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Marine and coastal ecosystems are among the most productive environments in the world and their stocks of natural capital offer a bundle of vital ecosystem services. Anthropogenic pressure seriously threatens health and long-term sustainability of marine environments. For these reasons, integrated approaches capable of combining ecological and socio-economic aspects are needed to achieve nature conservation and sustainability targets. In this study, the value of natural capital of the Egadi Islands Marine Protected Area (EI-MPA) was assessed through a biophysical and trophodynamic environmental accounting model. The emergy value of both autotrophic and heterotrophic natural capital stocks was calculated for the main habitats of the EI-MPA. Eventually, the emergy value of natural capital was converted into monetary units to better communicate its importance to local managers and policy-makers. The total value of natural capital in the EI-MPA resulted in 1.12·10 21 sej, equivalent to about 1.17 billion of euros. In addition, using Marxan software, the results of the environmental accounting were integrated with spatial data on main human uses. This integration took into account the trade-offs between conservation measures and human exploitation by means of two different scenarios, with and without considering human uses in the EI-MPA. The comparison between the scenarios highlighted the importance of taking into account human activities in marine spatial planning (MSP), allowing the identification of key areas for natural capital conservation. In conclusion, this study showed the importance of integrating environmental accounting with conservation planning to support effective strategies for ecological protection and sustainable management of human activities. The results of this study represent a first benchmark useful to explore alternative nature conservation strategies in the EI-MPA, and, more in general, in Mediterranean MPAs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and tolerability of flunisolide given once-daily in patients with persistent asthma versus other inhaled corticosteroids given in standard multidose regimens. Patients and Methods: A total of 515 patients aged 16 to 75 years with mild to moderate asthma stabilised on multidose regimens of various inhaled corticosteroids were enrolled in an 8-week, open-label, multicentre, randomised, parallel-group study. Patients were randomised in a 4:1 ratio to receive either once-daily flunisolide (1000µg at 6pm increased if necessary up to 2000µg; n = 416) administered via AeroChamber or their previous corticosteroid regimens (triamcinolone, beclomethasone or fluticasone propionate; n = 99), which were continued on a 2- to 4-times daily basis at the previously established dosages. The transfer to once-daily flunisolide from the previous regimen was made directly without a run-in period. Results: The treatment ‘success rate’ [percentage of patients whose forced expiratory volume in 1 second (FEV) values at the study end-point were at least 90% of baseline values] was 85.7% in both treatment groups. Other efficacy parameters, including percentage predicted FEV, morning and evening peak expiratory flow rate (PEFR) values, asthma symptom scores, salbutamol (albuterol) usage, nocturnal awakenings, quality-of-life scores and global rating of change were also similar in the two groups. The incidence of drug-related adverse events such as headache, increased cough, pharyngitis, nausea and oral candidiasis were low in both groups (≤1.7% with flunisolide), and there were no notable changes in vital signs or physical examination variables in either group. The majority of patients expressed a preference for the once-daily flunisolide dosage regimen. Conclusions: Once-daily flunisolide provided asthma therapy that was at least as effective and as well tolerated as the patients' previous inhaled corticosteroid medication, indicating that individuals with mild to moderate asthma can be directly transferred to once-daily flunisolide therapy without compromising efficacy and tolerability. [ABSTRACT FROM AUTHOR]

Marine Protected Areas (MPAs) are playing a central role in the achievement of ocean sustainability and, since 2000, their global coverage has increased over ten times. The success of MPAs, and therefore the delivery of their potential outcomes for human well-being and global sustainability, requires multi-disciplinary, holistic, and comprehensive approaches for its achievement. In this study, the global scientific literature on MPAs was quantitatively reviewed through bibliometrics approaches, investigating patterns and trends in its development over time. In particular, bibliometric network and citation burst analyses of keywords were performed using VOSviewer and CiteSpace software. The bibliographic search on the Scopus and Web of Science databases resulted in a total number of 5908 and 6036 scientific documents published on MPAs. The network analysis of the keywords co-occurrence produced four main clusters whose connections and overlapping showed a multidisciplinary structure of MPA science, in which the ecological, social, and economic domains of research are strongly interlinked. Temporal analyses showed a recent focus on topics related to the social-ecological systems theory (e.g., ecosystem services, marine spatial planning, governance, and small-scale fisheries) suggesting that newer research lines recognize the importance of integrating the "human dimension" in conservation and sustainability studies. Overall, the results of both the performed bibliometric analyses pointed out the evolution of MPA science from the conventional concept of "marine reserves" to a broader scope integrating ecological, economic, and social aspects. In conclusion, MPA research is timely responding to the identification of MPAs as ocean sustainability tools, opening MPA science to multi-disciplinary research lines by linking the ecological and socio-economic dimensions of sustainability. MPA research is expected to play a crucial role in generating the interdisciplinary scientific knowledge needed to fully contribute to global ocean sustainability and human well-being. Unlabelled Image • Scientific research on MPAs is highly interdisciplinary. • MPA research evolved over time encompassing ecological and socio-economic aspects. • Over the years, human-related keywords increased in MPA scientific literature. • The human dimension plays a central role in marine conservation. • MPA research is responding to international commitments for ocean sustainability. [ABSTRACT FROM AUTHOR]

