Seed dormancy, climate changes, desertification and soil use transformation threaten the Mediterranean endemic monospecific plant Petagnaea gussonei.

This study investigated the germination capacity (endogenous factor) of Petagnaea gussonei (Spreng.) Rauschert, an endemic monospecific plant considered as a relict species of the ancient Mediterranean Tertiary flora. This investigation focused also on the temporal trends of soil-use, climate and desertification (exogenous factors) across the natural range of P. gussonei. The final germination percentage showed low values between 14 and 32%, the latter obtained with GA3 and agar at 10 °C. The rising temperatures in the study area will further increase the dormancy of P. gussonei, whose germination capacity was lower and slower at temperatures higher than 10 °C. A further limiting factor of P. gussonei is its dormancy, which seems to be morpho-physiological. Regarding climate trends, in the period 1931-2020, the average temperature increased by 0.5 °C, from 15.4 to 15.9 °C, in line with the projected climate changes throughout the twenty-first century across the Mediterranean region. The average annual rainfall showed a relatively constant value of c. 900 mm, but extreme events grew considerably in the period 1991-2020. Similarly, the land affected by desertification expanded in an alarming way, by increasing from 21.2% in 2000 to 47.3% in 2020. Soil-use changes created also a complex impacting mosaic where c. 40% are agricultural areas. The effective conservation of P. gussonei should be multilateral by relying on germplasm banks, improving landscape connectivity and vegetation cover, and promoting climate policies.

Rise, fall and hope for the Sicilian endemic plant Muscari gussonei: A story of survival in the face of narrow germination optimum, climate changes, desertification and habitat fragmentation.

Muscari gussonei is an endangered endemic plant growing on fragmented Mediterranean coastal dunes. This study focused on the germination performance of M. gussonei at two fixed temperatures, 10 and 15 °C, and at an alternating one, 10/20 °C, and on the multi-temporal trends of temperature and rainfall during 1931-2020, as well as on the patterns of desertification and land-cover changes over the last 60 years. High and similar germinability was found for different populations of M. gussonei, in particular, the final germination percentage (FGP) was ≥95 % for the three treatments. The general pattern was the lower the temperature the higher and faster the germination. However, germination speed varied significantly among populations. This intraspecific variability of germination behavior may suggest a certain level of ecophysiological plasticity in M. gussonei, thus raising hopes on the capacity of M. gussonei to respond better to the ongoing severe environmental changes. In the period 1931-2020, indeed, the average temperature rose by 1.5 °C, from 16.8 to 18.3 °C, which is equivalent to the enormous increase of 0.17 °C per decade. Similarly, the average rainfall declined by 100 mm, from 600 to 500 mm. Another serious stressor was desertification, which affects >90 % of the distributional area of M. gussonei. A further factor of ecological degradation is a considerably altered landscape, where the agricultural component accounts for c. 85 %, whereas natural and seminatural areas were only c. 10 %. Increasing temperature and dryness will inevitably reduce the germinability of M. gussonei, characterized by a narrow germination optimum of 10-15 °C. The future of M. gussonei looks even more dramatic if we consider its small and scattered populations distributed in an agricultural matrix affected by high levels of desertification. Only multivariate information at different space-time scales can provide an exhaustive picture for implementing effective conservation strategies.

Evaluation of two unilateral laryngoplasty techniques and their effect on arytenoid cartilage abduction in cats.

OBJECTIVES: The aim of this study was to evaluate two unilateral laryngoplasty (arytenoid lateralisation) techniques for use in the surgical management of laryngeal paralysis in cats. METHODS: Left cricoarytenoid abduction (lateralisation) was performed in 20 ex vivo cat larynges; 10 following complete cricoarytenoid disarticulation (group LAA-dis) and 10 following no cricoarytenoid disarticulation (group LAA-nodis). For both groups, left arytenoid abduction (LAA) was measured in the resting and postoperative larynges using image analysis software. Measurements were evaluated using the Mann-Whitney U-test. For both groups, dorsal images of the postoperative larynges were assessed visually for evidence of epiglottic coverage of the entrance to the larynx. RESULTS: The mean percentage increase in LAA was 311.5% and 199.4% (P <0.006) for group LAA-dis (complete cricoarytenoid disarticulation) and group LAA-nodis (no cricoarytenoid disarticulation), respectively. In both groups, there was no evidence of a lack of epiglottic coverage of the entrance of the larynx for any of the postoperative larynges. CONCLUSIONS AND RELEVANCE: Placement of a single, tensioned suture between the muscular process of the left arytenoid cartilage and the caudolateral aspect of the ipsilateral cricoid cartilage (unilateral cricoarytenoid lateralisation) resulted in abduction of the left arytenoid cartilage and a corresponding increase in the area of the rima glottidis on the operated side. The clinical significance of the difference in outcome between left cricoarytenoid abduction following complete cricoarytenoid disarticulation and abduction following no cricoarytenoid disarticulation remains unclear, and both might be considered appropriate for the surgical management of laryngeal paralysis in the cat.

