“Blocked broken heart syndrome”: an unusual case of a complete atrioventricular block complicating a Takotsubo cardiomyopathy

Background

Complete heart block is considered a unique and rare complication of Takotsubo cardiomyopathy, an otherwise self-resolving disease. When this occurs, there is a double clinical dilemma: first to find out which triggered the other and second, to decide whether or not to implant a permanent pacemaker.

Case presentation

We present a case of a 77 years-old female patient, with previous medical history of arterial hypertension, diabetes mellitus, dyslipidemia and bifascicular block known since 2013. She came to the emergency department after recurrent syncopal episodes. At admission a complete heart block was diagnosed, and it was implanted a single chamber temporary pacemaker. The patient remained in disproportional acute decompensated heart failure despite pacemaker implantation. She denied chest pain although referring an episode of self-limiting chest pain 2 days before, after an argument with the family. Blood analysis showed an important rise in NTproBNP and troponin levels. Transthoracic echocardiogram showed a dilated left ventricle with akinesia of apical and mid segments, hyperkinesia of basal segments and severely depressed left ventricle ejection fraction. Coronary angiography showed no significant lesions and the diagnosis of Takotsubo cardiomyopathy was suspected. During the following days, she recovered her own intrinsic rhythm. Electrocardiogram evolved with deep T-wave inversion and prolonged QT interval and transthoracic echocardiogram showed resolution of the previous alterations. Despite complete reversion of rhythm alteration, it was decided to implant a permanent pacemaker.

Conclusions

We describe a rare, life-threatening and often underdiagnosed complication of the stress cardiomyopathy. Furthermore, we performed a literature revision of this rare complication and discussed the therapeutic challenge encountered in such patients.

What is there to EAARN with a CRT implantation? Predictive factors of mortality or clinical deterioration in patients receiving cardiac resynchronization therapy based on pre-implant factors

Introduction

Cardiac resynchronization therapy (CRT) in heart failure patients with reduced ejection fraction (HFrEF) and wide QRS complexes has been shown to improve both functional capacity and quality of life, and to decrease hospital admissions and mortality. Mortality in CRT patients has been associated with several pre-implant risk factors and some risk scores, like the EAARN score, have been developed to try and predict mortality and morbidity in this population.

Purpose

Our aim was to assess risk factors for a compositive end-point of admissions for heart failure or cardiovascular death at 5 years, particularly the EAARN SCORE (EF, Age, Atrial Fibrillation (AF), Renal dysfunction, New York Heart Association (NYHA) class IV), in patients with EF <35% and QRS >130ms submitted to CRT implantation.

Methods

We performed a retrospective analysis between 2012 and May of 2019 of all patients admitted for CRT implantation due to HFrEF with EF <35% and QRS >130ms in a single expert centre. Medical records were analysed for clinical, procedural data and outcomes. The predictive accuracy of the score was assessed using the area under curve (AUC) of receiver operating characteristics (ROC) curve. The association between EAARN and the composite end-point at 5-years was analyzed using a Cox regression model.

Results

Of the 134 patients assessed, 101 patients fulfilled all inclusion criteria. The mean age at implantation was 70.2±10 years with a male preponderance (67.2%).

This population was significantly symptomatic, with 35% in NYHA class II, 58% in NYHA class III and 5% in NYHA class IV. Most had an ischemic etiology (74.2%). 75% of patients were considered responders after implantation (NYHA improvement of at least 1 class and/or increase in 10% in EF). A primary composite end-point occurred in 17.8% of patients. The pre-procedure characteristics associated with an event were an ischemic etiology (OR 4.66; CI 95% 1.52–14.24, p<0.05) and pre-procedure EF (OR 0.81; CI 95% 0.81–0.97, p<0.05). The age, sex, NYHA class, presence of AF, renal function, bundle branch block morphology and responder status were non significant. The EAARN Score showed predictive power for the occurrence of an event (OR 1.95; CI 95% 1.13–3.36, p<0.05) and a reasonable discriminative capacity with the ROC curve analysis (figure 1A) demonstrating an AUC of 0.70. The survival analysis (figure 1B) with a Hazard Ratio of 1.88 (CI 95% 1.158–3.058, p<0.05) signifying an increased risk of an event of 88% per EAARN class increase, with the Kaplan Meier curves widening significantly in the different categories of the score.

Conclusions

In patients who implanted a CRT due to HFrEF with EF <35% and QRS >130ms the EAARN score demonstrated a good predictive power and discriminative capacity for admission for heart failure or cardiovascular death at 5 years although it does not account for the etiology which was also a significant factor.

Funding Acknowledgement

Type of funding sources: None.

