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• New dopa-responsive phenotype expands the spectrum of GlyR antibody-associated PERM syndrome. • Appendicular rigidity with axial hypotonia and oculomotor abnormalities suggested hypodopaminergic tone. • Downstream effects GlyR antibody may interfere with the dopamine network. [ABSTRACT FROM AUTHOR]

Abstract We describe the case of a woman with Parkinson disease who developed an N -methyl- d -aspartate receptor antibody-mediated encephalitis. As a novelty, the encephalitis presentation mimicked a worsening of the pre-existing extrapyramidal syndrome, manifesting mainly as severe bradykinesia and, eventually, akinesia. Brain MRI was normal, whereas cerebrospinal fluid (CSF) analysis disclosed unique-to-CSF oligoclonal bands. Prompt identification and timely immunotherapy led to a complete recovery. [ABSTRACT FROM AUTHOR]

Over the last 15 years it has become clear that rare but highly recognizable diseases of the central nervous system (CNS), including newly identified forms of limbic encephalitis and other encephalopathies, are likely to be mediated by antibodies (Abs) to CNS proteins. The Abs are directed against membrane receptors and ion channel-associated proteins that are expressed on the surface of neurons in the CNS, such as N-methyl D-aspartate receptors and leucine-rich, glioma inactivated 1 protein and contactin-associated protein like 2, that are associated with voltage-gated potassium channels. The diseases are not invariably cancer-related and are therefore different from the classical paraneoplastic neurological diseases that are associated with, but not caused by, Abs to intracellular proteins. Most importantly, the new antibody-associated diseases almost invariably respond to immunotherapies with considerable and sometimes complete recovery, and there is convincing evidence of their pathogenicity in the relatively limited studies performed so far. Treatments include first-line steroids, intravenous immunoglobulins, and plasma exchange, and second-line rituximab and cyclophosphamide, followed in many cases by steroid-sparing agents in the long-term. This review focuses mainly on N-methyl D-aspartate receptor- and voltage-gated potassium channel complex-related Abs in adults, the clinical phenotypes, and treatment responses. Pediatric cases are referred to but not reviewed in detail. As there have been very few prospective studies, the conclusions regarding immunotherapies are based on retrospective studies. [ABSTRACT FROM AUTHOR]

• Micro-cracks, induced by mechanical loading, were characterized in width and depth. • Sound and micro-cracked specimens were subject to pure diffusion of chloride ions. • Chloride diffusion coefficient was evaluated via colorimetric and titration methods. • In uncracked conditions good correlation subsisted between the two methods. • The effect of micro-cracks resulted more pronounced in more impervious concretes. Concrete resistance to chloride penetration is one of the main design parameters for the assessment of reinforced concrete structures durability in chloride-contaminated environments, and it is usually determined through one of the accredited accelerated tests in uncracked configuration. In this study, the resistance to chloride penetration was evaluated on six different concrete types, in uncracked and load-induced micro-cracked configurations, subject to pure diffusion and considering two different analysis techniques, colorimetric and potentiometric titration. Results showed that in uncracked conditions, good correlation subsisted between the diffusion coefficients evaluated through the two techniques. In cracked configuration (micro-cracks 10–75 μm wide and 5–45 mm deep) with both techniques a significant increase in chloride diffusion coefficient was detected for concretes with lower w/c ratio, suggesting that the effect of cracks may be more pronounced for more impervious concretes. [ABSTRACT FROM AUTHOR]

Objectives : In this retrospective multicenter study, we evaluated the safety of SARS-CoV-2 vaccination in patients harboring autoantibodies targeting neuronal surface and/or synaptic antigens. Methods : From eight Italian Neurology Units, we included patients with: a) serum and/or CSF positivity for specific neuronal autoantibodies; b) a compatible neurological syndrome; and c) available follow-up ≥6 weeks after vaccination with any of the approved SARS-CoV-2 vaccines. Demographics, clinical data, and information regarding previous SARS-CoV-2 infection and vaccination were collected. Disease relapses were considered "post-infectious" or "post-vaccination" when occurring within 6 weeks from infection/vaccination. Results : We included 66 patients; 7/66 (11%) had a previous history of SARS-CoV-2 infection and 1/7 (14%) had post-infection relapses. BNT162b2-Pfizer-BioNTec was administered in 55 cases (83.3%) and mRNA-1273-Moderna in 11 (16.7%). The median number of doses administered per patient was 2 (1–3) and >50% of patients did not experience side effects. Five patients (8%) had post-vaccination relapses (seizure 3/5); 4/5 improved after immunotherapy, while one did not receive immunotherapy and worsened. Patients with post-vaccination relapses had higher disability scores at vaccination (p = 0.025), a trend favoring Leucine-rich glioma-inactivated protein 1 LGI1 glutamic acid decarboxylase 65 (GAD65) antibodies (p = 0.054) and shorter time from last relapse (p = 0.057). Discussion : Our data support the safety of SARS-CoV-2 vaccines in patients with neurological disorders associated with antibodies to neuronal and synaptic antigens. [ABSTRACT FROM AUTHOR]

