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The study documents the presence of the box jellyfish Carybdea marsupialis in the waters of the Ionian Sea in Italy, which constitutes important data for the knowledge of new areal distribution of this species along the coasts of the Mediterranean basin. Carybdea marsupialis belongs to the phylum Cnidaria, class Cubozoa, and is known for its stinging and potentially dangerous stings for humans, making it a species of significant ecological and health interest. The species has previously been observed in other areas of the western Mediterranean, but the report in the Ionian Sea represents an eastward expansion of its distribution range. Results suggest that climate change, influenced by global warming processes and anthropogenic activities, facilitated the expansion of this species into the rest of the Mediterranean Sea. The work highlights the importance of continuous monitoring of indigenous and non-indigenous species and calls for international cooperation to manage any ecological impacts linked to the spread of these marine species.

New individuals of Porpita porpita were detected along the Italian coasts of the Mediterranean Sea. In recent years, due to warming Mediterranean waters, the species has spread even further. This observation opens new horizons for further reports of this species in the Ionian and Tyrrhenian Seas of Italy.

Abstract Background Currently, there is no consensus on the optimal management of women with low prognosis in ART. In this Delphi consensus, a panel of international experts provided real-world clinical perspectives on a series of literature-supported consensus statements regarding the overall relevance of the POSEIDON criteria for women with low prognosis in ART. Methods Using a Delphi-consensus framework, twelve experts plus two Scientific Coordinators discussed and amended statements and supporting references proposed by the Scientific Coordinators (Round 1). Statements were distributed via an online survey to an extended panel of 53 experts, of whom 36 who voted anonymously on their level of agreement or disagreement with each statement using a six-point Likert-type scale (1 = Absolutely agree; 2 = More than agree; 3 = Agree; 4 = Disagree; 5 = More than disagree; 6 = Absolutely disagree) (Round 2). Consensus was reached if > 66% of participants agreed or disagreed. Results The extended panel voted on seventeen statements and subcategorized them according to relevance. All but one statement reached consensus during the first round; the remaining statement reached consensus after rewording. Statements were categorized according to impact, low-prognosis validation, outcomes and patient management. The POSEIDON criteria are timely and clinically sound. The preferred success measure is cumulative live birth and key management strategies include the use of recombinant FSH preparations, supplementation with r-hLH, dose increases and oocyte/embryo accumulation through vitrification. Tools such as the ART Calculator and Follicle-to-Oocyte Index may be considered. Validation data from large, prospective studies in each POSEIDON group are now needed to corroborate existing retrospective data. Conclusions This Delphi consensus provides an overview of expert opinion on the clinical implications of the POSEIDON criteria for women with low prognosis to ovarian stimulation.