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Even if the sensitivity of vegetation phenology to climate change has been accepted on global and continental scales, the correlation between global warming and phenotypic variability shows a modulated answer depending on altitude, latitude, and the local seasonal thermal trend. To connect global patterns of change with local effects, we investigated the impact of the observed signal of warming found in Central Italy on two different willow species, Salix acutifolia and Salix smithiana, growing in three phenological gardens of the International Phenological Gardens' network (IPG) located in different orographic positions. The time series of temperatures and phenological data for the period 2005–2018 were analysed first to find trends over time in the three gardens and then to correlate the recent local warming and the change in the two species phenology. The results confirmed the correlation between phenological trends and local trend of temperatures. In particular: budburst showed a trend of advancement of 1.4 days/year on average in all three gardens; flowering showed a divergent pattern between the gardens of either advancement of 1.0 days/year on average or delay of 1.1 days/year on average; while senescence showed a delay reaching even 3.3 days/year, although significant in only two gardens for both species. These trends were found to be correlated mainly with the temperatures of the months preceding the occurrence of the phase, with a shift in terms of days of the year (DOY) of the two species. Our conclusion is that the observed warming in Central Italy played a key role in controlling the phenophases occurrences of the two willow species, and that the orographic forcing leads to the different shift in DOY of phenophases (from 5 to 20 days) due to the local thermal forcing of the three phenological gardens. [ABSTRACT FROM AUTHOR]

ABSTRACT Phenological investigations that adopt aerobiological monitoring methodologies are frequently used for species that rely on the wind for pollen grain dispersion, such as the olive in the Mediterranean basin. The present study of olive flowering dates was carried out in the Calabria region (southern Italy). These were calculated on the basis of a phenological study of pollen levels in the atmosphere in three typical olive-growing areas over an 11 year study period (1999-2009). This phenological method provides olive flowering maps that are based on temperatures (as the growing degree days: GDDs), which are highly correlated with the release of the pollen grains. According to the model developed, the average GDDs corresponding to the flowering dates were calculated for the baseline period of 1981-2000. Moreover, with the use of meteorological data derived from the Intergovernmental Panel on Climate Change scenarios, the future olive flowering dates are estimated for the 20 year period from 2081 to 2100. The close relationships between the spring temperature trends and the reproductive phenological phases in the olive are highly sensitive to climatic change, which has implications in terms of potential latitude and altitude shifts in the olive cultivation areas. In some cultivation areas in southern Italy, the present particular combination of microclimate, soil status and level of erosion is considered as limiting to regular vegetative plant development. However, the use of olive cultivars that are specifically adapted to extremely stressful environments, in terms of high temperatures and water deficit, might represent the main solution for the mitigation of the consequences of climatic change. [ABSTRACT FROM AUTHOR]

In phenological studies, the plant developments are analysed considering their relationships with seasonal meteorological conditions; moreover, the influences of geographical features on biological responses have to be also considered. Different studies analysed the influence of latitude on phenological phases to investigate the possible different magnitude of biological response. In our experience, this type of geographic evaluation was conducted considering one of the more important plant species of Mediterranean shrub, the olive ( Olea europaea L.) in fifteen olive monitoring stations, four located in Tunisia and eleven in Italy, from the southern Zarzis area at 33° to the northern Perugia area at 43° of latitude. The olive flowering phenomenon was studied, utilising an aerobiological monitoring method through appropriate pollen traps located inside olive groves from 1999 to 2008. The olive monitored pollen grains were recognised and evaluated to obtain daily pollen concentrations to define the flowering dates in the different study areas. The biometeorological statistical analysis showed the 7°C threshold temperature and the single triangle method for growing degree days (GDD) yearly computing as the better ones in comparison to others. Moreover, the regression analysis between the dates of full flowering and the GDD amounts at the different monitoring latitudes permitted us to evidence the biological response of olive species in geographic regions with different climate patterns. The specific biological response at different latitude was investigated, the slope results, as flowering days per heat amounts, evidenced that olive species behaviours are very constant in consequence to similar meteorological conditions independently to latitude variations. Averagely, the relationships between plant's phenology, temperature trends and geographical features are very close, even if the yearly mesoscale meteorological variations force to consider, year by year, phenological advances or delays as local events. [ABSTRACT FROM AUTHOR]

