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The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals.

The efficiency of an outdoor pilot-scale raceway pond treating the wastewaters generated by a large-scale piggery farm in Northern Italy was evaluated. The biomass productivity over 208 days of experimentation was 10.7 ± 6.5 g TSS·m−2·d−1, and ammoniacal nitrogen, orthophosphate, and COD average removal efficiencies were 90%, 90%, and 59%, respectively. Results were used to perform a comprehensive techno-economic analysis for integrating algae-based processes in farms of different sizes (100–10000 pigs). The amount of N disposed of on agricultural land could be reduced from 91% to 21%, increasing the fraction returned to the atmosphere from 2.4% to 63%, and the fraction in the biomass from 6.2% to 16%. For intensive farming, the release of 110 t N·ha−1·y−1 contained in the digestate could be avoided by including algae-bacteria processes. The biomass production cost was as low as 1.9 €·kg−1, while the cost for nitrogen removal was 4.3 €·kg N−1.

The current epidemics of cardiovascular and metabolic noncommunicable diseases have emerged alongside dramatic modifications in lifestyle and living environments. These correspond to changes in our ”modern” postwar societies globally characterized by rural-to-urban migration, modernization of agricultural practices, and transportation, climate change, and aging. Evidence suggests that these changes are related to each other, although the social and biological mechanisms as well as their interactions have yet to be uncovered. LongITools, as one of the 9 projects included in the European Human Exposome Network, will tackle this environmental health equation linking multidimensional environmental exposures to the occurrence of cardiovascular and metabolic noncommunicable diseases.

Activated carbon pre-treatment was applied to anaerobic digestion effluent in order to reduce the optical density. Up to 78% reduction of OD was achieved suggesting activated carbon pre-treatment a promising tool to increase the light transmission of agricultural digestate. The pre-treated digestate was applied for microalgae cultivation as a source of nutrients and compared to the untreated diluted digestate. Microalgae growth was similar at the first period of cultivation in pre-treated and diluted untreated digestate. However, at the other part of the cultivation higher growth rate and biomass accumulation in untreated digestate was observed. We discuss the possibility of too high nutrient load in pre-treated digestate that may have limited the microalgae growth. PAM measurements showed no stress from the substrate highlighting that activated carbon pre-treated digestate is a suitable medium for microalgae growth. Moreover, vitality of cultures in pre-treated PBRs dropped at the end of the cultivation suggesting some inhibitory effect may be present. Results of current study demonstrate that activated carbon holds a great potential for agricultural digestate pre-treatment to decrease the optical density., Proceedings of the 29th European Biomass Conference and Exhibition, 26-29 April 2021, Online, pp. 124-131

This study provides deeper insights on our knowledge of the 847 AD earthquake that struck a large area in Central-Southern Italy causing diffuse damages in northern Campania, Molise, and Latium. Through the integration of archaeoseismic observations, geological and geophysical surveys together with a critical review of historical written sources, it was possible to identify evidence of seismic effects on ancient Medieval buildings or structures uncovered during archaeological excavations.

In the past 30 years several studies have proved that the rivers flow regime is fundamental in structuring biotic communities. The condition of the ecosystem results from the occurrence of extreme events, such as floods and droughts, but also from habitat availability and from its temporal variation. Describe the relationships between macroinvertebrate community characteristics and environmental gradients of flow, temperature, nutrient supplies and habitat conditions is fundamental to understand ecological dynamics. This is the basis for predicting changes within the communities and in ecosystem functions and ultimately to properly manage and conserve the riverine ecosystems. Seven sites, along a 20-km river sector, were surveyed for macroinvertebrates and water chemistry seasonally, from 2012 to 2016. Habitat conditions were assessed along a 500 m stretch in each site. The river discharge was continuously monitored by two water level recorders and used to reconstruct various hydrological indices specific for each sampling location. During the sampling period numerous high flow events and some prolonged periods of low flow were observed. Quantile regression was used to describe the effects of potential limiting factors on macroinvertebrate community which were primarily driven by antecedent flow conditions and season while habitat conditions and water chemistry played only a minor role. Quantitative models have been developed to predict structural and functional characteristics of macroinvertebrate community as a function of antecedent flow conditions, habitat and physico-chemical water characteristics. Those models allow to identify the main drivers and predict the effect of different water management strategies to riverine ecosystem.

