Mediterranean-Oriented Dietary Intervention Is Effective to Reduce Liver Steatosis in Patients with Nonalcoholic Fatty Liver Disease: Results from an Italian Clinical Trial.

Results: One hundred and fifty five subjects aged 20-59 years underwent (i) liver ultrasound (US), (ii) clinical and anthropometric evaluations, (iii) blood tests, and (iv) assessment of dietary habits. According to US evaluation, 73 of them had severe, moderate, or mild liver steatosis (NAFLD patients) and 82 had no liver steatosis (healthy controls). Fifty-eight NAFLD patients and 73 controls completed the study. Among NAFLD patients, 26 (45%) downgraded steatosis severity, 12 of which achieved complete steatosis regression (21%). Three of the healthy controls developed NAFLD. The NAFLD patients improved their dietary habits and reduced BMI and waist circumference, during the study period, more than healthy controls. Liver steatosis remission/regression was independent of changes in BMI or liver enzymes and was more frequent among patients with mild steatosis at baseline. Conclusions: Mediterranean dietary advices, without a personalised meal planning, were efficient in reducing/remitting NAFLD, especially among patients with mild disease, which argues in favour of early identification and lifestyle intervention. This trial is registered with NCT03300661.

Characterization of environmental drivers influencing the abundance of Anopheles maculipennis complex in Northern Italy.

BACKGROUND: In Italy, malaria was endemic until the 1970s, when it was declared eradicated by WHO. Nowadays, with the persistence of competent mosquito populations, the effect of climate change, and increased possibility of importing malaria parasites from endemic counties due to growing migration, a malaria resurgence in Italy has become more likely. Hence, enhancing the understanding of the current distribution of the Anopheles maculipennis complex and the factors that influence the presence of this malaria vector is crucial, especially in Northern Italy, characterised by a high density of both human population and livestock. METHODS: To assess the presence and abundance of malaria vectors, a 4-year field survey in the plain areas of Lombardy and Emilia-Romagna region in Italy was conducted. Every sampling point was characterised in space by the land use in a 500-m radius and in time considering meteorological data collected in the short and long time periods before sampling. We combined the results of a linear regression model with a random forest analysis to understand the relative importance of the investigated niche dimensions in determining Anopheles mosquito presence and abundance. RESULTS: The estimated normalised variable importance indicates that rice fields were the most important land use class explaining the presence of Anopheles, followed by transitional woodlands and shrubland. Farm buildings were the third variable in terms of importance, likely because of the presence of animal shelters, followed by urbanised land. The two most important meteorological variables influencing the abundance of Anopheles in our study area were mean temperature in the 24 h before the sampling date and the sum of degree-days with temperature between 18 °C and 30 °C in the 14 days before the sampling date. CONCLUSIONS: The results obtained in this study could be helpful in predicting the risk of autochthonous malaria transmission, based on local information on land cover classes that might facilitate the presence of malaria vectors and presence of short- and medium-term meteorological conditions favourable to mosquito development and activity. The results can support the design of vector control measures through environmental management.

A model for predicting the phenology of Philaenus spumarius.

The design and implementation of Philaenus spumarius control strategies can take advantage of properly calibrated models describing and predicting the phenology of vector populations in agroecosystems. We developed a temperature-driven physiological-based model based on the system of Kolmogorov partial differential equations to predict the phenological dynamics of P. spumarius. The model considers the initial physiological age distribution of eggs, the diapause termination process, and the development rate functions of post-diapausing eggs and nymphal stages, estimated from data collected in laboratory experiments and field surveys in Italy. The temperature threshold and cumulative degree days for egg diapause termination were estimated as 6.5 °C and 120 DD, respectively. Preimaginal development rate functions exhibited lower thresholds ranging between 2.1 and 5.0 °C, optimal temperatures between 26.6 and 28.3 °C, and upper threshold between 33.0 and 35 °C. The model correctly simulates the emergence of the 3rd, 4th, and 5th nymphal instars, key stages to target monitoring actions and control measures against P. spumarius. Precision in simulating the phenology of the 1st and 2nd nymphal stages was less satisfactory. The model is a useful rational decision tool to support scheduling monitoring and control actions against the late and most important nymphal stages of P. spumarius.

