COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Response of steel fiber reinforced high strength concrete beams: Experiments and code predictions

The shear-flexure response of steel fiber reinforced concrete (SFRC) beams was investigated. Thirty-six reinforced concrete beams with and without conventional shear reinforcement (stirrups) were tested under a four-point bending configuration to study the effectiveness of steel fibers on shear and flexural strengths, failure mechanisms, crack control, and ductility. The major factors considered were compressive strength (normal strength and high strength concrete up to 100 MPa), shear span-effective depth ratio (a/d = 1.5, 2.5, 3.5), and web reinforcement (none, stirrups and/or steel fibers). The response of RC beams was evaluated based on the results of crack patterns, load at first cracking, ultimate shear capacity, and failure modes. The experimental evidence showed that the addition of steel fibers improves the mechanical response, i.e., flexural and shear strengths and the ductility of the flexural members. Finally, the most recent code-based shear resistance predictions for SFRC beams were considered to discuss their reliability with respect to the experimental findings. The crack pattern predictions are also reviewed based on the major factors that affect the results

Opening and mixed mode fracture processes in a quasi-brittle material via digital imaging

Fracture tests were performed on sandstone specimens under three-point bending with a variety of notch positions to achieve KII/KI = 0???12%. At peak load, the maximum crack opening displacement measured by digital image correlation was 45 lm under mixed mode loading and 30 lm under mode I, and these values were used to determine the length of the cohesive zone: 10???12 mm for mixed mode and 5???7 mm for mode I. For mixed mode fracture, the displacement in the cohesive zone was identified to be opening only, while sliding and opening were detected along the remaining length