ATS Sardegna (Italy)

Eutrophication is a pervasive issue in Mediterranean reservoirs, where external nutrient inputs and internal sediment releases interact to impair water quality and ecological stability. This study assessed the trophic condition of the artificial lake Cuga in Sardinia (Italy), mainly used for irrigation and providing potable water, by integrating watershed nutrient load estimates, inter-lake transfers, and internal phosphorus release. Field campaigns between July 2022 and May 2023 provided bi-monthly measurements of physical, chemical, and biological parameters, complemented by GIS-based land cover analysis and export coefficient modeling to quantify spatial nutrient sources. Additional phosphorus inputs from water transfers with a nearby reservoir were calculated, while internal sediment release was estimated using a calibrated mass balance model. Results revealed high nutrient concentrations, with mean total phosphorus of 128 mg P m−3, chlorophyll a averaging 9.9 mg m−3, and Secchi depth below 1 m, classifying the reservoir as eutrophic to hypertrophic under OECD and Carlson indices. Spatial loads were dominated by agricultural areas, while inter-lake transfers and internal sediment release contributed substantially to the overall phosphorus budget. The predictive Vollenweider model closely matched the observed conditions, confirming the robustness of the combined approach. Maintaining good ecological status in Mediterranean reservoirs is essential for safeguarding human well-being, as eutrophication degrades drinking-water quality, increases treatment costs, and can promote toxin-producing algal blooms with direct implications for public health. These findings highlight the need for integrated management strategies addressing both external and internal nutrient sources to mitigate eutrophication in Mediterranean reservoirs, which affects the ecosystem functioning and the related human needs and well-being.

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Sardinia has an integrated water reserve system comprising more than 30 dams on rivers. Built in the last century, these dams have become part of the modern landscape, while also continuing to affect sediment transport. The trapping of sediment has hindered its natural movement towards the coastal system ever since, thereby reducing the supply of sediment to sandy beaches and increasing their vulnerability to coastal erosion. On the other hand, the reservoirs' capacity to store water is also impacted. These two issues are of particular concern in the context of climate change.For this reason, the present study addresses both issues by proposing a methodology to assess the feasibility of using reservoir sediment as a source of material for beach replenishment. The Autonomous Region of Sardinia and its regional partners are currently developing this methodology as part of the DesirMED project, which is funded through the HORIZON-MISS-2022-CLIMA-01 call, which addresses climate change adaptation through a nature-based approach.The methodology was designed and structured in the following steps: the development of a database of sediment characteristics and reservoir locations; the application of multi-criteria analysis using a defined set of indicators; the selection of case studies where to conduct technical visits involving measurements and sampling; a technical feasibility study on sediment-sand compatibility; and the assessment of the results from the perspective of potential sediment reuse for beach replenishment.This study is part of the ongoing process of implementing adaptation measures. The Autonomous Region of Sardinia incorporates this process into its Regional Adaptation to Climate Change Strategy, which was adopted in 2019 and recently revised. Although the methodology is still in its early stages, it will contribute to improving the resilience of coastal communities and the implementation of adaptation measures at a local level.

This research investigates the chemical properties of soil and groundwater in the ecologically sensitive coastal villages of Sankarpur, Chandpur, and Tajpur within the Purba Medinipur district of West Bengal. Given that over 60% of this region is dependent on fishing and associated economic activities, maintaining environmental quality is critical for local sustainability. Soil analysis reveals a predominantly alkaline nature across the study area, with pH values ranging significantly between 8.0 and 9.0. This alkalinity is attributed to low regional rainfall, the inherent nature of coastal soil, and high sea-water influence bringing in alkaline substances such as calcium and magnesium carbonates. Nutrient profiling indicates that Tajpur possesses the highest concentrations of Nitrate Nitrogen (reaching up to 45), suggesting potential suitability for specific crop cultivation. However, variable levels of Ammoniacal Nitrogen (ranging from 13 to 180) were recorded, with high values in specific locations of Sankarpur and Tajpur pointing toward potential ammonia pollution from organic decomposition or agricultural runoff. Groundwater analysis mirrors these alkaline trends, with pH levels observed between 7.2 and 9.5. Total Dissolved Solids (TDS) were recorded between 234 and 748, indicating varying degrees of salinity and mineral concentration across the coastal aquifers. The findings suggest that while the soil has certain nutrient strengths, the high alkalinity and localized ammonia concentrations necessitate strategic soil management and regular groundwater monitoring to support the region’s agricultural and environmental health.