Case report: Immune remission from generalized myasthenia gravis in a dog with a thymoma and cholangiocellular carcinoma.

A 9-year-old male neutered Cockapoo was presented with an acute and progressive history of exercise induced weakness involving all limbs, and bilateral decreased ability to blink. Investigations revealed generalized myasthenia gravis alongside the presence of a thymoma and a cholangiocellular carcinoma. Symptomatic treatment through pyridostigmine bromide was used to control clinical signs, and complete surgical removal of the thymoma and cholangiocellular carcinoma was performed. Serum acetylcholine receptor antibody concentration was measured serially. Clinical remission defined as resolution of clinical signs alongside discontinuation of treatment was achieved by day 251 (8.2 months). Immune remission defined as normalization of serum acetylcholine receptor antibody concentration alongside resolution of clinical signs and discontinuation of treatment was achieved by day 566 (18.5 months). Neurological examination was normal, and the owners did not report any clinical deterioration during the final follow-up appointment on day 752 (24 months), hence outcome was considered excellent. This is the first report describing the temporal evolution of serum acetylcholine receptor antibody concentration in a dog with thymoma-associated myasthenia gravis which achieved immune remission following thymectomy. Treatment was successfully discontinued without any evidence of clinical deterioration thereafter despite serum acetylcholine receptor antibody concentration not normalizing for another 315 days (10 months).

Methadone as First-line Opioid for the Management of Cancer Pain.

AIM: The aim of this study was to assess the efficacy and adverse effects of methadone when used as first-line therapy in patients that are either receiving low doses of opioids or none. METHODS: Patients with advanced cancer were prospectively assessed. Opioid-naive patients (L-group) were started with methadone at 6 mg/day. Patients receiving weak or other opioids in doses of <60 mg/day of OME (H-group) were started with methadone at 9 mg/day. Methadone doses were changed according to the clinical needs to obtain the most favorable balance between analgesia and adverse effects. Edmonton Symptom Asssement Score (ESAS), Memorial Delirium Assessment Score (MDAS), doses of methadone, and the use of adjuvant drugs were recorded before starting the study treatment (T0), 1 week after (T7), 2 weeks after (T14), 1 month after (T30), and 2 months after (T60). Methadone escalation index percent (MEI%) and in mg (MEImg) were calculated at T30 and T60. RESULTS: Eighty-two patients were assessed. In both groups H and L, there were significant changes in pain and symptom intensity at the different times during the study. Adverse effects as causes of drop-out were minimal. Mean MEImg was 0.09 (SD 0.28) and 0.02 (SD 0.07) at T30 and T60, respectively. MEI% was 1.01 (SD 3.08) and 0.27 (SD 0.86) at T30 and T60, respectively. CONCLUSION: Methadone used as a first-line opioid therapy provided good analgesia with limited adverse effects and a minimal opioid-induced tolerance.

The Role of Religiosity in Symptom Expression of Advanced Cancer Patients.

AIM: The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. METHODS: A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. RESULTS: Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. CONCLUSION: The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.

Spatial and temporal distribution of trace elements in Padina pavonica from the northern Adriatic Sea.

Chemical pollution is a major environmental concern especially in coastal areas, having adverse impacts on marine organisms and ecosystem services. Macroalgae can accumulate trace elements, but available studies are restricted to a limited number of elements and species. The goal of this research was to assess, seasonally, the concentrations of 22 elements in the brown alga Padina pavonica from monitoring sampling sites in Slovenian waters. The concentration of most elements in thalli differed significantly between spring and autumn, with generally higher levels in autumn samples. However, it was not possible to correlate these concentrations with the ecological status of macroalgae. The maximum values set by European regulations for the potentially hazardous As, Cd and Hg in food and feed were never exceeded, while Pb concentrations were slightly higher. The results show that P. pavonica can act as an effective bioindicator of chemical pollution.

Financial distress and its impact on symptom expression in advanced cancer patients.

