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Thoracic aortic rupture may present with subtle clinical and CT-angiography findings. Recognition of the imaging features of early rupture is key for timely diagnosis and treatment. This report presents a new sign of incipient proximal thoracic aortic rupture on CT-angiography.

Cardiovascular diseases represent one of the most frequent diseases worldwide; among these, lower limb ischemia is a threatening condition, which can lead to permanent disability if not promptly and correctly diagnosed and treated. A patient’s clinical evaluation and diagnostic imaging (e.g., color-Doppler ultrasound, computed tomography angiography (CTA), and magnetic resonance imaging (MRI)) are mandatory to carefully assess arterial lesion extension and severity. Digital subtraction angiography (DSA) is a minimally invasive technique that represents the gold standard for percutaneous revascularization treatment of symptomatic patients who are refractory to medical management. However, when dealing with patients with lower limb terminal ischemia, the correct interpretation of diagnostic DSA findings is mandatory for treatment re-planning and to effectively evaluate post-treatment results and complications. The purpose of this review is to provide interventional radiologists and endovascular practitioners with an up-to-date practical guide to diagnostic angiography of the lower limbs, which is mandatory to address correct treatment decisions and post-treatment evaluation.

Background Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) still experience a high rate of in-hospital complications. Liver fibrosis (LF) is a risk factor for mortality in the general population. We investigated whether the presence of LF detected by the validated fibrosis 4 (FIB-4) score may indicate ACS patients at higher risk of poor outcome. Methods In the prospective ongoing REAl-world observationaL rEgistry of Acute Coronary Syndrome (REALE-ACS), LF was defined by a FIB-4 score > 3.25. We repeated the analysis using an APRI score > 0.7. The primary endpoint was in-hospital adverse events (AEs) including a composite of in-hospital cardiogenic shock, PEA/asystole, acute pulmonary edema and death. Results A total of 469 consecutive ACS consecutive patients were enrolled. Overall, 21.1% of patients had a FIB-4 score > 3.25. Patients with LF were older, less frequently on P2Y12 inhibitors (p = 0.021) and admitted with higher serum levels of white blood cells (p p p = 0.013), hs-TnT (p p p p 3.25 (OR 3.1, 95%CI 1.4–6.9), admission left ventricular ejection fraction% below median (OR 9.2, 95%CI 3.9–21.7) and Killip class ≥ II (OR 6.3, 95%CI 2.2–18.4) were the strongest independent predictors of in-hospital AEs. Similar results were obtained using the APRI score. Conclusion LF detected by FIB-4 score > 3.25 was associated with more severe ACS presentation and worse in-hospital AEs irrespective of clinical and laboratory variables. Graphical abstract

The majority of patients with glioblastoma (GBM) experience disease progression. At recurrence, treatment options have limited efficacy. Many studies report a limited and short duration response rate. Although clinical trials represent the "gold standard" for providing evidence on efficacy of specific treatment strategies, real-world data can be considered more representative of the "real" GBM population.To describe the management of GBM recurrence in a large real-world sample.We analysed retrospectively the data stored in the database of the Neuro-oncology Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy. We considered only data of patients with histological diagnosis of GBM and disease recurrence during their follow-up. We excluded patients who did not receive treatment after the diagnosis.We analysed 422 patients (64% males, 36% females) with a mean age of 59.6 (range 16-87) years. At GBM recurrence, 135 (32.0%) patients underwent palliative care, and 287 (68.0%) underwent other treatments. Patients on palliative care were older, had a worse performance status, and a shorter time between GBM diagnosis and its recurrence. Patients who received chemotherapy in combination with other treatments (surgery and/or radiation therapy) at GBM recurrence had a longer survival than those in palliative care (p 0.001). Surgery or radiation therapy alone did not have any effect on survival as compared with palliative care (p 0.001).This study confirms the importance of a multidisciplinary approach even at GBM recurrence, suggesting that combination treatments play a key role in management of disease.

Malignant gliomas are brain tumors with dismal prognosis that can affect patients’ neurocognitive status. We performed longitudinal neuropsychological assessments to describe variations due to illness progression and treatment administration. Patients underwent a battery of standardized neuropsychological tests tapping into different cognitive domains (memory, attention, abstract reasoning, executive functions, learning), pre-radiotherapy and at 6, 12 and 24 month follow-up. We enrolled 130 patients, and almost 70% of them had at least one cognitive deficit. The most affected domains were executive function and long- and short-term memory. At follow-up assessments, cognitive status worsened in one-third of patients, whereas it remained unchanged or improved in two-thirds of patients. This is one of few longitudinal studies investigating cognitive function in a large sample of patients to monitor changes along the illness course.

