Sambucus nigra L. (fam. Viburnaceae) in Sicily: Distribution, Ecology, Traditional Use and Therapeutic Properties.

Sambucus nigra, the elderberry, has long been used for its medicinal properties in treating numerous diseases. Based on this traditional knowledge, its different pharmacological activities have been the focus of active research. All parts of the tree have long been used in traditional medicine, that is, the bark, the leaves, the flowers and the fruit. This study, carried out in Sicily (Italy), concerns the traditional uses of elder against human diseases. In order to trace the history of man's interaction with elder on the island, multidisciplinary research was carried out, aiming at (1) presenting a comprehensive overview of elderberry's applications and activities and (2) bridging traditional knowledge (uses and beliefs) with modern science, i.e., the most recent scientific findings in the biomedical and pharmacological fields. A rigorous literature review of scientific (and other local) reports on the elderberry tree and its application in food, health and household applications was undertaken. This article also provides a synthetic and updated picture of the ecology and distribution of S. nigra in Sicily. The elderberry is quite widespread in Sicily, yet its distribution is discontinuous. It prefers hedges, riparian woodlands, forest margins and clearings and is rather common along the watercourses flowing in the canyons of the Hyblaean Plateau, in the Madonie Mts. and in Enna province. Indeed, many old plants are often found near sacred places and rural houses, suggesting that in the past, it was extensively planted on purpose for its multiple uses. The complementary data obtained from multidisciplinary research confirm the usefulness of this approach in building a comprehensive and correct picture of the distribution of the most common woody species, for which the available knowledge is often fragmentary and imprecise.

Cost-Utility Analysis of Dupilumab for the Treatment of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in Italy.

The objective of this analysis was to estimate the incremental cost-utility ratio (ICUR) of dupilumab as an add-on treatment to best supportive care (BSC), versus BSC alone, in Italy for severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). A simulation of outcomes and costs was undertaken using a 1-year decision tree, followed by a lifetime horizon Markov model. Clinical data were derived from a pooled analysis of two studies (SINUS-24 NCT02912468 and SINUS-52 NCT02898454). The Italian National Healthcare Service (NHS) perspective was considered. Model robustness was tested through sensitivity analyses. In the base-case analysis, treatment with dupilumab + BSC resulted in an increase in quality of life-adjusted survival (+1.02 quality-adjusted life years (QALY-gained)), compared to the BSC alone. The resulted ICUR was €21,817 per QALY-gained and it is below the acceptability threshold commonly used in Italy. Both one-way deterministic and probabilistic sensitivity analyses confirmed the robustness of base-case results. The cost-utility analysis showed that dupilumab, as an add-on treatment to BSC, is a cost-effective therapeutic alternative to BSC in the treatment of patients with severe uncontrolled chronic rhinosinusitis with nasal polyps, confirming that it is economically sustainable.

Multidisciplinary management of type 2 inflammatory diseases.

Greater understanding of molecular pathophysiology has led to the recognition that an excessive type 2 inflammatory response is at the basis of the pathophysiology of several inflammatory diseases including atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyps (CRSwNP). Given the availability of biological agents that can permit management of specific disease endotypes, this reinforces the need for detailed characterization of these diseases through a multidisciplinary approach. Herein, these three conditions are briefly overviewed and practical guidance for a multidisciplinary approach to management is presented. Since type 2 inflammation is suppressed by steroids, drugs such as glucocorticoids have long been the workhorse of medical therapy. However, steroids have well-known local and systemic adverse effects, especially when used at high doses over prolonged periods of time, which is problematic when treating chronic diseases such as AD, asthma, and CRSwNP. Moreover, a substantial proportion of patients remain refractive to therapy. In the attempt to overcome these limitations, greater understanding of the molecular mechanisms of type 2 inflammation have led to the development of targeted biological drugs such as dupilumab, a fully human monoclonal antibody that targets the α chain of the IL-4 receptor. Dupilumab represents a unique therapy for type 2 inflammatory diseases and to date is the only therapy approved for AD, asthma, and CRSwNP. In terms of multidisciplinary management of type 2 inflammatory conditions, the main healthcare professionals involved include a dermatologist, pneumologist or allergologist, and ENT specialist. The model proposed herein takes into account the complex management of patients with type 2 inflammatory conditions and the new biological agents available. A multidisciplinary team can provide a central point for patient management, improve outcomes and specialist referrals, reduce costs, and guarantee that the most appropriate therapeutic decisions are made, as well as aid in management of adverse events. The multidisciplinary model should be structured and dedicated, but at the same time simple and flexible in order to not risk slowing down the patient's care. At present, it is believed that a structured multidisciplinary approach is currently the best means to optimize care of patients with type 2 inflammatory conditions.

Carbon stock increases up to old growth forest along a secondary succession in Mediterranean island ecosystems.

