literature, it is not yet clear which biological underlying mechanisms might explain this relationship. From a chronopsychological perspective, it has been widely demonstrated that evening-type individuals are more prone to develop addictive behaviour. In the present study, we investigated, for the first time, the role of circadian typology in the relationship between perfectionistic concerns and workaholism. A group of Italian workers (N = 369; 60.70% females; mean age of 38.60 years) took part in a survey. Participants filled in the Bergen Work Addiction Scale (for workaholism), the Morningness-Eveningness Questionnaire (for circadian typology), and the Short Almost-Perfect Scale (for perfectionism). In addition to age, we controlled for workload using the Job Content Questionnaire. Beyond the confirmation of the relationship between perfectionism and workaholism, we found that in high perfectionistic individuals, evening-types reported higher score in Bergen Work Addiction Scale. Based on these findings, limitations and suggestions for future research are discussed.

Effects of spike protein and toxin-like peptides found in COVID-19 patients on human 3D neuronal/glial model undergoing differentiation: possible implications for SARS-CoV-2 impact on brain development

The possible neurodevelopmental consequences of SARS-CoV-2 infection are presently unknown. In utero exposure to SARS-CoV-2 has been hypothesized to affect the developing brain, possibly disrupting neurodevelopment of children. Spike protein interactors, such as ACE2, have been found expressed in the fetal brain, and could play a role in potential SARS-CoV-2 fetal brain pathogenesis. Apart from the possible direct involvement of SARS-CoV-2 or its specific viral components in the occurrence of neurological and neurodevelopmental manifestations, we recently reported the presence of toxin-like peptides in plasma, urine and fecal samples specifically from COVID-19 patients. In this study, we investigated the possible neurotoxic effects elicited upon 72-hour exposure to human relevant levels of recombinant spike protein, toxin-like peptides found in COVID-19 patients, as well as a combination of both in 3D human iPSC-derived neural stem cells differentiated for either 2 weeks (short-term) or 8 weeks (long-term, 2 weeks in suspension + 6 weeks on MEA) towards neurons/glia. Whole transcriptome and qPCR analysis revealed that spike protein and toxin-like peptides at non-cytotoxic concentrations differentially perturb the expression of SPHK1, ELN, GASK1B, HEY1, UTS2, ACE2 and some neuronal-, glia- and NSC-related genes critical during brain development. Additionally, exposure to spike protein caused a decrease of spontaneous electrical activity after two days in long-term differentiated cultures. The perturbations of these neurodevelopmental endpoints are discussed in the context of recent knowledge about the key events described in Adverse Outcome Pathways relevant to COVID-19, gathered in the context of the CIAO project (https://www.ciao-covid.net/).

A roadmap for the generation of benchmarking resources for antimicrobial resistance detection using next generation sequencing

Next Generation Sequencing technologies significantly impact the field of Antimicrobial Resistance (AMR) detection and monitoring, with immediate uses in diagnosis and risk assessment. For this application and in general, considerable challenges remain in demonstrating sufficient trust to act upon the meaningful information produced from raw data, partly because of the reliance on bioinformatics pipelines, which can produce different results and therefore lead to different interpretations. With the constant evolution of the field, it is difficult to identify, harmonise and recommend specific methods for large-scale implementations over time. In this article, we propose to address this challenge through establishing a transparent, performance-based, evaluation approach to provide flexibility in the bioinformatics tools of choice, while demonstrating proficiency in meeting common performance standards. The approach is two-fold: first, a community-driven effort to establish and maintain “live” (dynamic) benchmarking platforms to provide relevant performance metrics, based on different use-cases, that would evolve together with the AMR field; second, agreed and defined datasets to allow the pipelines’ implementation, validation, and quality-control over time. Following previous discussions on the main challenges linked to this approach, we provide concrete recommendations and future steps, related to different aspects of the design of benchmarks, such as the selection and the characteristics of the datasets (quality, choice of pathogens and resistances, etc.), the evaluation criteria of the pipelines, and the way these resources should be deployed in the community.

