Use of phytoremediated sediments dredged in maritime port as plant nursery growing media.

We evaluated the potential of a phytoremediated sediment (TR) dredged from maritime port as peat-free growth substrate for seven ornamental plants, in comparison with an untreated sediment (NT), in a greenhouse experiment. The studied plants were Quercus ilex, Photinia x fraseri, Viburnum tinus, Cistus albidus, Raphiolepis indica, Westringia fruticosa and Teucrium fruticans. Plant growth was monitored for ten months, and the changes in the physico-chemical properties, toxicity, microbial biomass and enzyme activities involved in the C, P and N cycles were also monitored during the plant growth period. The results showed that the studied ornamental plants could grow on both NT and TR sediments, but that the growth was higher on TR sediment. The plant growth induced changes in the sediment chemical functional groups, with clear separation between NT and TR sediments for each of the studied plant. Microbial biomass and enzyme activities significantly increased during the plant growth, more in TR than in NT sediment. Toxicity was detected in NT sediments during the plant growth whereas it was not observed in NT sediments during the whole growth period. We concluded that phytoremediation converted the dredged maritime sediments into suitable substrates for growing ornamental plants, and that the re-use by plant nursery industry can be a sustainable management and valorization for remediated sediments.

Sleep Disturbances in Children Affected by Autism Spectrum Disorder.

BACKGROUND: Sleep disturbances are common in children affected by Autism Spectrum Disorder (ASD). The aim of our study was to describe sleep characteristics and disturbances in children with ASD, to evaluate possible related factors, and to assess parental stress. METHODS: Hundred children with a diagnosis of ASD (mean age: 66.7 months, SD: 27.4, range: 24.7-152.1 months, n = 79 males) were included in the study. We collected data on sociodemographic, clinical, genetic and instrumental variables as well as comorbid conditions. Parents filled out the Questionnaire on sleep behavior in the first years of life, the BEARS questionnaire, and the Parenting Stress Index Short Form. From the analysis on sleep characteristics, we excluded 25 children treated with melatonin. RESULTS: Fifty-seven (57%) out of 100 children met the criteria for insomnia. Sleep disorders were associated with developmental or cognitive delay, emotional and behavioral problems (such as anxiety problems and aggressive behaviors) and absence of strategies for inducing sleep after nocturnal awakenings. From parents' reports, sleep disorders had diurnal repercussions on their offspring; however, we found no statistical correlation between disturbances and family stress. Also, no significant correlation was found between sleep disturbances and epilepsy. Finally, a statistical correlation was found between the regular intake of melatonin and the resolution of insomnia. CONCLUSIONS: Multifactorial variables may be associated to insomnia that could have an impact on the children' behavior. Clinicians need to be aware of the value of screening for sleep disturbance in children with ASD to integrate sleep interventions in the treatment plan.

Dorsal and Ventral Stream Function in Children With Developmental Coordination Disorder.

Dorsal stream cortical networks underpin a cluster of visuomotor, visuospatial, and visual attention functions. Sensitivity to global coherence of motion and static form is considered a signature of visual cortical processing in the dorsal stream (motion) relative to the ventral stream (form). Poorer sensitivity to global motion compared to global static form has been found across a diverse range of neurodevelopmental disorders, suggesting a "dorsal stream vulnerability." However, previous studies of global coherence sensitivity in Developmental Coordination Disorder (DCD) have shown conflicting findings. We examined two groups totalling 102 children with DCD (age 5-12 years), using the "Ball in the Grass" psychophysical test to compare sensitivity to global motion and global static form. Motor impairment was measured using the Movement-ABC (M-ABC). Global coherence sensitivity was compared with a typically developing control group (N = 69) in the same age range. Children with DCD showed impaired sensitivity to global motion (p = 0.002), but not global form (p = 0.695), compared to controls. Within the DCD group, motor impairment showed a significant linear relationship with global form sensitivity (p < 0.001). There was also a significant quadratic relationship between motor impairment and global motion sensitivity (p = 0.046), where poorer global motion sensitivity was only apparent with greater motor impairment. We suggest that two distinct visually related components, associated with global form and global motion sensitivity, contribute to DCD differentially over the range of severity of the disorder. Possible neural circuitry underlying these relationships is discussed.

The IMPROVE study--a multinational, multicentre, observational study in type 2 diabetes: results from the Italian cohort.