Background Data on the interplay between sexual hormones balance, platelet function and clinical outcomes of adults with ischemic heart disease (IHD) are still lacking. Objective To assess the association between the Testosterone (T)-to-Estradiol (E2) Ratio (T/E2) and platelet activation biomarkers in IHD and its predictive value on adverse outcomes. Methods The EVA study is a prospective observational study of consecutive hospitalized adults with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Serum T/E2 ratios E2, levels of thromboxane B2 (TxB2) and nitrates (NO), were measured at admission and major adverse events, including all-cause mortality, were collected during a long-term follow-up. Results Among 509 adults with IHD (mean age 67 ± 11 years, 30% females), males were older with a more adverse cluster of cardiovascular risk factors than females. Acute coronary syndrome and non-obstructive coronary artery disease were more prevalent in females versus males. The lower sex-specific T/E2 ratios identified adults with the highest level of serum TxB2 and the lowest NO levels. During a median follow-up of 23.7 months, the lower sex-specific T/E2 was associated with higher all-cause mortality (HR 3.49; 95% CI 1.24–9.80; p = 0.018). In in vitro, platelets incubated with T/E2 ratios comparable to those measured in vivo in the lowest quartile showed increased platelet activation as indicated by higher levels of aggregation and TxB2 production. Conclusion Among adults with IHD, higher T/E2 ratio was associated with a lower long-term risk of fatal events. The effect of sex hormones on the platelet thromboxane release may partially explain such finding.

Background This study aimed to characterize the genetic profile of patients with glioma and discuss the impact of next-generation sequencing in glioma diagnosis and treatment. Methods Between 2019 and 2022, we analyzed the genetic profile of 99 patients with glioma through the Oncomine Focus Assay. The assay enables the detection of mutations in 52 driver genes, including single nucleotide variants (SNVs), copy number variants (CNVs), and gene fusions. We also collected and analyzed patients’ clinic characteristics and treatment outcomes. Results Over a period of 35 months, 700 patients with glioma followed by our neuro-oncology unit were screened, and 99 were enrolled in the study; most of the patients were excluded for inadequate non-morphological MRI or lack/inadequacy of the tissue samples. Based on our findings, most patients with glioma present mutations, such as SNVs, CNVs or gene fusions. Our data were similar to those reported by The Cancer Genome Atlas Program in terms of frequency of SNVs and CNVs, while we observed more cases of gene fusions. Median overall survival, progression-free survival, and time to progression were significantly lower for patients with grade VI glioblastoma than those with other gliomas. Only four patients were offered a targeted treatment based on the mutation detected; however, only one received treatment, the others could not receive the selected treatment because of worsening clinical status. Conclusion Routine timely molecular profiling in patients with glioma should be implemented to offer patients an individualized diagnostic approach and provide them with advanced targeted therapy options if available.

ObjectiveStarting from May 2022, a growing number of monkeypox cases have been identified in several countries in Europe and the United States. To date, information on social reaction to the news circulating about monkeypox is limited. Assessing psychological and social elements related to the tendency to misinterpret monkeypox information is urgent and useful in setting up tailored education and prevention programs for specific populations. The present study aims to explore the association of selected psychological and social variables to monkeypox attitudes as fake news.MethodsThree hundred and thirty-three participants (212 women, 110 men, and 11 other genders) from the general Italian population completed nine self-report measures.ResultsResults showed that people that were more likely to believe that monkeypox was a hoax were: older, heterosexual, politically conservative, and more religious. Moreoverm they were more likely to show more negative attitudes toward gay men, higher levels of sexual moralism, less knowledge and fear about monkeypox, no previous infections of COVID-19, lower number of COVID-19 vaccine doses, and being closer to no-vax theories. On the psychological side, participants that were more likely to believe that the monkeypox was a hoax were associated with lower levels of epistemic trust and order traits, with higher levels of epistemic mistrust, close-mindedness, and ability to process emotions. A full mediation model which explores the relationships between the main variables related to fake news attitudes toward monkeypox was tested, reporting good fit indices.ConclusionResults from the current study could be helpful to improve the effectiveness of health communication, design targeted education, and support people to engage in healthier behaviors.

Quantum Information Networks (QINs) attract increasing interest, as they enable connecting quantum devices over long distances, thus greatly enhancing their intrinsic computing, sensing, and security capabilities. The core mechanism of a QIN is quantum state teleportation, consuming quantum entanglement, which can be seen in this context as a new kind of network resource. Here we identify use cases per activity sector, including key performance targets, as a reference for the network requirements. We then define a high-level architecture of a generic QIN, before focusing on the architecture of the Space segment, with the aim of identifying the main design drivers and critical elements. A survey of the state-of-the-art of these critical elements is presented, as are issues related to standardisation. Finally, we explain our roadmap to developing the first QINs and detail the already concluded first step, the design and numerical simulation of a Space-to-ground entanglement distribution demonstrator., Comment: 21 pages, 9 figures, 4 tables

The goal of this scoping review is to understand the extent and type of evidence in relation to literature on individuals presenting with borderline personality pathology and clinical high-risk for psychosis (CHR-P), especially regarding early detection and intervention strategies provided in clinical service structures. This study aims to identify research gaps and recommend relevant research questions.

