Influence of hydraulic clam dredging and seasonal environmental changes on macro-benthic communities in the Southern Adriatic (Central Mediterranean Sea).

Macro-benthic communities on the shallowest soft bottoms are impacted by hydraulic dredgers used for the harvesting of the striped venus clam (Chamelea gallina). Changes in macro-benthic assemblages were analysed across four areas in the Southern Adriatic Sea (Central Mediterranean Sea) during the winter and summer 2022 (low and high fishing pressures, respectively). Two sampling surveys were carried out collecting abundance data (N/100m2) of 69 species. Diversity indices (Shannon-Weiner and Equitability) were calculated and differences between seasons and areas were tested using non-parametric tests. Changes in the assemblage and feeding habits were explored by adopting permutational multivariate analysis of variance on 34 species. Moreover, environmental conditions of all areas in the two seasons were characterized by a set of 8 variables. Seasonal changes in diversity were only detected for the Shannon-Weiner index, with values significantly higher in winter than summer. Macro-benthic assemblages differed between the two seasons, and the winter assemblages were well-distinct in each area. In contrast, a high overlap was shown in the summer assemblages of the four areas. Changes in feeding habits showed an increase in filter feeding polychaetes and opportunistic/scavenger species during the summer. Temperature, Salinity and primary production were positively correlated to summer stations indicating potential thermic stress on the assemblages. The results provide information on the benthic community impacted by dredge disturbance and seasonal changes driven by environmental conditions, stressing the need to integrate these aspects in assessments on the health status of marine ecosystems required by European directives and fishery management plans.

Does Cataract Extraction Significantly Affect Intraocular Pressure of Glaucomatous/Hypertensive Eyes? Meta-Analysis of Literature.

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the effect of cataract extraction on intraocular pressure at 6, 12, and 24 months and their difference compared to the baseline in diverse glaucoma subtypes. MATERIALS AND METHODS: We carried out research in the MEDLINE, Cochrane Library and EMBASE databases, as of April 2022 for relevant papers, filtered according to established inclusion and exclusion criteria. The meta-analysis evaluated the Mean Reduction and relative Standard Error in these subpopulations at predetermined times. A total of 41 groups (2302 eyes) were included in the systematic review. Due to the significant heterogeneity, they were analysed through a Random Effects Model. RESULTS: We obtained these differences from baseline: (1) Open Angle Glaucoma at 6, 12 and 24 months, respectively: -2.44 mmHg, -2.71 mmHg and -3.13 mmHg; (2) Angle Closure Glaucoma at 6, 12 and 24 months, respectively: -6.81 mmHg, -7.03 mmHg and -6.52 mmHg; (3) Pseudoexfoliation Glaucoma at 12 months: -5.30 mmHg; (4) Ocular Hypertension at 24 months: -2.27 mmHg. CONCLUSIONS: Despite a certain variability, the reduction in ocular pressure was statistically significant at 6, 12 and 24 months in both Open Angle Glaucoma and Angle Closure Glaucoma, the latter being superior. Data for Pseudoexfoliation Glaucoma and for Ocular Hypertension are available, respectively, only at 12 months and at 24 months, both being significant.

Wastewater-based Epidemiology and SARS-CoV-2: Variant Trends in the Apulia Region (Southern Italy) and Effect of Some Environmental Parameters.

During the COVID-19 pandemic, wastewater monitoring has been used to monitor the levels of SARS-CoV-2 RNA entering the sewerage system. In Italy, the Istituto Superiore di Sanità coordinated the SARI project (Sorveglianza Ambientale Reflue in Italia) to detect SARS-CoV-2 and its variants. In this study, the concentration of SARS-CoV-2 and its variants in raw wastewater against COVID-19 cases was evaluated together with the effect of temperature and precipitation on virus spread. We validated a predictive model, proposed by De Giglio et al., 2021, to establish the number of COVID-19 cases/100,000 inhabitants. A receiver operating characteristic curve model was applied to predict the number of COVID-19 cases and Poisson regression was applied to study the effect of temperature and rainfall on viral load. In Apulia, from October 2021 to December 2022, we analyzed 1041 samples, of which 985 (94.6%) tested positive for SARS-CoV-2. Median atmospheric temperature was inversely proportional to viral load in wastewater; no correlation was found with precipitation. The predictive model confirmed that at least 11 cases/100,000 inhabitants would occur in the 15 days following the detection of the virus in wastewater. Environmental surveillance of SARS-CoV-2 can be used to map the virus and its variants.