Past on the ground floor and future in the attic: The vertical mental timeline

Time is represented along a horizontal mental line with an association between the past (or short duration) and left space as well as between the future (or long duration) and right space. A possible vertical time representation is also supposed to exist, even if results are contradictory depending on the stimuli and response keys used. The aim of the present study was to test the presence of a vertical representation of temporal expressions, overcoming possible methodological limits. In Experiment 1, 167 Italian students had to categorize 20 Italian temporal expressions that appeared at the center of the screen with two analogous vertical response keys ("down" and "up" arrows of a regular keyboard). Specifically, in Experiment 1A participants pressed the down arrow with their left hand and the up arrow with their right hand, whereas in Experiment 1B the key-hand assignment was reversed. In Experiment 2, 25 participants underwent the same procedure using a vertically positioned response box. The same participants also performed a Time-to-Position task, in which they located temporal expressions along a vertical line. In both experiments, a space-time interaction was found, with an association between past expressions and the bottom (or down arrow) response key as well as between future expressions and the top (or up arrow) key. The results suggest a bottom-to-top mapping of time representation, according to the "more-is-up" metaphor. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Relationship between Acceptance and Sleep–Wake Quality before, during, and after the First Italian COVID-19 Lockdown

Several studies have reported that the COVID-19 pandemic has had deleterious effects on sleep quality and mood, but the mechanisms underlying these effects are not clearly understood. Recently, it has been shown that the acceptance component of mindfulness reduces anxiety, and, in turn, lower anxiety improves sleep quality. The purpose of this cross-sectional study was to assess changes in mindfulness traits, sleep–wake quality, and general distress, before, during, and after the first COVID-19 wave, testing the model in which acceptance influences sleep through anxiety in each period. A total of 250 participants were recruited before (Pre-Lockdown group: 69 participants, 29 females, 33.04 ± 12.94 years), during (Lockdown group: 78 participants, 59 females, 29.174 ± 8.50 years), and after (After-Lockdown group: 103 participants, 86 females, 30.29 ± 9.46 years) the first Italian lockdown. In each group, self-report questionnaires, assessing mindfulness facets, distress, and sleep–wake quality, were administered and assessed. The Lockdown group reported lower acceptance and higher depression, while the After-Lockdown group reported lower sleep–wake quality and higher anxiety. The results of the path analysis confirmed that higher acceptance reduced anxiety and higher anxiety decreased sleep–wake quality in all groups. Our results confirm that acceptance influences sleep through the mediating role of anxiety.

Morningness-Eveningness Preference, Time Perspective, and Passage of Time Judgments

Recent studies have shown that making accurate passage of time judgments (POTJs) for long-time intervals is an important cognitive ability. Different temporal domains, such as circadian typology (biological time) and time perspective (psychological time), could have an effect on subjective POTJs, but few studies have investigated the reciprocal influences among these temporal domains. The present study is the first systematic attempt to fill this gap. A sample of 222 participants (53.20% females; 19-60 years) filled in the Zimbardo Time Perspective Inventory for the measurement of time perspective, the reduced version of the Morningness-Eveningness Questionnaire (rMEQ) for chronotypes, and an ad-hoc questionnaire assessing sleep habits during weekdays and the weekend (for social jetlag). The POTJ was measured using a modified version of a pictorial timeline presented at five different moments. Also, participants judged how different temporal expressions were related to the past, present, and future along a 7-point Likert scale. After confirming the association between eveningness and present-hedonism orientation and morningness and future-orientation, we found that evening-types produced higher scores for future expressions. The subjective POTJ expressed in minutes was predicted by Deviation from Balanced Time (DBTP), present-fatalism orientation, and social jetlag. Finally, the rMEQ score, past-positive orientation, and DBTP predicted the difference between subjective and objective POT. The results are discussed offering an explanation in terms of the interconnections between circadian typology, individual time perspective, and the sense of the POT, suggesting the multicomponent nature of the concept of time.

The vertical space-time association

The space-time interaction suggests a left-to-right directionality in the mind's representation of elapsing time. However, studies showing a possible vertical time representation are scarce and contradictory. In Experiment 1, 32 participants had to judge the duration (200, 300, 500, or 600 ms) of the target stimulus that appeared at the top, centre, or bottom of the screen, compared with a reference stimulus (400 ms) that always appeared in the centre of the screen. In Experiment 2, 32 participants were administered the same procedure, but the reference stimulus appeared at the top, centre, or bottom of the screen and the target stimulus was fixed in the centre location. In both experiments, a space-time interaction was found with an association between short durations and bottom response key as well as between long durations and top key. The evidence of a vertical mental timeline was further confirmed by the distance effect with a lower level of performance for durations close to that of the reference stimulus. The results suggest a bottom-to-top mapping of time representation, more in line with the metaphor "more is up."