In patients (Pts) with ischemic stroke in addition to acute management, it is essential to prevent new episodes, first identifying the source of the stroke event. The primary objective of the study is to determine whether the parameters of duration, morphology (divided into the three factors optimal model order fitting, number of maximum and minimum and zero–crossing), and variability of the P wave, calculated with appropriate algorithms from high resolution recordings, correlate with the risk of developing atrial fibrillation (AF) in ischemic stroke Pts. As a secondary goal we have analyzed the differences of factors that are currently used in clinical practice for risk stratification. Methods and materials : 63 Pts with stroke ischemic were recruited,8 Pts excluded for finding of other arrhythmias during hospitalization,5 for incomplete data, reducing the sample to 50. In the Pts was recorded EKG track in high resolution with the Cardionica(R) device. We obtained,with special algorithms above mentioned,the parameters of duration, morphology and variability. The population studies as stratified in two groups based to continuous ECG monitoring data: those with AF detected and those without AF (control group). Results in the analysis of the P wave we found a significant difference in the parameter "number of zero crossings", that is the number of times the P wave crosses the isoelectric line reversing its polarity, the average of which was 1,60 (0,69) in the group of Pts that then developed AF and 0,97( 0,66) in the control group, with a p–value Conclusions The search for other predictive factors that allows a better stratification of the risk of developing AF is crucial to optimize the prevention of new stroke events. The study showed that the hight resolution parameters of P wave morphology, is significantly associated with increased incidence of AF, therefore the analysis of the P wave is potentially useful in the assessment of the risk of developing AF after a first stroke event. A greater number of Pts and a long–term follow up could definitely confirm the better predictive parameter to stratify the AF probability among the other parameters of the P wave.

Background Neuropsychological testing plays a cardinal role in the diagnosis and monitoring of Alzheimer’s disease. A major concern is represented by the heterogeneity of the neuropsychological batteries currently adopted in memory clinics and healthcare centers. The current study aimed to solve this issue. Methods Following the initiative of the University of Washington’s National Alzheimer’s Coordinating Center (NACC), we presented the Italian adaptation of the Neuropsychological Test Battery of the Uniform Data Set (I-UDSNB). We collected data from 433 healthy Italian individuals and employed regression models to evaluate the impact of demographic variables on the performance, deriving the reference norms. Results Higher education and lower age were associated with a better performance in the majority of tests, while sex affected only fluency tests and Digit Span Forward. Conclusions The I-UDSNB offers a valuable and harmonized tool for neuropsychological testing in Italy, to be used in clinical and research settings.

A 25-years old white female was admitted to our emergency department presenting with dyspnea, fever, cough and nausea. Her medical background included a small ventricular septal defect (VSD) (congenital) with a left to right shunt, micropolicistic ovary syndrome, Sars Cov 2 infection on January 2022, history of cutaneous infection after sternal piercing in the last three years. Patient showed onset of fever, headache and nausea since 20 days and had a history of ampicillin and cephalosporin usage for 15 days for comunitary pneumonia. Upon arrival in the emergency room, physical examination revealed temperature 38°C, crackles on down right lung fields, regular but tachycardic rhythm, 3/6 holosystolic murmur in the third left intercostal space, also skin redness around the piercing zone. Laboratory test showed increasing of WB (white blood cells), C-reactive protein (CPR) and procalcitonin. Because of worsening of respiratory conditions, CT chest was performed, showing tree in bud sign, with pulmonary pattern suggestive of staphylococcal “emboligenous-like” infectious state. According to patient's clinical history and CT results, she was referred to transthoracic echocardiogram (TTE) demonstrating the presence, on the right side of the small VSD, of a isoechoic large mass (20x 13 mm) with irregular margins attached to the right ventricular wall near the ostium of the VSD, compatible with vegetation; septal tricuspid valve leaflet involvement could not be ruled out. Methicillin-susceptible Staphylococcus aureus (MSSA) was detected six times from blood cultures; therapy with oxacillin 2 gr every 4 hours combined with daptomycin 750 mg daily was started. Cardiac MRI performed after few days, documented the infective involvement of the ventricular and atrial side of the septal leaflet with moderate tricuspid regurgitation (TR). Congenital heart disease (especially Tetralogy of Fallot, bicuspid aortic valve, aortic coarctation, ventricular septal defect) is a lifelong risk factor for infective endocarditis (IE). Size of VSD is generally not correlated with IE that is directly correlated with turbulent flow; tricuspid valve involvement is mostly seen in VSD, often complicated by pulmonary embolism. In this predisposing situation, skin infection of the piercing zone could have caused transient bacteremia which led to the formation of vegetations in the highest turbulence flow zone.

Aims New onset atrial fibrillation (NOAF) is associated with worse clinical outcomes after acute coronary syndrome (ACS). Identification of patients at risk of NOAF remains challenging, and various clinical scores of varying complexities have been proposed to predict incident AF. We tested the value of the simple C2HEST score for predicting NOAF in patients with ACS. Methods We studied patients from the prospective ongoing multicenter REALE-ACS registry of patients with ACS. NOAF was the primary endpoint of the study. The C2HEST score was calculated as coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). We also tested the mC2HEST score. Results We enrolled 555 patients (mean age 65.6±13.3 years; 22.9% women), of which 45 (8.1%) developed NOAF. Patients with NOAF were older (p3 was associated with NOAF occurrence (odds ratio 4.33, 95% confidence interval 2.19-8.59, p Conclusion The simple C2HEST score may be a useful tool to identify patients at higher risk of developing NOAF after presentation with ACS.