Phenology data are sensitive data to identify how plants are adapted to local climate and how they respond to climatic changes. Modeling flowering phenology allows us to identify the meteorological variables determining the reproductive cycle. Phenology of temperate of woody plants is assumed to be locally adapted to climate. Nevertheless, recent research shows that local adaptation may not be an important constraint in predicting phenological responses. We analyzed variations in flowering dates of Olea europaea L. at different sites of Spain and Italy, testing for a genetic differentiation of flowering phenology among olive varieties to estimate whether local modeling is necessary for olive or not. We build models for the onset and peak dates flowering in different sites of Andalusia and Puglia. Process-based phenological models using temperature as input variable and photoperiod as the threshold date to start temperature accumulation were developed to predict both dates. Our results confirm and update previous results that indicated an advance in olive onset dates. The results indicate that both internal and external validity were higher in the models that used the photoperiod as an indicator to start to cumulate temperature. The use of the unified model for modeling the start and peak dates in the different localities provides standardized results for the comparative study. The use of regional models grouping localities by varieties and climate similarities indicate that local adaptation would not be an important factor in predicting olive phenological responses face to the global temperature increase. [ABSTRACT FROM AUTHOR]

Phenological observations in olive tree (Olea europaea L.), on the first reproductive phase (budburst) and the winter chilling temperatures required for its onset, were analysed over a 4-year period (1998-2001). Research was carried out on two different cultivars growing in two Mediterranean olive-growing areas: `Ascolana' in central Italy and `Picudo' in southern Spain. The two main objectives of the study were: (1) to evaluate the different amounts of winter chilling, and their relationship with the budburst dates in outdoor olive plantations; and (2) to test the validity in the study areas of two chilling calculation methods, the Aron and the Utah method. Results show that for the Spanish cultivar the average chilling requirement of 997 h was approximately half of that recorded for the Italian cultivar (1848 h). Also, the year-to-year variability in chilling accumulation and the reproductive development date was observed to be higher in the Spanish area than in the Italian one, indicating a more consistent and predictable winter chilling response in the latter. As regards the validity of the methods, the Aron method seems to be more appropriate for use in warmer places, since it yielded better results in the Spanish site. [ABSTRACT FROM AUTHOR]

Plants have always been able to adapt to climate change by reacting through various responses, mainly at the phenological level. The aim of this work is to investigate the behavior of specific tree species located in two phenological gardens in central Italy in relation to the temperature increases recorded in recent years. Specifically, four main phenological phases, BBCH_11, BBCH_19, BBCH_91, and BBCH_65, were monitored during a 14-year time period. The data of the weeks corresponding to the first appearance of each phenological phase and the respective heat accumulations for each species were cross-referenced with the meteorological data recorded by the stations in the two considered areas. Based on average temperature, calculated over reference periods, the species were divided by creating "warm" year groups and "cold" year groups so as to better highlight any differences in the behavior of the same species. In addition, a strong correlation was shown between the maximum temperatures in February and the advances of phenological phases BBCH_11 and BBCH_65. Most of the tree species have shown strong adaptation to climate warming, changing the period of occurrence of the phases themselves., (© 2023. The Author(s).)

Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.

In order to estimate the impact of climate change on the phenological parameters and to compare them with the historical record, a decision support system (DSS) has been applied employing a Phenological Modelling Platform. Biological observations of two willow species (Salix acutifolia and smithiana Willd) in 3 gardens at different altitudes located in Central Italy were utilized to identify suitable phenological models related to four main vegetative phase timings (BBCH11, BBCH91, BBCH 94, BBCH95), and male full flowering (BBCH 65) clearly identifiable in these species. The present investigation identifies the best phenological models for the main phenophases allowing their practical application as real-time monitoring and plant development prediction tools. Sigmoid model revealed high performances in simulating spring vegetative phases, BBCH11 (First leaves unfolded), and BBCH91 (Shoot and foliage growth completed). Salix acutifolia Willd. development appeared to be more related to temperature amount interpreted by phenological models in comparison to Salix smithiana Willd. above all during spring (BBCH11 and 91), probably due to a different grade of phenotypic plasticity between the 2 considered species.

