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Abstract Background Mindfulness practice has gained interest in the management of Chronic Migraine associated with Medication Overuse Headache (CM-MOH). Mindfulness is characterized by present-moment self-awareness and relies on attention control and emotion regulation, improving headache-related pain management. Mindfulness modulates the Default Mode Network (DMN), Salience Network (SN), and Fronto-Parietal Network (FPN) functional connectivity. However, the neural mechanisms underlying headache-related pain management with mindfulness are still unclear. In this study, we tested neurofunctional changes after mindfulness practice added to pharmacological treatment as usual in CM-MOH patients. Methods The present study is a longitudinal phase-III single-blind Randomized Controlled Trial (MIND-CM study; NCT03671681). Patients had a diagnosis of CM-MOH, no history of neurological and severe psychiatric comorbidities, and were attending our specialty headache centre. Patients were divided in Treatment as Usual (TaU) and mindfulness added to TaU (TaU + MIND) groups. Patients underwent a neuroimaging and clinical assessment before the treatment and after one year. Longitudinal comparisons of DMN, SN, and FPN connectivity were performed between groups and correlated with clinical changes. Vertex-wise analysis was performed to assess cortical thickness changes. Results 177 CM-MOH patients were randomized to either TaU group or TaU + MIND group. Thirty-four patients, divided in 17 TaU and 17 TaU + MIND, completed the neuroimaging follow-up. At the follow-up, both groups showed an improvement in most clinical variables, whereas only TaU + MIND patients showed a significant headache frequency reduction (p = 0.028). After one year, TaU + MIND patients showed greater SN functional connectivity with the left posterior insula (p-FWE = 0.007) and sensorimotor cortex (p-FWE = 0.026). In TaU + MIND patients only, greater SN-insular connectivity was associated with improved depression scores (r = -0.51, p = 0.038). A longitudinal increase in cortical thickness was observed in the insular cluster in these patients (p = 0.015). Increased anterior cingulate cortex thickness was also reported in TaU + MIND group (p-FWE = 0.02). Conclusions Increased SN-insular connectivity might modulate chronic pain perception and the management of negative emotions. Enhanced SN-sensorimotor connectivity could reflect improved body-awareness of painful sensations. Expanded cingulate cortex thickness might sustain improved cognitive processing of nociceptive information. Our findings unveil the therapeutic potential of mindfulness and the underlying neural mechanisms in CM-MOH patients. Trial Registration Name of Registry; MIND-CM study; Registration Number ClinicalTrials.gov identifier: NCT0367168; Registration Date: 14/09/2018

Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up. Methods and results RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (−11.5 [−13.3 to −10.2] %) vs. the no-event group (−15.8 [−17.1 to −14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4–27.4] % vs. 31.5 [25.1–39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone. Conclusion RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC. [ABSTRACT FROM AUTHOR]

Vaccination against SARS-CoV-2 is an important preventive strategy against COVID-19 particularly in frail patients. Recent literature reports about suboptimal antibody response to COVID-19 vaccination in people with weakened immune system, including those with hematological malignancies and who are receiving or have received treatment for cancer. Here we report the case of a 63-year-old woman who was diagnosed a breast cancer and a stage 3 multiple myeloma with multiple bone lesions both in 2016. Following specific radio and chemotherapy and autologous stem cell transplantation, the diseases completely remitted. Currently, she presents serum hypogammaglobulinemia, a condition that usually prevents the immune system from producing circulating antibodies in adequate amounts. The immune response of the patient to the mRNA BNT162b2 vaccine against SARS-CoV-2 is presented and compared with that of a cohort of healthcare professionals. It was possible to conclude that the patient exhibits a good SARS-CoV-2 immune response comparable to that of the control population. [ABSTRACT FROM AUTHOR]