Background Coronary artery bypass grafting (CABG) is the most common revascularization mode for patients with multivessel coronary artery disease (CAD). Despite substantial improvements in the outcome of patients undergoing CABG surgery, graft occlusion remains a weakness of this procedure and has been associated with competitive flow of native coronary arteries. Our study aims to assess graft occlusion and the progression of CAD in native vessels after CABG surgery at follow-up with coronary CT angiography (CCTA), and their relationship with angiography-derived vessel-fractional flow reserve (vFFR) performed before surgery. Methods We retrospectively selected patients from two European institutions, treated with CABG between January 2006 and December 2018, who underwent follow-up with CCTA. All patients had a preoperative angiogram performed before CABG. Results In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 non-grafted vessels. Table 1 shows clinical and main procedural characteristics. Preoperative vFFR was assessed in 131 left anterior descending arteries (LAD), 132 left circumflex arteries (LCX) and 94 right coronary arteries (RCA) and was Conclusions Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.

WHO grade II and III meningiomas are more invasive than grade I malignancies and determine patients' shorter overall survival. Their tendency to recur after treatment has represented an important therapeutic challenge because of the limited treatment strategies at recurrence. Angiogenesis and mechanistic target of rapamycin (mTOR) activation are two of the main features of higher grade meningiomas, determining invasiveness and tendency to relapse. While these options prove promising, available clinical data on mTOR inhibitors' efficacy are somewhat limited.We report a case of a 25-year-old female patient diagnosed with a right parasagittal occipital anaplastic meningioma (grade III WHO) in 2013. The patient underwent multiple treatments and, in 2019, a further recurrence occurred. The patient reported an mTOR mutation, and it is for this reason that the MTB approved treatment with everolimus and bevacizumab. Therapy was administered in May 2019, and partial response and prolonged disease control was obtained in November 2021, when progression took place. The patient's death occurred in March 2022.This case report provides evidence on the efficacy of mTOR inhibitors as a treatment option in recurrent meningiomas. Furthermore, it highlights the importance of performing a molecular analysis as a preliminary step towards targeting the mTOR pathway.

Ischemia-Reperfusion Injury (IRI) is responsible for adverse outcomes in patients with ST-Elevation Myocardial Infarction (STEMI). Oxidative stress, resulting from the production of Reactive Oxygen Species (ROS) and low availability of Glutathione (GSH), are the two main mediators of IRI. The effectiveness of exogenous antioxidant therapy in this scenario is still debated, since the encouraging results obtained in animal models have not been fully reproduced in clinical studies. In this review we focus on the role of GSH, specifically on the biomolecular mechanisms that preserve myocardial cells from damage due to reperfusion. In this regard, we provide an extensive discussion about GSH intrinsic antioxidant properties, its current applications in clinical practice, and the future perspectives.

Takotsubo Syndrome (TTS) is usually triggered by emotional or physical stressors, thus suggesting that an increased sympathetic activity, leading to myocardial perfusion abnormalities and ventricular dysfunction, plays a major pathogenetic role. However, it remains to be elucidated why severe emotional and physical stress might trigger TTS in certain individuals but not others. Clinical research has been focused mainly on mechanisms underlying the activation of the sympathetic nervous system and the occurrence of myocardial ischemia in TTS. However, scientific evidence shows that additional factors might play a pathophysiologic role in the condition’s occurrence. In this regard, a significant contribution arrived from metabolomics studies that followed the systemic response to TTS. Specifically, preliminary data clearly show that there is an interplay between inflammation, genetics, and oxidative status which might explain susceptibility to the condition. This review aims to sum up the established pathogenetic factors underlying TTS and to appraise emerging mechanisms, with particular emphasis on oxidative status, which might better explain susceptibility to the condition.

Background Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) still experience a high rate of in-hospital complications. Liver fibrosis (LF) is a risk factor for mortality in the general population. However its prognostic role in ACS patients has been poorly investigated. Purpose We investigated whether the presence of LF detected by the validated fibrosis-4 (FIB-4) score may indicate ACS patients at higher risk of poor outcome. Methods In the prospective ongoing REAl-world observationaL rEgistry of Acute Coronary Syndrome (REALE-ACS), LF was defined by a FIB-4 score >3.25. The primary endpoint was in-hospital adverse events (AEs) including a composite of in-hospital cardiogenic shock, PEA/asystole, acute pulmonary edema and death. Results A total of 469 consecutive ACS consecutive patients were enrolled. Overall, 21.1% of patients had a FIB-4 score >3.25. Patients with LF were older, less frequently on P2Y12 inhibitors (p=0.021) and admitted with higher serum levels of white blood cells (p3.25 (OR 3.1, 95% CI 1.4 to 6.9), admission left ventricular ejection fraction% below median (OR 9.2, 95% CI 3.9 to 21.7) and Killip class ≥II (OR 6.3, 95% CI 2.2 to 18.4) were the strongest independent predictors of in-hospital AEs. Conclusions LF detected by FIB-4 score >3.25 was associated with more severe ACS presentation and worse in-hospital AEs irrespective of clinical and laboratory variables. Funding Acknowledgement Type of funding sources: None.