Classification schemes for reporting thyroid cytology of fine needle aspiration (FNA) of thyroid nodules are largely used in clinical practice, but the level of inter-observer agreement among cytopathologists is poorly acknowledged. The present study aimed to explore the inter-observer agreement among the experienced authors of the 2014 Italian Consensus for Classification and Reporting of Thyroid Cytology (ICCRTC). A stratified randomization was performed in order to obtain a sample homogeneously distributed and representative of all ICCRTC classes. Four high-experience raters were randomly selected among the extensors of the Italian consensus. They independently reviewed 60 FNA samples blindly of the initial cytological report and clinical features. Their overall agreement was evaluated according to Fleiss' kappa. The overall inter-observer agreement was moderate (κ 0.46). Specifically, a good agreement was found when the samples were consistent for malignancy (TIR5) or were not adequate for diagnosis (TIR1) (κ 0.67 and κ 0.73, respectively). A moderate agreement was present for suspicious-for-malignant category (TIR4), and a fair agreement was recorded in the two intermediate ones (TIR3A and TIR3B) (κ 0.36 and κ 0.35, respectively). For clinical purposes, the agreement was good (κ 0.74) in differentiating cases with surgical indication (TIR4/TIR5) from those in which surgery is not essential or requires limited extension (TIR3B/TIR3A/TIR2). In conclusion, the present study confirms the reliability of ICCRTC. These data represent a reference for cytopathologists using this system and are useful for the practice of clinicians and surgeons.

The available data on the natural history of pheochromocytomas and paragangliomas after radical surgery are heterogeneous and discordant. The aim of our retrospective multicenter study was to find predictors of recurrence in patients with pheochromocytomas and sympathetic paragangliomas submitted to radical surgery in Piedmont (a region in northwest Italy). We collected data from 242 patients diagnosed between 1990 and 2016. Forty-two patients (17.4%) had disease recurrence. Multivariate analysis showed that genetic mutation (HR = 3.62; 95% CI 1.44-9.13; p = 0.006), younger age (HR = 0.97; 95% CI 0.95-0.99; p = 0.031) and larger tumor size (HR = 1.01; 95% CI 1.00-1.02; p = 0.015) were independently associated with a higher recurrence risk of pheochromocytoma and paraganglioma; in pheochromocytomas, genetic mutation (HR = 3.4; 95% CI 1.00-11.48; p = 0.049), younger age (HR = 0.97; 95% CI 0.94-0.99; p = 0.02), higher tumor size (HR = 1.01; 95% CI 1.00-1.03; p = 0.043) and PASS value (HR = 1.16; 95% CI 1.03-1.3; p = 0.011) were associated with recurrence. Moreover, tumor size was the only predictor of metastatic pheochromocytoma and paraganglioma (HR = 4.6; 95% CI 1.4-15.0; p = 0.012); tumor size (HR = 3.93; 95% CI 1.2-16.4; p = 0.026) and PASS value (HR = 1.27; 95% CI 1.06-1.53; p = 0.007) were predictors of metastatic pheochromocytoma. In conclusion, our findings suggest that the recurrence of pheochromocytoma and sympathetic paraganglioma develops more frequently in younger subjects, patients with a family history of chromaffin tissue neoplasms, mutations in susceptibility genes, larger tumors and higher values of PASS. We recommend genetic testing in all patients with PPGL and strict follow-up at least on an annual basis.

The main characteristics of the heat accumulation period and the possible existence of different types of biological response to the environment in different populations of olive through the Mediterranean region have been evaluated. Chilling curves to determine the start date of the heat accumulation period were constructed and evaluated. The results allow us to conclude that the northern olive populations have the greatest heat requirements for the development of their floral buds, and they need a period of time longer than olives in others areas to completely satisfy their biothermic requirements. The olive trees located in the warmest winter areas have a faster transition from endogenous to exogenous inhibition once the peak of chilling is met, and they show more rapid floral development. The lower heat requirements are due to better adaptation to warmer regions. Both the threshold temperature and the peak of flowering date are closely related to latitude. Different types of biological responses of olives to the environment were found. The adaptive capacity shown by the olive tree should be considered as a useful tool with which to study the effects of global climatic change on agro-ecosystems.

Morton's neuroma is an entrapment neuropathy of the plantar digital nerve. We treated five patients with wound dehiscence and tendon exposure, after Morton's neuroma surgery excision using a dorsal approach. In this article we describe our technique. From July 2010 to August 2011, at the Department of Plastic and Reconstructive Surgery, University of Rome 'Tor Vergata', five patients (four females and one male), with ages ranging between 35 and 52 years, were treated with a combination of PRP (platelet rich plasma) and HA (hyaluronic acid). Thirty days following surgery, all patients showed a complete healing of the wound. The use of this technique for the treatment of postoperative wound dehiscence and tendon exposure has proven as satisfactory., (© 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.)

