On being a neurologist in Italy at the time of the COVID-19 outbreak

Italy is facing its fifth week of crisis due to the Coronavirus disease (COVID-19) outbreak, with affected patients and deaths near to 70,000 and 6,000, respectively,(1)numbers that are increasing every day. Whether government imposition of quarantines, travel bans, and lockdown throughout the country will have effect in the next weeks in limiting the spreading of this disease has still to be seen. Meanwhile, a great spirit of sacrifice is required to health care personnel, and authorities have to manage resource allocation to rapidly increase the number of intensive care beds to assist patients with COVID-19.(2)Although operating rooms and a number of wards have been turned into dedicated intensive units, beds and resources are hardly sufficient to satisfy the needs of so many simultaneously critically ill patients.(3,4)Notably, among infected people, about 10% are health workers, and their number is increasing, also due to the scarcity of efficacious protective measures

Transient global amnesia: An intriguing yetbenign disturbance

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Pathogenesis of leukoaraiosis : a review

Changes in the cerebral hemispheric white matter, detectable with increasing frequency by modern neuroimaging methods, are associated with aging and conceivably may contribute to the development of specific cognitive deficits. The pathogenesis of these cerebral white matter abnormalities (sometimes described as leukoaraiosis) is unknown. This review evaluates the available evidence in support of the hypothesis that the etiology of leukoaraiosis is related to a specific type of cerebral ischemia and highlights mechanisms by which ischemic injury to the brain may induce selected structural alterations limited to the cerebral white matter. Summary of Review The review is based on the critical analysis of over 100 publications (most appearing in the last decade) dealing with the anatomy and physiology of the arterial circulation to the cerebral white matter and with the pathogenesis of leukoaraiosis. Conclusions A significant number of clues support the hypothesis that some types of leukoaraiosis may be the result of ischemic injury to the brain. Structural changes affecting the small intraparenchymal cerebral arteries and arterioles that are associated with aging and with stroke risk factors, altered cerebral blood flow autoregulation, and the conditions created by the unique arterial blood supply of the hemispheric white matter each seem to contribute to the development of leukoaraiosis. To the best of our ability to interpret current information, the type of ischemic injury that is most likely responsible for these while matter changes involves transient repeated events characterized by moderate drops in regional cerebral blood flow that induce an incomplete form of infarction. This hypothesis could be tested in appropriate experimental models

Cytokines and cell adhesion molecules in cerebral ischemia: experimental bases and therapeutic perspectives

The possibility of reopening an occluded cerebral artery by means of thrombolysis has renewed interest in a number of the several mechanisms that are active during acute cerebral ischemia. Over recent years, it has become apparent that leukocytes play a central role not only during the healing stage of brain infarction but also during the early phases of cerebral ischemia, when it is postulated that these cells produce harmful effects, particularly in the presence of reperfusion. This review is based on the critical analysis of more than 150 publications dealing with the role of leukocytes and some inflammatory mediators (cytokines, chemokines, and adhesion molecules) in cerebral ischemia. Animal studies indicate that leukocyte involvement is promoted by a variety of inflammatory molecules produced immediately after the onset of cerebral ischemia. Considerable experimental evidence suggests that these mediators play a key role in the progression from ischemia to irreversible injury (ie, cellular death and necrosis). However, the precise role of each molecule alone remains to be further elucidated as well as in relation to the complex network existing among different mediators. Progress in our understanding of the inflammatory mechanisms operating in cerebral ischemia has enabled the testing of new compounds with promising results in animals; in contrast, one recent controlled trial of an anti-leukocyte molecule in acute stroke patients showed negative results. This discrepancy may derive in part from our incomplete understanding of the complexity of the inflammatory mechanisms involved in cerebral ischemia. Our analysis suggests that until sufficient knowledge of the underlying disease mechanisms is acquired, more care should be taken when testing new and potentially efficacious drugs in stroke patients

Stroke care during the COVID-19 pandemic : experience from three large European countries