To spread or not to spread? Assessing the suitability of sewage sludge and other biogenic wastes for agriculture reuse.

Sewage sludge (biosolids) management represents a worldwide issue. Due to its valuable properties, approximately one half of the EU production is recovered in agriculture. Nevertheless, growing attention is given to potential negative effects deriving from the presence of harmful pollutants. It is recognized that a (even very detailed) chemical characterization is not able to predict ecotoxicity of a mixture. However, this can be directly measured by bioassays. Actually, the choice of the most suitable tests is still under debate. This paper presents a multilevel characterization protocol of sewage sludge and other organic residues, based on bioassays and chemical-physical-microbiological analyses. The detailed description of the experimental procedure includes all the involved steps: the criteria for selecting the organic matrices to be tested and compared; the sample pre-treatment required before the analyses execution; the chemical, physical and microbiological characterisation; the bioassays, grouped in three classes (baseline toxicity; specific mode of action; reactive mode of action); data processing. The novelty of this paper lies in the integrated use of advanced tools, and is based on three pillars:•the direct ecosafety assessment of the matrices to be reused.•the adoption of innovative bioassays and analytical procedures.•the original criteria for data normalization and processing.

Effects of Strategy-Based Memory Training for Older Adults: Do Booster Sessions Prompt Long-Term Benefits?

This study examined the efficacy of a strategy-based memory training for older adults at short- and long-term with two (5- and 11 months) follow-ups. We also explored whether booster sessions (additional training before the first follow-up) facilitated the maintenance of benefits. Thirty-three older adults received a training based on the teaching of different effective memory strategies. One group completed three booster sessions before the 5 months follow-up. Training gains were examined using a word-list and a face-surname association recall tasks, and transfer effects with a grocery-word list (GL) recall task, a working memory (WM) measure, and a perceived memory functioning questionnaire. Training gains and transfer effects to the WM measure emerged and were maintained up to the second follow-up. No benefits for the GL and perceived memory functioning were found. The "boosted" group had only a slight advantage-in one of the transfer tasks-as shown by effect sizes. This pilot study confirms the efficacy of strategy-based memory training in supporting older adults' memory performance up to 11 months since training completion. However, booster sessions seem not to make a clear difference in prompting long-lasting benefits. Training features capable of fostering generalized, prolonged effects are worth investigating.

Popillia japonica - Italian outbreak management.

Popillia japonica, a priority pest for the EU, was first detected in Northern Italy in 2014. Since its discovery, the outbreak extended over an area of more than 16,000 square kilometers in Northern Italy and Southern Switzerland. In this review, we summarize the state-of-the-art of research conducted in Italy on both the spreading capacity and control measures of P. japonica. Chemical, physical, and biological control measures deployed since its detection are presented, by highlighting their strengths and weaknesses. An in-depth study of the ecosystems invaded by P. japonica disclosed the presence and pathogenicity of natural strains of entomopathogenic fungi and nematodes, some of which have shown to be particularly aggressive towards the larvae of this pest under laboratory conditions. The Plant Health authorities of the Lombardy and Piedmont regions, with the support of several research institutions, played a crucial role in the initial eradication attempt and subsequently in containing the spread of P. japonica. Control measures were performed in the infested area to suppress adult populations of P. japonica by installing several traps (e.g., for mass trapping, for auto-dissemination of the fungus Metarhizium anisopliae, and "attract & kill"). For larval control, the infested fields were treated with commercial strains of the entomopathogenic fungus M. anisopliae and nematode Heterorhabditis bacteriophora. Future studies will aim at integrating phenological and spread models developed with the most effective control measures, within an ecologically sustainable approach.

Phenology, Seasonal Abundance, and Host-Plant Association of Spittlebugs (Hemiptera: Aphrophoridae) in Vineyards of Northwestern Italy.