Abstract: Stainless steel reinforcing bars can be a means for prolonging the service life of reinforced concrete structures exposed to tropical climates. To select a suitable grade of stainless steel according to exposure conditions and design service life, the definition of the chloride threshold for pitting corrosion initiation is required. This paper investigates the effect of temperature in the range 20–60°C on the resistance to chloride-induced corrosion of low-nickel duplex stainless steel rebars and, for comparison, of traditional austenitic stainless steel rebars. Tests in concrete and in solutions simulating the concrete pore liquid were performed and an attempt to evaluate the chloride threshold levels for corrosion initiation was carried out. Results showed lower corrosion resistance and higher sensitivity to increase in temperature for low-nickel duplex stainless steel bars compared to traditional austenitic stainless steels. [Copyright &y& Elsevier]

This paper presents the results of a study of the effectiveness of submerged sacrificial anodes in preventing the onset of pitting corrosion in the emerged part of marine piles. Experimental tests were carried out on reinforced concrete columns with steel embedded both in chloride free concrete and chloride contaminated concrete in order to compare the effects of sacrificial anodes on passive steel and on corroding steel. Results have shown, at least under the present testing conditions, that sacrificial anodes may be more effective in preventing corrosion initiation (i.e. in providing cathodic prevention) than in controlling ongoing pitting corrosion (i.e. in guaranteeing cathodic protection). Monitoring criteria for this type of prevention are also discussed. [ABSTRACT FROM AUTHOR]

• NfL levels are increased in patients with MOGAD at onset • NfL levels decrease over time in most patients with MOGAD • NfL levels do not increase significantly during relapses in patients with MOGAD • Axonal damage predominantly occurs at onset in patients with MOGAD The unpredictable course and uncertain impact of relapses make treatment strategies of anti-myelin oligodendrocyte glycoprotein antibodies associated disorders (MOGAD) challenging. We analysed neurofilament light chain levels (NfL) in onset and follow-up sera of 18 patients with MOGAD to clarify the timing of axonal damage. In comparison with disease onset values (median 8.9 pg/mL, range 1.8-97), NfL levels remained stable or decreased in most follow-up measurements (n=52, median 6.7 pg/mL, range 0.2-207), including those measured on relapses. The predominant axonal damage occurs during onset, which could be the main driving factor of final disability, with subsequent relevant clinical and therapeutic implications. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) raises particular concerns for people with multiple sclerosis (PwMS) on disease-modifying treatments (DMTs), and for physicians caring for them. The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on PwMS receiving DMTs that inhibit immune cell trafficking, such as natalizumab (NTZ) and fingolimod (FTY), remains to be determined, as do the possible effects of these drugs on both the infection and the related disease. To describe self-reported COVID-19 symptoms and disease severity in PwMS on NTZ or FTY who received serology confirmation of SARS-CoV-2 infection. From 27th April to 3rd May 2020, telephone interviews were conducted with 140 PwMS under treatment with NTZ or FTY in order to collect structured data on multiple sclerosis (MS) and COVID-19. The patients, all followed at our center, were classified as symptomatic, paucisymptomatic or asymptomatic on the basis of their self-reported clinical characteristics. COVID-19 severity was rated on a 7-point ordinal scale. In addition, in the period 4th May to 3rd June 2020 SARS-CoV-2 serology testing, using the Roche SARS-CoV-2 IgG assay (ElecsysⓇ), was performed in 104/140 (74.2%) of the interviewed PwMS (50 treated with NTZ and 54 with FTY). 14/104 (13.4%) PwMS on NTZ or FTY had anti-SARS-CoV-2 antibodies: 8 met the criteria for asymptomatic, 3 for paucisymptomatic and 3 for symptomatic COVID-19 (COVID-19 severity score lower than 3). None of them required hospitalization or showed severe COVID-19 complications. Despite the relatively high SARS CoV-2 seroprevalence found in this sample of PwMS, all the positive cases showed either no or only mild COVID-19 symptoms. These reassuring findings indicate a lack of COVID-19 complications in PwMS on DMTs and support the hypothesis that it is safe to maintain ongoing treatment with these drugs in the current setting. [ABSTRACT FROM AUTHOR]

