The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a statistical analysis plan for a randomized controlled trial

BACKGROUND

Electroencephalography (EEG)-based brain-computer interfaces (BCIs) allow to modulate the sensorimotor rhythms and are emerging technologies for promoting post-stroke motor function recovery. The Promotoer study aims to assess the short and long-term efficacy of the Promotoer system, an EEG-based BCI assisting motor imagery (MI) practice, in enhancing post-stroke functional hand motor recovery. This paper details the statistical analysis plan of the Promotoer study.

METHODS

The Promotoer study is a randomized, controlled, assessor-blinded, single-centre, superiority trial, with two parallel groups and a 1:1 allocation ratio. Subacute stroke patients are randomized to EEG-based BCI-assisted MI training or to MI training alone (i.e. no BCI). An internal pilot study for sample size re-assessment is planned. The primary outcome is the effectiveness of the Upper Extremity Fugl-Meyer Assessment (UE-FMA) score. Secondary outcomes include clinical, functional, and user experience scores assessed at the end of intervention and at follow-up. Neurophysiological assessments are also planned. Effectiveness formulas have been specified, and intention-to-treat and per-protocol populations have been defined. Statistical methods for comparisons of groups and for development of a predictive score of significant improvement are described. Explorative subgroup analyses and methodology to handle missing data are considered.

DISCUSSION

The Promotoer study will provide robust evidence for the short/long-term efficacy of the Promotoer system in subacute stroke patients undergoing a rehabilitation program. Moreover, the development of a predictive score of response will allow transferring of the Promotoer system to optimal clinical practice. By carefully describing the statistical principles and procedures, the statistical analysis plan provides transparency in the analysis of data.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04353297 . Registered on April 15, 2020.

Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study

BACKGROUND

Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about the role of the specialized diets in modulating the lung microbiota, and little is known about the influence of lung microbiota structure in development of ventilator-associated pneumonia (VAP) in TBI pts. The aims of this study are to evaluate the impact of specific nutrients on the lung microbiota and the variation of lung microbiota in TBI pts developing VAP.

METHODS

A cohort of 31 TBI pts requiring mechanical ventilation in ICU was randomized for treatment with specialized (16pts) or standard nutrition (15pts). Alpha and beta diversity of lung microbiota were analyzed from bronco Alveolar Lavage (BAL) samples collected at admission and 7 days post-ICU admission in both groups. A further analysis was carried out on the same samples retrospectively grouped in VAP or no VAP pts.

RESULTS

None developed VAP in the first week. Thereafter, ten out of thirty-one pts developed VAP. The BAL microbiota on VAP group showed significant differences in beta diversity and Staphylococcus and Acinetobacter Genera were high. The specialized nutrition had influence on beta diversity that reached statistical significance only in Bray-Curtis distance.

CONCLUSION

Our data suggest that TBI patients who developed VAP during ICU stay have different structures of BAL microbiota either at admission and at 7 days post-ICU admission, while no correlation has been observed between different enteral formulas and microbiota composition in terms of richness and evenness. These findings suggest that targeting the lung microbiota may be a promising approach for preventing infections in critically ill patients.

Aspirin therapy on prophylactic anticoagulation for hospitalized patients with COVID-19: a propensity score-matched cohort analysis of the HOPE-COVID-19 registry

Background

COVID-19 is an infectious illness, featured by an increased risk of thromboembolism. However, no standard antithrombotic therapy is currently recommended for COVID-19 hospitalized patients. Aim of this study was to evaluate safety and efficacy of additional therapy with aspirin over prophylactic anticoagulation (PAC) in COVID-19 hospitalized patients and its impact on survival.

Methods

8168 patients hospitalized with COVID-19 were enrolled in a multicenter-international prospective registry (HOPE COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. 344 patients with incomplete data were excluded. Study population included patients treated with PAC or with PAC and aspirin. A comparison of clinical outcomes between patients treated with PAC and PAC and aspirin was performed using an adjusted analysis with propensity score matching.