In order to cope with the exponentially increasing number of patients infected with SARS-CoV-2, European countries made enormous efforts to reorganize medical assistance and several diseases, including stroke, were particularly impacted. We report the experience of stroke neurologists from three European countries (Italy, France and Germany) that faced the pandemic at diverse time points and with different approaches, depending on their resources and healthcare system organization. Pre-hospital and in-hospital acute stroke pathways were reorganized to prioritize COVID-19 management and, in severely affected regions of Italy and France, stroke care was centralized to a limited number of centers, whereas the remaining stroke units were dedicated to patients with COVID-19. Access to acute stroke diagnostics and time-dependent therapies was limited or delayed because of reduced capacities of emergency services due to the burden of patients with COVID-19. A marked reduction in the number of patients presenting with transient ischaemic attack and stroke was noted in the emergency departments of all three countries. Although we only have preliminary data, these conditions may have affected stroke outcome. These indirect effects of the COVID-19 pandemic could negate the efforts of stroke neurologists over the last few years to improve outcome and reduce mortality of stroke patients. Although the SARS-CoV-2 infection rate is slowing down in Europe, the effects of ending lockdown in the next months are unpredictable. It is important for the European and world stroke community to share what has been learned so far to be plan strategies to ensure stroke care in the future and upcoming challenging times

The effects of the initial mass function on Galactic chemical enrichment

Context. We have been seeing mounting evidence that the stellar initial mass function (IMF) might extend far beyond the canonical Mi ∼ 100 M⊙ limit, but the impact of such a hypothesis on the chemical enrichment of galaxies is yet to be clarified. Aims. We aim to address this question by analysing the observed abundances of thin- and thick-disc stars in the Milky Way with chemical evolution models that account for the contribution of very massive stars dying as pair instability supernovae. Methods. We built new sets of chemical yields from massive and very massive stars up to Mi ∼ 350 M⊙ by combining the wind ejecta extracted from our hydrostatic stellar evolution models with explosion ejecta from the literature. Using a simple chemical evolution code, we analysed the effects of adopting different yield tables by comparing predictions against observations of stars in the solar vicinity. Results. After several tests, we set our focus on the [O/Fe] ratio that best separates the chemical patterns of the two Milky Way components. We find that with a standard IMF, truncated at Mi ∼ 100 M⊙, we can reproduce various observational constraints for thin-disc stars; however, the same IMF fails to account for the [O/Fe] ratios of thick-disc stars. The best results are obtained by extending the IMF up to Mi = 350 M⊙, while including the chemical ejecta of very massive stars in the form of winds and pair instability supernova (PISN) explosions. Conclusions. Our study indicates that PISN may have played a significant role in shaping the chemical evolution of the thick disc of the Milky Way. Including their chemical yields makes it easier to reproduce not only the level of the α-enhancement, but also the observed slope of thick-disc stars in the [O/Fe] vs. [Fe/H] diagram. The bottom line is that the contribution of very massive stars to the chemical enrichment of galaxies is potentially quite important and should not be neglected in models of chemical evolution

Unveiling the nature of 11 dusty star-forming galaxies at the peak of cosmic star formation history

We present a panchromatic study of 11 (sub-)millimetre selected DSFGs with spectroscopically confirmed redshift (1.5 < zspec < 3) in the GOODS-S field, with the aim of constraining their astrophysical properties (e.g. age, stellar mass, dust, and gas content) and characterizing their role in the context of galaxy evolution. The multiwavelength coverage of GOODS-S, from X-rays to radio band, allow us to model galaxy SED by using cigale z with a novel approach, based on a physical motivated modelling of stellar light attenuation by dust. Median stellar mass (∼ 6.5 × 1010 M·) and SFR (∼ 241 M· yr-1) are consistent with galaxy main sequence at z ∼2. The galaxies are experiencing an intense and dusty burst of star formation (medianLIR ∼ 2 × 1012L·), with a median age of 750 Myr. The high median content of interstellar dust (Mdust ∼ 5 × 108 M·) suggests a rapid enrichment of the ISM (on time-scales ∼108 yr). We derived galaxy total and molecular gas content from CO spectroscopy and/or Rayleigh-Jeans dust continuum (1010 Mgas/M· 1011), depleted over a typical time-scale τdepl ∼200 Myr. X-ray and radio luminosities (LX = 1042-1044 erg s-1,L1.5, { m GHz}}=1030-C1 erg s-1,L 6, rm GHz=1029-C0 erg s-1) suggest that most of the galaxies hosts an accreting radio-silent/quiet SMBH. This evidence, along with their compact multiwavelength sizes (median rALMA ∼rVLA = 1.8 kpc, rHST = 2.3 kpc) measured from high-resolution imaging (θres 1 arcsec), indicates these objects as the high-z star-forming counterparts of massive quiescent galaxies, as predicted e.g. by the in situ scenario. Four objects show some signatures of a forthcoming/ongoing AGN feedback, which is thought to trigger the morphological transition from star-forming discs to ETGs