Multiple approach for assessing lagoon environmental status based on water bodies quality indices and microplastics accumulation.

Lagoon environments, like all the marine-coastal areas, offer a wide variety of ecosystem services, but at the same time are affected by pressing human activities that lead to deterioration of the environmental quality, loss of biodiversity, habitat destruction and pollution. Since the well-being of population and local economy depend on the environmental status of these ecosystems, it is essential to adopt long-term management tools to achieve the Good Environmental Status sensu European Marine Strategy Framework Directive and Water Framework Directive. A Nature 2000 site (Lesina lagoon, south Italy) was assessed within a project aimed at protecting and restoring biodiversity and lagoon habitat through integrated monitoring, suitable management, and good practices. Here we provide an assessment of the lagoon integrity based on a multi-metrics approach, highlighting match/mismatch among environmental quality indicators and microplastics (MP) pollution. Some environmental quality indices based on ecosystem components as vegetation, macroinvertebrates and water trophic variables were applied together with an accurate evaluation of MPs abundance, distribution, and composition to assess the ecological status of Lesina lagoon before and after cleaning actions with litter removal. Overall, all the ecological descriptors outlined a clear lagoon spatial gradient, with a western saltier and organic-enriched area characterized by the absence of vegetation, macrozoobenthos with lower diversity and richness and high MPs occurrence. The focus on macrozoobenthos, considered as a key component of the lagoon ecosystem, identified much more sites in "poor" status than the other indicators here considered. Moreover, it was found a negative relationship between the Multivariate Marine Biotic Index and MPs items in sediment, suggesting that MP pollution has a negative impact on macrobenthic fauna, concurring to the deterioration of the benthic ecological status.

Harmful algae and pressure-impact relationship: Noxious blooms and toxic microalgae occurrence from coastal waters of the Apulia region (Adriatic and Ionian Seas, Mediterranean).

The spatial distribution of harmful microalgal taxa along the coasts of the Apulia region (Mediterranean Sea) based on results of eight years (2012-2019) of routine monitoring program and a series of sporadic observations is presented. A total number of 69 potentially harmful taxa were found during the study period. Occurrence, abundance and richness of harmful taxa (toxic, potentially toxic and high biomass producers) varied along the Apulian coasts. The occurrence of harmful species was significantly higher where most of anthropogenic pressures overlap than only a few or no pressures existed. The physical alteration of coast is the most important pressure determining this pattern. Despite the variety and the abundances of the harmful microalgae, to our knowledge, no human health problems or risks have been ever recorded, nor were full-blown consequences on marine organisms such as fish kills during algal blooms. However, blooms coupled with water discoloration phenomena could become a big issue to tourism and recreational activities that have locally important socio-economic value.

Measuring optic nerve head perfusion to monitor glaucoma: a study on structure-function relationships using laser speckle flowgraphy.

PURPOSE: We aimed to describe the global and localized correlations among visual field (VF) sensitivity, optic nerve head (ONH) perfusion measured by laser speckle flowgraphy (LSFG) and neural structure measured by optical coherence tomography (OCT) in open-angle glaucoma (OAG) and to compare the floor effect for LSFG and OCT. METHODS: Cross-sectional, multicenter study including one eye each from fifty OAG patients (mean age 69.3 years; average VF mean deviation, MD, -8.5 dB, range -25.17 to 0.85 dB) and fifty-one controls. Patients underwent SITA standard 24-2 automated perimetry and measurement of ONH perfusion, peripapillary retinal nerve fibre layer thickness (RNFLT) and macular ganglion cell-inner plexiform layer thickness (GCIPLT). We tested the presence of a significant change (breakpoint) in the correlation slope with VF sensitivity to assess floor effect. RESULTS: The correlation between the LSFG parameter Mean All (MA) of the global disc area and MD (r = 0.56, p < 0.001) did not show a breakpoint, in contrast to the correlations between MD and OCT global parameters, which showed breakpoints at -8.53 and -4.05 dB for RNFLT and GCIPLT, respectively. Global and localized correlations with VF sensitivity were stronger for LSFG compared to OCT. In particular, LSFG outperformed OCT in the correlation with the central VF sector (r = 0.50, p < 0.001 and r = 0.06, p = 0.67 for MA and RNFLT, respectively). CONCLUSION: The global and sectoral correlations with VF sensitivity and the favourable floor effect compared to OCT indicate LSFG as a promising tool to monitor progression particularly in late-stage glaucoma. Further longitudinal studies are warranted.