Spittlebugs (Hemiptera: Aphrophoridae) are the vectors of the bacterium Xylella fastidiosa (Xf) in Europe. Xf may cause severe epidemics in cultivated plants, including grapevines. To assess the threat represented by the bacterium to grapevines, detailed information on the vectors' phenology, density, and ecology in vineyards is needed. The aim of the present work was to describe spittlebug diversity, phenology, and host-plant association in the vineyard agroecosystem. Two separate field surveys of nymphal and adult spittlebug populations, i.e., a two-year survey of a single site and a one-year survey of three sites, were performed in vineyards of northwestern Italy in three consecutive years. Philaenus spumarius was the most common species, reaching average nymph densities on herbaceous cover up to 60-130 nymphs/m2. Adults were sampled on grapevines from May to September, with a peak in June (up to 0.43 insects/sweep). Herbaceous cover was colonized after egg hatching and in late summer for oviposition, while wild woody hosts represented a refuge during summer. The results show that spittlebugs can reach high population levels in vineyards, at least in the areas where the ground is covered by herbaceous plants for the whole season and the use of insecticides is moderate. The extended presence of P. spumarius adults on grapevines represents a serious risk factor for the spread of Xf. The scenarios of Xf establishment in vineyards in northwestern Italy and Europe are discussed in relation to the abundance, phenology, and plant association of spittlebugs.

Dispersal of Philaenus spumarius (Hemiptera: Aphrophoridae), a Vector of Xylella fastidiosa, in Olive Grove and Meadow Agroecosystems.

The introduction of the Xylella fastidiosa Wells bacterium into Apulia (South Italy) has caused the massive dieback of olive trees, and is threatening olive production throughout the Mediterranean Region. The key vector of X. fastidiosa in Europe is the spittlebug Philaenus spumarius L. The dispersal capabilities of P. spumarius are poorly known, despite being a key parameter for the prediction of the spread of the bacterium. In this study, we have examined the dispersal of P. spumarius adults in two different agroecosystems in Italy: an olive grove in Apulia (Southern Italy) and a meadow in Piedmont (Northern Italy). Insects were marked with albumin and released during seven independent trials over 2 yr. The recapture data were pooled separately for each agroecosystem and used to estimate the dispersal kernels of P. spumarius in the olive grove and in the meadow. The diffusion coefficient estimate for P. spumarius was higher in the meadow than in the olive grove. The median distance from the release point for 1 d of dispersal was 26 m in the olive grove and 35 m in the meadow. On the basis of our model, we estimated that 50% of the spittlebug population remained within 200 m (98% within 400 m) during the 2 mo period of high abundance of the vector on olives in Apulia. The dispersal of P. spumarius is thus limited to some hundreds of meters throughout the whole year, although it can be influenced to a great extent by the structure of the agroecosystem.

The Effects of Cow-Milk Protein Supplementation in Elderly Population: Systematic Review and Narrative Synthesis.

BACKGROUND: To review currently available evidence on the effect of cow-milk proteins supplementation (CPS) on health in the elderly. METHODS: Five electronic databases (Pubmed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov) were searched for studies about CPS among older people. All types of publications were included, with the exception of systematic reviews, meta-analyses, opinion letters, editorials, case reports, conference abstracts and comments. An additional search in Google Scholar and a manual review of the reference lists were performed. RESULTS: Overall, 103 studies were included. Several studies explored the role of CPS in the preservation or improvement of muscle mass among healthy subjects (40 studies) and pre-frail, frail or sarcopenic patients (14), with evidence of beneficial effects. Other studies assessed the effect of CPS on bones (12), cardiovascular disease (8), inflamm-aging (7), chronic pulmonary disease (4), neurocognitive function (4), and vaccines (2), with weak evidence of positive effects. Seven studies in the field of protein metabolism investigated the role of CPS as an important contributor to nutritional needs. Other investigational areas are considered in the last five studies. CONCLUSIONS: The beneficial effects of CPS in achieving aged-related nutritional goals, in preserving muscle mass and in recovering after hospitalization may be particularly relevant in the elderly.

A new self-administered semi-quantitative food frequency questionnaire to estimate nutrient intake among Italian adults: development design and validation process.