Characterized by interlinked social, economic, and ecological dynamics, Marine Protected Areas (MPAs) are a management tool for achieving sustainability goals in social-ecological systems. The recent increase in their establishment worldwide, fostered by international policies, highlights the need for comprehensive and integrated assessment frameworks able to address the evaluation of their social-ecological effectiveness and management performance, which is of fundamental importance for their adaptive management and decision making processes. Although several indicators and methodologies exist to assess MPAs ecological or social performances, no comprehensive assessment framework currently captures their broad range of objectives, encompassing the ecological, socio-cultural, and economic spheres. In this study, we present a novel quantitative framework (named MPAs Overall Success Evaluation – MOSE) able to assess the overall effectiveness and management performance of MPAs under the perspective of social-ecological systems. The multicriteria framework includes indicators linked to nature conservation, socio-cultural, socio-economic, and management objectives, integrating the multidisciplinary knowledge on MPAs in a single but comprehensive approach. The proposed framework was applied to the case study of Cerbère-Banyuls Natural Marine Reserve (France), the first MPA included in the IUCN Green List. Results showed that a high level of management effort is applied to the investigated MPA, generating several social-ecological benefits. This study showed the applicability of the MOSE framework and its potential usefulness as a tool to inform managers and decision-makers in charge for developing adaptive management strategies. Image 1 • The MPAs Overall Success Evaluation (MOSE) framework is presented. • The framework is applied to the Cerbère-Banyuls Natural Marine Reserve (France). • Results show the MPA management effort and generated social-ecological benefits. • The framework represents a useful tool for adaptive management. • Future applications will target a wide variety of MPAs at different scales. [ABSTRACT FROM AUTHOR]

Children/adolescents with cancer can develop adverse effects impacting gross motor function. There is a lack of gross motor function assessment tools that have been validated for this population. The aim of this multicenter cross-sectional study was to preliminary validate the 88-item Gross Motor Function Measure (GMFM-88) for use in children/adolescents with cancer, exploring internal consistency and floor/ceiling effect. Inclusion criteria regarded children/adolescents diagnosed with cancer on treatment or <1 year off therapy. The internal consistency was assessed using Cronbach's α, and the floor-ceiling effects were calculated through percentage. This study involved 217 participants with heterogeneous neoplasm conditions. Internal consistency was good, with a Cronbach's α of 0.989. Floor-ceiling effect analysis reveals that several items obtained a dichotomous scoring distribution in each of the five sub-scales of the GMFM-88. This can be explained by the heterogeneous clinical characteristics of the target population. The preliminary validation of GMFM-88 in a group of children/adolescents affected by cancer suggests that some items are not able to discriminate between different gross motor function levels, and therefore it does not represent an informative tool to measure gross motor function in children with cancer. Future research is needed to define which ones could be more useful for clinical practice.

In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the consensus on the rehabilitation of children and adolescents with these cancers.