Effects of global warming on Mediterranean coral forests.

The effects of global warming have been addressed on coral reefs in tropical areas, while it is still unclear how coral forests are reacting, particularly at temperate latitudes. Here we show how mesophotic coral forests are affected by global warming in the Mediterranean Sea. We highlight how the current warming trend is causing the lowering of the thermocline and it is enhancing mucilaginous blooms. These stressors are facilitating a massive macroalgal epibiosis on living corals, here reported for the first time from different areas in the Western and Central Mediterranean Sea. We provide a focus of this phenomenon at Tremiti Islands Marine Protected Area (Adriatic Sea), were the density of the endemic red gorgonian Paramuricea clavata decreased of up to 47% in 5 years, while up to the 96% of the living corals showed signs of stress and macroalgal epibiosis. Only populations deeper than 60 m depth were not touched by this emerging phenomenon. Spot observations performed at Tuscan Archipelago and Tavolara Marine Protected Area (Tyrrhenian Sea) suggest that this this combination of stressors is likely widespread at basin scale.

Water Quality Assessment: A Quali-Quantitative Method for Evaluation of Environmental Pressures Potentially Impacting on Groundwater, Developed under the M.I.N.O.Re. Project.

Background: At global level, the vulnerability of aquifers is deteriorating at an alarming rate due to environmental pollution and intensive human activities. In this context, Local Health Authority ASL Lecce has launched the M.I.N.O.Re. (Not Compulsory Water Monitoring Activities at Regional level) project, in order to assess the vulnerability of the aquifer in Salento area (Puglia Region) by performing several non-compulsory analyses on groundwater samples. This first paper describes the quali-quantitative approach adopted under the M.I.N.O.Re. project for the assessment of environmental pressures suffered by groundwater and determines the number of wells to be monitored in specific sampling areas on the basis of the local potential contamination and vulnerability of the aquifer. Methods: We created a map of the entire Lecce province, interpolating it with a grid that led to the subdivision of the study area in 32 quadrangular blocks measuring 10 km × 10 km. Based on current hydrogeological knowledge and institutional data, we used GIS techniques to represent on these 32 blocks the 12 different layers corresponding to the main anthropic or environmental type of pressures potentially impacting on the aquifer. To each kind of pressure, a score from 0 to 1 was attributed on the basis of the potential impact on groundwater. A total score was assigned to each of the 32 blocks. A higher number of wells was selected to be monitored in those blocks presenting higher risk scores for possible groundwater contamination due to anthropic/environmental pressures. Results: The range of total scores varied from 2.4 to 42.5. On the basis of total scores, the 10 km × 10 km blocks were divided into four classes of environmental pressure (1st class: from 0,1 to 10,00; 2nd class: from 10,01 to 20,00; 3rd class: from 20,1 to 30,00; 4th class: from 30,01 to 42,50). There were 11 areas in the 1st class, 9 areas in the 2nd class, 8 areas in the 3rd class and 4 areas in the 4th class. We assigned 1 monitoring well in 1st class areas, 2 monitoring wells in 2nd class areas, 3 monitoring wells in 3rd class areas and 4 monitoring wells in 4th class areas. Conclusion: The methodology developed under the M.I.N.O.Re. project could represent a useful model to be used in other areas to assess the environmental pressures suffered by aquifers and the quality of the groundwater.

Two - stages bloom of Margalefidinium cf. polykrikoides in a Mediterranean shallow bay (Ionian Sea, Italy).

The emergence of a red tide resulting in yellow-brownish discoloration of waters in Porto Cesareo bay (Italy) during July-August 2018 is reported. The species responsible for the bloom was the dinoflagellate Margalefidinium cf. polykrikoides. Cell densities reached 9.1 × 106 cells L-1 during the initial outbreak. A second peak was observed about three weeks later reaching 6.7 × 105 cells L-1. Study of live specimens showed great variation in cell size and shape. Different cyst morphotypes were found in the water samples and in the sediment. For the first time, we followed several stages of the life cycle of M. cf. polykrikoides in natural samples. Fish die-offs in the bay were not observed, however this high-density bloom may have caused consequences on the ecosystem (amount of mucilage on the beach) and in turn, on tourism that is the main activity in the area during the summer season.