In 2010 a questionnaire was administered to the renal units of Piedmont and Valle d'Aosta to analyze their procedures for renal biopsy (RB). Seventy-eight percent of units performed RBs, 57% for more than 20 years, but only 43% performed at least 20 BRs per year. 20/21 units performed RB in an inpatient setting and 1/21 in day hospital with the patient remaining under observation the night after. Thirty-two percent did not consider a single kidney as a contraindication to RB, 59% considered it a relative contraindication and 9% considered it an absolute contraindication. In 90.5% of units there was a specific protocol for patient preparation for RB and 86% used a specific informed consent form. Ninety-five percent of units performed ultrasound-guided RB, 60% of them using needle guides attached to the probe. In 81% of units the left side was preferred; 71% put a pillow under the patient's abdomen. All units used disposable, automated or semi-automated needles. Needle size was 16G in 29%, 18G in 58%, and both 16G and 18G in 14% of units; 1 to 3 samples were drawn. One third of units had a microscope available for immediate evaluation of specimen adequacy. After RB, 86% of units kept patients in the prone position for 2-6 hours and all prescribed a period of bed rest (at least 24 hours in 90.5%). 90.5% of units followed a specific postbiopsy observation protocol consisting of blood pressure, heart rate and red blood cell measurements at different times, and urine monitoring and ultrasound control within 12-24 hours (only half of them also employing color Doppler). One third of all units discharged patients after 1 day and two thirds after 2-3 days; all prescribed abstention from effort and from antiplatelet drugs for 7-15 days. In 9 units both RB and tissue processing and examination were done in the same hospital, while 12 units sent the samples elsewhere. 76% obtained results in 2-4 days, 19% in 6-7 days, and 5% in 10-15 days. Less than 20% of the interviewed operators were fully familiar with the clauses of hospital insurance securing their activity. Use of RB is widespread in Piedmont and Valle d'Aosta but its practice shows variation between centers.

The integration of microalgae-bacteria consortia within existing wastewater treatment plants as alternative biological treatment could be an interesting option to improve the sustainability of these facilities. However, the fate of the produced biomass is decisive to make that option economically attractive. The present study aimed to valorize the microalgae grown at a pilot scale and used for the treatment of the centrate from municipal sewage sludge, producing microalgal-based iron nanoparticles (ME-nFe), by hydrothermal carbonization. The final product had high carbon content, strong sorbent power, and reducing properties, due to the presence of zerovalent iron. Different synthesis conditions were tested, comparing iron (III) nitrate nonahydrate (Fe (NO3)3·9H2O) and ammonium iron (III) sulfate dodecahydrate (NH4 Fe (SO4)2·12 H2O) as iron sources, four different Fe/C molar ratios (0.02, 0.05, 0.1, 0.2), and three process temperatures (180, 200, 225 °C). Based on the characterization of all the prototypes, the best one (having a specific area of 110 m2g−1) was chosen and tested for the removal of selected heavy metals by Jar tests. The removal of copper, zinc, cadmium, and nickel from the treated effluent from the wastewater treatment plant was 99.6%, 97.8%, 96.4%, and 80.3%, respectively, also for very low starting concentrations (1 mg L−1). The removal of total chromium, on the contrary, was only 12.4%. Thanks to the magnetic properties, the same batch of ME-nFe was recovered and used effectively for three consecutive Jar tests.

