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The recent growth of e-Commerce has induced an increasing freight demand, which could lead to negative externalities, in particular in urban areas. To foster sustainable development of cities and increase their livability, many local authorities are implementing urban vehicle access regulations, such as low-emission zones, banning the circulation of polluting vehicles. These measures prompted the adoption of new sustainable freight transport solutions for last mile deliveries, such as cargo bikes. The aim of this paper is to describe the study for the implementation of such a system. The procedure was tested (1) to define the location of a transshipment facility where parcels are moved from vans to cargo bikes, (2) to estimate the environmental and economic sustainability of the system, and (3) to quantify the effects of uncertainty in the final results. The framework was applied to the city center of Padova (Italy), where two sets of delivery system were considered: the first with traditional vans starting from an existing urban consolidation center and the second with manual and electric cargo bikes starting from a micro-depot. In particular, demand of home deliveries was estimated for a typical weekday; routes of freight transport means were defined by an optimization procedure; these data were used as input to a Discrete Event Simulation model. A sensitivity analysis was carried out modelling the potential uncertainty associated with load/unload times and travel speed of means, due to traffic congestion. Several scenarios were tested considering three locations as potential transshipment points. Outcomes of the simulations were used to estimate key performance indicators, evaluating the environmental and economic effects of the two delivery schemes. Results highlighted the potentiality of cargo bikes as a sustainable delivery system, and the impacts of uncertainty on the ranking of alternative options (i.e. micro-hubs).

Vegetated habitats play a key role in the structure and function of ecosystems by modifying local environmental conditions and providing food and habitat to a great range of organisms. The aim of this study is to assess the relative importance of two widely distributed macroalgae species in providing ecosystem functions in coastal areas where they are prevalent (Patagonia, Argentina, Lat 43.73°, Lon 64.92°) in comparison to low-vegetated areas without these two species. In October 2018 and May 2019, we tested whether Ulva spp. and Undaria pinnatifida perform a series of ecosystem functions commonly associated with vegetated coastal environments. Our study suggests that Ulva spp. decreases water current and provides habitat for epifauna, as the adjacent low-vegetated areas without Ulva spp. present higher gypsum block dissolution rates, lower biomass and richness of total epifauna, and lower grazer biomass than areas dominated by Ulva spp. U. pinnatifida, on the other hand, only showed a positive effect on epifauna biomass relative to low-vegetated areas, and no effect on the rest of the variables measured, despite providing similar levels of coverage to Ulva spp., and having a larger and more complex structure. None of the two macroalgae influence the habitat use by fishes. Despite smaller size and a labile structure, Ulva spp. presence had an effect on more variables than U. pinnatifida, and the function provided by U. pinnatifida was also provided by Ulva spp., namely U. pinnatifida did not provide new functions to the system.

Acute encephalitis and febrile infection-related epilepsy syndrome (FIRES) are debilitating neurological disorders. It is increasingly accepted that FIRES should be considered an autoinflammation-mediated epileptic encephalopathy, but the debate about its etiopathogenesis is still very much open. Despite showing a considerable overlap with encephalitis, it continues to be regarded as a distinct entity. We describe the case of a previously healthy 5-year-old child who, following a fever, developed acute encephalopathy, status epilepticus, neurological, neuropsychological, and psychiatric manifestations, and claustrum involvement on MRI. At symptom onset, his clinical and instrumental data met the diagnostic criteria for both FIRES and acute encephalitis. He received benzodiazepines, levetiracetam, phenytoin, phenobarbital, thiopental, and first-line immunotherapy for acute inflammatory encephalopathy (intravenous methylprednisolone and immunoglobulins), without substantial improvement. Following the detection of anti-neuronal antibodies through immunohistochemistry performed on rat brain slices, he received therapeutic plasma exchange (TPE). His neurological and behavioral conditions improved drastically and his antibody titer fell sharply from the first to the last course of PE. Claustrum abnormalities on MRI disappeared. The patient’s long-term outcome is favorable. At 13 months after discharge, he experienced a focal seizure and carbamazepine was started, achieving seizure control. At 10 years of age, he is still on carbamazepine, with well-controlled seizures, focal EEG abnormalities, and an otherwise normal neurological and cognitive profile and normal MRI. This case strengthens the view that FIRES might constitute the initial clinical presentation of a CNS inflammatory disease that could have, among multiple distinct etiologies, an autoimmune cause. Immunological and specific second- or third-level investigations including immunohistochemistry should be included in the diagnostic work up of patients with FIRES-like phenotypes. PE could be effective in this subset of patients, protecting them from long-term neurological sequelae.

