Neurologic manifestations in 1760 COVID-19 patients admitted to Papa Giovanni XXIII Hospital, Bergamo, Italy.

OBJECTIVES: Evidences from either small series or spontaneous reporting are accumulating that SARS-CoV-2 involves the Nervous Systems. The aim of this study is to provide an extensive overview on the major neurological complications in a large cohort of COVID-19 patients. METHODS: Retrospective, observational analysis on all COVID-19 patients admitted from February 23rd to April 30th, 2020 to ASST Papa Giovanni XXIII, Bergamo, Italy for whom a neurological consultation/neurophysiological assessment/neuroradiologic investigation was requested. Each identified neurologic complication was then classified into main neurologic categories. RESULTS: Of 1760 COVID-19 patients, 137 presented neurologic manifestations that manifested after COVID-19 symptoms in 98 pts and was the presenting symptom in 39. Neurological manifestations were classified as: (a) cerebrovascular disease [53 pts (38.7%)] including 37 ischemic and 11 haemorrhagic strokes, 4 transient ischemic attacks, 1 cerebral venous thrombosis; (b) peripheral nervous system diseases [31 (22.6%)] including 17 Guillain-Barrè syndromes; (c) altered mental status [49 (35.8%)] including one necrotizing encephalitis and 2 cases with RT-PCR detection of SARS-Cov-2 RNA in CSF; (d) miscellaneous disorders, among whom 2 patients with myelopathy associated with Ab anti-SARS-CoV-2 in CSF. Patients with peripheral nervous system involvement had more frequently severe ARDS compared to patients with cerebrovascular disease (87.1% vs 42%; difference = 45.1% 95% CI 42.0-48.2; χ2= 14.306; p < 0.0002) and with altered mental status (87.1% vs 55.6%; difference = 31.5% 95% CI 27.5-37.5%; χ2= 7.055; p < 0.01). CONCLUSION: This study confirms that involvement of nervous system is common in SARS-CoV-2 infection and offers clinicians useful information for prevention and prompt identification in order to set the adequate therapeutic strategies.

Ocean model resolution dependence of Caribbean sea-level projections.

Sea-level rise poses severe threats to coastal and low-lying regions around the world, by exacerbating coastal erosion and flooding. Adequate sea-level projections over the next decades are important for both decision making and for the development of successful adaptation strategies in these coastal and low-lying regions to climate change. Ocean components of climate models used in the most recent sea-level projections do not explicitly resolve ocean mesoscale processes. Only a few effects of these mesoscale processes are represented in these models, which leads to errors in the simulated properties of the ocean circulation that affect sea-level projections. Using the Caribbean Sea as an example region, we demonstrate a strong dependence of future sea-level change on ocean model resolution in simulations with a global climate model. The results indicate that, at least for the Caribbean Sea, adequate regional projections of sea-level change can only be obtained with ocean models which capture mesoscale processes.

Posterior reversible encephalopathy and Guillain-Barré syndrome: which came first, the chicken or the egg? A review of literature.

Posterior reversible encephalopathy (PRES) is a rare occurrence in patients with Guillain-Barré syndrome (GBS) with only nine adult cases reported to date. We conducted a review of the literature and compared previous cases with a novel case admitted to our clinic. In light of the timing of the symptoms, it is assumable that arterial hypertension can develop acutely during a phase of GBS-related autonomic dysfunction and subsequently precipitates PRES. According to this, dysautonomia caused by GBS could precede motor weakness; thus, PRES in the absence of any strong alternative etiology may suggest an underlying GBS.

A revised acceleration rate from the altimetry-derived global mean sea level record.

Satellite radar altimetry has been providing estimates of global mean sea level (GMSL) since 1992. The early TOPEX record originates from two identical instruments, which requires the estimation of an intermission bias and careful handling of the problematic first part of the record. Calibration of TOPEX is crucial to obtain a continuous and consistent record, which is needed to quantify any recent acceleration. We propose a novel approach to calibrate TOPEX altimeter data using sea surface height differences at crossovers of TOPEX and ERS. Tide gauges are only used to determine a drift in one of the two datasets. We provide a new and more accurate estimate of the intra-mission bias, which leads to a much reduced GMSL acceleration over the whole record. Hence, the conundrum of an uncertain GMSL acceleration from altimetry is still unsolved, in spite of recent opposite claims, and in contrast to the expected effect of ocean warming and continental freshwater fluxes.

Reassessment of 20th century global mean sea level rise.