Magnetocardiography as a noninvasive diagnostic strategy for suspected coronary microvascular dysfunction

Background

Coronary microvascular dysfunction (CMD) is increasingly recognized as an independent predictor of mortality with a 4-fold higher risk. However current diagnostic modalities are limited by the need for an invasive procedure, access, cost, and exposure of ionizing radiation.

Purpose

To investigate the ability of magnetocardiography (MCG) to identify CMD in patients with suspected ischemia and no obstructive coronary artery disease (INOCA).

Methods

This is an observational, prospective pilot study of patients scheduled for coronary functional angiography (CFA), gold standard for evaluation for CMD (defined as coronary flow reserve (CFR) ≤2). 13 patients underwent both CFA and a noninvasive 36-channel MCG scan. A machine learning model was developed to characterize the presence of CMD in these patients against age matched controls (AMCs). The model consists of a logistic regression classifier which takes features representing the relative strengths of the “characteristic dipoles” of the MCG scan as input. The characteristic dipoles are parameterizations of the three strongest magnetic field map components resulting from a singular value decomposition of the MCG signal. A total of 37 patients were included in this analysis including 13 patients who completed CFA (7 had CMD and 6 had CFR >2 and included in the AMCs group). An additional 24 asymptomatic, healthy patients that did not undergo CFR were also included in the AMC group.

Results

The mean age for AMCs was 57 years (70% women) and mean age for CMD patients was 54 years (100% women). The performance of the model was evaluated using repeated stratified cross-validation with 5 folds and 3 repeats, resulting in 15 different 80%/20% train/test splits. Figure 1 shows the distribution of samples belonging to the CMD and AMC groups in a 2-dimensional representation of the feature space. The clear separation of the two groups and the clustering of the AMCs demonstrates the ability of the model to identify patients with CMD. We found that MCG had a mean accuracy of 94.8% (±6.4%), sensitivity of 100% (±0.0%) and specificity of 93.3% (±8.2%) for the detection of CMD using gold standard CFR ≤2 as reference.

Conclusion(s)

First study to show that MCG can be used with 94.8% accuracy to identify CMD among patients suspicious for INOCA with no exposure to ionization, 90 seconds of scan time and minimal cost. The use of this noninvasive modality to identify CMD warrants further investigation.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Genetesis

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Health literacy and hypertension outcomes in a multi-ethnic population: the HELIUS study

BACKGROUND

Hypertension disproportionately affects ethnic minority groups. Although health literacy may play role in these ethnic inequalities, little is known about the extent to which health literacy affects hypertension prevalence, awareness, treatment and control in different ethnic groups. Therefore, we assessed these associations in a multi-ethnic population.

METHODS

Baseline data from the HELIUS study were used including participants of Dutch (n = 1948), South-Asian Surinamese (n = 2054) and African Surinamese (n = 1932) origin aged 18-70 years, who lived in Amsterdam, the Netherlands, were fluent in Dutch and underwent health literacy assessment through the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D). The REALM-D was categorized either as low (<60 sumscore) or adequate (≥60 sumscore) health literacy. Participants completed questionnaires and underwent physical examination.

RESULTS

After adjusting for confounding variables, Dutch [odds ratio (OR) 2.02; 95% confidence interval (CI), 1.11-3.64] and African Surinamese (OR 1.36; 1.03-1.79) with low health literacy were more likely than those with adequate health literacy to have hypertension, whereas in South-Asian Surinamese this association was not significant. No significant associations were found between health literacy and hypertension awareness, treatment and control in any of the ethnic groups.

CONCLUSION

Findings indicate that health literacy is associated with hypertension prevalence in selected ethnic groups, but not with hypertension awareness, treatment and control. Targeting health literacy might be an entry point for tackling ethnic inequalities in hypertension prevalence. To substantially reduce these inequalities, further research is needed to explore other factors and pathways through which health literacy may impact hypertension outcomes in different ethnic groups.

Lanthanide-porphyrin species as Kondo irreversible switches through tip-induced coordination chemistry

Metallosupramolecular chemical protocols are applied to in situ design dysprosium porphyrin complexes on Au(111) by sequential deposition of 2H-4FTPP species and Dy, resulting in the production of premetallated Dy-2H-4FTPP, partially metallated Dy-1H-4FTPP and fully metallated Dy-0H-4FTPP complexes, as determined by scanning tunneling microscopy (STM) and density functional theory (DFT) calculations. A zero bias resonance is found in the Dy-2H-4FTPP species which, upon study of its spatial distribution and behavior with temperature, is assigned to a Kondo resonance resulting from an unpaired spin in the molecular backbone, featuring a Kondo temperature (TK) of ≈ 21 K. Notably, the Kondo resonance can be switched off by removing one hydrogen atom of the macrocycle through tip-induced voltage pulses with submolecular precision. The species with this Kondo resonance can be laterally manipulated illustrating the potential to assemble artificial Kondo lattices. Our study demonstrates that the pre-metallation of macrocycles by lanthanides and their controlled manipulation is a novel strategy to engineer in situ tunable Kondo nanoarchitectures, enhancing the potential of coordination chemistry for spintronics.