AIM: To assess financial distress (FD) and its impact on symptom expression and other quality of life issues PATIENTS AND METHODS: Advanced cancer patients admitted to inpatient and outpatient clinics were selected. Standard epidemiological data including age, gender, primary cancer diagnosis, and Karnofsky level were recorded. Data regarding marital status, number of cohabitants, religious belief, educational level, and family income (< 1000, 1000-3.000, > 3000 euros), as well as extra costs not covered by health care system, were collected. Symptom burden including FD was measured by Edmonton Symptom Assessment Scale (ESAS), FACT-G (Functional Assessment of Cancer Therapy-General), and HADS (Hospital Anxiety Depression scale) were measured. RESULTS: Two hundred thirty-six patients were evaluated. The mean FD was 3.55 (SD 3.1). One hundred patients (42%) had a FD of ≥ 4. There was an inverse correlation between FD and income (P = 0.032). Most patients incurred in extra-costs, the most frequent being for drugs (n, 114). FD was inversely associated with age (P = 0.024), marital status (divorced or separated, P = 0.005), ESAS anxiety (P = 0.006), total ESAS (P = 0.019), physical well-being (P = 0.033), poor social family well-being (P = 0.004), emotional well-being (P = 0.045), poor functional well-being (P = 0.019), HADS-A (P = 0.003), and global HADS (P = 0.034). Family income was inversely related to age (P = 0.023), education level (P < 0.0005), less number of hospital admissions in the last month (P = 0.020), physical well-being (P = 0.039), social/family well-being (P = 0.020), and total well-being (P = 0.001). CONCLUSION: FD is very common in advanced cancer patients. FD was associated with anxiety, depression, and poor quality of life. The screening of FD may allow to develop effective interventions of social support.

Non-indigenous macrophytes in Central Mediterranean ports, marinas and transitional waters: Origin, vectors and pathways of dispersal.

Non-indigenous species are confirmed to be among the biggest threats for marine biodiversity. Among them, non-indigenous macrophytes (NIM) are well known to have local negative effects, especially in coastal ecosystems. Since transitional waters (TWs), ports and also marinas are recognized as very vulnerable coastal ecosystems, greatly subjected to biological invasions, the present study analysed the available scientific literature on NIM in such areas in the Central Mediterranean Sea (CMED), in the period 1970-2019. The analysis underlined that 27 NIM were recorded in CMED TWs, marinas and ports. Around 37% of them (10 species) are marked as invasive, while about 11% (3 species) are considered as potentially invasive. Maricultural activities resulted the key vector of introduction, while the primary pathway of NIM dispersion is related to maritime activities. The paper also discusses why in CMED TWs, marinas and ports, currently, less NIM were detected than in similar Adriatic areas.

Seagrass Cymodocea nodosa and seaweed Ulva lactuca as tools for trace element biomonitoring. A comparative study.

This study compared the capacity of the seagrass Cymodocea nodosa and the green alga Ulva lactuca to sequester the trace elements Cd, Cr, Cu, Ni, Pb and Zn, in seawater and benthic sediments, under the same environmental conditions. Samples of C. nodosa leaves and U. lactuca thalli were collected in four sites off the coast of Sicily (Italy), with varying degrees of anthropogenic impact. C. nodosa accumulated generally higher levels of trace elements, suggesting a better performance in marine phytoremediation. In turn, C. nodosa and U. lactuca showed a similar performance regarding the bioindication of trace elements. Since salinity, temperature and pH had relatively constant values, their role in the accumulation processes in both species should be considered as secondary. Although C. nodosa and U. lactuca fulfill several criteria as bioindicators, including widespread distribution, abundance and tolerance to toxicity, their regular use in biomonitoring programs is still limited.

Marine plastics: What risks and policies exist for seagrass ecosystems in the Plasticene?

Plastic debris is nowadays a well-recognized global threat to marine ecosystems, due to its increasing abundance and pervasiveness. Although the effects of marine plastics on animal wildlife is generally documented, the available studies of plastics affecting seagrasses and their associated biota are relatively scarce. This makes the degree of risk uncertain as regards seagrass ecosystems affected by plastic debris, but also it results in several critical knowledge gaps such as to what extent plastic debris can affect food webs supported by seagrasses. In the age of plastics, the Plasticene, the international political agenda shows great interest in this matter. However, to date, no conservation policies have specifically targeted the protection of seagrasses from plastics debris. Future actions should therefore move in two directions: prompting a radical shift in plastics consumption, and shedding further light on plastics-biota interactions in the marine environment.

Episodic Breathlessness with and without Background Dyspnea in Advanced Cancer Patients Admitted to an Acute Supportive Care Unit.