A three-gene signature based on MYC, BCL-2 and NFKBIA improves risk stratification in diffuse large B-cell lymphoma

Recent randomized trials focused on gene expression-based determination of the cell of origin in diffuse large B-cell lymphoma could not show significant improvements by adding novel agents to standard chemoimmunotherapy. The aim of this study was the identification of a gene signature able to refine current prognostication algorithms and applicable to clinical practice. Here we used a targeted gene expression profiling panel combining the Lymph2Cx signature for cell of origin classification with additional targets including MYC, BCL-2 and NFKBIA, in 186 patients from two randomized trials (discovery cohort) (clinicaltrials gov. Identifier: NCT00355199 and NCT00499018). Data were validated in three independent series (two large public datasets and a real-life cohort). By integrating the cell of origin, MYC/BCL-2 double expressor status and NFKBIA expression, we defined a three-gene signature combining MYC, BCL-2 and NFKBIA (MBN-signature), which outperformed the MYC/BCL-2 double expressor status in multivariate analysis, and allowed further risk stratification within the germinal center B-cell/unclassified subset. The high-risk (MBN Sig-high) subgroup identified the vast majority of double hit cases and a significant fraction of activated B-cell-derived diffuse large B-cell lymphomas. These results were validated in three independent series including a cohort from the REMoDL-B trial, where, in an exploratory ad hoc analysis, the addition of bortezomib in the MBN Sig-high subgroup provided a progression free survival advantage compared with standard chemoimmunotherapy. These data indicate that a simple three-gene signature based on MYC, BCL-2 and NFKBIA could refine the prognostic stratification in diffuse large B-cell lymphoma, and might be the basis for future precision-therapy approaches.

The categorical use of a continuous time representation

The abstract concept of time is mentally represented as a spatially oriented line, with the past associated with the left space and the future associated with the right. Although the line is supposed to be continuous, most available evidence is also consistent with a categorical representation that only discriminates between past and future. The aim of the present study was to test the continuous or categorical nature of the mental timeline. Italian participants judged the temporal reference of 20 temporal expressions by pressing keys on either the left or the right. In Experiment 1 (N = 32), all words were presented at the center of the screen. In Experiment 2 (N = 32), each word was presented on the screen in a central, left, or right position. In Experiment 3 (N = 32), all text was mirror-reversed. In all experiments, participants were asked to place the 20 temporal expressions on a 10-cm line. The results showed a clear Spatial–TEmporal Association of Response Codes (STEARC) effect which did not vary in strength depending on the location of the temporal expressions on the line. However, there was also a clear Distance effect: latencies were slower for words that were closer to the present than further away. We conclude that the mental timeline is a continuous representation that can be used in a categorical way when an explicit past vs. future discrimination is required by the task.

Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative mini-invasive approach

Background

Interstitial localisation of ectopic pregnancy is associated with high rates of maternal morbidity and mortality. Considering the rarity of interstitial pregnancy, the optimal treatment regimen remains unclear. We propose the management of interstitial pregnancy with local methotrexate injection using a combined hysteroscopic and ultrasonographic approach.

Technique

Hysteroscopy was performed under local anaesthesia in the operating room, using a 2.9-mm Hopkins II Forward-Oblique Telescope 30° endoscope with a 4.3-mm inner sheath and 5 FR instruments. A needle was pushed into the cornual region injecting methotrexate solution directly into the gestational sac and into the myometrial tissue tangentially at the four cardinal points. A contemporary transabdominal ultrasound (US) was performed in order to reduce risks of complications.

Experience

Five patients with an US diagnosis of interstitial ectopic pregnancy admitted to our department between January 2016 and September 2019 were managed with a local hysteroscopic injection of methotrexate. The technique was effective in all patients and no surgical complications occurred during or after the procedure. Three patients were evaluated for tubal patency with contrast ultrasonography confirming bilateral tubal patency 9 months from treatment, while one patient had a spontaneous birth 22 months from their initial surgery.