Evidence for a spin acoustic surface plasmon from inelastic atom scattering

Closed-shell atoms scattered from a metal surface exchange energy and momentum with surface phonons mostly via the interposed surface valence electrons, i.e., via the creation of virtual electron-hole pairs. The latter can then decay into surface phonons via electron-phonon interaction, as well as into acoustic surface plasmons (ASPs). While the first channel is the basis of the current inelastic atom scattering (IAS) surface-phonon spectroscopy, no attempt to observe ASPs with IAS has been made so far. In this study we provide evidence of ASP in Ni(111) with both Ne atom scattering and He atom scattering. While the former measurements confirm and extend so far unexplained data, the latter illustrate the coupling of ASP with phonons inside the surface-projected phonon continuum, leading to a substantial reduction of the ASP velocity and possibly to avoided crossing with the optical surface phonon branches. The analysis is substantiated by a self-consistent calculation of the surface response function to atom collisions and of the first-principle surface-phonon dynamics of Ni(111). It is shown that in Ni(111) ASP originate from the majority-spin Shockley surface state and are therefore collective oscillation of surface electrons with the same spin, i.e. it represents a new kind of collective quasiparticle: a Spin Acoustic Surface Plasmon (SASP).

Medicinal cannabis, a medicine. Characterization of the reality in Portugal

Cannabis has been used over the centuries for medicinal purposes. The first evidence dates from the third millennium BC in India and Chinese Empire, due to its analgesic, antiemetic and anticonvulsant properties. Nevertheless, its use is also associated to manufacture industry - hemp - translating a widespread function. However, through time, it is its recreational, additive and illegal purposes are the ones that we most quickly associate with it. This stigmatized its use in society and neglected the benefits. Its only in the XX century with the discover of the of the endocannabinoid system that allowed a new vision on the theme, challenging and revolutionizing the, until then, ingrained classic vision. In fact, its benefits in several pathologies or clinical symptons are well documented today. In light of the current debate on the use of cannabis for medicinal purposes worldwide and recently in Portugal with new legislation, a review of the available literature is required to explain the national reality and its context in the international reality. Due to the clinical and social relevance of the theme, the authors aimed to study, collect and systematize information in order to uptodate the state of art in: innovation, potential indications for its therapeutic use; understand the existing legal framework in Portugal, for cannabinoids and for the previous phases, such as cultivation and production; understand and compare the international reality and that existing in Portugal, namely in Portuguese hospitals; and, understand what are the future perspectives for cannabis as a therapeutic line.

Key messages

Clinical and social relevance of the theme and its legal framework. What are the future perspectives for cannabis as a therapeutic line nd the stigma of using it.

475 A rare cause of right ventricular mass

Introduction

Intracardiac masses are always a challenging diagnosis, especially when it involves the right side of the heart. There are multiples etiologies that can be responsible for these masses, namely thrombosis, neoplasm or vegetations. Occasionally, these may be related to an autoimmune process not yet discovered.

Case Report

17-year-old male, with a previous history of genital ulcers, medicated with penicillin with complete resolution of symptoms.

In January 2019, he started an history of recurrent fever, associated with right anterior thoracalgia, weight loss and oral afthosis. He went to the emergency department several times, where he was medicated with antibiotic, with partial symptom relief.

Three months later, he returned to medical attention due to an episode of abundant hemoptysis, followed by hematemesis and cough. At hospital admission, he was hemodynamically stable, tachycardic (100/min) and with occasional episodes of cough. Cardiac and pulmonary auscultation were unremarkable. Thoracic CT revealed the presence of pulmonary thromboembolism (PTE) and a large mass in the right ventricle (RV). It was performed an echocardiogram (echo) that confirmed the presence of a large mass in the RV (50x53mm) from which a projecting hypermobile mass appeared to prolapse into the right atrium.

Taking into account the diagnosis of PTE and the presence of a right ventricular mass, the patient was hospitalized and started anticoagulation. The case was immediately discussed with cardiac surgery, that confirmed that there was no surgical indication. During hospitalization, there were no more episodes of hemoptysis or hematemesis.Consecutive echos were performed, that did not reveal a significant decrease in mass dimensions despite anticoagulation. Viral serologies and autoimmunity panel were all negative. Cardiac RMI was performed raising the suspicion of a possible mass covered with thrombus.