AIM: To characterize episodic breathlessness (EB) in patients with advanced cancer, and to determine factors influencing its clinical appearance. METHODS: A consecutive sample of advanced cancer patients admitted to an acute palliative care unit was surveyed. Continuous dyspnea and EB were measured by a numerical scale. The use of drugs used for continuous dyspnea and EB was recorded. Patients were asked about the characteristics of EB (frequency, intensity, duration and triggers). The Multidimensional dyspnea profile (MDP), the Brief dyspnea inventory (BDI), the Athens sleep scale (AIS) and the Hospital Anxiety and Depression Scale (HADS) were also administered. RESULTS: From 439 advanced cancer patients surveyed, 34 and 27 patients had EB, without and with background dyspnea, respectively. The mean intensity and the number of episodes were higher in patients with background dyspnea (p < 0.0005 and p = 0.05, respectively). No differences in duration were observed. Most episodes lasted <10 min. A recognizable cause triggering EB was often found. The presence of both background dyspnea and EB was associated with higher values of MDP and BDI. EB was independently associated with frequency and intensity of background dyspnea (OR = 20.9, 95% CI (Confidence interval) 9.1-48.0; p < 0.0005 and OR = 1.97, 95% CI 1.09-3.58; p = 0.025, respectively) and a lower Karnofsky level (OR = 0.96, 95%CI 0.92-0.98, p = 0.05). DISCUSSION: EB may occur in patients with and without continuous dyspnea, and is often induced by physical and psychological factors. EB intensity is higher in patients with continuous dyspnea. The duration was often so short that the use of drugs, as needed, may be too late, unless administered pre-emptively when the trigger was predictable.

Accidental poisoning with Aconitum: Case report and review of the literature.

Aconitine intoxication by ingestion of Aconitum roots can lead to ventricular tachycardia and cardiac arrest and provides an example of the potential effect of self-medication. Educational campaigns should be implemented to contain acute intoxications caused by herbal-derived products.

Association between night/after-hours surgery and mortality: a systematic review and meta-analysis.

BACKGROUND: The association between night/after-hours surgery and patients' mortality is unclear. METHODS: The protocol of this systematic review was registered in PROSPERO (CRD42019128534). We searched Medline, PubMed, and EMBASE from inception until August 29, 2019 for studies examining an association between timing of surgical procedures (time of anaesthesia induction or surgery start) and mortality (within 30 days or in-hospital) in adult patients. Studies reporting patients' mortality after surgery performed during the weekend only were excluded. All analyses were done using the random-effects model. RESULTS: We included 40 observational studies (36 retrospective and four prospective) that examined a total of 2 957 065 patients. Twenty-eight studies were judged of good quality and 12 of poor quality according to Newcastle-Ottawa score, owing to a lack of adequate comparability between study groups. Primary analysis from adjusted estimates demonstrated as association between night/after-hours surgery and a higher risk of mortality (odds ratio [OR]=1.16; 95% confidence interval [CI], 1.06-1.28; P=0.002; number of studies=18; I2=67%) based on low certainty evidence. Analysis from unadjusted estimates demonstrated a consistent association (OR=1.47; 95% CI, 1.19-1.83; P=0.0005; studies=38, I2=97%; low certainty). The number of centres per study had no credible subgroup effect on the association between the time of surgery and mortality. We were unable to evaluate the subgroup effect of urgency of surgery because of high heterogeneity. CONCLUSIONS: Night/after-hours surgery may be associated with a higher risk of mortality. Patients' and surgical characteristics seem not to completely explain this finding. However, the certainty of the evidence was low.

Comparative assessment of trace element accumulation and biomonitoring in seaweed Ulva lactuca and seagrass Posidonia oceanica.

The present research compared the capability of the green seaweed Ulva lactuca and the seagrass Posidonia oceanica to accumulate and biomonitor the levels of six trace elements: Cd, Cr, Cu, Ni, Pb, Zn. The concentrations of these elements were analyzed in seawater, bottom sediments, U. lactuca thalli and P. oceanica leaves, in four sites of Sicily (Italy) with different levels of pollution. The results showed that P. oceanica is able to accumulate greater concentrations of trace elements compared to U. lactuca. Both species, instead, acted equally as good bioindicators of marine pollution, showing significant correlations with the levels of trace elements in the surrounding environment. The use of P. oceanica and U. lactuca as bioindicators is still limited in biomonitoring programs, and should be further encouraged given the ever-increasing marine pollution.

Fake news and patient-family-physician interaction in critical care: concepts, beliefs and potential countermeasures.