This paper investigates the factors affecting Italian provinces' separate collection rates from 2007 to 2016, as these rates are relevant environmental performance indicators in urban waste management. We observe data spanning this decade from 103 Italian provinces and use panel data regressions to explore if and how some relevant socio-economic factors-including convictions for crimes committed against the public administration and many indicators of equitable and sustainable well-being that describe the quality of life in Italy-significantly affect provinces' capability to reach European and national regulators' separate collection rate targets. The results reveal that the greater the prosecuted crime committed against the public administration, average income, expected age, number of people with a diploma or a degree, and the percentage of female municipal administrators, the greater the separate waste collection rate. In contrast, the greater the number of household members, youth employment rate, total waste produced per capita, and the recourse for landfills, the lower the separate waste collection rate. These results highlight for policy-makers and waste utility managers the need to implement different strategies to increase the ability to meet expected targets and increase environmental performance, and thus, further increasing the quality of life.

N-Methyl-D-Aspartate receptor antibody (NMDAR-ab) encephalitis is the most common antibody-mediated encephalitis. We compared four NMDAR-Ab assay methods: 1) live (a, L-CBA) or fixed (b, F-CBA) cell-based assays (CBA); 2) immunohistochemistry (IHC); 3) a commercially available CBA (C-CBA, Euroimmun AG). 180 sera and 48 CSFs were tested. Sera previously positive by the Oxford L-CBA but with unlikely phenotypes were intentionally over-represented. The results of the four assays agreed in only 55.6% of sera and 82% of CSFs. C-CBA was least likely to agree with other methods (37.7% in serum). Diagnosis was available, so far, for 54 patients (NMDAR ab-encephalitis ‘definite’ in 34, ‘unlikely’ in 20). In serum, L-CBA detected NMDAR-abs in 88% of ‘definite’ patients, but had a high false-positive rate (consistent with the biased selection). IHC was negative in all unlikely patients, but positive in only 73.5% ‘definite’ patients. F-CBA and C-CBA had intermediate performances. There was a worrying lack of concordance between tests. Assay results should be interpreted in the light of clinical information and a combination of L-CBA and IHC may give the most useful results. Further clinical information is being made available in order to increase the serum numbers and determine assay performance using CSF alone.

Background and aims: Acquired Neuromyotonia (NMT) is an autoimmune condition frequently associated with anti-contactin-associated-protein-like-2 (Caspr2) antibodies. NMT can occur as a paraneoplastic disorder in patients with thymoma, alone or in combination with Myasthenia Gravis (MG). Recently, antibodies against netrin-1-receptors (DCC and UNC5A) have been reported as predictors of thymoma in 6/9 patients with concomitant NMT and MG. We aimed to clinically characterize a large cohort of patients with thymoma-associated MG, and to explore serological correlation of NMT symptoms. Methods: 268 consecutive patients with thymoma-associated MG were retrospectively collected. NMT was defined as muscle twitching/cramps in at least 2 skeletal districts. Patients with NMT(23) were screened for anti-neuronal antibodies by immunohistochemistry on rat brain and cell based assay. Results: 23/268 patients developed NMT symptoms (muscle twitching, 3; cramps, 3, or both, 17). Overall, 33/268 patients with thymoma had a tumor recurrence, which was more frequent in those with (8/23) vs those without NMT (25/245, p=0.003). NMT onset preceded the tumor recurrence in 5/6 patients. In univariate analysis predictors of thymoma recurrence were younger age at thymectomy (odds ratio-OR:0.95, confidence interval-CI:0.93-0.97), Masaoka staging (OR:10.73, CI:2.38-48.36) and NMT (OR:4.69, CI:1.76-12.46). 6 patients with NMT had anti-neuronal antibodies (patient#1: Caspr2; patient#2: AMPAR; patient#3: DCC; patient#4: LGI1; patient#5: Caspr2+LGI1+DCC+UNC5A; patient#6: Caspr2+LGI1+DCC). Thymoma recurrence was found less frequently in negative (3/17) vs positive patients with NMT (4/6, #1, #2, #5 and #6; p=0.045). Conclusion: The occurrence of NMT symptoms in patients with thymoma-associated MG can predict tumor recurrence, and warrants a closer oncologic follow-up. Anti-neuronal surface autoantibodies may be useful to further stratify the recurrence risk. Disclosure: This work was funded by the ‘Ricerca finalizzata ministeriale 2015-2017’ provided by the Italian ministry of health