After discussion with rheumatology, and according to clinical signs, the hypothesis of vasculitis was placed, and the patient started treatment with steroids. This treatment had to be suspended after a few days due to an infectious intercurrence. After a course of antibiotic therapy, the patient started therapy with cyclophosphamide with good clinical and echocardiographic response (reduced mass dimensions).

It was admitted Behçet’s disease with cardiac complications, and the patient was referred to the rheumatology consultation.

Conclusion

Behçet’s disease is a multi-system, chronic disorder that behaves like vasculitis.There are some typical clinical manifestations associated with this disease, such as oral and genital afthosis, uveitis, arthritis, skin lesions and nervous system involvement.Presentations with cardiac symptoms are one of the extremely rare manifestations of this disease, posing a challenge for the treating physician.

Abstract 475 Figure. Right ventricular mass

P1808 The impact of valve type in morbimortality of patients with infectious endocarditis

Introduction

Infectious endocarditis (IE) represents one of the main causes of morbimortality in patients (pts) with valvular heart disease. Prosthetic valves infection is usually associated with worse outcomes.

Aim

To compare the clinical features and adverse outcomes of patients with native vs prosthetic valve IE.

Methods

We analysed a population with suspected/confirmed IE, according to Duke criteria, in the last 12 years (2006-2017). The clinical and imaging data were collected as well as complication rates and mortality data.

Results

174 pts, 75% males with mean age of 61 ± 16 years. Native valve EI occurred in 74,1%. of pts. 25,3% had heart failure (HF), 16,1% chronic kidney disease(7,1% on haemodialysis), 12,8% HIV infection, 9,3% active neoplasm and 7,1% were on immunosuppression. 16 pts with native valve disease had previous valvular disease: 1 congenital valve disease, 2 with rheumatic heart disease, 3 with previous IE and 10 with degenerative disease. At admission: 73,1% had fever, 53,2% murmur and 47,9% anemia. The majority (78,4%) had single valve IE and 15,8% had double valve involvement. Aortic valve (AoV) was affected in 54% of the cases and mitral valve involvement was seen in 43,7%. 13,3% had right valve disease. S. Aureus was the most frequent microrganism. Echocardiographic findings: 87,7% had vegetation, 21,2% valve destruction , 5,6% valve obstruction, 14,3% abscess, 3,7% valve aneurysm, 5,6% pseudoaneurysm and 5,6% fistula. Regurgitation was observed in 62,1%. The intrahospitalar mortality was 29,9%.

Comparing both groups, pts with prosthetic IE had more previous history of HF (40,5% vs 20,5% p = 0,009) and diabetes (31,7% vs 15,3% p = 0,020). No differences were found in what concerns microrganisms involved.

Echocardiographically, pts with prosthetic valve had predominantly AoV involvement (81,1% vs 45,5% p &lt; 0,001), less vegetation (75% vs 91,8% p = 0,01) and less regurgitation (45% vs 67,8% p = 0,01). They had more local complications (61% vs 27,7% p&gt; 0,001) like valve obstruction (12,5% vs 3,3% p = 0,043), abscess (32,5% vs 8,3% p&gt; 0,001) or pseudoaneurysm (17,5% vs 1,7% p= 0,001).

In what concerns morbidity burden, developed more HF during hospitalization (56,1% vs 37,7% p= 0,037) as well as more isquemic and haemorragic stroke(85,7% vs 42,3%. P = 0,004 and 28,6% vs 2,4% p = 0,012, respectively). However there were no differences regarding the development of septic shock (p = 0,542) or overall embolization (p = 0,732). At last, no differences were found in intrahospitalar(IH) mortality (p = 0,085), relapse (p = 0,573) or overall survival between both groups (log rank: 1,5, p = 0,217).

Conclusion

Pts with prosthetic valve IE usually have worse outcomes. However,for this population,we conclude that besides having more HF and stroke, there were no differences in what concerns septic shock or overall embolization, as well as IH mortality and survival between both groups.

MRI imaging of soft tissue tumours of the foot and ankle

The majority of soft tissue lesions in the foot and ankle are benign. The aim of this review is to provide the reader with a comprehensive overview of the magnetic resonance imaging (MRI) characteristics of the most common benign and malignant soft tissue neoplasms which occur around the foot and ankle. This should enable the reader to formulate a reasonable differential diagnosis and, most importantly, to recognise those rare aggressive lesions that require further assessment and tissue biopsy.