Transition from pediatric to adult-centered healthcare involves both medical and psychological needs of adolescents and young adults. This process can be especially complex in rare neurological diseases, including neuromuscular disorders. Duchenne Muscular Dystrophy (DMD) is a rare X-linked disorder characterized by progressive muscle degeneration, causing the loss of independent ambulation and severe multisystem complications. Over the past few years, the survival perspectives for people with DMD have improved, leading to the need for a transition process from pediatric to adult healthcare. The present study aims to explore the experiences of adolescents and young adults with DMD and their families in three countries, identifying the challenges and supportive factors encountered during the transition process. This will help to understand how to improve health care, including rehabilitation systems, for individuals with DMD and other rare diseases. People with DMD aged 15-25 years and their caregivers undergo semi-structured interviews on their transition experiences and daily life challenges and facilitators. This study is included in the project "Growing into Adulthood with DMD - Comparing Patient Experiences and Systems to Optimize Care", funded by the European Joint Programme on Rare Diseases 2020 (N°825575), and involved German, Italian, and Canadian research centers. Data collection and qualitative synthesis of data from interviews are ongoing. The themes that emerge most from interviews include the need for transition policies, help from public institutions and the lack of information on transition for patients and caregivers. Without structured guidelines, young people and their families feel left alone during this process. The experiences of people with DMD and families across various countries will inform recommendations to improve the knowledge and development of transition programs from pediatric to adult care systems. [ABSTRACT FROM AUTHOR]

Duchenne muscular dystrophy (DMD) is a rare X-linked disorder characterized by progressive muscle degeneration. The period of transition from pediatric to adult care is particularly challenging for adolescents with DMD, with the disease progressing at a time when youth typically strive for greater independence. With life expectancies increasing over the last years, health care providers are in need for better concepts to meet patients' and families' needs when going through this challenging period. Within the context of the GrowDMD study (http://www.growdmd.org), we aim to explore which measures and strategies are currently implemented in Canada, Germany and Italy to support and facilitate the transition of care for adolescents with DMD. We conduct semi-structured interviews with healthcare providers involved in the transition process, the total number being n=30 (10/country). In follow-up interviews healthcare providers are presented with two case vignettes that have been developed in collaboration with adolescents with DMD and their caregivers. Qualitative data are categorized across three countries and four languages. Data collection is ongoing, with the analysis of the first interviews having started. Preliminary results point toward the importance of roles (of patients, caregivers and healthcare providers), the existence and lack of support for these groups and several specific enablers and barriers for the transition process. Transitioning from pediatric to adult care is a challenge for patients and caregivers around the world. Findings from this international study will help to inform healthcare providers on how to navigate this process, delivering support for patients and families where needed and better understanding of their own role. [ABSTRACT FROM AUTHOR]

Care pathways for transition from childhood to adulthood are a well-described phenomenon. However, the transition of patients with Duchenne muscular dystrophy (DMD) is still neither defined nor implemented at national or international levels. DMD is a rare X-linked disorder characterized by progressive muscle degeneration, making it a chronic debilitating disease. The period of transition from pediatric to adult care is particularly challenging for adolescents with DMD, with the disease progressing at a time when youth typically strive for greater independence. The study GrowDMD (http://www.growdmd.org) aims to explore the diverse experiences of young people living with DMD and their families, as well as healthcare providers, in Canada, Germany, and Italy, addressing the following research questions: 1. How do patients with DMD and their caregivers experience the transition to adult care? 2. What measures and strategies are currently implemented in the care organizations of participating countries to support and facilitate the transition of care? 3. How can the transition of care be improved? This study utilizes an integrated knowledge translation process in which researchers, knowledge users, Patient Advocacy Organisations (PAOs) representatives, and patient partners collaborate across all stages of the research process. Following a systematic review of the literature; we conduct semi-structured interviews with 1) adolescents living with DMD and their parents/caregivers, 2) healthcare providers involved in the transition process, as well as qualitative surveys and focus groups. Together with youth with DMD and caregivers we aim to identify potential solutions and develop knowledge translation products. The integrated nature of this project will facilitate the co-creation of general recommendations, tailored to local contexts that can serve as a model for the transition care path for youth with DMD and other rare disease in participating countries and around the world. [ABSTRACT FROM AUTHOR]

Aims: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up., Methods and Results: RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (-11.5 [-13.3 to -10.2] %) vs. the no-event group (-15.8 [-17.1 to -14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4-27.4] % vs. 31.5 [25.1-39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone., Conclusion: RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC., Competing Interests: Conflict of interest: A.M.S. received educational grants from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, BMS/Pfizer, and Medtronic; and speaker fees from Boston Scientific and BMS/Pfizer. The other authors report no potential conflicts of interest related to this work., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)