The rate at which global mean sea level (GMSL) rose during the 20th century is uncertain, with little consensus between various reconstructions that indicate rates of rise ranging from 1.3 to 2 mm⋅y-1 Here we present a 20th-century GMSL reconstruction computed using an area-weighting technique for averaging tide gauge records that both incorporates up-to-date observations of vertical land motion (VLM) and corrections for local geoid changes resulting from ice melting and terrestrial freshwater storage and allows for the identification of possible differences compared with earlier attempts. Our reconstructed GMSL trend of 1.1 ± 0.3 mm⋅y-1 (1σ) before 1990 falls below previous estimates, whereas our estimate of 3.1 ± 1.4 mm⋅y-1 from 1993 to 2012 is consistent with independent estimates from satellite altimetry, leading to overall acceleration larger than previously suggested. This feature is geographically dominated by the Indian Ocean-Southern Pacific region, marking a transition from lower-than-average rates before 1990 toward unprecedented high rates in recent decades. We demonstrate that VLM corrections, area weighting, and our use of a common reference datum for tide gauges may explain the lower rates compared with earlier GMSL estimates in approximately equal proportion. The trends and multidecadal variability of our GMSL curve also compare well to the sum of individual contributions obtained from historical outputs of the Coupled Model Intercomparison Project Phase 5. This, in turn, increases our confidence in process-based projections presented in the Fifth Assessment Report of the Intergovernmental Panel on Climate Change.

Coastal sea level rise with warming above 2 °C.

Two degrees of global warming above the preindustrial level is widely suggested as an appropriate threshold beyond which climate change risks become unacceptably high. This "2 °C" threshold is likely to be reached between 2040 and 2050 for both Representative Concentration Pathway (RCP) 8.5 and 4.5. Resulting sea level rises will not be globally uniform, due to ocean dynamical processes and changes in gravity associated with water mass redistribution. Here we provide probabilistic sea level rise projections for the global coastline with warming above the 2 °C goal. By 2040, with a 2 °C warming under the RCP8.5 scenario, more than 90% of coastal areas will experience sea level rise exceeding the global estimate of 0.2 m, with up to 0.4 m expected along the Atlantic coast of North America and Norway. With a 5 °C rise by 2100, sea level will rise rapidly, reaching 0.9 m (median), and 80% of the coastline will exceed the global sea level rise at the 95th percentile upper limit of 1.8 m. Under RCP8.5, by 2100, New York may expect rises of 1.09 m, Guangzhou may expect rises of 0.91 m, and Lagos may expect rises of 0.90 m, with the 95th percentile upper limit of 2.24 m, 1.93 m, and 1.92 m, respectively. The coastal communities of rapidly expanding cities in the developing world, and vulnerable tropical coastal ecosystems, will have a very limited time after midcentury to adapt to sea level rises unprecedented since the dawn of the Bronze Age.

(123) I-2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single photon emission computed tomography and (123) I-metaiodobenzylguanidine myocardial scintigraphy in differentiating dementia with lewy bodies from other dementias: A comparative study.

OBJECTIVE: To compare the diagnostic value of striatal (123) I-2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123) I-FP-CIT) single photon emission computed tomography (SPECT) and (123) I-metaiodobenzylguanidine ((123) I-MIBG) myocardial scintigraphy in differentiating dementia with Lewy bodies (DLB) from other dementia types. METHODS: This prospective longitudinal study included 30 patients with a clinical diagnosis of DLB and 29 patients with non-DLB dementia (Alzheimer disease, n = 16; behavioral variant frontotemporal dementia, n = 13). All patients underwent (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy within a few weeks of clinical diagnosis. All diagnoses at each center were agreed upon by the local clinician and an independent expert, both unaware of imaging data, and re-evaluated after 12 months. Each image was visually classified as either normal or abnormal by 3 independent nuclear physicians blinded to patients' clinical data. RESULTS: Overall, sensitivity and specificity to DLB were respectively 93% and 100% for (123) I-MIBG myocardial scintigraphy, and 90% and 76% for (123) I-FP-CIT SPECT. Lower specificity of striatal compared to myocardial imaging was due to decreased (123) I-FP-CIT uptake in 7 non-DLB subjects (3 with concomitant parkinsonism) who had normal (123) I-MIBG myocardial uptake. Notably, in our non-DLB group, myocardial imaging gave no false-positive readings even in those subjects (n = 7) with concurrent medical illnesses (diabetes and/or heart disease) supposed to potentially interfere with (123) I-MIBG uptake. INTERPRETATION: (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy have similar sensitivity for detecting DLB, but the latter appears to be more specific for excluding non-DLB dementias, especially when parkinsonism is the only "core feature" exhibited by the patient. Our data also indicate that the potential confounding effects of diabetes and heart disease on (123) I-MIBG myocardial scintigraphy results might have been overestimated. Ann Neurol 2016;80:368-378.