Recent studies have shown that there are many effects of climate change on aeroallergens, and thus on allergic diseases in humans. In the Mediterranean region, despite the importance of the olive tree for production, there is high allergenicity of olive pollen and related risks to human health. Aerobiological sampling techniques can be used to analyse the pollinosis phenomenon through determination of mean daily pollen concentrations per cubic metre of air. The present study was carried out from 1999 to 2008 in 16 olive-growing areas in Italy, to update the information on the pollinosis characteristics of Olea europaea in the study areas. The analysis of the average flowering season over the study period highlights a temporal scaling of pollen in the atmosphere that depends on the different climatic characteristics. This is mainly dependent on temperature, and in part, determined by latitude. Generally, the levels of O. europaea pollen in the atmosphere are higher from mid-April to the end of June, with the period of greatest risk to human health due to this olive pollen in this area currently limited primarily to the last 10 days of May. However, the pollen season can move, depending on the climate scenario considered, and data here can be used to determine potential time shifts in pollinosis that might cause more precocious asthma and allergy problems. The allergy season for this type of pollen might be significantly precocious in future decades (20-30 days earlier in the year), which will impact on the severity and duration of allergies attributable to olive tree pollen.

Objective: Multiple endocrine neoplasia type 2 (MEN 2) is a genetic disease characterized by medullary thyroid carcinoma (MTC) associated (MEN 2A and 2B) or not familial MTC (FMTC) with other endocrine neoplasia due to germline RET gene mutations. The prevalence of these rare genetic diseases and their corresponding RET mutations are unknown due to the small size of the study population., Methods: We collected data on germline RET mutations of 250 families with hereditary MTC followed in 20 different Italian centres., Results and Conclusions: The most frequent RET amino acid substitution was Val804Met (19.6%) followed by Cys634Arg (13.6%). A total of 40 different germline RET mutations were present. Six families (2.4%) were negative for germline RET mutations. The comparison of the prevalence of RET germline mutations in the present study with those published by other European studies showed a higher prevalence of Val804Met and Ser891Ala mutations and a lower prevalence of Leu790Phe and Tyr791Phe (P<0.0001). A statistically significant higher prevalence of mutations affecting non-cysteine codons was also found (P<0.0001). Furthermore, the phenotype data collection showed an unexpected higher prevalence of FMTC (57.6%) with respect to other MEN 2 syndromes (34% MEN 2A and 6.8% of MEN 2B). In conclusion, we observed a statistically significant different pattern of RET mutations in Italian MEN 2 families with respect to other European studies and a higher prevalence of FMTC phenotype. The different ethnic origins of the patients and the particular attention given to analysing apparently sporadic MTC for RET germline mutations may explain these findings.

The aim of this study was to investigate the main climatic and biological trends related to olive flowering in central-southern Italy compared to those in Andalusia, Spain. Results since 1982 were compared for the two long-series monitoring areas of Cordoba and Perugia, and since 1992-1999 for the short-series areas. The relationship between climatic trends and the biological response of the olive, a widespread culture in the Mediterranean basin, were investigated. An aerobiological method involving capturing pollen released into the atmosphere was utilised as a bioindicator of flowering phenology. The study results confirm the strong relationship between flowering periods and spring temperature trends for the olive. Temperature during March, April and May was the parameter most related to flowering date in the study areas, particularly in Italy. In some cases we found a significant correlation between flowering and past autumn temperatures, probably due to their effect on floral bud dormancy induction, but this phenomenon appeared to be of minor importance in the studied areas. The phenological trend results show the continuous advance of flowering dates to the late 1990s, followed by a relatively stationary time series related to a short-term temperature fluctuation in the Mediterranean area. This latter period probably represents a mesoscale event forced by a macroscale event-the North Atlantic Oscillation. The results reveal that the trend towards increased temperatures, and the consequent flowering advance of some species, indicated some years ago is nowadays not as clear as was expected and should be confirmed over the next few years in the Mediterranean areas under investigation.

Olives are one of the largest crops in the Mediterranean and in central and southern Italy. This work investigates the correlation of the Olea europaea L. pollen season in Perugia, the capital city of the region of Umbria in central Italy, with atmospheric parameters. The aim of the study is twofold. First, we study the correlation between the pollen season and the surface air temperature of the spring and late spring in Perugia. Second, the correlation between the pollen season and large-scale atmospheric patterns is investigated. The average surface temperature in the spring and late spring has a clear impact on the pollen season in Perugia. Years with higher average temperatures have an earlier onset of the pollen season. In particular, a 1 degrees C higher (lower) average surface temperature corresponds to an earlier (later) start of the pollen season of about 1 week. The correlation between the pollen season and large-scale atmospheric patterns of sea level pressure and 500-hPa geopotential height shows that the cyclonic activity in the Mediterranean is unequivocally tied to the pollen season in Perugia. A larger than average cyclonic activity in the Mediterranean Basin corresponds to a later than average pollen season. Larger than average cyclonic activity in Northern Europe and Siberia corresponds to an earlier than average pollen season. A possible explanation of this correlation, that needs further investigation to be proven, is given. These results can have a practical application by using the seasonal forecast of atmospheric general circulation models.