Results

Of 7824 patients, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC. Propensity-score matching yielded 298 patients from each group. Mean age was 73±11 years, 67% were male, prevalence of hypertension and diabetes was 79 and 33% respectively and 7.5% underwent invasive ventilation.

In the propensity score-matched population, cumulative incidence of in-hospital mortality was lower in patients treated with PAC and aspirin vs PAC (15% vs 21%, Log Rank p=0.01, Figure 1). At multivariable analysis in propensity matched population of COVID-19 patients, including age, sex, hypertension, diabetes, kidney failure and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality (HR 0.62, CI 95% 0.42–0.92, p=0.018).

Conclusions

Additional therapy with aspirin over PAC in COVID-19 hospitalized patients was associated with lower mortality risk in a propensity score matched population.

Funding Acknowledgement

Type of funding sources: None.

Long-term mayor adverse cardiovascular events after COVID-19 infection: a clinical score from a cohort of 2575 patients enrolled in the multicenter international HOPE 2 registry

Background

Long-term consequences of COVID-19 infection are still partly known. According to some studies several patients may experience long term symptoms; however, predictors of long-term mayor adverse cardiovascular events among (MACE) patients with previous COVID-19 infection are .

Aim of the study

To derive a simple clinical score for risk prediction of long-term MACE among patients with previous covid-19 infection.

Methods

2575 consecutive patients were enrolled in a multicenter, international registry (HOPE-2) from February 2020 to April 2021, and followed-up at long-term. A risk score was developed using a stepwise multivariable regression analysis.

Results

Out of 2575 patients enrolled in the HOPE-2 registry, 1481 (58%) were male, with mean age of 60±16 years. At long-term follow-up overall rate of MACE was 7.9% (202 of 2545 pts, 3.3% death, 2.4% inflammatory myocardial disease, 1.3% arterial thrombosis, 0.7% venous thrombosis). After multivariable regression analysis, independent predictors of MACE were used to derive a simple prognostic score: The HOPE-2 prognostic score may be calculated by giving: ½ point for every 10 years of age, 2 points for previous cardiovascular disease, 1 point for increased troponin serum levels during hospitalization, 2.5 points for heart failure and 3 points for sepsis during hospitalization, −1.5 points for vaccination at follow-up. Score accuracy at receiver operating characteristic curve analysis was 0.81.

Stratification into 3 risk groups (0–2, 3–5, and >5 points) classified into low, intermediate and high risk. The observed MACE rates were 0.5% for low-risk patients, 4% for intermediate-risk patients, and 19.5% for high-risk patients (log-Rank p<0.001, Figure 1).

Conclusions

The HOPE-2 prognostic score may be useful for long-term risk stratification in patients with previous COVID-19 infection. High-risk patients may require a strict cardiological follow-up.

Funding Acknowledgement

Type of funding sources: None.

Fever following Covid-19 vaccination in subjects with Brugada syndrome: incidence and management

Funding Acknowledgements

Type of funding sources: None.

Background

Fever is a potential side effect of Covid-19 vaccination. Patients with Brugada syndrome (BS) have an increased risk of life-threatening arrhythmias when experiencing fever. A prompt treatment with antipyretic drugs is suggested in these patients.

Aim of the study: To evaluate the incidence and management of fever within 48 hours from Covid-19 vaccination among BS patients.

Methods

163 consecutive patients were enrolled in a prospective registry involving 5 European hospitals with a dedicated inherited disease ambulatory.

Results

Mean age was 50 ±14 years and 121 (75%) patients were male. Prevalence of Brugada ECG pattern type-1,-2 and -3 was 32 %, 44%, 24%, respectively. Twenty-eight (17%) patients had an implantable cardioverter defibrillator.

Fever occurred in 32 (19%) BS patients after 16±10 hours from vaccination, with peak of body temperature of 37.9±0.5 degrees. Patients with fever were younger (39±13 vs 48±13 years, p=0.04). No additional differences in term of sex and cardiovascular risk factors were found between patients with fever and not.