Conclusion

The hysteroscopic ultrasound-guided approach combined with the local injection of methotrexate is a minimally invasive conservative approach that seems to be promising in the management of interstitial ectopic pregnancy.

Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG-OCCUPATION-COVID-19 Study

Sero-epidemiological surveys are valuable attempts to estimate the circulation of SARS-CoV-2 in general or selected populations. Within this context, a prospective observational study was conducted to estimate the prevalence and persistence of SARS-CoV-2 antibodies in different categories of workers and factors associated with positivity, through the detection of virus-specific immunoglobulin G and M (IgG/IgM) in serum samples. Enrollees were divided in low exposure and medium-high groups on the basis of their work activity. Antibody responders were re-contacted after 3 months for the follow-up. Of 2255 sampled workers, 4.8% tested positive for SARS-CoV-2 IgG/IgM antibodies, with 81.7% to IgG only. Workers who continued to go to their place of work, were healthcare workers, or experienced at least one COVID-19-related symptom were more likely to test positive for SARS-CoV-2 antibodies. SARS-CoV-2 antibodies prevalence was significantly higher in the medium-high risk vs. low-risk group (7.2% vs. 3.0%, p < 0.0001). At 3-month follow-up, 81.3% of subjects still had antibody response. This study provided important information of SARS-CoV-2 infection prevalence among workers in northern Italy, where the impact of COVID-19 was particularly intense. The presented surveillance data give a contribution to refine current estimates of the disease burden expected from the SARS-CoV-2.

The EU one-stop-shop collection of publicly available information on COVID-19 in vitro diagnostic medical devices

The JRC COVID-19 In Vitro Diagnostic Devices and Test Methods Database, aimed to collect in a single place all publicly available information on performance of CE-marked in vitro diagnostic medical devices (IVDs) as well as in house laboratory-developed devices and related test methods for COVID-19, is here presented. The database, manually curated and regularly updated, has been developed as a follow-up to the Communication from the European Commission “Guidelines on in vitro diagnostic tests and their performance” of 15 April 2020 and is freely accessible at https://covid-19-diagnostics.jrc.ec.europa.eu/.

A roadmap for the generation of benchmarking resources for antimicrobial resistance detection using next generation sequencing

Next Generation Sequencing technologies significantly impact the field of Antimicrobial Resistance (AMR) detection and monitoring, with immediate uses in diagnosis and risk assessment. For this application and in general, considerable challenges remain in demonstrating sufficient trust to act upon the meaningful information produced from raw data, partly because of the reliance on bioinformatics pipelines, which can produce different results and therefore lead to different interpretations. With the constant evolution of the field, it is difficult to identify, harmonise and recommend specific methods for large-scale implementations over time. In this article, we propose to address this challenge through establishing a transparent, performance-based, evaluation approach to provide flexibility in the bioinformatics tools of choice, while demonstrating proficiency in meeting common performance standards. The approach is two-fold: first, a community-driven effort to establish and maintain “live” (dynamic) benchmarking platforms to provide relevant performance metrics, based on different use-cases, that would evolve together with the AMR field; second, agreed and defined datasets to allow the pipelines’ implementation, validation, and quality-control over time. Following previous discussions on the main challenges linked to this approach, we provide concrete recommendations and future steps, related to different aspects of the design of benchmarks, such as the selection and the characteristics of the datasets (quality, choice of pathogens and resistances, etc.), the evaluation criteria of the pipelines, and the way these resources should be deployed in the community.

Variation of circadian activity rhythm according to body mass index in children

BACKGROUND/OBJECTIVES

This study aimed to examine the variations of circadian activity rhythm of children according to objective body mass index (BMI) values, using a novel statistical framework (ie, Functional Linear Modeling, FLM), separately for school- and weekend days.

METHODS

A total of 107 participants (60 females; mean age: 10.25 ± 0.48 years) wore an actigraph for seven days during a regular school-week. While valid actigraphic data during school days were available for each of these children, this number decreased to 53 (31 females; mean age: 10.28 ± 0.51 years) during weekend days.

RESULTS

Examining the school days, significantly higher motor activity in participants with higher BMI was observed from around 4:00 a.m. to 6:00 a.m., with a peak about 5:00 a.m. On the contrary, applying the FLM to the weekend days actigraphic data, no significantly different variation of circadian activity rhythm was observed, according to BMI.