Food Frequency Questionnaires (FFQs) are valuable research tools in nutritional epidemiology. This study aimed to develop and validate a new semi-quantitative FFQ, specifically designed for the Italian population and best fitted for self-administration. During the development process, we adapted to Italian needs the validated FFQ proposed by the Fred Hutchinson Cancer Research Center, revising food items, food frequency scale, portion sizes, and time frame. To assess the validity of the proposed FFQ, we compared the estimated daily intake using FFQ with the mean of 3-day food diaries and one 24-hour recall (considered as reference method). The validation process was conducted among a cohort of 51 healthy subjects enrolled in a clinical trial. Four statistical tests were applied on 23 estimated nutrient intakes. Spearman's coefficients ranged from 0.223 (sodium) to 0.748 (alcohol) and were good (≥0.50) and acceptable (0.20-0.49) for 7 and 16 nutrients, respectively. Cross classification showed a good agreement (≥50% in the same tertile or ≤10% in the opposite tertile) for 7 nutrients. The weighted Cohen's kappa values indicated an acceptable outcome (0.20-0.60) for 13 nutrients. Bland Altman plots did not show heteroscedasticity in the error terms, despite the presence of a bias. Our study provided a new Italian semi-quantitative FFQ for self-administration with an acceptable validation level. Its definitive release requires additional refinements and efforts.

Spittlebugs of Mediterranean Olive Groves: Host-Plant Exploitation throughout the Year.

Spittlebugs are the vectors of the bacterium Xylella fastidiosa Wells in Europe, the causal agent of olive dieback epidemic in Apulia, Italy. Selection and distribution of different spittlebug species on host-plants were investigated during field surveys in 2016-2018 in four olive orchards of Apulia and Liguria Regions of Italy. The nymphal population in the herbaceous cover was estimated using quadrat samplings. Adults were collected by sweeping net on three different vegetational components: herbaceous cover, olive canopy, and wild woody plants. Three species of spittlebugs were collected: Philaenus spumarius L., Neophilaenus campestris (Fallén), and Aphrophora alni (L.) (Hemiptera: Aphrophoridae). Philaenus spumarius was the predominant species both in Apulia and Liguria olive groves. Nymphal stages are highly polyphagous, selecting preferentially Asteraceae Fabaceae plant families, in particular some genera, e.g., Picris, Crepis, Sonchus, Bellis, Cichorium, and Medicago. Host-plant preference of nymphs varies according to the Region and through time and nymphal instar. In the monitored sites, adults peak on olive trees earlier in Apulia (i.e., during inflorescence emergence) than in Liguria (i.e., during flowering and beginning of fruit development). Principal alternative woody hosts are Quercus spp. and Pistacia spp. Knowledge concerning plant selection and ecological traits of spittlebugs in different Mediterranean olive production areas is needed to design effective and precise control strategies against X. fastidiosa vectors in olive groves, such as ground cover modifications to reduce populations of spittlebug vectors.

Phenology, seasonal abundance and stage-structure of spittlebug (Hemiptera: Aphrophoridae) populations in olive groves in Italy.

Spittlebugs (Hemiptera: Aphrophoridae) are the dominant xylem-sap feeders in the Mediterranean area and the only proven vectors of Xylella fastidiosa ST53, the causal agent of the olive dieback epidemic in Apulia, Italy. We have investigated the structured population phenology, abundance and seasonal movement between crops and wild plant species of both the nymphal and adult stages of different spittlebug species in olive groves. Field surveys were conducted during the 2016-2018 period in four olive orchards located in coastal and inland areas in the Apulia and Liguria regions in Italy. The nymphal population in the herbaceous cover was estimated using quadrat samplings. Adults were collected through sweep nets on three different vegetational components: herbaceous cover, olive canopy and wild woody plants. Philaenus spumarius was the most abundant species; its nymphs were collected from early March and reached a peak around mid-April, when the 4th instar was prevalent. Spittlebug adults were collected from late April until late autumn. P. spumarius adults were abundant on the herbaceous cover and olive trees in late spring, and they then dispersed to wild woody hosts during the summer and returned to the olive groves in autumn when searching for oviposition sites in the herbaceous cover. A relatively high abundance of P. spumarius was observed on olive trees during summer in the Liguria Region. The present work provides a large amount of data on the life cycle of spittlebugs within an olive agroecosystem that can be used to design effective control programmes against these vectors in infected areas and to assess the risk of the establishment and spread of X. fastidiosa to Xylella-free areas.