Discrete Electronic Subbands due to Bragg Scattering at Molecular Edges

The discretization of the electronic structure of nanometer-size solid systems due to quantum confinement and the concomitant modification of their physical properties is one of the cornerstones for the development of nanoscience and nanotechnology. In this Letter we demonstrate that the Bragg scattering of Cu(111) surface-state electrons by the periodic arrangement of tetracyanoquinodimethane molecules at the edges of self-assembled molecular islands, along with the dominant contribution of backscattering processes to the electronic density of states, discretizes the possible values of the electron momentum parallel to the island edge. The electronic structure consists thus of a discrete number of subbands which occur in a nonclosed space, and therefore without quantum confinement.

Isolated atrophy and fatty infiltration of supraspinatus: A rare finding

Isolated atrophy and fatty infiltration of supraspinatus is very rare. We report the case of a 53 year old male with isolated atrophy and complete fatty replacement of supraspinatus and discuss potential aetiologies.

Graphene catalyzes the reversible formation of a C-C bond between two molecules

Carbon deposits are well-known inhibitors of transition metal catalysts. In contrast to this undesirable behavior, here we show that epitaxial graphene grown on Ru(0001) promotes the reversible formation of a C-C bond between -CH₂CN and 7,7,8,8-tetracyano-p-quinodimethane (TCNQ). The catalytic role of graphene is multifaceted: First, it allows for an efficient charge transfer between the surface and the reactants, thus favoring changes in carbon hybridization; second, it holds the reactants in place and makes them reactive. The reaction is fully reversible by injecting electrons with an STM tip on the empty molecular orbitals of the product. The making and breaking of the C-C bond is accompanied by the switching off and on of a Kondo resonance, so that the system can be viewed as a reversible magnetic switch controlled by a chemical reaction.

Reactivity of O2 on Pd/Ru(0001) and PdRu/Ru(0001) surface alloys

The reactivity of a Pd monolayer epitaxially grown on Ru(0001) toward O₂ has been investigated by molecular beam techniques. O₂ initial sticking coefficients were determined using the King and Wells method in the incident energy range of 40-450 meV and for sample temperatures of 100 K and 300 K, and compared to the corresponding values measured on the clean Ru(0001) and Pd(111) surfaces. In contrast to the high reactivity shown by Ru(0001) at 100 K, the Pd/Ru(0001) system exhibits a monotonic decrease in the sticking probability of O₂ as a function of normal incident energy. At room temperature, the system was found to be inert. Thermal desorption measurements show that O₂ is adsorbed molecularly at 100 K. A completely different behaviour has been measured for the Pd_0.95Ru_0.05/Ru(0001) surface alloy. On this surface, the O₂ sticking probability increases with incident energy and resembles the one observed on the clean Ru(0001) surface, even at 300 K. Thermal desorption measurements point to dissociative adsorption of O₂ in this system. Both the charge transfer from the Pd to the Ru substrate and the compressive strain on the Pd monolayer contribute to decrease in the reactivity of the Pd/Ru(0001) system well below those of both Ru(0001) and Pd(111).

Giant Cell Fibroblastoma of the Scrotum. A Case Report

A case of giant cell fibroblastoma occurring in the scrotum of a 21-year-old male is described. It may have been a recurrence of a previous lesion in the same region, which was only clinically diagnosed as fibrolipoma when excised 10 years before. Giant cell fibroblastoma is a benign, locally recurrent tumor of youth and childhood which arises from superficial soft tissue. To our knowledge, only 2 other cases of scrotal involvement by this neoplasm have been reported.

Encapsulating Chemically Doped Graphene via Atomic Layer Deposition

Controlling graphene's doping will be critically important for its incorporation into future electronic and optoelectronic devices. Noncovalent functionalization through adsorption of organic molecules on graphene's surface has proved to be a promising route for achieving p- or n-type doping. However, due to the poor adhesion of the molecules, these tend to desorb over time under standard environmental conditions or in the presence of certain solvents. The resulting reversal in the achieved chemical doping is a major obstacle to using organic molecules as noncovalent graphene dopants. In this work, we present a simple method for achieving long-term p- and n-doping of graphene devices through vapor phase evaporation of organic molecules, followed by encapsulation under an inert Al₂O₃ film. This film, grown via an optimized atomic layer deposition process, ensures long-term doping stability, as confirmed by electrical transport and Raman spectroscopy measurements. The doping is maintained even after storing the devices for six weeks in ambient conditions and immersing them in a dopant removing solvent, demonstrating that the film is as an effective barrier against environmental degradation of the doped devices.

Are ultrasound features at the first metatarsophalangeal joint associated with clinically-assessed pain and function? A study of people with gout, asymptomatic hyperuricaemia and normouricaemia

Background

The first metatatarsophalangeal joint (1st MTP joint) is a common location for sonographic evidence of urate deposition in people with gout and asymptomatic hyperuricaemia. However, it is unclear whether these are related to clinically-assessed pain and function. This study aimed to determine the association between ultrasound features and clinical characteristics of the 1st MTP joint in people with gout, asymptomatic hyperuricaemia and age- and sex-matched normouricaemic individuals.