• MOG Abs are associated with seizures in heterogeneous clinical settings. • Isolated seizures in MOG Ab-positive patients can precede demyelinating events. • Testing for MOG Abs might be considered in children with unexplained seizures. • Evidence of MOG Ab-associated autoimmune epilepsy is circumstantial at present. Myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs) have been associated with a heterogeneous range of acquired CNS demyelinating disorders. More recently, increasing evidence correlates the presence of such Abs with seizures, occurring in concomitance with CNS demyelinating events, or even as isolated phenomena. In this scenario, the full clinical spectrum of MOG Ab-associated seizures and the contribution of such Abs to epileptogenesis are unclear. We report on two paradigmatic cases of MOG Ab-associated seizures, one showing isolated seizures, without evidence of encephalopathy or MRI changes, followed by a demyelinating event one month later, and the other presenting with seizures as the main manifestation of an acute disseminated encephalomyelitis (ADEM) event. To better frame this topic, we performed a literature review, identifying 49 patients with MOG Ab-associated disorders presenting seizures at any stage of their disease, and analysed the clinico-therapeutic, brain MRI, cerebrospinal fluid, and EEG features. MOG Ab-associated seizures occurred mostly during encephalitis, including: a) "cortical encephalitis", a clinically poorly defined syndrome characterised by gray matter lesions on brain MRI, with or without subcortical white matter involvement; b) ADEM; c) NMDAR encephalitis with demyelinating features. Seizures can also occur in isolation, often in clusters of focal motor seizures, in patients with normal brain MRI, heralding the more typical MOG Ab-associated demyelinating syndrome by days to months. Testing for MOG Abs should be considered in children with isolated and unexplained seizures, and in adults with suspected encephalitis and/or seizures. In these cases, MOG Abs detection is highly relevant for patients' clinical management. [ABSTRACT FROM AUTHOR]

• Optic disc edema at onset is suggestive for MOG positive optic neuritis. • Increased retinal nerve fiber layer at onset is suggestive for MOG positive optic neuritis. • Visual acuity impairment is similar at onset in MOG positive and seronegative optic neuritis. • MOG positive patients show better outcome. • Multiple sclerosis is frequent in seronegative optic neuritis, but is exceptionally rare in MOG positive optic neuritis. recent studies reported that anti myelin oligodendrocyte glycoprotein (MOG) antibody (ab) related optic neuritis (ON) tend to have characteristics that differ from seronegative ones. The aim of our study was to investigate the clinical characteristics of pediatric anti-MOG ON by comparing anti MOG-ab-seropositive and seronegative patients with ON. in this retrospective Italian multicentre study, participants were identified by chart review of patients evaluated for acquired demyelinating syndromes of the central nervous system (over the period 2009–2019). We selected patients presenting with ON as their first demyelinating event. Inclusion criteria were age < 18 years at symptoms onset; presentation consistent with ON; negativity of anti-aquaporin 4 antibodies (AQP4). Only patients who were tested for MOG-IgG1-ab with a live cell-based assay were included. 22 patients (10 MOG-ab-positive and 12 MOG-ab-negative) were included. Fundus oculi examination at onset showed disc swelling in 9/10 in the MOG-ab-positive cohort and 2/10 in the seronegative group (P = 0.002). Retinal Fiber Nerve Layer (RFNL) thickness measured by Spectral Domain Optical Coherence Tomography (S-OCT) was increased in the 5/5 MOG-ab-positive patients tested and was normal or reduced in the seronegative patients tested (4/4 patients) (P = 0.024). Visual acuity impairment at onset did not differ significantly between the two groups, but the MOG-ab-positive cohort showed better recovery at follow-up both regarding visual acuity (P = 0.025) and expanded disability status scale (EDSS) (P = 0.013). A final diagnosis of MS was frequent among seronegative patients (6/12, 50%), whereas none of the MOG-ab-positive group received a diagnosis of MS (P = 0.015). Clinical relapse frequency was low in both groups: 2/10 MOG-ab-positive and 2/12 seronegative cases relapsed, with a median follow up of 25 months. optic disc swelling and increased RFNL at baseline are strongly associated with MOG-ab positivity. MOG-ab-positive patients with ON showed better recovery compared to the seronegative ones. The relapse rate was low and did not differ among the two groups. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is an acquired demyelinating disease of the central nervous system (CNS) that traditionally has been considered to be mediated primarily by T cells. Increasing evidence, however, suggests the fundamental role of B cells in the pathogenesis and development of the disease. Recently, anti-CD20 B cell-based therapies have demonstrated impressive and somewhat surprising results in MS, showing profound anti-inflammatory effects with a favorable risk–benefit ratio. Moreover, for the first time in the MS therapeutic scenario, the anti-CD20 monoclonal antibody ocrelizumab has been granted for the treatment of the primary progressive form of the disease. In this review, we provide a brief overview about anti-CD20 B cell-based therapies in MS, in the perspective of their influence on the future management of the disease, and of their possible positioning in a new wider therapeutic scenario. • B cells represent the new scenario in personalized therapy in multiple sclerosis. • The CD20-targeted B cell depleting therapies are efficacious which could be used in an induction approach too. • The safety of CD20-targeted B cell-depleting therapies requires deeper investigations and longer surveillance in real-life. • We dramatically need prospective, preferably head-to-head studies for assessing the optimal and personalized use of such drugs. [ABSTRACT FROM AUTHOR]