Introduction: Breast cancer (BC) is one of the most common tumors; better screening policies and multidisciplinary approach allow personalized treatment. Radiotherapy (RT) plays a central role in the multimodal approach in BC, and recent evidence has shown the non-inferiority of hypofractionated treatments. The aim of this study was to describe the feasibility and validity of stereotactic RT (SBRT) in BC in a neoadjuvant and exclusive setting. Methods: A PubMed/MEDLINE and Embase systematic review was conducted to assess the role of radiomics in BC. The search strategy was “breast [All Fields] AND “stereotactic” [All Fields] AND “radiotherapy” [All Fields]” and only original articles referred to BC in humans in the English language were considered. Results: A total of 2,149 studies were obtained using the mentioned search strategy on PubMed and Embase. After the complete selection process, a total of 12 papers were considered eligible for the analysis of the results. SBRT in BC was described in 8 studies regarding neoadjuvant approach and 4 papers regarding exclusive approach. Conclusions: Relative low toxicity rates, the reduced treatment volumes in the neoadjuvant setting, and the possibility to replace surgery when not feasible in exclusive setting resulted to be main advantages for SBRT in BC. Current evidence shows that both the neoadjuvant and the definitive settings seem to be promising clinical scenarios for SBRT, especially for EBC.

The use of phototrophic organisms in wastewater treatment is gaining increasing interest, due to the possibility of exploiting photosynthetic oxygenation, thus lowering treatment costs and environmental impacts. Mixed consortia of phototrophic organisms and aerobic bacteria rapidly develop in photobioreactors receiving wastewaters; in this case, the complex mutualistic interactions among microorganisms cannot be easily described, making difficult to forecast removal efficiencies and biomass productivities. Respirometric methods are applied for evaluating bacterial activity in activated sludge (conventional respirometry) or photosynthetic activity in phototrophic organisms (photorespirometry). Photo-respirometric methods can be also exploited for monitoring algae-bacteria systems and for calibrating mathematical models, allowing for a better comprehension of the interactions involved and a more accurate prediction of system efficiencies. A general protocol and a series of guidelines for conducting photorespirometric tests on algal-bacterial suspensions are here proposed, based on the review of experimental protocols applied to evaluate the effects of several parameters on these systems.

The integration of microalgae in the municipal wastewater treatment scheme could certainly be an interesting option to reduce the carbon footprint of the process. The obtained microalgae could be valorized through hydrothermal carbonization (HTC), producing a sorbent material to be used as an alternative to activated carbon. However, HTC of microalgae does produce potentially harmful byproducts. The present work aims to investigate the possibility of using the effluent derived from the hydrothermal carbonization of microalgae (HTC-LF), performed to produce microalgal-based carbon encapsulated iron nanoparticles (ME-nFe), as a growth medium for the microalgae. Since this raw effluent was proved to be toxic for Allivibrio fisheri (EC50 = 1.8 %), the microalgal activity was studied also for detoxification. A 20 % dilution of the HTC-LF, using municipal centrate as the diluent, was proved to be suitable for microalgal growth without affecting the photochemical efficiency. In a continuous test, a community made of Chlorella spp. and Euglena gracilis was able to grow with and without CO2 addition, with average productivity of 62 +/- 5 and 43 +/- 8 mg L-1 d(-1), respectively. The treatment led to a 60 % COD removal, suggesting that the HTC-LF was not harmful to the microalgae-bacteria consortia, which was also able to decrease its toxicity. Environmental implications: The liquid byproduct of the hydrothermal carbonization (HTC-LF) is a known toxic for the water compartment. The possibility to exploit its nutrient content for microalgal growth was already proved by different studies using strong dilution with synthetic medium to perform batch cultivations. Here, the HTC-LF was diluted with the blackwater from biosolid dewatering, without adding any microelements or main nutrients to perform a continuous cultivation. A microalgal community was grown, consuming nutrients and the COD, lowering the toxicity. The obtained biomass was used to produce second-generation nano -particles, designing our process as a cycle in an eco-sustainable way.