Methods

Twenty-three people with gout, 29 with asymptomatic hyperuricaemia and 34 with normouricaemia participated in a cross-sectional study. No participant had clinical evidence of acute inflammatory arthritis at the time of assessment. Four sonographic features at the 1st MTP joint were analysed: double contour sign, tophus, bone erosion and synovitis. Clinical characteristics included in the analysis were 1st MTP joint pain, overall foot pain and disability, 1st MTP joint temperature, 1st MTP joint range of motion and gait velocity. Statistical analyses adjusted for the diagnostic group of the participant.

Results

After accounting for the diagnostic group, double contour sign was associated with higher foot pain and disability scores (P < 0.001). Ultrasound tophus was associated with higher foot pain and disability scores (P < 0.001), increased temperature (P = 0.005), and reduced walking velocity (P = 0.001). No associations were observed between ultrasound synovitis or erosion and the clinical characteristics.

Conclusions

Ultrasound features of urate crystal deposition, rather than soft tissue inflammation or bone erosion, are associated with clinical measures of foot-related functional impairment and disability even in the absence of clinical evidence of current acute inflammatory arthritis. This association persisted regardless of the diagnosis of the participant as having gout or asymptomatic hyperuricaemia.

Ultrasound Features of the First Metatarsophalangeal Joint in Gout and Asymptomatic Hyperuricemia: Comparison With Normouricemic Individuals

OBJECTIVE

The first metatarsophalangeal (MTP1) joint is frequently affected in gout. The aim of this study was to identify ultrasound features of the MTP1 joint in people with gout and people with asymptomatic hyperuricemia compared with normouricemic controls.

METHODS

Participants with gout (n = 23) and asymptomatic hyperuricemia (n = 29), and age- and sex-matched normouricemic control participants (n = 34), underwent a gray-scale and power Doppler ultrasound assessment of bilateral MTP1 joints by a single musculoskeletal radiologist. No participants had clinical evidence of joint inflammation at the time of scanning. The static images were later read by 2 musculoskeletal radiologists for the presence of the double contour sign, tophus, erosion, effusion, synovial hypertrophy, synovitis, and cartilage thickness.

RESULTS

Compared to normouricemic control participants, participants with gout and participants with asymptomatic hyperuricemia had more frequent double contour sign (odds ratio [OR] 3.91, P = 0.011 and OR 3.81, P = 0.009, respectively). Participants with gout also had more erosion (OR 10.13, P = 0.001) and synovitis (OR 9.00, P < 0.001) and had greater tophus and erosion diameters (P = 0.035 and P < 0.001, respectively). More severe erosion and synovitis grades and a less severe effusion grade were independently associated with gout compared with asymptomatic hyperuricemia (R²  = 0.65, P < 0.001).

CONCLUSION

Urate deposition, synovitis, and bone erosion are common at the MTP1 joint in people with gout, even in the absence of flare. Although individuals with asymptomatic hyperuricemia lack ultrasound features of inflammation or structural joint changes, they demonstrate a similar frequency of urate deposition.

Preservation of electronic properties of double-decker complexes on metallic supports

Single-molecule magnets based on lanthanide double-deckers are attracting significant attention due to their unrivaled single-ion anisotropy. To exploit their fascinating electronic and magnetic properties in devices for information storage or spin transport, studies on the preservation or variation of electronic and magnetic functionalities upon adsorption on surfaces are necessary. Herein, we introduced a comprehensive scanning tunneling microscopy (STM) and X-ray photoelectron spectroscopy (XPS) surface science study, complemented by density functional theory (DFT) simulations, of a recently synthesized single-molecule magnet based on porphyrazine deckers, conveniently equipped with ethyl moieties to make them soluble and sublimable. We demonstrated that the double-decker species were intactly adsorbed on Au(111), Ag(111), and Cu(111) in a flat-on fashion and self-assembled in hexagonal close-packed layers. Systematic multi- and monolayer XPS was performed on the surface-confined species, confirming the preservation of the electronic properties of the ligands and the lanthanide center upon adsorption.

Causes of hepatic capsular retraction: a pictorial essay

Abstract

Hepatic capsular retraction refers to the loss of the normal convex hepatic contour, with the formation of an area of flattening or concavity. This can result from myriad causes, including intrinsic hepatic conditions such as cirrhosis, biliary obstruction, benign tumours, malignancy and infections, as well as extrahepatic causes such as trauma. This article aims to provide familiarity with this wide spectrum of conditions, including mimics of hepatic capsular retraction, by highlighting the anatomic, pathologic and imaging features that help distinguish these entities from one another.