Management of acute pulmonary embolism (PE) during pregnancy or post-partum is challenging especially in women at intermediate or high-risk of adverse outcomes. Catheter-directed therapies (CDTs) are increasingly used given their potential efficacy and relatively low complication rates. We systematically reviewed the evidence on CDTs use in pregnancy and post-partum PE. Literature search was conducted in bibliographic databases, reference lists, and review articles until 2 July 2025, without restrictions. Main efficacy and safety outcomes were maternal all-cause and PE-related mortality, fetal mortality, improved right ventricle dysfunction (RVD) and/or pulmonary artery (PA) pressures, improved lung perfusion/clot burden reduction, and maternal major bleeding (MB). We identified 65 case reports, 4 case series and 1 cohort study for a total of 76 patients. Maternal all-cause mortality within 7 days from CDT was 2.8% (2/72; 95% confidence interval [CI], 0.3-9.7%) with no PE-related deaths. In-hospital fetal mortality was 12.5% (5/40; 95% CI, 4.2-26.8%). Within 72h from CDT were observed: an improvement of RVD and/or PA pressures in 96.2% (25/26; 95% CI, 80.4-99.9%), and in lung perfusion/reduction in clot burden in 94.4% of cases (34/36; 95% CI, 81.3-99.3%); maternal MB in 17.2% of cases (11/64; 95% CI, 8.9-28.7%), with 10 out of 11 events (90.9%) reported in the post-partum period. Current evidence is limited and of low quality. CDTs should be considered only after a multidisciplinary evaluation of selected cases, balancing potential benefits and bleeding risks, the latter being mainly observed in the post-partum.

Background and ObjectivesPatients with multiple sclerosis (MS) exhibit variability in disability progression and response to disease-modifying therapies (DMTs). Identifying those at greatest risk of disability worsening and most likely to benefit from high-efficacy DMTs remains challenging. We aimed to identify distinct disability worsening phenotypes, explore their mechanisms, and evaluate DMT impact across them.MethodsIn this multicenter cohort study, we analyzed clinical and MRI data from propensity-matched cohorts of treated and untreated patients with relapse-onset MS from the Italian MS Register. Inclusion criteria were as follows: ≥3 years of follow-up, ≤1 year between disease onset and first assessment, and complete clinical and baseline MRI data. Latent class mixture models were applied to Expanded Disability Status Scale (EDSS) scores from untreated patients to identify disability worsening phenotypes. We compared proportions of progression independent of relapse activity (PIRA) and relapse-associated worsening events across phenotypes. A random forest algorithm, trained (70%) and tested (30%) on baseline clinical and MRI features of untreated patients, was used to assign phenotypes to treated patients. Linear mixed-effects models estimated DMT impact on disability trajectories within each phenotype.ResultsWe analyzed data from 2,563 untreated (mean age 41.2 ± 10 years, 67% female) and 2,952 treated (mean age 40.8 ± 11.4 years, 66% female) patients with MS over a median follow-up of 10.1 (interquartile range: 7.0–13.0) years. Four phenotypes were identified in untreated patients: “minimal-worsening” (15%), “late-worsening” (70%), “early-worsening” (3%), and “rapid-worsening” (12%). In all phenotypes, PIRA represented the main disability accrual mechanism. “Early-worsening” and “rapid-worsening” phenotypes exhibited more brain and spinal cord T2-hyperintense and gadolinium-enhancing lesions at baseline. The classification algorithm assigned phenotypes to patients receiving DMTs with 71% accuracy: “minimal-worsening” (18%), “late-worsening” (61%), “early-worsening” (13%), and “rapid-worsening” (8%). DMT exposure significantly reduced disability accrual in all phenotypes, with high-efficacy DMTs (β = −0.16, standard error (SE) = 0.06, p < 0.001) and early escalation (β = −0.18, SE = 0.06, p < 0.001) proving especially beneficial for the “rapid-worsening” phenotype.DiscussionWe identified 4 clinically relevant disability worsening phenotypes in relapse-onset MS, primarily driven by PIRA, with greater CNS involvement linked to early and rapid progression. Despite reliance on EDSS alone, these phenotypes may inform personalized treatment and response assessment.