Twenty-seven (84%) out of 32 patients experienced mild fever and five (16%) moderate fever. Pharmacological treatment with antipyretic drugs was required in 18 (56%) out of 32 patients and was associated with resolution of symptoms.

No patient required hospital admission and no arrhythmic episode was recorded in patients with ICD within 48 hours after vaccination.

Conclusion

Fever is a common side effect in BS patients after Covid-19 vaccination. Careful evaluation of body temperature and prompt treatment with antipyretic drug may be needed.

Cognitive disorders in takotsubo syndrome: incidence, short and long-term outcome. Results from a prospective multi-center registry

Background

Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. There are evidence suggesting a possible link between neurological disease and TTS. Aim of the study was to evaluate incidence and prognostic value of cognitive neurological disorders among TTS patients.

Methods

379 consecutive patients were enrolled in a prospective multicenter registry. History, clinical features, echocardiographic parameters, in-hospital complications and long-term follow up events of all patients were recorded. Cognitive neurological disorders included Alzheimer disease, old age dementia and cognitive impairment for other causes.

Results

Prevalence of cognitive neurological disorders among TTS patients was 5.5% (num=21). Among this subset of patients 48% (num=10) had Alzheimer syndrome, 24% (num=5) old age dementia and 28% (num=6) cognitive impairment for other causes.

Compared to the control group, these patients were older (81±5 vs 71±12, p=0.01) and predominantly men (24% vs 9%, p=0.01). No differences in term of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found among the two groups.

TTS patients with cognitive neurological disorders experienced higher rate of in-hospital complications (62% vs 28% p=0.01), that were mainly driven by higher rate of pulmonary edema (14% vs 9% p=0.01), cardiogenic shock (29% vs 8%, p=0.01), death (24% vs 4% p=0.01), ischemic stroke (10% vs 4% p=0.01) and left ventricular thrombi (10% vs 3%, p=0.01).

At long term follow up patients with cognitive neurological disorders when compared to those without, experienced higher rate of mayor cardiovascular events (48% vs 16%, p=0.01), cardiovascular re-hospitalization (14% vs 10%, p=0.01) and death (43% vs 9%, p=0.01).

Conclusion

TTS patients with cognitive neurological disorders had an increased risk of in and out of hospital mayor cardiac adverse events and mortality at short and long-term follow-up.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Ospedali Riuniti di Foggia-Università di Foggia

Antiplatelet therapy and outcome in patients with COVID-19. Results from a multi-center international prospective registry (HOPE-COVID19)

Background

No standard therapy is currently recommended for Corona-virus-19 disease (COVID-19). Autopsy studies showed high prevalence of platelet-fibrin rich micro-thrombi in several organs. Aim of the study was to evaluate safety and efficacy of antiplatelet therapy (APT) in COVID-19 hospitalized patients and its impact on survival.

Methods

7824 consecutive patients with COVID-19 were enrolled in a multicenter-international prospective registry (HOPE-COVID19). Clinical data and in-hospital complications were recorded. AP regimen, including aspirin and other antiplatelet drugs, was obtained for each patient.

Results

During hospitalization 730 (9.3%) patients received AP drugs with single (93%, n=680) or dual APT (7%, n=50). Patients treated with APT were older (73±12 vs 62±17 years, p<0.01), more frequently male (70% vs 64%, p<0.01) and had higher prevalence of diabetes (39.5% vs 17%, p<0.01).

Patients treated with APT showed no differences in terms of in-hospital mortality (18% vs 19%, p=0.64, Log Rank p=0.23), need of invasive ventilation (8.7% vs 8.5%, p=0.88) and bleeding (2.1% vs 2.4%, p=0.43); However, after excluding patients treated only with anticoagulation, APT was associated with lower mortality rates (Log Rank p<0.01, relative risk 0.79, 95% CI 0.70–0.94) (Figure 1).