Teaching Points

• Hepatic capsular retraction can occur due to various intrinsic or extrinsic hepatic causes.

• Hepatic capsular retraction is observed in both benign and malignant conditions.

• Recognising associated imaging features can help elicit causes of hepatic capsular retraction.

Very-low-calorie ketogenic diet with aminoacid supplement versus very low restricted-calorie diet for preserving muscle mass during weight loss: a pilot double-blind study

OBJECTIVE

Obesity plays a relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional and metabolic factors. We conducted a dietary intervention case-control randomized trial, to compare the effectiveness on body composition of two nutritional protocols: a very-low-carbohydrate ketogenic diet (VLCKD), integrated by an aminoacid supplement with whey protein, and very low restricted-calorie diet (VLCD).

PATIENTS AND METHODS

The clinical study was conducted with a randomized case-control in which twenty-five healthy subjects gave informed consent to participate in the interventional study and were evaluated for their health and nutritional status, by anthropometric, and body composition evaluation.

RESULTS

The results of this pilot study show that a diet low in carbohydrates, associated with a decreased caloric intake, is effective in weight loss. After VLCKD, versus VLCD, no significant differences in body lean of the trunk, body lean distribution (android and gynoid), total body lean were observed (p > 0.05). After VLCKD, no increasing of sarcopenia frequency, according ASSMI, was observed.

DISCUSSION

Many studies have shown the effectiveness of the ketogenic diet on weight loss; even if not know how to work effectively, as some researchers believe that the weight loss is due to reduced calorie intake, satiety could also be induced by the effect of the proteins, rather than the low-carbohydrates.

CONCLUSIONS

Our pilot study showed that a VLCKD was highly effective in terms of body weight reduction without to induce lean body mass loss, preventing the risk of sarcopenia. Further clinical trials are needed on a larger population and long-term body weight maintenance and risk factors management effects of VLCKD. There is no doubt, however, that a proper dietary approach would impact significantly on the reduction of public expenditure costs, in view of prospective data on increasing the percentage of obese people in our nation.

Cu diffusion as an alternative method for nanopatterned CuTCNQ film growth

In this paper we show by means of 'in situ' x-ray diffraction studies that CuTCNQ formation from Cu(solid)-TCNQ(solid tetracyanoquinodimethane) goes through Cu diffusion at room temperature. The film quality depends on the TCNQ evaporation rate. At low evaporation rate we get a single phase-I CuTCNQ film very well crystallized and well oriented. The film has a CuTCNQ(0 2 0) orientation. The film is formed by CuTCNQ nanorods of a very homogeneous size. The film homogeneity has also been seen by atomic force microscopy (AFM). The electronic properties of the film have been measured by x-ray photoelectron spectroscopy (XPS) and ultra-violet photoelectron spectroscopy (UPS). Thus, the Cu-diffusion method has arisen as a very simple, clean and efficient method to grow localized CuTCNQ nanorods on Cu, opening up new insights for technological applications.

Observation of Localized Vibrational Modes of Graphene Nanodomes by Inelastic Atom Scattering

Inelastic helium atom scattering (HAS) is suitable to determine low-energy (few meV) vibrations spatially localized on structures in the nanometer range. This is illustrated for the nanodomes that appear often on graphene (Gr) epitaxially grown on single crystal metal surfaces. The nature of the inelastic losses observed in Gr/Ru(0001) and Gr/Cu/Ru(0001) has been clarified by intercalation of Cu below the Gr monolayer, which decouples the Gr layer from the Ru substrate and changes substantially the out-of-plane, flexural phonon dispersion of epitaxial Gr, while maintaining the nanodomes and their localized vibrations. He diffraction proves that the Cu-intercalated Gr layer is well ordered structurally, while scanning tunneling microscopy reveals the persistence of the (slightly modified) periodic array of Gr nanodomes. A simple model explains the order of magnitude of the energy losses associated with the Gr nanodomes and their size dependence. The dispersionless, low-energy phonon branches may radically alter the transport of heat in intercalated Gr.

Dysprosium-carboxylate nanomeshes with tunable cavity size and assembly motif through ionic interactions

Tunability of cavity size and assembly motif of dysprosium-directed nanomeshes through ionic interactions.

Comparative efficiency of TiO2 nanoparticles in suspension vs. immobilization into P(VDF–TrFE) porous membranes

Optimized photocatalytic membranes based on TiO₂ and NaY immobilized into P(VDF–TrFE) have been developed showing a degradation efficiency of 96%.