Background: Graft occlusion after coronary artery bypass graft surgery (CABG) has been associated with native coronary artery competitive flow. Objectives: The present study aims to characterize the functional progression of coronary artery disease (CAD) in native vessels after CABG, and to assess the relationship between preoperative FFR as derived from angiography and graft occlusion. Methods: Multicenter study of consecutive patients undergoing CABG between 2013 and 2018, in whom a follow-up angiogram had been performed. Serial vessel-fractional flow reserve (vFFR) analyses were obtained in each major native coronary vessel before and after CABG, excluding post-anastomotic segments and graft conduits. Results: In 73 patients, serial angiograms were suitable for vFFR analysis, including 118 grafted (86 arterial and 32 saphenous grafts) and 64 non-grafted vessels. The median time between CABG and follow-up angiography was 2.4 years [IQR 1.5, 3.3]. Functional CAD progression, by means of decline in vFFR, was observed in grafted but not in non-grafted vessels (delta vFFR in grafted vessels 0.10 [IQR 0.05, 0.18] vs. 0.01 [IQR -0.01, 0.03], in non-grafted vessels, p < 0.001). Preoperative vFFR predicted graft occlusion (AUC: 0.66, 95% CI 0.52 to 0.80, p = 0.031). Conclusions: In patients undergoing CABG, preoperative vFFR derived from conventional angiograms without use of pressure wire was able to predict graft occlusion. Graft occlusion was more frequent in vessels with high vFFR values. Grafted native coronary vessels exhibited accelerated functional CAD progression, whereas in non-grafted native coronaries the functional status remained unchanged.

BACKGROUND: Cardiac magnetic resonance (CMR) is the standard of reference for myocardial fibrosis detection by late gadolinium enhancement. Cardiac computed tomography (CCT) is emerging as a promising alternative. The Evidence for a comPrehensive evaLUation of left ventRicle dysfnctIon By a whole-heart coverage cardiac compUted tomography Scanner study will assess the feasibility and diagnostic accuracy of a comprehensive functional and anatomical cardiac evaluation with CCT as compared with CMR and invasive coronary angiography as standard of reference. METHODS: Consecutive patients with a newly diagnosed left ventricle (LV) dysfunction (left ventricular ejection fraction

Large multicenter studies and meta-analysis have documented the diagnostic accuracy and the prognostic implications of stress echocardiography, cardiac magnetic resonance and, mainly, nuclear stress tests. However, none of them provides a comprehensive anatomical and functional evaluation within the same study as stress CT perfusion. Myocardial CT perfusion is the only non-invasive modality that allows to quantifying coronary stenosis and determining its functional relevance, constituting a potential “one-stop-shop” method for the diagnosis and global management of patients with known or suspected coronary artery disease. In comparison with the dynamic modality, that requires increased radiation, precise acquisition protocols and dedicated post-processing softwares, static CT perfusion was associated with less radiation exposure, non-inferior diagnostic accuracy, easier interpretation of images and is nowadays more widely available.

Developing strategies aimed to shorten the length of stay (LOS) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is a healthcare goal to be pursued. We carried out a sub-analysis of the GSH 2014 trial to assess the potentiality of glutathione sodium salt infusion to impact on LOS.100 consecutive patients with STEMI, aged more than 18 years and referred to the three enrolling centers for primary angioplasty (p-PCI), were asked to participate to the GSH 2014 trial. Fifty patients were randomized to treatment group and fifty to placebo; treatment consisted into an intravenous infusion of gluthatione sodium salt over 10 min before p-PCI; after interventions, glutathione was infused at the same doses at 24, 48 and 72 h elapsing time. A stepwise linear multivariate model was built in order to assess independent predictors of LOS.Subjects receiving infusion of glutathione sodium salt had a significantly lower LOS than subjects receiving placebo (8.6±3 vs 10.8±4 days, p=0.006). At multivariate analysis, the randomization to GSH group was negatively associated with length of stay (β±SEβ -1.64±0.74, cumulative R2 0.43, p=0.03) independently from age, sex, cardiovascular risk factors, number of treated vessels, infarct-related coronary artery (left anterior descending artery as reference) and enrolment hospital.Results from this sub-analysis support the hypothesis that an early and prolonged glutathione sodium salt administration, as antioxidant therapy to patients with STEMI, may favorably impact on LOS. Further studies with larger sample size are necessary to confirm these data.

IntroductionTherapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective.MethodsIn the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast.ResultsThe results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy.DiscussionThese results, albeit preliminary, shed light on the role played by therapists’ memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed.

