Spatio-temporal distribution pattern of COVID-19 in the Northern Italy during the first-wave scenario. The role of the highway network

Background: The rapid outbreak of Coronavirus disease 2019 (COVID-19) has posed several challenges to the scientific community. The goal of this paper is to investigate the spread of COVID-19 in Northern Italy during the so-called first wave scenario and to provide a qualitative comparison with the local highway net. Methods: Fixed a grid of days from February 27, 2020, the cumulative numbers of infections in each considered province have been compared to sequences of thresholds. As a consequence, a time-evolving classification of the state of danger in terms of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, in view of the smallest threshold overtaken by this comparison, has been obtained for each considered province. The provinces with a significant amount of cases have then been collected into matrices containing only the ones featuring a significant amount of cases. Results: The time evolution of the classification has then been qualitatively compared to the highway network, to identify similarities and thus linking the rapid spreading of COVID-19 and the highway connections. Conclusions: The obtained results demonstrate how the proposed model properly fits with the spread of COVID-19 along with the Italian highway transport network and could be implemented to analyze qualitatively other disease transmissions in different contexts and time periods

Cyclists at Roundabouts: Risk Analysis and Rational Criteria for Choosing Safer Layouts

Cycling for transportation is an important resource to reduce urban traffic congestion, enhance personal health, reduce energy consumption, and improve air quality, and the safety of cyclists in the cities is becoming a topic of growing interest. As shown in the literature, an important number of cyclist fatalities is due to road crashes occurring at urban intersections. This study combines a probabilistic and a damage model to perform a risk analysis for the collisions between motor vehicles and bicycles in the merging and diverging conflict points of a single-lane conventional roundabout with four arms, characterized by a permanent traffic flow. The probabilistic model is based on Poisson’s law and is aimed to measure the probability of a collision between bikes and motor vehicles within the elementary unit of exposure in each conflict point of the roundabout. The damage model exploits the reaction time of a road user to avoid a collision and has been built to develop a danger classification for the conflict points. The goal of this study is then to estimate the so-called risk of collision at the roundabout, to compare different possible layouts for various traffic volumes with increasing bike flows and geometric configurations, and to identify the most effective solutions to improve safety for cyclists. The results demonstrate the risk reduction given by a roundabike compared to a standard layout where cyclists and motor vehicles share the circulatory roadway. Therefore, the study here presented could help road managers to implement mitigation strategies taking into consideration both geometric and functional constraints

An observational study on electrolyte disorders in the acute phase of ischemic stroke and their prognostic value

Data on electrolyte disorders in neurological conditions and in acute stroke are somewhat scanty and not easily compared. In our Stroke Unit we studied patients hospitalized within six hours of the onset of an acute ischemic stroke and recorded their demographic and clinical data. Blood test results were recorded before any pharmacological therapy. A total of 475 individuals (256 males, 219 females; age range: 14-96 years) treated over a period of 18 consecutive months, were selected. According to a multiple logistic regression analysis, the baseline National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.22-1.44) and alterations in serum sodium (OR = 6.89; 95% CI = 1.94-24.40) were associated with higher odds of death. Based on an ordinal logistic regression analysis, the baseline NIHSS score (OR = 1.07; 95% CI = 1.03-1.10) and baseline hypernatremia (OR = 9.69; 95% CI = 1.55-60.69) were related to early neurological worsening. Our work suggests an association between serum sodium alterations and mortality, and between high sodium levels and neurological clinical impairment, in the acute phase of an ischemic stroke. (C) 2011 Elsevier Ltd. All rights reserved

Neopterin production and tryptophan degradation during 24-months therapy with interferon beta-1a in multiple sclerosis patients

<p/> <p>Background</p> <p>Increased synthesis of neopterin and degradation of tryptophan to kynurenine, measured as kynurenine/tryptophan ratio (kyn/trp ratio), are considered <it>in vitro </it>markers of interferon beta-1a (IFNβ-1a) activity. The aim of the study was to investigate the dynamic profile of neopterin and kyn/trp ratio in patients with relapsing remitting multiple sclerosis (RRMS) treated with two different doses of IFNβ-1a over a period of 24 months.</p> <p>Methods</p> <p>RRMS patients (n = 101) received open-label IFNβ-1a 22 mcg (low dose, LD) or 44 mcg (high dose, HD) subcutaneously (sc), three times weekly for 24 months. Serum measurements of neopterin, kyn/trp ratio and neutralizing antibodies (NAbs) were obtained before treatment (i.e., at baseline) and 48 hours post-injection every 3 months thereafter. Clinical assessments were performed at baseline and every 6 months. Changes in biomarkers over time were compared between LD- and HD-group as well as between patients with/without relapses and with/without NAbs using Analysis of Variance and Mann-Whitney tests.</p> <p>Results</p> <p>Neopterin (p < 0.001) and kyn/trp ratio (p = 0.0013) values increased over time vs baseline in both treatment groups. Neopterin values were higher (p = 0.046) in the HD-compared to the LD-group at every time point with the exclusion of months 21 and 24 of therapy. Conversely, there were no differences between the two doses groups in the kyn/trp ratio with the exclusion of month 6 of therapy (p < 0.05). Neopterin levels were significantly reduced in NAb-positive patients starting from month 9 of therapy (p < 0.05); the same result was observed for kyn/trp ratio but only at month 9 (p = 0.02). Clinical status did not significantly affect neopterin production and tryptophan degradation.</p> <p>Conclusions</p> <p>Although differences in serum markers concentration were found following IFNβ administration the clinical relevance of these findings needs to be confirmed with more detailed studies.</p

Neuroimaging in idiopathic adult-onset focal dystonia

We aimed to study the attitude of Italian neurologists in the use of conventional MRI in patients with idiopathic adult-onset focal dystonia. Patients were included in the Italian Dystonia Registry by experts working in different Italian centers. MRI was available for 1045 of the 1471 (71%) patients included in the analysis. Using logistic regression analysis, we found that MRI was more likely to be performed in patients with cervical dystonia, spasmodic dysphonia, or non-task-specific upper limb dystonia, whereas it was less likely to be performed in patients with blepharospasm or task-specific upper limb dystonia. We did not find differences in the number of MRIs performed between neurological centers in Northern, Central, and Southern Italy. We conclude that although the diagnosis of idiopathic adult-onset dystonia is mainly based on clinical grounds, many movement disorder experts rely on MRI to confirm a diagnosis of idiopathic dystonia. We suggest that neuroimaging should be used in patients with adult-onset focal dystonia to rule out secondary forms