Abstract: The paper describes a study on the mortars of the basilica of San Lorenzo in Milan, which was carried out to support an archaeological study aimed at dating and documenting the construction techniques used throughout the centuries. The church, which was founded between the 4th and 5th century, at the end of the period when Milan was the capital of the Roman Empire, was subjected in time to extensions, collapses and reconstructions that lasted until the Renaissance period and even later on. Thanks to the good state of conservation, San Lorenzo church is a collection of materials and construction techniques throughout a period of more than a millennium. Mortars were investigated in order to compare the binders used for structural elements built in different historical ages. From an archaeological study, samples of mortars attributed to the late Roman period, the Middle Ages and the Renaissance were available. The binder of each sample was separated by the aggregates and it was characterised on the basis of X-ray diffraction analysis, thermogravimetric analysis and scanning electron microscopy. Constituents of the binder were identified and their origin is discussed in order to investigate if they could be attributed to the original composition of the binder or to possible alteration in time due to atmospheric pollution. Results show that, even though the binder is mainly based on magnesian lime, there are significant differences in the microstructure of the binding matrix used in mortars ascribed to the different historical periods. In the Roman period, in correspondence of the structural elements that required higher strength, also hydraulic cocciopesto mortars were detected. Gypsum was found in most samples, which was maybe added intentionally. [Copyright &y& Elsevier]

Background: Anti-N-methyl-d-aspartate receptor encephalitis is a central nervous system inflammatory autoimmune disease affecting adults and children. The use of first- and second-line immunotherapies is supported. Recent reports suggest the efficacy of bortezomib in severe anti-N-methyl-d-aspartate encephalitis in adult patients not responsive to second-line treatment; there are no data about pediatric patients.Patient Description: We describe an eight-year-old child with anti-N-methyl-d-aspartate encephalitis not responsive to first- and second-line treatments who experienced marked clinical improvement after bortezomib administration.Discussion: Bortezomib is a selective and reversible inhibitor of the 26S proteasome, which is used to treat oncologic and rare autoimmune disorders in pediatric patients. As observed in adult patients, bortezomib administration induced anti-N-methyl-d-aspartate antibody titer decline and clinical improvement with an acceptable risk profile.Conclusion: This is the first report of the use of bortezomib in children with anti-N-methyl-d-aspartate encephalitis; it could be a useful therapeutic option in children with refractory anti-N-methyl-d-aspartate encephalitis. [ABSTRACT FROM AUTHOR]

A 44-year-old previously healthy woman developed acute myelitis in close temporal relationship with ChAdOx1 nCoV-19 vaccine first-dose administration. The neurological involvement was mainly sensory with neuroimaging showing two mono-metameric lesions involving the posterior and lateral cord at dorsal level. Significant improvement was promptly recorded with high-dose intravenous steroids, with complete recovery within one month. The strict temporal relationship between vaccination and myelitis, together with the absence of clues pointing to alternative diagnoses, might suggest a conceivable role for anti-SARS-CoV-2 vaccine as immunological trigger, although a causal relationship has yet to be established and our preliminary observation suggests caution. [Display omitted] • Vaccine-related autoimmunity has been an interesting and rather complex matter of debate for years. • Any adverse event can be defined as vaccine-induced if peculiar requirements are met i.e., temporal association, consistency, specificity and strength. • We report on a patient with an inflammatory myelopathy in close temporal relationship with the first-dose of ChAdOx1 nCoV-19 vaccine administration. • The short interval between the onset of symptoms and the vaccination might point to a non-specific immunological mechanism of bystander activation. • Our preliminary observation suggests caution and further confirmation in larger cohorts is needed. [ABSTRACT FROM AUTHOR]