Data on long-term monitoring programs to assess environmental pressures on coastal area.

The concentration of six metals/metalloids, five congeners of high molecular weight Polycyclic Aromatic Hydrocarbons (PAHs), and sum of five congeners of Polychlorinated Biphenyls (PCBs) determined within marine-coastal sediments of the Apulia Coast during a 5-year long-term monitoring program, are reported through tables and radial graphs. The data are referred to the pollutant concentration determined within 70 sites alongside two marine transects (500 m from coastline and 1750 m of coastline) representing different morphologic features of the coast and different pollution stressors loading [1]. Concentration variability during the five monitored years and data generated by the non-parametric correlation analyses among sediment physical-chemical main parameters and metal concentrations are also included.

First bloom event of the small dinoflagellate Prorocentrum shikokuense in the Mediterranean Sea: cryptogenic or introduced?

A bloom of putatively non-indigenous species (NIS) Prorocentrum shikokuense was detected for the first time in the Mediterranean Sea at the Brindisi harbor (Southern Adriatic Sea) on September 2016, in the context of EU Marine Strategy Framework Directive monitoring in the ports. This species is usually observed in the East China Sea and Japanese and Korean waters. In the Brindisi harbor this dinoflagellate reached the concentration 105 cell/L and represented from 30 to 50% of the total phytoplankton population. Besides this event, Prorocentrum shikokuense has not been found blooming until today in Mediterranean waters. This study suggests the necessity to improve the monitoring surveys in areas that are known vulnerable systems to alien and invasive species, such as ports.

Plastic-associated harmful microalgal assemblages in marine environment.

Plastic debris carry fouling a variety of class-size organisms, among them harmful microorganisms that potentially play a role in the dispersal of allochthonous species and toxic compounds with ecological impacts on the marine environment and human health. We analyzed samples of marine plastics floating at the sea surface using a molecular qPCR assay to quantify the attached microalgal taxa, in particular, harmful species. Diatoms were the most abundant group of plastic colonizers with maximum abundance of 8.2 × 104 cells cm-2 of plastics, the maximum abundance of dinoflagellates amounted to 1.1 × 103 cells cm-2 of plastics. The most abundant harmful microalgal taxon was the diatom Pseudo-nitzschia spp., including at least 12 toxic species, and the dinoflagellate Ostreopsis cf. ovata with 6606 and 259 cells cm-2, respectively. The abundance of other harmful microalgal species including the toxic allochthonous dinoflagellate Alexandrium pacificum ranged from 1 to 73 cells cm-2. In the present study, a direct relationship between the abundance of harmful algal species colonizing the plastic substrates and their toxin production was found. The levels of potential toxins on plastic samples ranged from 101 to 102 ng cm-2, considering the various toxin families produced by the colonized harmful microalgal species. We also measured the rate of adhesion by several target microalgal species. It ranged from 1.8 to 0.3 day-1 demonstrating the capacity of plastic substrate colonizing rapidly by microalgae. The present study reports the first estimates of molecular quantification of microorganisms including toxin producing species that can colonize plastics. Such findings provide important insights for improving the monitoring practice of plastics and illustrate how the epi-plastic community can exacerbate the harmful effects of plastics by dispersal, acting as an alien and toxic species carrier and potentially being ingested through the marine trophic web.

Statistical Analysis of Bathing Water Quality in Puglia Region (Italy).

Geostatistic analysis was applied to the dataset from multi-year monitoring, in the Apulian marine-coastal zone (Mediterranean Sea, Italy), on the presence and abundance of intestinal Enterococci and Escherichia coli, microbiological indicators of faecal contamination at the sea. The same faecal contamination can be considered as the main cause of pollution phenomenon under current Italian and European regulations for the bathing waters (Italian Government Decree 116/2008, European Directive 2006/7/CE). The main objective of the study is to verify, taking into the account the anthropic pressures acting on the coastal zone, the efficiency of the Apulian regional monitoring plan currently in force for the assessment of bathing waters quality, with a view to a hypothetical reduction of sample collection points.

Comparison of Surgical Outcomes between Canaloplasty and Schlemm's Canal Scaffold at 24 Months' Follow-Up.