Update of the Scientific Opinion on the risks to plant health posed by Xylella fastidiosa in the EU territory.

EFSA was asked to update the 2015 EFSA risk assessment on Xylella fastidiosa for the territory of the EU. In particular, EFSA was asked to focus on potential establishment, short- and long-range spread, the length of the asymptomatic period, the impact of X. fastidiosa and an update on risk reduction options. EFSA was asked to take into account the different subspecies and Sequence Types of X. fastidiosa. This was attempted throughout the scientific opinion but several issues with data availability meant that this could only be partially achieved. Models for risk of establishment showed most of the EU territory may be potentially suitable for X. fastidiosa although southern EU is most at risk. Differences in estimated areas of potential establishment were evident among X. fastidiosa subspecies, particularly X. fastidiosa subsp. multiplex which demonstrated areas of potential establishment further north in the EU. The model of establishment could be used to develop targeted surveys by Member States. The asymptomatic period of X. fastidiosa varied significantly for different host and pathogen subspecies combinations, for example from a median of approximately 1 month in ornamental plants and up to 10 months in olive, for pauca. This variable and long asymptomatic period is a considerable limitation to successful detection and control, particularly where surveillance is based on visual inspection. Modelling suggested that local eradication (e.g. within orchards) is possible, providing sampling intensity is sufficient for early detection and effective control measures are implemented swiftly (e.g. within 30 days). Modelling of long-range spread (e.g. regional scale) demonstrated the important role of long-range dispersal and the need to better understand this. Reducing buffer zone width in both containment and eradication scenarios increased the area infected. Intensive surveillance for early detection, and consequent plant removal, of new outbreaks is crucial for both successful eradication and containment at the regional scale, in addition to effective vector control. The assessment of impacts indicated that almond and Citrus spp. were at lower impact on yield compared to olive. Although the lowest impact was estimated for grapevine, and the highest for olive, this was based on several assumptions including that the assessment considered only Philaenus spumarius as a vector. If other xylem-feeding insects act as vectors the impact could be different. Since the Scientific Opinion published in 2015, there are still no risk reduction options that can remove the bacterium from the plant in open field conditions. Short- and long-range spread modelling showed that an early detection and rapid application of phytosanitary measures, consisting among others of plant removal and vector control, are essential to prevent further spread of the pathogen to new areas. Further data collection will allow a reduction in uncertainty and facilitate more tailored and effective control given the intraspecific diversity of X. fastidiosa and wide host range.

Correction of presbyopia in hyperopia with a center-distance, paracentral-near technique using the Technolas 217z platform.

PURPOSE: To analyze the results of hyperopic patients treated with a peripheral presbyLASIK algorithm for the correction of presbyopia. METHODS: The study included 44 eyes of 22 hyperopic patients treated with a peripheral presbyLASIK technique using a Technolas 217z excimer laser. Mean patient age was 56 years (range: 47 to 72 years), mean preoperative spherical equivalent refraction was +1.21 +/- 0.77 diopters (D) (range: +0.50 to +4.00 D), and mean spectacle near addition was +1.76 +/- 0.42 D (range: +1.00 to +2.75 D). The Peripheral Multifocal LASIK (PML) ablation pattern creates a multifocal corneal profile over a 6.5-mm diameter, performing the distance correction first in a 6-mm optical zone and then near correction in a 6.5-mm zone. Main outcome measures were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) for near and distance, spherical equivalent refraction, contrast sensitivity, and corneal aberrations. RESULTS: Six months postoperatively, mean binocular UCVA was 1.06 +/- 0.13 for distance and 0.84 +/- 0.14 for near. Mean postoperative spherical equivalent refraction was -0.42 D (range: -1.12 to +0.87 D). Two (4.5%) eyes lost 1 line of BSCVA for distance and near vision, and 20 (45%) eyes gained 1 line of distance BSCVA. Contrast sensitivity decreased for 3, 6, 12, and 18 cycles/degree. Corneal aberration analysis showed a slight increase in coma and decrease in spherical aberration. CONCLUSIONS: The peripheral presbyLASIK technique used in this study is a safe and efficient treatment that may improve functional near vision in presbyopic patients with low and moderate hyperopia (from +0.50 to +3.00 D).