AIMS: The IMPROVE study evaluated the safety and effectiveness of biphasic insulin aspart 30/70 (BIAsp 30) in type 2 diabetes patients in the routine practice. Here we present the results for patients from Italy. METHODS: Adverse events, hypoglycaemia, glycaemic control, patient treatment satisfaction and physician resource utilisation were assessed at baseline and 26 weeks. RESULTS: Out of the 1371 patients enrolled, 84.1% (n=1153) were receiving BIAsp 30 at baseline (in accordance with local regulations), and were included in the study. Mean HlbA, reduction was--0.63% after 26 weeks (p < 0.001); 26.5% and 13.5% of patients reached the HbA(1c) targets of < 7% and < 6.5%, respectively. Fasting and postprandial blood glucose significantly decreased; 65% of patients were using BIAsp 30 once daily and 32% twice daily at final visit. Rates of major and minor hypoglycaemic events also significantly decreased. Small weight increase was observed, and total insulin daily dose increased from 0.29 IU/kg pre-study to 0.32 IU/kg at final visit. CONCLUSIONS: In Italy, BIAsp 30 in the routine care improved glycaemic control and reduced hypoglycaemia; however, there was little intensification and titration. This may partly explain the relatively small improvement in glycaemic control in Italy compared with other countries in the IMPROVE study.

Digital governance in tax-funded European healthcare systems: from the Back office to patient empowerment.

Digital healthcare promises to achieve cost-efficiency gains, improve clinical effectiveness, support better public sector governance by enhancing transparency and accountability, and increase confidence in medical diagnoses, especially in the field of oncology. This article aims to discuss the benefits offered by digital technologies in tax-based European healthcare systems against the backdrop of structural bureaucratic rigidities and a slow pace of implementation.Artificial intelligence (AI) will transform the existing delivery of healthcare services, inducing a redesign of public accountability systems and the traditional relationships between professionals and patients. Despite legitimate ethical and accountability concerns, which call for clearer guidance and regulation, digital governance of healthcare is a powerful means of empowering patients and improving their medical treatment in terms of quality and effectiveness. On the path to better health, the use of digital technologies has moved beyond the back office of administrative processes and procedures, and is now being applied to clinical activities and direct patient engagement.

Phytoremediated marine sediments as suitable peat-free growing media for production of red robin photinia (Photinia x fraseri).

Sediments dredged by an industrial port, slightly contaminated by heavy metals and petroleoum hydrocarbons, were phytoremediated and used as peat-free growing media for the red robin photinia (Photinia x fraseri L.). Plants were grown on sediment only (S), sediment mixed with composted pruning residues (S + PR), sediment fertilized with controlled release fertilizers (S + F) and peat-based growing media as control (C). Plant elongation and dry weight, leaf contents of chlorophyll, malondialdehyde (MDA), macronutrients and heavy metals were determined at the end of one growing season. Environmental impact related to the use of sediment-based as compared to peat-based growing media was assessed by the Life Cycle Analysis (LCA). Sediment-based growing media presented significantly higher bulk density, pH and electrical conductivity values, lower C and N contents, and significantly higher total and available P. Red robin photinia grown on S + F growing media showed morphological and chemical parameters similar to those of control plants (C), whereas plants grown on S and S + PR showed lower growth. Leaf concentration of nutrients and heavy metals varied depending on the considered element and growing media, but were all within the common values for ornamental plants, whereas the highest MDA concentrations were found in plants grown on traditional growing media. The LCA indicated the use of sediments as growing media reduced the C footprint of ornamental plant production and the contribute of growing media to the environmental impact per produced plant. We concluded that sediments phytoremediation and use in plant nursery is a practical alternative re-use option for dredged sediments.

Evaluation of dredged sediment co-composted with green waste as plant growing media assessed by eco-toxicological tests, plant growth and microbial community structure.

Dredged sediments have currently no broad reuse options as compared to other wastes due to their peculiar physico-chemical properties, posing problems for the management of the large volumes of sediments dredged worldwide. In this study we evaluated the performance of sediment (S) co-composted with green waste (GW) as growing medium for ornamental plants. Analysis of the microbial community structure, eco-toxicological tests, were conducted on sediments at 1:1 and 3:1S:GW composting ratios. Sediment-based growing media were then reused to growth the ornamental plant Photina x fraseri in a pilot-scale experiment and plants' physiological and chemical parameters were measured. The results showed that co-composting with green waste increased the diversity of bacteria, fungi and archaea as compared to the untreated sediments, and that both the 1:1 and 3:1 S:GW composted sediments had no substantial eco-toxicological impacts, allowing an excellent plant growth. We concluded that co-composted of sediment with green waste produce a growing medium with suitable properties for growing ornamental plants, and represent a sustainable option for beneficial use of dredged sediments.