Nano-vesicular carriers are promising tissue-specific drug delivery platforms. Here, biomimetic proteolipid vesicles (BPLVs) were used for delivery of glycosylphosphatidylinositol (GPI)-anchored proteins to GPI deficient paroxysmal nocturnal hemoglobinuria (PNH) cells. BPLVs were assembled as single unilamellar monodispersed (polydispersity index, 0.1) negatively charged (ζ-potential, -28.6 ± 5.6 mV) system using microfluidic technique equipped with Y-shaped chip. GPI-anchored and not-GPI proteins on BPLV surface were detected by flow cytometry. Peripheral blood mononuclear cells (PBMCs) from healthy and PNH subjects were treated with BPLVs (final concentration, 0.5 mg/mL), and cells displayed an excellent protein uptake, documented by flow cytometry immunophenotyping and confocal microscopy. BPLV-treated cells stressed with complement components showed an increased resistance to complement-mediated lysis, both healthy and PNH PBMCs. In conclusion, BPLVs could be effective nanocarriers for protein transfer to targeted cells to revert protein deficiency, like in PNH disease. However, further in vivo studies are required to validate our preclinical in vitro results., Competing Interests: The Authors V.G., P.S., E.P.L., G.D.P., and C.S. disclose a patent no. 102023000015003 (18/07/2023)., (© 2024 The Author(s).)

Background: Anorexia Nervosa (AN) poses significant therapeutic challenges, especially in cases meeting the criteria for Severe and Enduring Anorexia Nervosa (SE-AN). This subset of AN is associated with severe medical complications, frequent use of services, and the highest mortality rate among psychiatric disorders., Case Presentation: In the present case series, 14 patients were selected from those currently or previously taken care of at the Eating Disorders Outpatients Unit of the Maggiore Hospital in Bologna between January 2012 and May 2023. This case series focuses on the effects of the disease, the treatment compliance, and the description of those variables that could help understand the great complexity of the disorder., Conclusion: This case series highlights the relevant issue of resistance to treatment, as well as medical and psychological complications that mark the life course of SE-AN patients. The chronicity of these disorders is determined by the overlapping of the disorder's ego-syntonic nature, the health system's difficulty in recognizing the problem in its early stages, and the presence of occupational and social impairment., (© 2023. The Author(s).)

Gambling disorder (GD) is a psychiatric disease that has been recently classified as a behavioural addiction. So far, a very few studies have investigated the alteration of functional connectivity in GD patients, thus the concrete interplay between relevant function-dependent circuitries in such disease has not been comprehensively assessed. The aim of this research was to investigate resting-state functional connectivity in GD patients, searching for a correlation with GD symptoms severity. GD patients were assessed for gambling behaviour, impulsivity, cognitive distortions, anxiety and depression, in comparison with healthy controls (HC). Afterwards, they were assessed for resting-state functional magnetic resonance imaging; functional connectivity was assessed through a data-driven approach, by using independent component analysis. The correlation between gambling severity and the strength of specific resting-state networks was also investigated. Our results show that GD patients displayed higher emotional and behavioural impairment than HC, together with an increased resting state functional connectivity in the network including anterior cingulate cortex, the caudate nucleus and nucleus accumbens, and within the cerebellum, in comparison with the control group. Moreover, a significant correlation between behavioural parameters and the strength of the resting-state cerebellar network was found. Overall, the functional alterations in brain connectivity involving the cerebellum observed in this study underpin the emotional and behavioural impairment recorded in GD patients. This evidence suggests the employment of novel neuromodulatory therapeutic approaches involving specific and salient targets such as the cerebellum in addictive disorders., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.

Background: Mometasone furoate (MF) is a new inhaled glucocorticoid administered by dry powder inhaler (DPI)., Objective: MF-DPI was evaluated for safety and efficacy and compared with placebo DPI and beclomethasone dipropionate (BDP) administered by metered dose inhaler (MDI) in the treatment of patients with moderate persistent asthma., Methods: Eligible patients (n = 227), 13 to 75 years of age, maintained on inhaled glucocorticoids before entering the trial, were randomized to receive: MF-DPI, 100 microg, twice daily, MF-DPI, 200 microg, twice daily, BDP MDI, 168 microg, twice daily, or placebo in a 12-week, multicenter, double-blind study., Results: At endpoint, FEV1 (primary efficacy variable) significantly improved for all three active treatments compared with placebo (P < .01, all comparisons). The response to MF-DPI, 200 microg, twice daily treatment was approximately twice as large as the response to MF-DPI, 100 microg, twice daily or BDP MDI treatment, although the differences between these groups did not reach statistical significance. Secondary efficacy variables including PEFR, asthma symptoms, nocturnal awakenings, and albuterol use showed similar trends. The MF-DPI, 100 microg, twice daily and BDP MDI, 168 microg, twice daily treatment groups produced comparable results for all efficacy variables., Conclusions: MF-DPI, 100 microg and 200 microg, twice daily were well-tolerated and significantly improved lung function and symptom control in the treatment of patients with moderate persistent asthma. In this study, MF-DPI, 200 microg, twice daily seemed to be the most effective dosage.