The results of canaloplasty (CP) and Hydrus Microstent (HM) implantation were retrospectively compared at 24 months' follow-up in a cohort of subjects referred to our Institution for uncontrolled IOP in primary or secondary (e.g., pseudoexfoliative and pigmentary) open-angle glaucoma. The outcome was labelled as "complete" success, "qualified" success, or "failure" if, two years after surgery, the eyes operated on needed "no" hypotensive medications, "some" hypotensive medications, or further glaucoma surgery to attain the target IOP, respectively. Both CP and HM implant allowed significant IOP reductions, with comparable rate of clinical success and safety profile. A slightly (albeit not significant) better trend for a "complete" clinical success was observed in the CP group.

Anterior Segment Findings in Vitamin A Deficiency: A Case Series.

Vitamin A deficiency is a rare but vision threatening disorder in the developed world, which can lead to blindness for severe keratomalacia with cornea scarring and perforation or night blindness due to impaired dark adaptation. Conversely, the disease is quite common in developing countries, as a consequence of chronic malnutrition. The correct diagnosis and therapy with prompt vitamin A supplementation avoid blindness. We report a series of 3 local cases with different age and causes for vitamin A deficiency. The diagnostic workup, therapy, and prognosis are discussed.

Are conventional statistical techniques exhaustive for defining metal background concentrations in harbour sediments? A case study: The Coastal Area of Bari (Southeast Italy).

Sediment contamination by metals poses significant risks to coastal ecosystems and is considered to be problematic for dredging operations. The determination of the background values of metal and metalloid distribution based on site-specific variability is fundamental in assessing pollution levels in harbour sediments. The novelty of the present work consists of addressing the scope and limitation of analysing port sediments through the use of conventional statistical techniques (such as: linear regression analysis, construction of cumulative frequency curves and the iterative 2σ technique), that are commonly employed for assessing Regional Geochemical Background (RGB) values in coastal sediments. This study ascertained that although the tout court use of such techniques in determining the RGB values in harbour sediments seems appropriate (the chemical-physical parameters of port sediments fit well with statistical equations), it should nevertheless be avoided because it may be misleading and can mask key aspects of the study area that can only be revealed by further investigations, such as mineralogical and multivariate statistical analyses.

A 10-year follow-up to determine the effect of YAG laser iridotomy on the natural history of pigment dispersion syndrome: a randomized clinical trial.

IMPORTANCE: Prospective long-term analyses of the role of drug-induced mydriasis and laser peripheral iridotomy (LPI) are needed to identify and manage the eyes of patients with pigment dispersion syndrome (PDS) at risk for progressing to ocular hypertension. OBJECTIVE: To assess the 10-year incidence of increased intraocular pressure (IOP) in the 2 eyes of patients with PDS, with 1 eye that underwent LPI and the other that did not. DESIGN, SETTING, AND PARTICIPANTS: In a randomized clinical trial in the glaucoma research unit at the University Hospital of Parma, Italy, 72 patients with PDS underwent phenylephrine testing. Of these 72 patients, 29 (58 eyes) tested positive for succeeding IOP elevation, and 43 (59 eyes) tested negative. For the 29 high-risk patients (all in both eyes), one eye was randomly assigned to LPI, and the fellow eye was left untreated. For the 43 low-risk patients, the affected eyes were left untreated. MAIN OUTCOMES AND MEASURES: An IOP elevation of 5 mm Hg or higher vs baseline (daily phasing) was considered to be a significant increase (ie, an event). RESULTS: In the high-risk group, 3 of 21 eyes that underwent LPI (14.3%) and 13 of 21 untreated eyes (61.9%) showed an increase in IOP of 5 mm Hg or higher during the follow-up period; 4 of 35 low-risk eyes (11.4%) showed a similar increase. Event-free mean (SD) time was 7.99 (0.43) years for high-risk treated eyes, 3.89 (0.68) years for high-risk untreated eyes, and 7.16 (0.23) years for low-risk eyes. The log-rank test showed the following: P < .001 for treated high-risk eyes vs untreated high-risk eyes, P = .74 for treated high-risk eyes vs low-risk eyes, and P < .001 for untreated high-risk eyes vs low-risk eyes. CONCLUSIONS AND RELEVANCE: At the end of the 10-year follow-up, (1) approximately one-third of the whole PDS patient population showed an IOP increase of 5 mm Hg or higher in at least 1 eye; (2) phenylephrine testing identified eyes at high risk for developing IOP elevation; and (3) LPI, when performed on high-risk eyes, reduced the rate of IOP elevation to the same level as the low-risk eyes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01053416.