BackgroundA wide gap exists between the number of patients awaiting organ transplantation and the availability of donor organs. For most vital organs, no artificial substitutes are available, resulting in the death of approximately 3–4% of patients on transplant waiting lists.Deceased organ donation occurs through one of two pathways: donation after brain death (DBD) or after controlled circulatory death (cDCD). In the absence of documented consent during the patient’s lifetime, many countries rely on family members to make the decision, placing an emotional burden on them during a time of acute grief.Data on family attitudes toward organ donation, particularly in relation to the mode of death (DBD vs. cDCD), remains limited. This study aimed to examine the frequency of family refusal in the context of deceased organ donation and assess whether it differs between DBD and cDCD cases.MethodsThis retrospective, single-center observational study analyzed 6 years of hospital data (2019–2024) from five intensive care units at a tertiary university hospital in Varese, Italy. All patients, regardless of age, who were eligible for deceased organ donation through either DBD or cDCD were included.ResultsA total of 158 patients were evaluated for donation (135 DBD; 23 cDCD).Documented opt-in consent, as recorded in the national donor registry, was available for 41 patients (20%), while 3 had registered their refusal. Two patients were ineligible for donation; for the remaining 112 patients (71%), consent was sought from family members. Family refusal occurred in 28 cases (25% of the 112 families asked for consent). No significant difference in consent rates was observed between DBD and cDCD pathways (DBD: 73/98 vs. cDCD: 11/14; p = 0.74).ConclusionsFamily refusal was the leading reason for missed donation opportunities among patients without documented opt-in consent, accounting for one in four cases. The donation pathway (DBD vs. cDCD) did not significantly influence family decision-making. Given ongoing organ shortages and high wait-list mortality, strategies are needed to support family decisions and to promote the formal registration of opt-in consent among citizens.

Background and study aimsEndoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been proposed as a minimally invasive alternative to surgery for treatment of both functional (F-) and non-functional (NF-) pancreatic neuroendocrine tumors (PanNETs). We performed a large prospective multicenter study to evaluate safety and effectiveness of EUS-RFA in patients with F- and NF-PanNETs.Patients and methodsPatients with F- (≤ 2 cm) and NF-PanNETs (15 mm-25 mm) were prospectively enrolled over a 43-month period. The primary aim was safety, defined as rate of adverse events (AEs). The secondary aim was effectiveness defined as complete disappearance of the hormonal secretion syndrome in F- PanNETs, whereas for NF-PanNETs, complete response was defined as absence of enhancing tissue and of detectable lesion at magnetic resonance imaging/computed tomography scan and Gallium-positron emission tomography, respectively. The EUSRA 19G needle was used in all patients. After treatment completion, follow-up was performed for 1 year.ResultsDuring the study period, a total of 60 patients were enrolled, 30 with insulinomas and 30 with NF-PanNETs (mean lesion size 14.5 ± 4.5 mm). In 78.3% of patients, a single RFA session was performed. Overall, AEs occurred in nine of 60 patients (15%), in four patients (13.3%) with insulinomas and in five (16.7%) with NF-PanNETs, with only one severe AE. Complete insulin hypersecretion symptom resolution was obtained in 29 of 30 patients (96.7%) with insulinomas, whereas for NF-PanNETs, complete radiological response was obtained in 22 of 25 patients (88%) with long-term follow up.ConclusionsOur prospective international multicenter study demonstrated that EUS-RFA is highly safe and effective for the treatment for both F- and NF-PanNETs.

Mesothelioma of the tunica vaginalis testis (MTVT) is an exceedingly rare tumor. We performed a registry-based study on MTVT patient management and survival in Italy. Cases were extracted from the dataset of the Italian National Mesothelioma Registry. A descriptive analysis of patient characteristics, including asbestos exposure, clinical presentation, diagnostic work-up and therapeutic management, was performed. Overall survival was evaluated. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for selected variables by fitting univariate and multivariable Cox models. Overall, 104 patients with MTVT were included. Median age was 72 years (range 17-92). Epithelioid histotype was the most frequent. Previous asbestos exposure was identified in two thirds of cases. Data on diagnostic and therapeutic management were available for 74 patients (71%). The most frequent presentations were scrotal swelling/mass, hydrocele and inguinal pain. All patients underwent surgery, mostly with orchi-funicolectomy. Adjuvant therapy was administered to 15 patients (20%). Overall median survival was 26.2 months (95% CI 22.1-52.1); 3-, 5- and 10-year survival was 49%, 30% and 18%. Older age at diagnosis and presence of distant metastasis (HR 1.91, CI: 0.85-4.26) were negative prognostic factors. Adjuvant therapy was associated with higher mortality (HR 2.54, CI: 1.25-5.15), indicating a more advanced stage at diagnosis. Surgery remains the mainstay of treatment for MTVT; adjuvant therapy in our study did not improve outcome. Data from cancer registries are essential for rare cancers, but they should be integrated routinely with additional diagnostic and therapeutic information.