At multivariable analysis including age, gender, diabetes, hypertension, respiratory failure, pre-hospital therapy with antiplatelet drugs, in-hospital APT, and anticoagulation therapy, in-hospital APT was associated with a lower mortality risk (relative risk 0.29, 95% CI 0.22–0.38, p<0.001).

Conclusions

APT during hospitalization for COVID-19 could be associated with lower mortality risk without increased risk of bleeding. Randomized trials are needed to confirm these preliminary data.

Funding Acknowledgement

Type of funding sources: None.

Cerebrovascular events in takotsubo syndrome: short and long-term outcome. Results from a multicenter-prospective registry

Background

Several studies have shown that Takotsubo syndrome (TTS) secondary to neurological disorders is associated with higher rate of in-hospital complications. Imaging brain studies found that atrophy or damage of some regions and their altered connectivity with other brain regions are typical features of TTS patients.

Aim of the study

To evaluate rates of in hospital and long-term follow up events in TTS patients with history or acute cerebrovascular events (CVE).

Methods

395 consecutive patients were enrolled in a multicenter prospective registry. History, clinical data, echocardiographic parameters and in-hospital and long-term follow up events of all patients were evaluated.

Results

Prevalence of CVE among TTS patients was 9.4% (N=37). Compared to the control group, these patients were older (80±7 vs 71±12 years, p=0.01) and predominantly men (24% vs 9%, p=0.01). No differences in terms of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found between the two groups. The prevalence of physical stressors was higher in the CVE group (67% vs 44% p=0.01).

The incidence of in-hospital adverse events was higher in the CVE group (70% vs 29%), mainly driven by higher rates of cardiogenic shock (19 vs 8%, p=0.01) and in-hospital death (19 vs 4%, p=0.01).

At long-term follow-up, patients in the CVE group had higher mortality rates (38% vs 20%, p=0.01).

Patients presenting with acute CVE, 10 out of 37 patients (27%), when compared with chronic CVE had higher in-hospital mortality rates (40% vs 11%, p=0.01).

Conclusion

TTS patients with history or CVE had higher rates of in-hospital events and death at long-term follow-up. Acute CVEs in the setting of TTS are associated with a worse prognosis.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Ospedali Riuniti di Foggia. Università di Foggia

Prognostic value of acute mitral insufficiency among patients admitted with Takotsubo syndrome. Preliminary data from a prospective multicenter registry

Background

Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. Aim of the study is to evaluate the incidence and prognostic value of acute mitral insufficiency among TTS patients.

Methods

Three hundred sixteen consecutive patients admitted for TTS were enrolled from July 2007 to December 2019 in a prospective registry among four hospitals. Clinical features, laboratory data, ECG and echocardiographic parameters and in-hospital complications were recorded.

Results

Eighty-five (27%) patients, mean age 76±8 years, presented with moderate/severe mitral insufficiency (msMI). Compared to the control group, patients that presented with msMI were older (76±8 vs 71±12 years, p&lt;0.01), had lower LVEF (34±7% vs 37±9% p=0.02) and experienced higher rate of in-hospital complications (42 vs 32% p=0.04).

The incidence of in-hospital adverse events was higher in case of both msMI and LVEF &lt;35% than in one of the two previous conditions or neither (69%, 42%, 23% respectively, p&lt;0.05). Differences remained statistically significant even after correction for age and gender in the multivariate analysis.

There was a reduction of mitral insufficiency from moderate/severe into mild in 30 out of 87 (34%) pts after 48h from admission and in 52 out of 87 pts at discharge (60%).

Left ventricular outflow tract obstruction (LVOTO) was found in 13 out of 87 (15%) pts with msMI at admission and was transient in 11 out of 13 pts (84%).

At long term follow up (650 days) patients with msIM when compared to those without, experienced higher rate of mayor cardiovascular events (31.7% vs 20% p=0.03).

Conclusions

Patients with TTS and moderate/severe mitral insufficiency at admission have an increased risk of in and out-of hospital mayor cardiac adverse events.