CONCLUSIONS

In this specific sample of children, during school days, higher BMI is associated with higher activity level in a specific time window in the second half of nocturnal sleep. The lack of significant findings during weekend days could be explained because of higher variability of get-up time and/or the reduced sample size. Future longitudinal studies could explore if the higher motor activity in that specific time window qualifies as a predictive marker of the development of overweight and obesity. If so, early preventive strategies directed towards those at higher risk could be effectively implemented.

Sleep and Prospective Memory: A Retrospective Study in Different Clinical Populations

Prospective memory (PM) is essential in everyday life because it concerns the ability to remember to perform an intended action in the future. This ability could be influenced by poor sleep quality, the role of which, however, is still being debated. To examine the role of sleep quality in PM in depth, we decided to perform a retrospective naturalistic study examining different clinical populations with a primary sleep disorder or comorbid low sleep quality. If sleep is important for PM function, we could expect poor sleep to affect PM performance tasks both directly and indirectly. We examined a total of 3600 nights, recorded using actigraphy in participants belonging to the following groups: primary insomnia (731 nights); narcolepsy type 1 (1069 nights); attention deficit hyperactivity disorder (152 nights in children and 239 in adults); severe obesity (232 nights); essential hypertension (226 nights); menopause (143 nights); healthy controls (808 nights). In a naturalistic activity-based PM task, each participant originally wore an actigraph around the non-dominant wrist and was requested to push the event-marker button at two specific times of day: bedtime (activity 1) and get-up time (activity 2). Each clinical group showed significantly lower sleep quality in comparison to the control group. However, only narcolepsy type 1 patients presented a significantly impaired PM performance at get-up time, remembering to push the event-marker button around half the time compared not only to healthy controls but also to the other clinical groups. Overall, the present results seem to point to sleep quality having no effect on the efficiency of a naturalistic activity-based PM task. Moreover, the data indicated that narcolepsy type 1 patients may show a disease-specific cognitive deficit of PM.

Morningness-eveningness preference and sensation seeking

The aim of this study was to explore the relationship between circadian preference and sensation seeking. To this aim 1041 university students (408 males and 633 females), ranging in age between 18 and 30 years, filled the reduced version of the Morningness-Eveningness Questionnaire (MEQr) and the Sensation Seeking Scale-Form V (SSS-V). Males scored higher than females in SSS-V total score and all subscales, except experience seeking (ES). As regards circadian preference, evening types scored higher than morning types in SSS-V total score and all subscales, except boredom susceptibility (BS) where they significantly differed only from intermediate types. On the whole our results highlight a significant relationship between circadian preference and sensation seeking.

In vitro and bioinformatics mechanistic-based approach for cadmium carcinogenicity understanding

Cadmium is a toxic metal able to enter the cells through channels and transport pathways dedicated to essential ions, leading, among others, to the dysregulation of divalent ions homeostasis. Despite its recognized human carcinogenicity, the mechanisms are still under investigation. A powerful tool for mechanistic studies of carcinogenesis is the Cell Transformation Assay (CTA). We have isolated and characterized by whole genome microarray and bioinformatics analysis of differentially expressed genes (DEGs) cadmium-transformed cells from different foci (F1, F2, and F3) at the end of CTA (6 weeks). The systematic analysis of up- and down-regulated transcripts and the comparison of DEGs in transformed cells evidence different functional targets and the complex picture of cadmium-induced transformation. Only 34 in common DEGs are found in cells from all foci, and among these, only 4 genes are jointly up-regulated (Ccl2, Ccl5, IL6 and Spp1), all responsible for cytokines/chemokines coding. Most in common DEGs are down-regulated, suggesting that the switching-off of specific functions plays a major role in this process. In addition, the comparison of dysregulated pathways immediately after cadmium treatment with those in transformed cells provides a valuable means to the comprehension of the overall process.

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Cell transformation Assay and toxicogenomics are integrated to study cadmium carcinogenesis mechanisms

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Inflammatory response is the only common feature in Cd-transformed cells from all different foci

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Switching-off of specific functions plays a major role in Cd-induced carcinogenesis

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Comparison of triggering signals and deregulated pathways in transformed cells provides hints on cadmium mechanisms

Dissection of DLBCL microenvironment provides a gene expression-based predictor of survival applicable to formalin-fixed paraffin-embedded tissue

Background

Gene expression profiling (GEP) studies recognized a prognostic role for tumor microenvironment (TME) in diffuse large B-cell lymphoma (DLBCL), but the routinely adoption of prognostic stromal signatures remains limited.