Recent literature on the mental health consequences of social distancing measures has found a substantial increase in self-reported sleep disorders, anxiety and depressive symptoms during lockdown periods. We investigate this issue with data on monthly purchases of psychotropic drugs from the universe of Italian pharmacies during the first wave of the COVID-19 pandemic and find that purchases of mental health-related drugs have increased with respect to 2019. However, the excess volumes do not match the massive increase in anxiety and depressive disorders found in survey-based studies. We also study the interplay between mobility, measured with anonymized mobile phone data, and mental health and report no significant effect of mobility restrictions on antidepressants and anxiolytics purchases during 2020. We provide three potential mechanisms that could drive the discrepancy between self-reported mental health surveys and psychotropic drugs prescription registries: (1) stockpiling practices in the early phases of the pandemic; (2) the adoption of compensatory behavior and (3) unexpressed and unmet needs due to both demand- and supply-side shortages in healthcare services.

Melanoma is an extremely aggressive tumor and is considered to be an extremely immunogenic tumor because compared to other cancers it usually presents a well-expressed lymphoid infiltration. The aim of this paper is to perform a multidisciplinary comprehensive review of the evidence available about the combination of radiotherapy and immunotherapy for melanoma. Radiation, in fact, can increase tumor antigens visibility and promote priming of T cells but can also exert immunosuppressive action on tumor microenvironment. Combining radiotherapy with immunotherapy provides an opportunity to increase immunostimulatory potential of radiation. We therefore provide the latest clinical evidence about radiobiological rationale, radiotherapy techniques, timing, and role both in advanced and systemic disease (with a special focus on ocular melanoma and brain, liver, and bone metastases) with a particular attention also in geriatric patients. The combination of immunotherapy and radiotherapy seems to be a safe therapeutic option, supported by a clear biological rationale, even though the available data confirm that radiotherapy is employed more for metastatic than for non-metastatic disease. Such a combination shows promising results in terms of survival outcomes; however, further studies, hopefully prospective, are needed to confirm such evidence.

Phytobenthos is the dominant primary producer in streams and sustains, with the allochthonous organic matter inputs, the higher trophic levels. Among the different groups that constitute the phytobenthos community some, especially diatoms, have been studied deeply while others remain quite overlooked. Hence, a characterisation of the overall phytobenthos community is needed, considering all the main taxonomic groups (diatoms, green algae, cyanobacteria and red algae), as related to the environmental conditions characterizing different alpine streams. Moreover, despite the ecological role played by the phytobenthos the knowledge about the factors that control the variations of the community among streams and throughout the different seasons is still poor. Among the different drivers that regulate the phytobenthos component, a pivotal factor is the occurrence of high-flow events that, controlling the stability of riverbed substrates, influences both the phyto and the zoobenthos composition and distribution. Thus, the frequency and the magnitude of flow disturbances are determinant in regulating the phytobenthos density and the recolonization patterns. The aim of this work was to characterize and compare the phytobenthos communities in different streams highlighting the role of the flow regulation due to hydropower reservoirs accounting for the influence of the lithology and the seasonality. The presented phytobenthos data derive from a one-year sampling campaign in four alpine streams representative of different flow conditions (natural vs regulated flow discharge) and lithology (silicate vs carbonate). The riverbed coverage has been estimated monthly in each stream and the biomass has been quantified. In lab, phytobenthos samples have been analysed to measure the photosynthetic activity and define their composition. The main groups (cyanobacteria, green algae, diatoms and algae with phycoerythrin) have been determined both by phyto-PAM deconvolution and by the quantification of the photosynthetic pigments. In order to estimate the bed disturbance, painted stones of different size classes were located in regular arrays along three transversal transects and the distance travelled was measured during every sampling. The preliminary results indicate that regulated streams seem characterized by a greater algae biomass possibly due to a more stable environment. Concerning the community composition, the percentage of diatoms is significatively higher in silicate substrates. Despite the few hours of light, winter promotes phytobenthos colonisation especially for the low frequency of relevant high-flow events but also for the absence of the shadow due to tree canopy on the riverbed.