Funding Acknowledgement

Type of funding source: None

Neoplastic markers in Takotsubo syndrome. Results from a prospective registry

Background

Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rate of in and out-of hospital mayor cardiac adverse events (MACE).

Aim of this study

Evaluate the possible role of neoplastic biomarkers (CA 15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)) as prognostic marker at short- and long-term follow-up in subjects with TTS.

Methods

Ninety consecutive subjects with TTC were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9, CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded.

Results

Forty-three (46%) patients experienced MACE during hospitalization. These patients were older (78±9 vs 72±12 p=0.01), had lower LVEF (32±7 vs 38±8 p=0,01) and increased levels of CEA (4.3±6.2 vs 2.2±1.5 ng/ml p=0.03). CEA and CA 19.9 levels at admission were statistically correlated with CRP and NT-proBNP levels (both p&lt;0.05).

At long term follow-up CEA and CA 19.9 levels (higher than median) were associated with increased risk of death (log rank p&lt;0.01 (both) RR=5.3 CI 95% 1.9–14.8 p&lt;0.01; RR=7.8 CI 95% 2.4–25.1 p&lt;0.01 respectively). At multivariate analysis including age, sex and admission LVEF, CEA and CA 19.9 levels higher than median were an independent predictor of MACE at long term (p&lt;0.01 RR 3.5 CI 1.6–7.3).

Conclusion

CEA and CA 19.9 serum levels are associated with higher risk of in-hospital MACE and death at long-term.

Funding Acknowledgement

Type of funding source: None

Precursory worldwide signatures of earthquake occurrences on Swarm satellite data

The study of the preparation phase of large earthquakes is essential to understand the physical processes involved, and potentially useful also to develop a future reliable short-term warning system. Here we analyse electron density and magnetic field data measured by Swarm three-satellite constellation for 4.7 years, to look for possible in-situ ionospheric precursors of large earthquakes to study the interactions between the lithosphere and the above atmosphere and ionosphere, in what is called the Lithosphere-Atmosphere-Ionosphere Coupling (LAIC). We define these anomalies statistically in the whole space-time interval of interest and use a Worldwide Statistical Correlation (WSC) analysis through a superposed epoch approach to study the possible relation with the earthquakes. We find some clear concentrations of electron density and magnetic anomalies from more than two months to some days before the earthquake occurrences. Such anomaly clustering is, in general, statistically significant with respect to homogeneous random simulations, supporting a LAIC during the preparation phase of earthquakes. By investigating different earthquake magnitude ranges, not only do we confirm the well-known Rikitake empirical law between ionospheric anomaly precursor time and earthquake magnitude, but we also give more reliability to the seismic source origin for many of the identified anomalies.

P3689Association of echocardiographic progression and genetic profile in arrhythmogenic right ventricular cardiomyopathy

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is frequently associated with mutations in genes coding for desmosomal proteins. In this study, we investigated the association of genetic status with ARVC progression as defined by echocardiographic parameters.

Methods

We tested 62 ARVC patients for their genetic profile. Accordingly, they were grouped in mutation positive (48 (77%) patients; median age 48.5 years; 33 (69%) males), and mutation negative (14 (23%) patients; median age 45 years; 10 (71%) males). Prevalent mutations were Desmoglein-2 (DSG2) in 16 (26%), Desmoplakin (DSP) in 14 (23%), and Plakophilin-2 (PKP2) in 9 (15%) patients.

Results

At baseline, there were no significant differences in clinical characteristics between the two groups. Patients were followed-up for a median time period of 1420 days, and there was no significant difference in the duration of follow-up between the two groups (p=0.05).

In the mutation positive group, there was a significant increase in right ventricular end-diastolic area (p=0.002), right atrial short (p=0.008) and long (p=0.002) diameter, left atrial diameter (p=0.014), and a decrease in left ventricular ejection fraction (p=0.014) during follow up. Right ventricular functial parameters did not change significantly (tricuspid annular plane systolic excursion: p=0.24; fractional area change: p=0.088).