Patients and methods

Here, we applied the computational method CIBERSORT to generate a 1028-gene matrix incorporating signatures of 17 immune and stromal cytotypes. Then, we carried out a deconvolution on publicly available GEP data of 482 untreated DLBCLs to reveal associations between clinical outcomes and proportions of putative tumor-infiltrating cell types. Forty-five genes related to peculiar prognostic cytotypes were selected and their expression digitally quantified by NanoString technology on a validation set of 175 formalin-fixed, paraffin-embedded DLBCLs from two randomized trials. Data from an unsupervised clustering analysis were used to build a model of clustering assignment, whose prognostic value was also assessed on an independent cohort of 40 cases. All tissue samples consisted of pretreatment biopsies of advanced-stage DLBCLs treated by comparable R-CHOP/R-CHOP-like regimens.

Results

In silico analysis demonstrated that higher proportion of myofibroblasts (MFs), dendritic cells, and CD4⁺ T cells correlated with better outcomes and the expression of genes in our panel is associated with a risk of overall and progression-free survival. In a multivariate Cox model, the microenvironment genes retained high prognostic performance independently of the cell-of-origin (COO), and integration of the two prognosticators (COO + TME) improved survival prediction in both validation set and independent cohort. Moreover, the major contribution of MF-related genes to the panel and Gene Set Enrichment Analysis suggested a strong influence of extracellular matrix determinants in DLBCL biology.

Conclusions

Our study identified new prognostic categories of DLBCL, providing an easy-to-apply gene panel that powerfully predicts patients’ survival. Moreover, owing to its relationship with specific stromal and immune components, the panel may acquire a predictive relevance in clinical trials exploring new drugs with known impact on TME.

In vitro human cord blood platelet lysate characterisation with potential application in wound healing

Platelets contain abundant growth factors and cytokines that have a positive influence on the migration and proliferation of different cell types by modulating its physiopathological processes. As it is known that human umbilical cord blood platelet lysate (UCB-PL) contains a supraphysiological concentration of growth factors, in the present study, we investigated its effectiveness in wound-healing processes. Human UCB-PL was obtained by the freeze/thaw of platelet concentrate (1.1 × 10⁹ platelets/L), and its effect was evaluated on human or mouse endothelial cells, monocytes, fibroblasts, and keratinocytes in different concentrations. Human UCB-PL was observed to have high levels of pro-angiogenic growth factor than peripheral blood platelet-rich plasma. Among the cell lines, different concentrations of human UCB-PL were necessary to influence their viability and proliferation. For L929 cells, 5% of total volume was necessary, while for human umbilical vein endothelial cell, it was 10%. Cell migration on monocytes was increased with respect to the positive control, and scratch closure on keratinocytes was increased with respect to serum-free medium with only 10% of human UCB-PL. We concluded that the human UCB-PL may be useful to produce a large amount of standard platelet concentrates sufficient for several clinical-scale expansions avoiding inter-individual variability, which can also be used as a functional tool for clinical regenerative application for wound healing.

Workaholism, Intensive Smartphone Use, and the Sleep-Wake Cycle: A Multiple Mediation Analysis

Recent contributions have reported sleep disorders as one of the health impairment outcomes of workaholism. A possible factor affecting the sleep-wake cycle might be the intensive use of smartphones. The current study aimed to explore the role of intensive smartphone use in the relationship between workaholism and the sleep-wake cycle. Two serial multiple mediation models were tested on a sample of 418 employees, who filled self-report questionnaires measuring workaholism, use of smartphones, sleep quality and daytime sleepiness, using conditional process analysis for testing direct and indirect effects. Results supported our hypotheses regarding two serial multiple mediation models-that intensive smartphone use and poor sleep quality mediated the relationship between workaholism and daytime sleepiness, and that smartphone use and daytime sleepiness mediated the relationship between workaholism and poor quality of sleep. Although the use of a cross-sectional design and the snowball technique for collecting data can be considered as possible limitations, the current study is one of the first to document the potential detrimental role of the intensive smartphone use on the workaholism-sleep disorders relationship.