Alpine and pre-alpine lotic ecosystems are often remote and not affected by humans, which makes them some of the world’s most pristine ecosystems. However, their status is often altered by the presence of reservoirs that are built to fulfill agricultural needs and hydroelectric demands. These reservoirs also disrupt stream continuity and alter the magnitude, timing, and frequency of natural flows. The present work assessed how high-altitude reservoirs affect the riverine ecosystems focusing on the following: (i) the macroinvertebrate communities, (ii) the breakdown of organic matter, and (iii) the thermal regime. Stretches altered by high-altitude reservoirs had the best conditions for most macroinvertebrate families due to a more stable flow conditions. The breakdown rate of coarse particulate organic matter was not affected by high-altitude reservoirs but its availability was higher in altered compared to pristine stretches. The presence of hydroelectric power plants modified the stream thermal regime. Reservoirs mitigate the atmospheric influence on stream water temperature while run of the river plants strengthen it in the diverted stretches. Where both these alterations were present, the thermal regime of the stream was more similar to the natural ones compared to stretches subjected to only one kind of alteration. This research showed how river impoundment alters the structure of macroinvertebrate communities and the function of the downstream lotic ecosystems and can provide the basis to correctly guide management strategies for lotic ecosystems affected by hydrological alterations.

Tetraselmis suecica was cultivated in a semi-continuously operated tubular photobioreactor fed on aquaculture wastewater (AW) testing two hydraulic retention times (HRT): 10 and 7 days (RUN_1 and RUN_2, respectively). The integrated mechanistic model BIO_ALGAE was validated with experimental data in order to simulate the biomass production and nutrient uptake of T. suecica. Moreover, AW was used as substitute synthetic cultivation medium to test the production of lipids, proteins, and carbohydrates in the microalgal biomass. Preliminary photo-respirometric tests were carried out on the AW suspension containing microalgae and bacteria. Dissolved Inorganic Nitrogen (DIN) and Dissolved Inorganic Phosphorus (DIP) were analyzed for the two RUNs, and no significant difference was highlighted (p > 0.05). On the contrary, the productivity of the Total suspended solids (TSS) was significantly higher (p < 0.05) for RUN_1 (900 mg TSS/L) than for RUN_2 (550 mg TSS/L). The analysis of the biochemical composition of biomass has demonstrated a higher content of proteins than of lipids and carbohydrates for the two RUNs. BIO_ALGAE model was validated by comparing simulated results to experimental data. The model was able to reproduce the pattern of these experimental data quite well, for both nutrient uptake and biomass production. The simulated curve follows the same pattern as the experimental data for both RUNs. The wavelike trend indicates the good accuracy of the simulated curves to reproduce the microalgae growth and nutrient uptake that occurring during daytime and at night. With this study, BIO_ALGAE Model was demonstrated to be useful to simulate bioremediation and microalgae production in aquaculture wastewater in a semi-continuous system with different environmental factors. The photo-respirometric outputs were compared with the process rates affecting dissolved oxygen dynamics computed by the mathematical model. The authors would like to thank the Italian Ministry of University and Research (MIUR) and Fondazione Cariplo, for funding part of this research (“Vademecum” and “Il polo delle microalghe” projects) and Dr. Nadia Margariti for her valuable help in laboratory.

Milk whey processing wastewaters (MWPWs) are characterized by high COD and organic nitrogen content, the concentrations of phosphorus are also relevant. A microalgal-based process was tested at lab scale in order to assess the feasibility of treating MWPW without any dilution or pre-treatment. Different microalgal strains and populations were tested. Based on the obtained results, Scenedesmus acuminatus (SA) and a mixed population (PM) chiefly made of Chlorella, Scenedesmus, and Chlamydomonas spp. were grown in duplicate for 70 days in Plexiglas column photobioreactors (PBRs), fed continuously (2.5 L culture volume, 7 days hydraulic retention time). Nutrient removal, microalgae growth, photosynthetic efficiency, and the composition of microalgal populations in the columns were monitored. At steady state, the microalgal growth was similar for SA and PM. The average removal efficiencies for the main pollutants were: 93% (SA), 94% (PM) for COD, 88% (SA) and 90% (PM) for total N, and 69% (SA) and 73% (PM) for total P. The residual pollution levels in the effluent from the PBRs were low enough to allow their discharge into surface waters, such good results were achieved thanks to the synergy between the microalgae and bacteria in the CO2 and oxygen production/consumption and in the nitrogen mineralization.