In the mutation negative group, none of the aforementioned echocardiographic findings exhibited any significant difference during follow-up: right ventricular end-diastolic area (p=0.1); right atrial short (p=0.7) and long (p=0.9) diameter, left atrial diameter (p=0.6), and left ventricular ejection fraction (p=0.3). Similarly, right ventricular functional parameters did not change significantly (tricuspid annular plane systolic excursion: p=0.77; fractional area change: p=0.80. Results are summarized in the figure.

Change in echocardiographic findings.

Conclusions

There is a strong association between echocardiographic progression of ARVC phenotype and the presence of a pathogenic mutation. Such mutations should be searched in all patients with an ARVC phenotype, and mutation positive individuals should be followed-up in shorter intervals.

P3691Intra-aortic balloon counterpulsation in takotsubo syndrome complicated by cardiogenic shock: short- and long-term results from a cohort of 2250 patients of the German-Italian-Spanish registry

Background

Takotsubo syndrome (TTS) is featured by an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock. Intra-aortic balloon pumping (IABP) use in this setting is controversial, and few data are available from large populations. Aim of this study was therefore to evaluate short- and long-term impact of IABP on mortality in TTS complicated by cardiogenic shock.

Methods

The GEIST registry is a multicenter, international registry on TTS involving 38 centers from Germany, Italy and Spain. Between 2006 and 2017, 2250 consecutive patients with TTS were enrolled.

Results

Of the 2250 patients, 211 (9%) experienced cardiogenic shock during hospitalization for TTS. Admission left ventricular ejection fraction (LVEF) was 30±15% and systolic blood pressure was 90±35 mmHg. Apical ballooning pattern was found in 77%, mid-ventricular/basal pattern in 11%, and 2% of the patients, respectively.

Forty-two patients out of 211 (19%) received IABP after coronary angiography. Patients receiving IABP compared to standard medical therapy did not differ in terms of age, gender, cardiovascular risk factors and admission LVEF.

No differences were found in term of in-hospital mortality (9.5% vs 17% p=0.35), length of hospitalization (19.3 vs 16.3 days p=0.34), need of invasive ventilation (35% vs 41% p=0.60), stroke (4.7% vs 11% p=0.17) and LV thrombus (0.5% vs 1.7%, p=0.98).

At long-term follow-up, with a median of 2 years, overall mortality in patients with cardiogenic shock and TTS was 34.1%. Mortality was not different between the IABP and the control group (33.7% vs 35.0%; p=0.85).

Conclusions

In this large multicenter observational registry, the use of IABP has no impact on mortality at short and long-term follow-up. Further studies are needed to evaluate the best therapeutic strategy in TTS complicated by cardiogenic shock.

[The biological resources and molecule archives organization: turn a need into an opportunity for the Smart Specialization Strategy of the Lazio region.]

Smart Specialization Strategy (S3) of Lazio defines smart specialization strategies to bring out the excellence of the territory with prospects of success on the global market. Chemical-pharmaceutical, biomedical and biotechnological field is one of the 7 sectors considered of greatest interest for the S3. Key engine of biotechnology development are biological materials and associated data, stored in biobanks. However, to ensure that the research and product development carried out with that resources gives statistically significant and reproducible results, it is essential that they are collected, manipulated and stored using standardized and traced methods. Implementation of the recent published standard ISO 20387- "Biotechnology-Biobanking-General requirements for biobanking" is bridging biobanks toward to storage and distribution of qualified biological material only. Human biobanks are also an essential part of the assistance and care of the citizen and constitute an unavoidable cost of the regional health system. However, biobanks organization, rationalization of their territorial distribution, completion of the process of recognition and regional accreditation, parallel to the implementation of the offer of remunerated services for biobanking, can turn the cost of the necessary preservation of the samples, into an opportunity of territorial development. The paper describes the necessity, shared by a working group represented by several Lazio biobanks, of including biobank activities in the virtuous circle designed by the S3,concretizing the framework prefigured by the S3 document on infrastructures for research, innovation and technology transfer. To allow inclusion of biobank activities in the virtuous circle, we underline the need to quickly start the process of recognition of the territorial research biobanks, to implement at regional level the process of optimization and rationalization of the management of biological samples, in accordance with the international harmonization standards and with the territorial indications of sustainability.