Despite the use of aggressive multimodality therapies, the prognosis of brain tumor patients remains poor. Tumors of glial origin typically have the worst prognosis, with a predicted median survival of 12-15months for glioblastoma multiforme (WHO grade IV) and 2-5years for anaplastic glioma (WHO grade III). Palliative care problems and needs in patients with primary and secondary brain tumors are significantly different, both due to different trajectory of disease and to variable prognosis which in metastatic brain tumors is related to the natural history of primary tumors. This chapter describes the complex interactions influencing communication and the treatment decision process in primary brain tumor patients. The whole trajectory of disease and particularly the end-of-life (EOL) phase of brain tumor (BT) patients are quite different in respect to the expected trajectory observed in the general cancer population. The need to improve the communication of prognosis in BT patients has been clearly reported in neuro-oncological literature, but several issues may hinder a good communication in these patients. Adequate prognostic awareness (PA) is important for several reasons: to respect patient autonomy, to obtain her/his preferences about treatments and goal of care, and to share EOL treatment decisions. The high incidence of cognitive deficits in BT patients is one of the most challenging issues influencing the quality of communication and the participation of patients in the process of treatment decisions. Impaired neurocognitive functions may impact capacities of understanding, appreciation, reasoning, and expression of choice, reducing Medical Decisions Capacity (MDC). The lack of capacity to express preferences about EOL treatment decisions represents an important ethical issue, with a great impact on both the patient's family and healthcare professionals involved in the decision processes. Also, patients' coping styles may have an important influence in critical aspects of care such as communication of diagnosis and prognosis, discussion with patients and their caregivers about goal of treatments, early introduction of PC, and advanced planning of patients' preferences concerning EOL treatment and issues. Several barriers hinder good communication in BT patients. This chapter analyzes emerging literature data and possible strategies to improve communication about prognosis and goals of care and to promote patients' involvement in the treatment decision process particularly in the palliative care setting.

Background: Anxiety and depressive disorders represent predisposing factors for the autonomic dysfunctions that characterize the acute phase of Takotsubo syndrome (TS). However, there is insufficient data on this relationship after the acute event. The present study aimed at evaluating the psychological and autonomic status of patients with a history of TS. Methods: Ten TS patients whose acute event occurred at least 1 year prior to the evaluation and nine healthy age- and sex-matched subjects were evaluated. The cardiovascular assessment included a clinical examination, beat-to-beat heart rate monitoring to assess heart rate variability, and a psychological examination using the 16 Personality Factors-C Form (16PF), the Acceptance and Action Questionnaire-II, the Coping Orientations to Problems Experienced (COPE), the Beck Depression Inventory-II, and the State-Trait Anxiety Inventory (STAI). Results: TS patients scored significantly higher on the STAI (i.e., Anxiety Trait), 16PF (i.e., Tension), and COPE (i.e., Transcendental Orientation). TS patients also showed lower heart rate variability. Moreover, a significant inverse correlation was found between sympathetic tone (LF/HF ratio) and coping orientation. Conclusions: Long after the acute event, TS patients are characterized by elevated anxiety, high tension, and a specific religious coping strategy.

BACKGROUND: On March 9, 2020, the Italian government imposed a national lockdown to tackle the COronaVIrus Disease 19 (COVID-19) pandemic, including stay at home recommendations. The precise impact of COVID-19 scare and lockdown on emergency access for acute myocardial infarction (MI) is still subject to debate. METHODS: Data on all patients undergoing invasive coronary angiography at 9 hospitals in the greater area of Rome, Italy, between February 19, 2020 and March 29, 2020, 9, 2020, were retrospectively collected. Incidence of ST-elevation MI (STEMI), and non-ST-elevation MI (NSTEMI), as well as corresponding percutaneous coronary intervention (PCI), was compared distinguishing two different 20-day time periods (before vs on or after March 10, 2020). RESULTS: During the study period, 1,068 patients underwent coronary angiography, 142 (13%) with STEMI and 169 (16%) with NSTEMI. The average daily number of STEMI decreased from 4.3 before the lockdown to 2.9 after the lockdown (p=0.021). Similarly, the average daily number of NSTEMI changed from 5.0 to 3.5 (p=0.028). The average daily number of primary PCI changed from 4.2 to 2.9 (p=0.030), while the average daily number of PCI for NSTEMI changed from 3.5 to 2.5 (p=0.087). For STEMI patients, the time from symptom onset to hospital arrival (onset-to-door time less than three hours) showed a significant increase after the lockdown (p=0.018), whereas door-to-balloon time did not change significantly from before to after the lockdown (p=0.609). CONCLUSIONS: The present study, originally reporting on the trends in STEMI and NSTEMI in the Rome area, highlights that significant decreases in the incidence of both acute coronary syndromes occurred between February 19, 2020 and March 29, 2020, together with increases in time from symptom onset to hospital arrival, luckily without changes in door-to-balloon time.

Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy.A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance.Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance.Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.

