Practical feasibility, scalability and effectiveness of coordinated scheduling algorithms in cellular networks towards 5G

Coordinated Scheduling (CS) is used to mitigate inter-cell interference in present (4G) and future (5G) cellular networks. We show that coordination of a cluster of nodes can be formulated as an optimization problem, i.e., placing the Resource Blocks (RB) in each node’s subframe with the least possible over-lapping with neighboring nodes. We provide a clever formulation, which allows optimal solutions to be computed in clusters of ten nodes, and algorithms that compute good suboptimal solutions for clusters of tens of nodes, fast enough for a network to respond to traffic changes in real time. This allows us to assess the relationship between the scale at which CS is performed and its benefits in terms of network energy efficiency and cell-edge user rate. Our results, obtained using realistic power, radiation and Signal-to-Interference-and-Noise-Ratio (SINR) models, show that optimal CS allows a significant protection of cell-edge users. Moreover, this goes hand-in-hand with a reduction in the num-ber of allocated RBs, which in turn allows an operator to reduce its energy consumption. Both benefits actually increase with the size of the clusters. The evaluation is carried out in both a 4G and a foreseen 5G setting, using different power models, system bandwidths and SINR-to-datarate mappings

Novel Potent Muscarinic Receptor Antagonists: Investigation on the Nature of Lipophilic Substituents in the 5- and/or 6-Positions of the 1,4-Dioxane Nucleus

A series of novel 1,4-dioxane analogues of the muscarinic acetylcholine receptor (mAChR) antagonist 2 was synthesized and studied for their affinity at M1-M5 mAChRs. The 6-cyclohexyl-6-phenyl derivative 3b, with a cis configuration between the CH2N+(CH3)3 chain in the 2-position and the cyclohexyl moiety in the 6-position, showed pKi values for mAChRs higher than those of 2 and a selectivity profile analogous to that of the clinically approved drug oxybutynin. The study of the enantiomers of 3b and the corresponding tertiary amine 33b revealed that the eutomers are (2S,6S)-(-)-3b and (2S,6S)-(-)-33b, respectively. Docking simulations on the M3 mAChR-resolved structure rationalized the experimental observations. The quaternary ammonium function, which should prevent the crossing of the blood-brain barrier, and the high M3/M2 selectivity, which might limit cardiovascular side effects, make 3b a valuable starting point for the design of novel antagonists potentially useful in peripheral diseases in which M3 receptors are involved

Agenesis of the internal carotid artery associated with generalized epilepsy

Agenesis of the internal carotid artery (ICA) is a rare congenital malformation, with approximately 150 cases having been described.1 In rare cases it has been linked to seizures.23 We report a case of earlier-onset epilepsy in which the diagnosis of agenesis of ICA was incidentally performed during brain magnetic resonance imaging (MRI). A 27-year-old male with slightly delayed psychological development was hospitalized due to an episode of short-term unconsciousness (about 1 min) followed by generalized seizures and delirium. Brain computed tomography (CT) and MRI showed slight asymmetry of the ventricles (Fig. 1A) and the absence of left ICA flow in its intracranial tract, which was confirmed by magnetic resonance angiography and Doppler ultrasound. Transcranial Doppler ultrasound showed hemodynamic compensation through the anterior communicating artery (ACoA) and posterior communicating artery (PCoA). Perfusion MRI showed asymmetric perfusion of the cerebral hemispheres with a high mean transit time in the right frontoparietal area (Fig. 1B and C). CT angiography confirmed the complete absence of the cervical and intracranial left ICA with the left common carotid artery continuing as an external carotid artery, hemodynamic compensation through the anterior and posterior circulations (Fig. 1D, E, and H), and also the absence of the bony carotid canal on the left side while the right carotid canal had developed normally (Fig. 1F and G). The electroencephalogram (EEG) contained diffuse, bilateral, and synchronous spike-and-wave discharges. A neuropsychological survey performed with the WAIS-R scale highlighted cognitive alterations (his IQ was 45). The patient was started on carbamazepine (400 mg/day) and acetylsalicylic acid (100 mg/day). The most-frequent pattern of collateral circulation in agenesis of the ICA is the fetal type, where the anterior cerebral artery is supplied by the contralateral ICA via the ACoA, and the middle cerebral artery receives basilar artery blood supplied by the PCoA.1 This situation results in most cases remaining asymptomatic for a long time.34 Various and inconstant symptoms such as headache, blurred vision, hearing loss, Horner's syndrome, and hypopituitarism are reported, as are cases of ischemic stroke, subarachnoid hemorrhage, transient global amnesia, and focal and generalized seizures.235 ICA dysgenesis can also present in PHACE syndrome, which is a rare pediatric condition.6 ICA agenesis is often diagnosed incidentally. Interest in this condition is mainly related to associated disorders such as malformations of the circle of Willis or pathological anastomosis associated with a risk of cerebrovascular events. The condition is easily diagnosed using noninvasive methods such as CT angiography, MRI, and perfusion MRI, which are useful for discovering organic causes in apparently idiopathic juvenile epilepsy. The present case had an absent bone canal and fetal-type collateral circulation. Wang et al.2 described a similar case of a young child with partial epilepsy and absence of the left ICA and ipsilateral bony carotid canal in 1994. However, the clinical manifestation in our case was characterized by generalized seizures with diffuse EEG alterations and defective perfusion in the frontoparietal region. Indeed, there is increasing evidence that the frontal area plays a role in the generation of generalized spike-and-wave discharges.7 We suggest that the symptoms of the present patient were related to a brain perfusion disorder and played a role in the genesis of the mild mental retardation. We therefore recommend performing Doppler ultrasound and cerebral CT angiography in patients with idiopathic epilepsy and negative MRI findings