Effects of coenzyme Q10 in conjunction with vitamin E on retinal-evoked and cortical-evoked responses in patients with open-angle glaucoma.

PURPOSE: To evaluate pattern-evoked retinal and cortical responses [pattern electroretinogram (PERG) and visual-evoked potential (VEP), respectively] after treatment with coenzyme Q10 in conjunction with vitamin E in open-angle glaucoma (OAG) patients. METHODS: Forty-three OAG patients (mean age, 52.5±5.29 y; intraocular pressure <18 mm Hg with ß-blocker monoterapy only) were enrolled. At baseline and after 6 and 12 months, simultaneous recordings of PERG and VEPs were obtained from 22 OAG patients who underwent treatment consisting of coenzyme Q10 and vitamin E (Coqun, 2 drops/d) in addition to ß-blocker monoterapy (GC group), and from 21 OAG patients who were only treated with ß-blockers (GP group). RESULTS: At baseline, intraocular pressure, PERG, and VEP parameters were similar in both GC and GP groups (analysis of variance, P>0.05). After 6 and 12 months, PERG and VEP response parameters of GP patients were unchanged when compared to baseline. In GC patients, PERG P50 and VEP P100 implicit times were decreased, whereas PERG P50-N95 and VEP N75-P100 amplitudes were increased (P<0.01) when compared to baseline. In the GC group, the differences in implicit times and amplitudes with respect to baseline were significantly larger (P<0.01) than those recorded in the GP group. The improvement (12 mo minus baseline) of VEP implicit time was significantly correlated with the changes of PERG P50-N95 amplitude (r=-0.66171, P=0.0008) and P50 implicit time (r=0.68364, P=0.00045) over a period of 12 months. CONCLUSIONS: Coenzyme Q10 associated with vitamin E administration in OAG shows a beneficial effect on the inner retinal function (PERG improvement) with consequent enhancement of the visual cortical responses (VEP improvement).

Chlorinated compounds and polybrominated diphenyl ethers (PBDEs) in mussels (Mytilus galloprovincialis) collected from Apulia Region coasts.

This project was carried out to assess the levels and spatial distribution of organochlorine compounds in the coastal marine environment, using mussels as bioindicators to evaluate the coastal water quality. Levels of polychlorobiphenils (PCB), chlorinated pesticides (DDT isomers, HCH isomers, Aldrin, Dieldrin, alfa-Endosulfan, Hexachlorobenzene, Pentachlorobenzene) and polybrominated diphenyl ethers (PBDEs) were determined in tissues from mussels (Mytilus galloprovincialis) collected along the Apulia Region coasts (Mediterranean Sea). Results indicate that contamination by organochlorine compounds is higher in mussels sampled in the Ionian Sea than in those from the Adriatic Sea, with PCB levels up to seven times higher in mussels from Ionian than from the Adriatic Sea. Although PCB levels were above the maximum values indicated by both European Community (EC) and National regulation in several sample sites, the PCB concentrations were particularly high in some stations, suggesting that these locations require a much specific attention. Conversely, results on the mussel contamination by PBDEs highlight their ubiquitous environmental distribution, and underline the need to establish the maximum level for these compounds in foodstuff, according to European Regulations.

Management of a toxic cyanobacterium bloom (Planktothrix rubescens) affecting an Italian drinking water basin: a case study.

An extraordinary bloom of Planktothrix rubescens, which can produce microcystins (MCs), was observed in early 2009 in the Occhito basin, used even as a source of drinking water in Southern Italy. Several activities, coordinated by a task force, were implemented to assess and manage the risk associated to drinking water contaminated by cyanobacteria. Main actions were: evaluation of analytical protocols for screening and confirmatory purpose, monitoring the drinking water supply chain, training of operators, a dedicated web site for risk communication. ELISA assay was considered suitable for health authorities as screening method for MCs and to optimize frequency of sampling according to alert levels, and as internal control for the water supplier. A liquid chromatography-tandem mass spectrometric method able to quantify 9 MCs was optimized with the aim of supporting health authorities in a comprehensive risk evaluation based on the relative toxicity of different congeners. Short, medium, and long-term corrective actions were implemented to mitigate the health risk. Preoxidation with chlorine dioxide followed by flocculation and settling have been shown to be effective in removing MCs in the water treatment plant. Over two years, despite the high levels of cyanobacteria (up to 160 × 10(6) cells/L) and MCs (28.4 µg/L) initially reached in surface waters, the drinking water distribution was never limited.