Endothelial dysfunction and oxidative stress in chronic renal failure.

Uremic patients have an increased incidence of cardiovascular disease (CVD), endothelial dysfunction and oxidative stress that can contribute to cardiovascular (CV) events. To assess the relationship between endothelial dysfunction, oxidative stress and renal failure severity, we studied 40 patients (age 57 +/- 7 yrs, 24 males) affected by chronic kidney disease (CKD) K/DOQI stage 3-5 (serum creatinine (Cr) 5.6 +/- 2.2 mg/dL) on conservative treatment, 20 uremic patients (age 57 +/- 12 yrs, 13 males) on hemodialysis (HD) and 30 healthy controls (56 +/- 12 yrs, 20 males). Before and 2 hr after oral vitamin C (2 g) administration, we measured brachial artery endothelium-dependent vasodilation (flow mediated dilation (FMD)) to reactive hyperemia following 5 min of forearm ischemia and the response to sublingual glyceril trinitrate (GTN). Measurements were made by high-resolution ultrasound and computerized analysis. FMD was lower in CKD patients than in controls (5.3 +/- 2.2 vs. 6.9 +/- 2.8%; p<0.01) and was further reduced in HD patients (3.6 +/- 2.7; p<0.01 vs. CKD patients). Response to GTN was similar in all groups. FMD was related to Cr clearance (r=0.42; p<0.01) in CKD patients, while it related inversely to Kt/V(urea) (r=-0.52; p<0.05) in HD patients. After vitamin C administration, FMD was significantly enhanced in HD (4.7 +/- 2.4%; p<0.01 vs. baseline), but not in CKD patients. Response to GTN was unaffected. However, vitamin C load reduced oxidative stress markers, and increased plasma antioxidant capability in both groups. In conclusion, the reduced endothelium-dependent dilation in the brachial artery of CKD patients is related to renal failure severity. HD patients showed a more marked alteration, which seems to be related, at least in part, to increased oxidative stress.

Staphylococcus protein A-based extracorporeal immunoadsorption and thalidomide in the treatment of skin manifestation of dermatomyositis: a case report.

Cutaneous involvement in dermatomyositis can be the prevalent component of disease, failing to respond to adequate therapies for myositis. In this case report, we describe a patient affected by dermatomyositis, characterized by prevalent skin involvement, successfully treated with Staphylococcus protein A-based extracorporeal immunoadsorption (Immunosorba, Fresenius Medical Care AG & Co. KGaA, Bad Homburg, Germany) and thalidomide. The patient showed panniculitic ulcerative lesions of the skin, difficult to treat because of side effects or ineffectiveness of various therapies. Skin manifestations rapidly improved after introduction of immunoadsorption; The association of thalidomide allowed a good maintenance of these results until the remission of skin lesions, despite several infective complications of some residual ulcers. Considering the difficulties in the management of our patient, combined therapy with Immunosorba and thalidomide has allowed a good clinical response. If confirmed, the observed beneficial effects suggest that protein A-based immunoadsorption and thalidomide can represent an alternative option in dermatomyositis, especially when cutaneous manifestations are predominant.

Acute and subacute effect of rheopheresis on microvascular endothelial function in patients suffering from age-related macular degeneration.

This study was performed on seven patients affected by the atrophic form of age-related macular degeneration (AF-ARMD). The patients under investigation belonged to a larger study aimed at evaluating the efficacy of rheopheresis treatment (RT) on the visual function of AF-ARMD patients. Following the protocol of the larger study, patients received RT twice a week, every two weeks, for a total of ten treatments, as well as high-dose supplementation with zinc and vitamins A, E and beta-carotene. Recruited patients underwent skin laser Doppler flowmetry coupled with skin iontophoresis of the endothelium-dependent vasodilator acetylcholine (ACh) and a test of skin post-ischemic reactive hyperemia, before and after the first RT (time 1: all seven patients) and the fifth RT (time 2: six patients). A significantly higher absolute (anova for repeated measures) and relative (percentage change from the baseline) skin blood flux response (SBFR) to ACh iontophoresis was observed after RT, compared to before RT at time 1 (679 +/- 43% and 436 +/- 78%, respectively; P < 0.05), as well as before RT at time 2 compared to before RT at time 1 (683 +/- 74% and 436 +/- 78%, respectively; P < 0.05). Absolute and relative SBFR to ischemia did not differ either after RT compared to before RT at time 1, or before RT at time 2 compared to before RT at time 1. These findings are consistent with an acute and subacute beneficial effect of RT on skin microvascular endothelial function in the studied AF-ARMD patients.