The occurrence of old-growth forests is quite limited in Mediterranean islands, which have been subject to particularly pronounced human impacts. Little is known about the carbon stocks of such peculiar ecosystems compared with different stages of secondary succession. We investigated the carbon variation in aboveground woody biomass, in litter and soil, and the nitrogen variation in litter and soil, in a 100 years long secondary succession in Mediterranean ecosystems. A vineyard, three stages of plant succession (high maquis, maquis-forest, and forest-maquis), and an old growth forest were compared. Soil samples at two soil depths (0-15 and 15-30 cm), and two litter types, relatively undecomposed and partly decomposed, were collected. Carbon stock in aboveground woody biomass increased from 6 Mg ha-1 in the vineyard to 105 Mg ha-1 in old growth forest. Along the secondary succession, soil carbon considerably increased from about 33 Mg ha-1 in the vineyard to about 69 Mg ha-1 in old growth forest. Soil nitrogen has more than doubled, ranging from 4.1 Mg ha-1 in the vineyard to 8.8 Mg ha-1 in old growth forest. Both soil parameters were found to be affected by successional stage and soil depth but not by their interaction. While the C/N ratio in the soil remained relatively constant during the succession, the C/N ratio of the litter strongly decreased, probably following the progressive increase in the holm oak contribution. While carbon content in litter decreased along the succession, nitrogen content slightly increased. Overall, carbon stock in aboveground woody biomass, litter and soil increased from about 48 Mg ha-1 in the vineyard to about 198 Mg ha-1 in old growth forest. The results of this study indicate that, even in Mediterranean environments, considerable amounts of carbon may be stored through secondary succession processes up to old growth forest.

Formation and Characterization of Early Bacterial Biofilms on Different Wood Typologies Applied in Dairy Production.

The main hypothesis of this work was that Sicilian forestry resources are suitable for the production of equipment to be used in cheese making and indigenous milk lactic acid bacteria (LAB) are able to develop stable biofilms providing starter and nonstarter cultures necessary for curd fermentation and cheese ripening, respectively. Hence, the present work was carried out with deproteinized whey to evaluate LAB biofilm formation on different woods derived from tree species grown in Sicily. Microbiological and scanning electron microscopy analyses showed minimal differences in microbial levels and compositions for the neoformed biofilms. The specific investigation of Salmonella spp., Listeria monocytogenes, Escherichia coli, coagulase-positive staphylococci (CPS), and sulfite-reducing anaerobes did not generate any colony for all vats before and after bacterial adhesion. LAB populations dominated all vat surfaces. The highest levels (7.63 log CFU/cm2) were registered for thermophilic cocci. Different colonies were characterized physiologically, biochemically, and genetically (at strain and species levels). Six species within the genera Enterococcus, Lactobacillus, Lactococcus, and Streptococcus were identified. The species most frequently present were Lactobacillus fermentum and Lactococcus lactis LAB found on the surfaces of the wooden vats in this study showed interesting characteristics important for dairy manufacture. To thoroughly investigate the safety of the wooden vat, a test of artificial contamination on new Calabrian chestnut (control wood) vats was carried out. The results showed that LAB represent efficient barriers to the adhesion of the main dairy pathogens, probably due to their acidity and bacteriocin generation.IMPORTANCE This study highlights the importance of using wooden vats for traditional cheese production and provides evidence for the valorization of the Sicilian forest wood resources via the production of dairy equipment.

Agricultural land abandonment in Mediterranean environment provides ecosystem services via soil carbon sequestration.

Abandonment of agricultural land leads to several consequences for ecosystem functions. Agricultural abandonment may be a significant and low cost strategy for carbon sequestration and mitigation of anthropogenic CO2 emissions due to the vegetation recovery and increase in soil organic matter. The aim of this study was to: (i) estimate the influence of different Soil Regions (areas characterized by a typical climate and parent material association) and Bioclimates (zones with homogeneous climatic regions and thermotype indices) on soil organic carbon (SOC) dynamics after agricultural land abandonment; and (ii) to analyse the efficiency of the agri-environment policy (agri-environment measures) suggested by the European Commission in relation to potential SOC stock ability in the Sicilian Region (Italy). In order to quantify the effects of agricultural abandonment on SOC, a dataset with original data that was sampled in Sicily and existing data from the literature were analysed according to the IPCC (Intergovernmental Panel on Climate Change) methodology. Results showed that abandonment of cropland soils increased SOC stock by 9.03MgCha-1 on average, ranging from 5.4MgCha-1 to 26.7MgCha-1 in relation to the Soil Region and Bioclimate. The estimation of SOC change after agricultural use permitted calculation of the payments for ecosystem service (PES) of C sequestration after agricultural land abandonment in relation to environmental benefits, increasing in this way the efficiency of PES. Considering the 14,337ha of abandoned lands in Sicily, the CO2 emission as a whole was reduced by 887,745Mg CO2. Therefore, it could be concluded that abandoned agricultural fields represents a valid opportunity to mitigate agriculture sector emissions in Sicily.