Crude cockroach extract elicited positive skin tests in 50% of patients with positive and in 4% with negative environmental history for cockroach exposure, suggesting a possible role of cockroach in perennial atopic disease. Three major allergens in crude American and German cockroach extracts have been identified using sequential purification steps on Sephadex G-75, diethylaminoethyl (DEAE) cellulose, and agarose gel electrophoresis. Cr-I elicits positive skin tests in 70% of patients sensitive to the crude extracts. It has a molecular weight of approximately 25,500 daltons, is highly acidic, and resists boiling for four hours. Boiling in 4 N acetic acid completely abolishes its allergenicity. The purified allergen elicits positive skin tests at a concentration of 3 mug/ml and is capable of inducing greater than 50% histamine release from sensitive leukocytes at 0.05 ng/ml. A second antigen, Cr-II, elicits positive skin tests also in approximately 70% of cockroach-sensitive individuals, has a molecular weight of approximately 63,000 to 65,000 daltons, and has similar heat stability and acid hydrolysis characteristics to Cr-I. A third, less well-characterized antigen, Cr-III, has a molecular weight less than 10,000 daltons and elicits positive skin tests in 30% of individuals sensitive to the crude extract.

Vascular tissues from uremic patients show increased prostaglandin synthesizing capacity while uremic platelets have decreased thromboxane synthesis. It has been suggested that the platelet defects in uremia are partially corrected by hemodialysis and a correlation with the levels of guanidinsuccinic acid, phenolic acid, creatinine or urea has been demonstrated. In our study 6 patients with end-stage renal disease on RHT, underwent, daily and for ten days, two-hours hemoperfusion, in order to obtain lower levels of toxic metabolites such as creatinine (less than 6 mg/dl.). Before and after this intensive treatment we have evaluated BTG plasmatic levels and thromboxane formation by platelets after thrombin and arachidonic acid stimulation. The thromboxane formation was not increased following this treatment, whereas BTG plasmatic levels were significantly diminished.

6 patients with end-stage renal disease underwent hemoperfusion with charcoal columns, for 60 min. Blood samples anticoagulated with 2% EDTA/aspirin solution were obtained from arteriovenous fistulas in the basal condition, 5 min after a bolus injection of heparin (7,500 U), at the end of hemoperfusion, and 30 min after. The study was repeated few days later, in the same patients, two hours after 100 mg aspirin by mouth. TXB2 and 6-keto-PGF1 alpha were assayed with RIA in unextracted (U) and extracted (E) and chromatographed platelet poor plasma (PPP). Platelet counts before and after hemoperfusion were also performed. Low levels of the two prostaglandins were found in plasma; this could be related to the procedures for collection and processing of plasma samples; no significant differences were observed between extracted and unextracted samples: there were slightly higher levels of 6-keto-PGF1 alpha in unextracted samples. After charcoal hemoperfusion there was only a slight and not significant increase of TXB2 and 6-keto-PGF1 alpha; low dose aspirin did not modify significantly plasma levels of the two prostaglandins before hemoperfusion but it reduced TXB2 and 6-keto-PGF1 alpha levels after charcoal hemoperfusion. The platelet count fell (-22%) after charcoal hemoperfusion with heparin alone and in similar manner after low-dose aspirin pretreatment (-24%, 7%).

Scleroderma is a chronic disease of unknown origin characterized by diffuse sclerosis of the connective tissue of the integument and other organs. As in systemic lupus erythematosus (SLE), rheumatoid arthritis and dermatomyositis, a variety of antibodies may be found in the serum, suggesting that immune mechanisms may be involved. In two uremic patients with scleroderma, the effects were studied of the removal, by pheresis, of antinuclear antibodies, immune complexes, and immunoglobulin factors perpetuating the inflammatory response. We used a membrane plasmapheresis with a hollow-fiber type plasmafilter (Plasmaflo, Asahi) connected online with a hemofilter for conventional dialysis. The aim of this preliminary study was to induce a remission of the edematous inflammatory phase. The correlation of a improvement in clinical response and a decrease in the levels of immune complexes or other factors of inflammation was observed. In our view membrane-plasmapheresis is a process safely carried out by the hemodialysis staff and it may be of clinical effectiveness, especially, in patients with life-threatening complications of progressive systemic sclerosis.