Fake news has been defined as fabricated information mimicking media content in form but not in organizational process or intent. Science and medicine are deeply affected by this increasing phenomenon. Critical care represents a hot spot for fake news due to the high risk of conflictive communication, the rapid turnaround of clinical news and high prevalence of unpleasant information. Communication with patients' relatives is one of the hardest aspects. The relationship between physicians and families is pivotal to improve relatives' comfort, and reduce anxiety and pain. Fake news may undermine this relationship, posing an alternative truth between the critical care physician and relatives, which must be countered without worsening their suffering. The aim of this review is to provide intensivists an overview of concepts, characteristics and risk to better understand the fake news phenomenon and counter its potentially devastating effects.

The alga Ulva lactuca (Ulvaceae, Chlorophyta) as a bioindicator of trace element contamination along the coast of Sicily, Italy.

The marine environment is subjected to ever-increasing levels of contamination, especially along the coastal areas with urban and industrial activities. Consequently, monitoring campaigns on large scales should be conducted on a regular basis for a better management of marine ecosystems. This study tested the capacity of the green alga Ulva lactuca to act as a bioindicator of trace elements along the coasts of Sicily (Italy). The concentrations of the metals Cd, Cr, Cu, Ni, Pb and Zn were analyzed in samples of water, sediments and U. lactuca thalli, which were collected in ten different sites at diverse levels of human impact. The results showed that U. lactuca can accumulate essential and non-essential elements at similar concentrations. The analysis of trace elements showed also that the metal content in U. lactuca is significantly correlated with the levels of trace elements in water and sediments. U. lactuca fits numerous features that make it one of the best bioindicators of marine pollution, also thanks to its worldwide distribution and capacity to accumulate trace elements under toxic conditions. The use of U. lactuca should be encouraged to set up large-scale monitoring programs, especially in highly impacted seas like the Mediterranean where U. lactuca is widespread.

Non-indigenous macrophytes in Adriatic ports and transitional waters: Trends, taxonomy, introduction vectors, pathways and management.

The Adriatic Sea is considered as a hotspot of marine biodiversity but, due to intense human activities (e.g. maritime transport, mariculture), it is also a recipient area of non-indigenous species (NIS). This study analyzed the scientific literature on non-indigenous macrophytes (NIM) recorded in ports, marinas and transitional waters (TWs) of the Adriatic Sea, in the period 1987-2018. The results show that 51 out of 118 Mediterranean NIM are found in Adriatic ports and TWs. The Venice Lagoon is the main Adriatic recipient area of NIM. Mariculture is the main vector of introduction, whereas the principal pathways of NIM dispersal are shipping and shellfish transfer. The largest group of NIM is of temperate northern Pacific origin. This study corroborated the fact that ports and TWs act as dispersal hubs and invasion hotspots. The importance of early detection of NIM at such sites should be considered in any environmental management strategy.

Perspectives on using marine species as bioindicators of plastic pollution.

The ever-increasing level of marine pollution due to plastic debris is a globally recognized threat that needs effective actions of control and mitigation. Using marine organisms as bioindicators of plastic pollution can provide crucial information that would better integrate the spatial and temporal presence of plastic debris in the sea. Given their long and frequent migrations, numerous marine species that ingest plastics can provide information on the presence of plastic debris but only on large spatial and temporal scales, thus making it difficult to identify quantitative correlations of ingested plastics within well-defined spatio-temporal patterns. Given the complex dynamics of plastics in the sea, the biomonitoring of marine plastic debris should rely on the combination of several bioindicator species with different characteristics that complement each other. Other critical aspects include the standardization of sampling protocols, analytical detection methods and metrics to evaluate the effects of ingested plastics in marine species.

Comparative assessment of trace element accumulation and bioindication in seagrasses Posidonia oceanica, Cymodocea nodosa and Halophila stipulacea.

Accumulation and bioindication of trace elements were compared in three seagrasses growing in the Mediterranean Sea: Posidonia oceanica, Cymodocea nodosa and Halophila stipulacea. The levels of the elements As, Cd, Cr, Cu, Hg, Mn, Ni, Pb and Zn were investigated in water, sediments, and roots, rhizomes and leaves of seagrasses. Results showed that seagrasses can accumulate comparable levels of trace elements, but P. oceanica and C. nodosa showed higher mean values of element accumulation. Moreover, P. oceanica and C. nodosa may accumulate high element concentrations in their leaves, whereas in H. stipulacea restricted with the bulk of trace elements in roots and rhizomes. Seagrasses reflected to a different degree the levels of several trace elements in sediments, especially P. oceanica and C. nodosa, whose use as bioindicators is recommended. The future step for an effective use of seagrasses as bioindicators of marine pollution is to set up biomonitoring networks on a large scale.