Background: In the USA, about 30 200 well-differentiated thyroid carcinomas were diagnosed in 2007, but the prevalence of thyroid nodules is much higher (about 5% of the adult population). Unfortunately, the preoperative characterisation of follicular thyroid nodules is still a challenge, and many benign lesions, which remain indeterminate after fine-needle aspiration (FNA) cytology are referred to surgery. About 85% of these thyroid nodules are classified as benign at final histology. We aimed to assess the diagnostic effect of galectin-3 expression analysis in distinguishing preoperatively benign from malignant follicular thyroid nodules when FNA findings were indeterminate., Methods: 544 patients were enrolled between June 1, 2003, and Aug 30, 2006. We used a purified monoclonal antibody to galectin-3, a biotin-free immunocytohistochemical assay, and a morphological and phenotypic analysis of FNA-derived cell-block preparations. Galectin-3-expression analysis was applied preoperatively on 465 follicular thyroid proliferations that were candidates for surgery, and its diagnostic accuracy was compared with the final histology., Findings: 31 patients were excluded because they had small galectin-3-negative thyroid nodules; we did not have data for 47 patients; and one patient with an oncocytic nodule was excluded. 331 (71%) of the assessable 465 preoperative thyroid FNA samples did not express galectin-3. 280 (85%) of these galectin-3-negative lesions were classified as benign at final histology. Galectin-3 expression was detected, instead, in 134 of 465 (29%) thyroid proliferations, 101 (75%) of which were confirmed as malignant. The overall sensitivity of the galectin-3 test was 78% (95% CI 74-82) and specificity was 93% (90-95). Estimated positive predictive value was 82% (79-86) and negative predictive value was 91% (88-93). 381 (88%) of 432 patients with follicular thyroid nodules who were referred for thyroidectomy were correctly classified preoperatively by use of the galectin-3 test. However, 29 (22%) of 130 cancers were missed by the galectin-3 method., Interpretation: Our findings show that if the option of surgery was based theoretically on galectin-3 expression alone, only 134 thyroid operations would have been done in 465 patients; therefore a large proportion (71%) of unnecessary thyroid surgical procedures could be avoided, although a number of galectin-3-negative cancers could be potentially missed. The galectin-3 test proposed here does not replace conventional FNA cytology, but represents a complementary diagnostic method for those follicular nodules that remain indeterminate.

A patient with Hunter syndrome, or mucopolysaccharidosis type II (MPS-osis II), was subjected to bone marrow transplantation (BMT), at the age of 2 9/12 years. A two-year follow-up ensued to the purpose of comparing clinical, biochemical, neuropsychologic status pre- and post-BMT. From the clinical standpoint, a complete normalization of hepatosplenomegaly was observed. In addition the skin decreased in thickness and joint mobility improved. The echocardiography showed normalization of left ventricle size. With the exception of verbal capabilities, there was no further deterioration of the neuropsychologic profile. The ultrastructural examination of the liver showed an almost total disappearance of storage material. Normal iduronate sulfatase levels in leukocytes and lymphoblasts were constantly found after BMT. A qualitative and quantitative improvement in urinary glycosaminoglycan (GAG) excretion was also found. The effectiveness of the BMT in our patient is also assessed in the context of the few cases of MPS-osis II that have been reported to date. A final evaluation of the efficacy of BMT in MPS-osis II will be possible only when a higher number of patients, diagnosed as early as possible and transplanted within the first months of life, can be followed-up for more extended periods of time.

The authors discuss some aspects of Gastrointestinal Endoscopy in Italy emphasizing, in accordance with other countries, the importance of preventing the separation of Gastrointestinal Endoscopy and Gastroenterology. An endoscopist should be a gastroenterologist capable of clinically assessing endoscopic results and not just an individual providing a technical service. In a hospital organization, excessive diffusion of the method in small hospitals should be avoided and the more complex techniques should be concentrated in the Gastroenterology and Gastrointestinal Endoscopy Departments in order to guarantee the quality of care and patient safety. Great attention must be given to the training of endoscopists and an adequate preparation of the nursing staff in also important.