Eating habits in the population of the Aeolian Islands. An observational study

Objective We conducted a study to describe food profile, health status and stroke risk factors in the population of the Aeolian Islands.Design Self-administrated questionnaires regarding eating habits, health status and stroke risk factors were obtained from a sample of the general Aeolian population. We analysed the difference from common healthy eating habits indicated by the Italian Institute of Nutrition.Setting Current evidence finds the Mediterranean diet is a protective factor for cardio- and cerebrovascular diseases. The Aeolian Islands are an interesting study setting because of their peculiarity in the epidemiology of cerebrovascular and neurodegenerative diseases.Participants Individuals (n 586; age range 15-93 years; mean 52 (sd 18) years) living in the Aeolian Islands.Results We found low fish consumption in 13·3% and vitamin intake deficiency in 5·8% of participants. A marked excess of saturated fats was observed in 71·0% of participants. Sodium excess was reported almost in half of participants (49·0%). Eating habits were characterized by high consumption of fruits and vegetables, consistent use of olive oil and scanty use of cured meat. Health status as evaluated by the General Health Questionnaire was characterized by 'normal distress' level in the majority of participants.Conclusions Study findings show the eating habits and health status of the Aeolian people in an interesting setting of low incidence of cerebrovascular disease. This nutrition regimen has been proved to be protective against cerebrovascular disease. Nutrition is likely to contribute to the low incidence of stroke in this population

Immune response to one dose of BNT162b2 mRNA Covid-19 vaccine followed by SARS-CoV-2 infection: An Italian prospective observational study

Introduction: A mass vaccination campaign against SARS-CoV-2 was initiated in European countries on December 27, 2020. This study compared the antibody response in a sample of healthcare workers (HCWs) who, after the first dose of the BNT162b2 mRNA vaccine, were infected with SARS-CoV-2 (infection group) with the response in a control group of HCWs immunized with two doses (vaccine group). Methods: This two-arm observational cohort study was carried out using routine health surveillance data obtained from HCWs at Bari Policlinico General Hospital (Italy). The antibody response was determined infection group and vaccine group. Results: Among the 100 HCWs, 25 (25.0%) were in the infection group and 75 (75.0%) in the full-vaccine group. At the serological evaluation, all of the HCWs tested positive, with a geometric mean titer (GMT) of 7106.8 (95 %CI = 5628.5–8973.4) and a statistically significant difference (p < 0.0001) between the infection group (GMT = 2139.7; 95 %CI = 1310.4–3493.6) and the vaccine group (GMT = 10603.6; 95 %CI = 8698.0–12926.8). Discussion: Our results shed light on the vaccine response of individuals in different risk categories. It also emphasizes the need for the continued use by HCWs of PPE and good practices during the window between the first and second anti-SARS-CoV-2 vaccinations

Post-marketing active surveillance of adverse reactions following influenza cell-based quadrivalent vaccine: An Italian prospective observational study

Since the influenza season 2018/19, the Italian Ministry of Health recommended a dose of cell-based quadrivalent vaccine (Flucelvax Tetra) for HCWs (healthcare workers), because this vaccine seemed more efficacious in the prevention of AH3N2 virus. Due to the lack of pre-registration data, the safety profile of this new vaccine must be investigated in post-marketing surveillance. The aim of our study is to evaluate, through a post-marketing active surveillance program developed during the 2019/20 influenza season, any Adverse Events Following Immunization (AEFIs) that happened in the 7 days after immunization with Flucelvax Tetra. The study was carried out in a sample of HCWs of Policlinico General University-Hospital (Apulia, South Italy). AEFIs were classified as ‘serious’ or ‘not serious’ according to the WHO (World Health Organization) guidelines; the WHO causality assessment algorithm was applied to classify serious AEFIs. A total of 741 HCWs were enrolled, and 430 AEFIs (reporting rate: 58.0 (95%CI: 54.4–61.6) × 100 enrolled) were recorded. Of these, 429 of 430 (99.8%; reporting rate: 57.8 (95%CI: 54.2–61.5) × 100 enrolled) were classified as not serious and one (0.2%; reporting rate: 0.13 (0.03–0.75) × 100 enrolled) was classified as serious. Local reactions were the adverse reaction reported most frequently (88%); regarding the serious AEFI, causality assessment excluded the causal link with the administration of the vaccine. All the AEFIs resolved without sequelae. Flucelvax Tetra showed a profile of high safety. Due to their characteristics of greater sensitivity than passive surveillance, active surveillance programs can be useful in defining the safety profiles of a given vaccine/drug in certain population subgroups

