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Background: Amyotrophic lateral sclerosis (ALS) is a devastating and untreatable motor neuron disease, with a 3–5-year survival from diagnosis. Possible prognostic serum biomarkers include albumin, C-reactive protein, ferritin, creatinine, uric acid, hemoglobin, potassium, sodium, calcium, glucose, and the neutrophil-to-lymphocyte ratio (NLR), a marker of subclinical inflammation. Objective: To ascertain the influence of NLR on ALS progression rate and survival. Methods: Cross-sectional multicenter study including 146 consecutive incident and prevalent patients (88 males), aged >18 years, diagnosed according to the El Escorial criteria. The exclusion criteria were: (1) patients with tracheostomy or receiving mechanical ventilation; (2) patients with percutaneous endoscopic gastrostomy; and (3) patients who did not sign the informed consent. The rate of disease progression (ΔFS score) represents the monthly decline of the ALSFRS-R score, and was computed as (48 − total ALSFRS-R at recruitment)/symptom duration in months. Patients were followed up to tracheotomy, death, or the end of the follow-up, whichever occurred first. To validate our findings, we used data retrieved from the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) Database. Results: The median disease duration was 15 (range = 2–30) months. The mean ALSFRS-R score at recruitment was 35.8 ± 8.0 (range: 10–48), and the median ΔFS was 0.66 (range: 0–5.33). Age at onset, at diagnosis, and at recruitment were significantly lower in the lowest NLR tertile. NLR values positively correlated with ΔFS values (r = 0.28): the regression slope of NLR (log-values) was 0.60 (p < 0.001) before and 0.49 (p = 0.006) after adjustment for age at recruitment. The ΔFS score progressively increased from the lowest to the highest NLR tertile: 0.35 (IQR: 0.18–0.93), 0.62 (IQR: 0.25–1.09), and 0.86 (IQR: 0.53–1.92). Patients were followed for a median of 2 years. The mortality rate passed from 15.9 events per 100 person-years in patients belonging to the lowest NLR tertile to 52.8 in those in the highest tertile. The optimal cut-off value which best classified patients with the lowest and the highest mortality rate was set at the NLR value of 2.315. Indeed, the mortality rate of patients with an NLR value above such cut-off was twice the mortality rate of patients with a value below the cut-off (age adjusted hazard ratio (HR): 2.16, 95% confidence interval (CI): 1.32–3.53). In the PRO-ACT validation sample, patients with an NLR value above the cut-off consistently had a higher mortality rate than those with a value below the cut-off (age adjusted HR: 1.17, 95%CI: 1.01–1.35). Conclusions: NLR could be a candidate easy, fast, and low-cost marker of disease progression and survival in ALS. It may be associated with low-grade inflammation either as a direct mirror of the pathological process of disease progression, or as a consequence of neuronal death (reverse causation). However, prospective studies are needed to understand whether NLR changes during the course of the disease, before using it to monitor disease progression in ALS.

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Girnavaz Höyük is a key site for better understanding the cultural and economic relationship between northern Mesopotamia and the Upper Tigris region between the third and the first millennia BC. The site is located in the liminal zone of the northern Jazirah at the start of the Tur ‘Abdin mountains, in a spot that most likely allowed it to play an important role in financial, cultural, and social exchange during the end of the third and the beginning of the second millennium BC when Assyrian merchants began engaging in long-distance trade with Anatolian settlements. During this period, the Khabur Ware (within the Upper Khabur river valley) and other types of Band Painted Wares (from other neighbouring regions) became clear archaeological correlates of this temporal phase. In this paper, I will focus on a preliminary analysis of the Khabur Ware from Girnavaz Höyük in order to define the similarities and differences between contemporary pottery assemblages discovered in the region as well as in other neighbouring areas. The aim will be to provide an initial definition of a relative inner chronology for this specific ceramic assemblage at the site that has never been previously published.Girnavaz Höyük is a key site for better understanding the cultural and economic relationship between northern Mesopotamia and the Upper Tigris region between the third and the first millennia BC. The site is located in the liminal zone of the northern Jazirah at the start of the Tur ‘Abdin mountains, in a spot that most likely allowed it to play an important role in financial, cultural, and social exchange during the end of the third and the beginning of the second millennium BC when Assyrian merchants began engaging in long-distance trade with Anatolian settlements. During this period, the Khabur Ware (within the Upper Khabur river valley) and other types of Band Painted Wares (from other neighbouring regions) became clear archaeological correlates of this temporal phase. In this paper, I will focus on a preliminary analysis of the Khabur Ware from Girnavaz Höyük in order to define the similarities and differences between contemporary pottery assemblages discovered in the region as well as in other neighbouring areas. The aim will be to provide an initial definition of a relative inner chronology for this specific ceramic assemblage at the site that has never been previously published.