Closing the sea level budget on a regional scale: Trends and variability on the Northwestern European continental shelf.

Long-term trends and decadal variability of sea level in the North Sea and along the Norwegian coast have been studied over the period 1958-2014. We model the spatially nonuniform sea level and solid earth response to large-scale ice melt and terrestrial water storage changes. GPS observations, corrected for the solid earth deformation, are used to estimate vertical land motion. We find a clear correlation between sea level in the North Sea and along the Norwegian coast and open ocean steric variability in the Bay of Biscay and west of Portugal, which is consistent with the presence of wind-driven coastally trapped waves. The observed nodal cycle is consistent with tidal equilibrium. We are able to explain the observed sea level trend over the period 1958-2014 well within the standard error of the sum of all contributing processes, as well as the large majority of the observed decadal sea level variability.

Detecting anthropogenic footprints in sea level rise.

While there is scientific consensus that global and local mean sea level (GMSL and LMSL) has risen since the late nineteenth century, the relative contribution of natural and anthropogenic forcing remains unclear. Here we provide a probabilistic upper range of long-term persistent natural GMSL/LMSL variability (P=0.99), which in turn, determines the minimum/maximum anthropogenic contribution since 1900. To account for different spectral characteristics of various contributing processes, we separate LMSL into two components: a slowly varying volumetric component and a more rapidly changing atmospheric component. We find that the persistence of slow natural volumetric changes is underestimated in records where transient atmospheric processes dominate the spectrum. This leads to a local underestimation of possible natural trends of up to ∼1 mm per year erroneously enhancing the significance of anthropogenic footprints. The GMSL, however, remains unaffected by such biases. On the basis of a model assessment of the separate components, we conclude that it is virtually certain (P=0.99) that at least 45% of the observed increase in GMSL is of anthropogenic origin.

Reassessment of the potential sea-level rise from a collapse of the West Antarctic Ice Sheet.

Theory has suggested that the West Antarctic Ice Sheet may be inherently unstable. Recent observations lend weight to this hypothesis. We reassess the potential contribution to eustatic and regional sea level from a rapid collapse of the ice sheet and find that previous assessments have substantially overestimated its likely primary contribution. We obtain a value for the global, eustatic sea-level rise contribution of about 3.3 meters, with important regional variations. The maximum increase is concentrated along the Pacific and Atlantic seaboard of the United States, where the value is about 25% greater than the global mean, even for the case of a partial collapse.

Reliability of the El Escorial diagnostic criteria for amyotrophic lateral sclerosis.

BACKGROUND: The El Escorial diagnostic criteria are the most commonly used in clinical studies and therapeutic trials in patients with amyotrophic lateral sclerosis (ALS). The accuracy of the El Escorial criteria was tested in clinical practice, but the reliability is unknown when the diagnosis of ALS must be assessed on the basis of medical records. OBJECTIVE: To assess the reliability of the El Escorial criteria for the diagnosis of ALS in different settings. DESIGN AND METHODS: Semistructured forms were used to include the main diagnostic information on 20 patients with definite (n = 6), probable (n = 6), possible (n = 6), and suspected ALS (n = 2) and 19 patients with clinical conditions considered in the differential diagnosis. Agreement was tested by comparing the diagnosis made by the attending physician (the 'gold standard') with that of 4 raters with different backgrounds: a teaching neurologist with research and practical experience in the field of motor neuron disorders, a neurologist with specific interest in motor neuron disorders and neurophysiological background, a neurophysiologist, and a general neurologist with only occasional ALS patients. Sources of disagreement were discussed and the agreement was tested further on the medical records of 98 additional cases taken from an ongoing ALS registry. Eight additional cases (ALS: 4; other conditions: 4) were examined directly by the 4 raters. RESULTS: The interrater agreement on the medical records was poor (overall kappa 0.05-0.29). When the differential diagnosis was made between ALS (all diagnostic levels) and other conditions, interrater agreement was at best modest, with moderate variations when raters were compared in pairs (kappa 0.03-0.58) and when each rater was compared with the physician (kappa 0.27-0.51). Agreement was higher after direct examination of the patients (kappa 0.33-1) and increased significantly on the medical records after training (overall kappa 0.52-0.79). However, concordance was low (overall kappa 0.08-0.36), even after training, at the lowest diagnostic level (definite to suspected ALS vs. other conditions). CONCLUSIONS: The El Escorial criteria are a poor diagnostic indicator when patients' records are examined. Although medical education significantly improves the reliability of the criteria, concordance is still modest when the diagnosis includes suspected ALS.