Bamlanivimab and Etesevimab administered in an outpatient setting for SARS-CoV-2 infection

: The early administration of anti-SARS-CoV-2 monoclonal antibodies (mAb) could decrease the risk of severe disease and the need of inpatients care. Herein, our clinical experience with Bamlanivimab/Etesevimab for the treatment of early SARS-CoV-2 infection through an outpatient service was described. Patients with confirmed COVID-19 were selected by General Practitioners (GPs) if eligible to mAb administration, according to manufacturer and AIFA (Agenzia-Italiana-del-Farmaco) criteria. If suitability was confirmed by the Multidisciplinary Team, the patient was evaluated within the next 48-72 hours. Then, all patients underwent a medical evaluation, followed by mAb infusion or hospitalization if the medical condition had worsened. Overall, from March 29th to June 4th, 2021, 106 patients with confirmed COVID-19 were identified by GPs; 26 were considered not eligible and then excluded, while 9 refused treatment. Among the 71 remaining, 6 were not treated because of worsening of symptoms soon after selection. Finally, 65 received mAb therapy. All treated patients survived. However, 2/65 developed adverse events (allergic reaction and atrial fibrillation, respectively) and 6/65 needed hospitalization. By performing univariate logistic regression analysis, diabetes was the only risk factor for hospitalization after mAb administration [aOR = 9.34, 95%CI = 1.31-66.49, p= .026]. Importantly, subjects who worsened awaiting mAb were more frequently obese (OR = 16.66, 95%CI = 1.80-153.9, p= .013) and received home corticosteroid therapy for COVID-19 (OR = 14.11, 95%CI = 1.53-129.6, p= .019). Establishing a network among GPs and COVID units could be an effective strategy to provide mAb treatment to patients with early SARS-CoV-2 infection to reduce hospitalizations and pressure on healthcare systems

Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study

Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1-4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86-95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0-3) in 40.7% of cases, 25.9% reached mRS 0-2, and 29.6% had a poor clinical outcome (mRS 4-5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI

Rapid decrease of SARS-CoV-2 circulation in a large Italian hospital six weeks after the start of the immunization program

Since the start of SARS-CoV-2 pandemic, clusters in hospital settings have been described worldwide. Therefore, healthcare workers (HCWs) are considered as a group at high risk of SARS-CoV-2 infection. In Italy, in FebruaryeMay 2020, 119 doctors died because of COVID-19 and globally, in 2020, 91,270 COVID-19 cases were notified among HCWs, with a case-fatality rate of 0.2%. On 27th December 2020, the Italian Ministry of Health began the immunization campaign against SARS-CoV-2, targeting, as a priority group, HCWs

Ischemic Stroke and Asymptomatic Pulmonary Opacities

Purpose: Pulmonary opacities are described in many chest radiograph reports in stroke patients and are often asymptomatic. The aim of this study is to investigate the clinical features associated with asymptomatic pulmonary opacities (APO) and evaluate APO prognostic value in ischemic stroke. Methods: We prospectively analyzed patients with acute ischemic stroke without pneumonia symptoms referred to our stroke center. All patients underwent a chest x-ray within 48 hours after admission. We divided patients with APO (defined as asymptomatic area of increased pulmonary attenuation) and patients without APO. Firstly, we compared clinical, laboratory, and echocardiographic parameters between groups; secondly, APO were evaluated as a possible predictor of the neurological severity at discharge and functional outcome at 90 days. Results: We included 162 patients, 78 of whom had APO. On univariate analysis, we observed a significant difference between patients with APO and patients without APO in terms of neutrophils (73,56±10,10 vs 69,72±12,29; p=0,031), atrial fibrillation (AF, paroxysmal 27,4% vs 25,6%; permanent 19% vs 2,6%; p<0,002), cardioembolic etiology (37,2% vs 22,7%, p <0,033), thrombectomy (58,3% vs 42,9%, p <0,05), dysphagia/vomit (34,5% vs 14,10%, p<0,005), admission NIHSS (14,20±5,98 vs 10,29±5,82, p=0,001), discharge NIHSS (8,68±6,73 vs 5,64±6,20; p=0,003), and 90 days mRS (3,47±2,12 vs 2,31±1,93; p=0,001). On multivariate analysis, APO were significantly associated with admission NIHSS and AF. APO were a predictor of outcome on univariate analysis, but not on multivariate. Conclusion: APO in acute ischemic stroke are associated with AF. APO were not a predictor of neurological and functional outcome