Bioelectronics goes 3D: new trends in cell–chip interface engineering

Bioelectronic platforms can be used for electrophysiology, monitoring and stimulating specific cellular functions.

Improving Provision of Care for Long-term Survivors of Lymphoma

The progressive improvement of lymphoma therapies has led to a significant prolongation of patient survival and life expectancy. However, lymphoma survivors are at high risk of experiencing a range of early and late adverse effects associated with the extent of treatment exposure. Among these, second malignancies and cardiopulmonary diseases can be fatal, and neurocognitive dysfunction, endocrinopathy, muscle atrophy, and persistent fatigue can affect patients' quality of life for decades after treatment. Early recognition and reduction of risk factors and proper monitoring and treatment of these complications require well-defined follow-up criteria, close coordination among specialists of different disciplines, and a tailored model of survivorship care. We have summarized the major aspects of therapy-related effects in lymphoma patients, reviewed the current recommendations for follow-up protocols, and described a new hospital-based model of survivorship care provision from a recent multicenter Italian experience.

Optical absorption and magnetic circular dichroism spectra of thiouracils: a quantum mechanical study in solution

The excited electronic states of thiouracils, the analogues of uracil where the carbonyl oxygens are substituted by sulphur atoms, have been investigated by computing the magnetic circular dichroism (MCD) and one-photon absorption (OPA) spectra at the TD-DFT level of theory.

Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis

BACKGROUND

We investigated the additional contribution of mammography to screening accuracy in BRCA1/2 mutation carriers screened with MRI at different ages using individual patient data from six high-risk screening trials.

METHODS

Sensitivity and specificity of MRI, mammography and the combination of these tests were compared stratified for BRCA mutation and age using generalised linear mixed models with random effect for studies. Number of screens needed (NSN) for additional mammography-only detected cancer was estimated.

RESULTS

In BRCA1/2 mutation carriers of all ages (BRCA1 = 1,219 and BRCA2 = 732), adding mammography to MRI did not significantly increase screening sensitivity (increased by 3.9% in BRCA1 and 12.6% in BRCA2 mutation carriers, P > 0.05). However, in women with BRCA2 mutation younger than 40 years, one-third of breast cancers were detected by mammography only. Number of screens needed for mammography to detect one breast cancer not detected by MRI was much higher for BRCA1 compared with BRCA2 mutation carriers at initial and repeat screening.

CONCLUSIONS

Additional screening sensitivity from mammography above that from MRI is limited in BRCA1 mutation carriers, whereas mammography contributes to screening sensitivity in BRCA2 mutation carriers, especially those ⩽ 40 years. The evidence from our work highlights that a differential screening schedule by BRCA status is worth considering.

Ultra-thin resin embedding method for scanning electron microscopy of individual cells on high and low aspect ratio 3D nanostructures

The preparation of biological cells for either scanning or transmission electron microscopy requires a complex process of fixation, dehydration and drying. Critical point drying is commonly used for samples investigated with a scanning electron beam, whereas resin-infiltration is typically used for transmission electron microscopy. Critical point drying may cause cracks at the cellular surface and a sponge-like morphology of nondistinguishable intracellular compartments. Resin-infiltrated biological samples result in a solid block of resin, which can be further processed by mechanical sectioning, however that does not allow a top view examination of small cell-cell and cell-surface contacts. Here, we propose a method for removing resin excess on biological samples before effective polymerization. In this way the cells result to be embedded in an ultra-thin layer of epoxy resin. This novel method highlights in contrast to standard methods the imaging of individual cells not only on nanostructured planar surfaces but also on topologically challenging substrates with high aspect ratio three-dimensional features by scanning electron microscopy.