Resilience and corpus callosum microstructure in adolescence

BACKGROUND

Resilience is the capacity of individuals to resist mental disorders despite exposure to stress. Little is known about its neural underpinnings. The putative variation of white-matter microstructure with resilience in adolescence, a critical period for brain maturation and onset of high-prevalence mental disorders, has not been assessed by diffusion tensor imaging (DTI). Lower fractional anisotropy (FA) though, has been reported in the corpus callosum (CC), the brain's largest white-matter structure, in psychiatric and stress-related conditions. We hypothesized that higher FA in the CC would characterize stress-resilient adolescents.

METHOD

Three groups of adolescents recruited from the community were compared: resilient with low risk of mental disorder despite high exposure to lifetime stress (n = 55), at-risk of mental disorder exposed to the same level of stress (n = 68), and controls (n = 123). Personality was assessed by the NEO-Five Factor Inventory (NEO-FFI). Voxelwise statistics of DTI values in CC were obtained using tract-based spatial statistics. Regional projections were identified by probabilistic tractography.

RESULTS

Higher FA values were detected in the anterior CC of resilient compared to both non-resilient and control adolescents. FA values varied according to resilience capacity. Seed regional changes in anterior CC projected onto anterior cingulate and frontal cortex. Neuroticism and three other NEO-FFI factor scores differentiated non-resilient participants from the other two groups.

CONCLUSION

High FA was detected in resilient adolescents in an anterior CC region projecting to frontal areas subserving cognitive resources. Psychiatric risk was associated with personality characteristics. Resilience in adolescence may be related to white-matter microstructure.

Vectorial Kerr magnetometer for simultaneous and quantitative measurements of the in-plane magnetization components

A vectorial magneto-optic Kerr effect (v-MOKE) setup with simultaneous and quantitative determination of the two in-plane magnetization components is described. The setup provides both polarization rotations and reflectivity changes at the same time for a given sample orientation with respect to a variable external magnetic field, as well as allowing full angular studies. A classical description based on the Jones formalism is used to calculate the setup's properties. The use of different incoming light polarizations and/or MOKE geometries, as well as the errors due to misalignment and solutions are discussed. To illustrate the capabilities of the setup a detailed study of a model four-fold anisotropy system is presented. Among others, the setup allows to study the angular dependence of the hysteresis phenomena, remanences, critical fields, and magnetization reversal processes, as well as the accurate determination of the easy and hard magnetization directions, domain wall orientations, and magnetic anisotropies.

Vulnérabilité aux troubles de l’humeur à l’adolescence

L’instabilité émotionnelle est fréquente à l’adolescence et peut parfois être considérée comme un trouble de l’humeur subsyndromique. Or, les tableaux subsyndromiques de manie ou de dépression à l’adolescence évoluent souvent vers des troubles de l’humeur. Nous avons recherché, chez des adolescents « subsyndromiques », s’il existait des modifications cérébrales voisines de celles retrouvées dans les troubles de l’humeur avérés. Les participants étaient tous issus de la cohorte IMAGEN qui a rassemblé des données de plus de 2000 adolescents européens scolarisés en classes de 4e et 3e. Ils avaient été examinés en imagerie cérébrale anatomique (IRM T1 et de diffusion) et évalués par un entretien diagnostique informatisé permettant l’évaluation d’éventuels symptômes. Une première étude a comparé la microstructure de la substance blanche et le volume de substance grise chez des participants présentant des symptômes bipolaires maniaques subsyndromiques comparés à des adolescents pris comme témoins. Une deuxième étude a été menée chez des adolescents ayant des symptômes subsyndromiques de dépression. L’analyse des images a mis en évidence chez les adolescents à bipolarité subsyndromique des variations de la microstructure de la substance blanche dans plusieurs faisceaux en cours de maturation, et un moindre volume de substance grise dans des régions du cerveau contribuant à la régulation émotionnelle. Chez les adolescents « subdéprimés », des modifications étaient également présentes dans le réseau fronto-striatal. Pour la première fois, des modifications de la structure cérébrale de régions impliquées dans les troubles de l’humeur ont été mises en évidence chez des adolescents scolarisés ayant des symptômes subsyndromiques. Ces résultats suggèrent des particularités de maturation cérébrale à l’adolescence qui pourraient entraîner une vulnérabilité aux troubles de l’humeur.

Helium, neon and argon diffraction from Ru(0001)

We present an experimental and theoretical study of He, Ne and Ar diffraction from the Ru(0001) surface. Close-coupling calculations were performed to estimate the corrugation function and the potential well depth in the atom-surface interaction in all three cases. DFT (density functional theory) calculations, including van der Waals dispersion forces, were used to validate the close-coupling results and to further analyze the experimental results. Our DFT calculations indicate that, in the incident energy range 20-150 meV, anticorrugating effects are present in the case of He and Ar diffraction, whereas normal corrugation is observed with Ne beams.