Introduction: Contrast-induced acute kidney injury (CIAKI) is one of the main causes of acute renal failure in hospitalized patients, following the administration of iodinated contrast medium used for CT scans and angiographic procedures. CIAKI determines a high cardiovascular risk and appears to be one of the most feared complications of coronary angiography, causing a notable worsening of the prognosis with high morbidity and mortality. Aim: To evaluate a possible association between the renal resistive index (RRI) and the development of CIAKI, as well as an association with the main subclinical markers of atherosclerosis and the main cardiovascular risk factors. Materials and Methods: We enrolled 101 patients with an indication for coronary angiography. Patients underwent an assessment of renal function (serum nitrogen and basal creatinine, 48 and 72 h after administration of contrast medium), inflammation (C reactive protein (CRP), serum calcium and phosphorus, intact parathormone (iPTH), 25-hydroxyvitaminD (25-OH-VitD), serum uric acid (SUA), total cholesterol, serum triglycerides, serum glucose and insulin). All patients also carried out an evaluation of RRI, intima-media thickness (IMT), interventricular septum (IVS) and the ankle-brachial index (ABI). Results: 101 patients (68 male), with a mean age of 73.0 ± 15.0 years, were enrolled for the study; 35 are affected by type 2 diabetes mellitus. A total of 19 cases of CIAKI were reported (19%), while among diabetic patients we reported an incidence of 23% (8 patients). In our study, patients with CIAKI had significantly higher RRI (p < 0.001) and IMT (p < 0.001) with respect to the patients who did not develop CIAKI. Furthermore, patients with CIAKI had significantly higher CRP (p < 0.001) and SUA (p < 0.006). Conclusions: We showed a significant difference in RRI, IMT, SUA and CRP values between the population developing CIAKI and patients without CIAKI. This data appears relevant considering that RRI and IMT are low-cost, non-invasive and easily reproducible markers of endothelial dysfunction and atherosclerosis.

The food industry needs tools to improve the efficiency of their production processes by minimizing waste, detecting timely potential process issues, as well as reducing the efforts and workforce devoted to laboratory analysis while, at the same time, maintaining high-quality standards of products. This can be achieved by developing on-line monitoring systems and models. The present work presents a feasibility study toward establishing the on-line monitoring of a pesto sauce production process by means of NIR spectroscopy and chemometric tools. The spectra of an intermediate product were acquired on-line and continuously by a NIR probe installed directly on the process line. Principal Component Analysis (PCA) was used both to perform an exploratory data analysis and to build Multivariate Statistical Process Control (MSPC) charts. Moreover, Partial Least Squares (PLS) regression was employed to compute real time prediction models for two different pesto quality parameters, namely, consistency and total lipids content. PCA highlighted some differences related to the origin of basil plants, the main pesto ingredient, such as plant age and supplier. MSPC charts were able to detect production stops/restarts. Finally, it was possible to obtain a rough estimation of the quality of some properties in the early production stage through PLS.

Case Report Caucasian 84–years–old woman was found on the floor at her house and was brought to the ED of Policlinico Umberto I with the diagnosis of cranial trauma following a syncope. A head CT showed right paramedian fracture of the occipital bone, left frontal subarachnoid hemorrhage and left frontal subdural hemorrhage. The neurosurgeon gave no indication to urgent evacuation of the hemorrhage. Then elevation of cardiac enzymes and ST–segment elevation at the EKG were found but due to the state of the patient a coronary angiography was not performed and the patient was transferred to the CCU. The patient was hemodynamically stable with right hemiplegia. The EKG showed rapid ventricular rate atrial fibrillation with ST segment elevation in inferior and lateral leads with T wave inversion in the same leads and elevated serum troponin levels. ETT showed: EF 30% with a global reduction of left ventricular systolic function with diffuse akinesis. Intravenous therapy with mannitol and corticosteroids for perilesional oedema was started. Beta blockers and a class III antiarrhythmic drug were also started, but hemodynamic conditions declined and acute kidney failure occurred with progressive hypotension followed by cardiogenic shock. The patient had an episode of nonsustained ventricular tachycardia treated with antiarrhythmic drugs and magnesium sulfate. The EKG started to show a normalization of the repolarization phase with regression of ST segment elevation and persistent T wave inversion.The patient’s neurological conditions were complicated with epileptic seizures.On the fifth day of hospitalization the TTE revealed a slight improvement of global systolic function and the presence of an apical thrombotic apposition.The patient’s clinical conditions worsened and led to exitus. Discussion The interpretation of this patient’s history was made more difficult by the lack of witnesses of the trauma.The patient’s age, her history of hypertension and the presence of regional wall motion abnormalities at the TTE suggested the presence of CAD. On the other side the atrial fibrillation could hint a primitive cerebral event. This case report shows the potentially severe cardiac manifestations of cerebral hemorrhage and the necessity to consider cerebrovascular events as the cause of EKG changes mimicking a myocardial infarction, cardiac enzymes elevation and ventricular wall motion abnormalities, in order to avoid inappropriate or delated therapies.

Purpose To evaluate the feasibility, safety and efficacy of a combined single-step therapy in patients with unresectable single large (> 5 cm) hepatocellular carcinoma (HCC), with balloon-occluded microwave ablation (b-MWA) plus transcatheter arterial balloon-occluded chemoembolization (b-TACE). Five consecutive Child A patients (mean age: 71.4 ± 3.2 yo; range 68–76 yo) with an unresectable single large HCC (> 5 cm) (mean size: 5.7 ± 0.6 cm; range 5.1–6.5 cm) were enrolled in our pilot study. The schedule consisted of percutaneous microwave ablation of the lesion during balloon occlusion of the hepatic artery supplying the tumor (b-MWA), followed by TACE under the occlusion of feeding arteries by a microballoon catheter (b-TACE). Adverse events and intra- and peri-procedural complications were clinically assessed. Early local efficacy was evaluated on 1- and 6-month follow-up multiphasic computed tomography (CT) on the basis of m-RECIST criteria. Technical success was obtained in all procedures. No major complications occurred. A mean necrotic area of 6.8 ± 0.47 cm (range 6.3–7.4 cm) was obtained, with a complete response at 1-month follow-up obtained in 4 out of 5 lesions, with 1 partial response (less than 30% of residual tumor), successfully treated with a single TACE treatment. No residual tumor or local recurrence was registered at 6-month CT follow-up. Our preliminary experience seems to demonstrate that b-MWA plus b-TACE could be a safe and effective combined therapy for unresectable large HCC lesions, allowing a high rate of local response also in lesion exceeding 5 cm in size.

Glioblastoma (GBM) has an increasing incidence and dismal prognosis in older adults. This study evaluated neurocognitive status of an older adult population with GBM and its correlation with clinical and demographical variables.Each patient underwent an extended neuropsychological evaluation by means of a battery of standardized tests describing eight cognitive domains: global function; verbal learning; short- and long-term memory (LTM); executive functions (EFs); abstract reasoning (AR); attention; and visuo-constructional abilities (CA).We assessed 79 patients with GBM (median age: 74 years). Out of this initial sample, a subgroup of seventeen patients with six-month median time underwent a follow-up test session. 46 out of the 79 patients (58.2%) presented multi-domain cognitive impairment, 24 patients (30.3%) showed single-domain cognitive impairment and only seven (9%) showed no cognitive impairment. Kaplan Meier estimator showed that patients with AR deficit had a poorer prognosis in terms of progression-free survival and overall survival (p .001). At the multivariate analysis AR (deficit vs non; hazard ratio (HR) = 5.07, 95%; confidence interval (CI): 1.91-13.46; p .001) was correlated with disease progression and overall survival, AR (deficit vs non; HR = 7.24, 95% CI: 2.58-20.32; p .001). Eight out of seventeen patients who underwent follow-up test session showed cognitive improvement, five resulted in further deterioration, and four patients remained stable. LTM, EF, and CA were the most affected functions at follow-up, while verbal learning was the most improved one in patients with cognitive improvement.Cognitive functioning evaluation should be included among the standard clinical endpoints in the treatment of older adult neuro-oncology patients.

This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists (N = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.

The BNT162b2 vaccine conferred 95% protection against COVID-19 in people aged 16 years or older.The aim of this observational study was to evaluate safety and efficacy of vaccine in patients affected by primary brain tumor (PBT).We proposed COVID-19 vaccine to all patients affected by PBT followed by Neuroncology Unit of National Cancer Institute Regina Elena.102 patients received the first dose, 100 the second, and 73 patients received the booster dose. After first dose, we observed one patient with fever and severe fatigue, while after the second one, we recorded adverse events in ten patients. No correlation was observed between adverse events and comorbidities.The COVID-19 vaccine is safe and well tolerated in PBT patients.

Pulmonary embolism represents a common life-threatening condition. Prompt identification and treatment of this pathological condition are mandatory. In cases of massive pulmonary embolism and hemodynamic instability or right heart failure, interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment (systemic thrombolysis) and surgical treatment. Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration, which can prove useful in cases of failure or infeasibility of medical and surgical approaches.

Slowness of information processing (SIP) is frequently reported after traumatic brain injury (TBI). Previous studies point toward a pivotal role of white matter damage on speed of information processing. However, little is known about the more comprehensive and ecological assessment of SIP in TBI. Here, we combined an ecological assessment of SIP with the use of tract-based spatial statistics (TBSS) on individuals' fractional anisotropy (FA) maps. Twenty-six moderate-to-severe patients with TBI (21 males and 5 females) participated in this study: 10 individuals were classified as not having SIP (SIP-) and 16 were classified as having SIP (SIP +). SIP + showed lower FA in bilateral anterior thalamic radiation, corticospinal tract, cingulum, and forceps, as well as in bilateral inferior fronto-occipital, inferior and superior longitudinal fasciculi and uncinate fasciculus. Overall, this result is consistent with and expands previous reports on information processing speed to a more comprehensive and ecological perspective on SIP in TBI.