River functionality influences the distribution of the dipper Cinclus cinclus (Linnaeus, 1758).

The dipper (Cinclus cinclus) is a species strongly linked to the riparian ecosystem, known to feed on aquatic macroinvertebrates, which are sensitive to water pollution. For this, dippers have been proposed as useful bioindicators of water quality. While the distribution and ecology of the dipper are well known in Northern European rivers, few studies focus on this in Central Italy, lacking data for dipper conservation. Here, we aimed to (i) assess the dipper occurrence related to water quality using biotic indices based on diatom and macroinvertebrate communities, and (ii) evaluate the river ecosystem's overall state, through the River Functionality Index and land-use analysis in buffer areas. Overall, water quality alone does not explain the dipper occurrence, as the species was not found in many potentially suitable sites with good or high-water quality. Moreover, the diversity of the diatom and macroinvertebrate communities was not a sufficient constraint either. Conversely, the dipper occurrence significantly correlated with the River Functionality Index, which integrates several riparian ecosystem factors, indicating that well-preserved ecosystems with high functionality levels are important for dipper occurrence. Land use analyses in the areas surrounding the presence sites have shown, although not significantly, a fair level of naturalness, potentially favouring the riparian zone maintenance. As the dipper was considered in decline and threatened in Central Italy, further research on its auto-ecology and conservation threats is urgently needed. Finally, given the link between the species and the riparian ecosystem, a charismatic species such as the dipper could be used as an umbrella species in protection and conservation projects for the benefit of the entire riparian belt, which represents a buffer area of fundamental importance between terrestrial and aquatic ecosystems, although often resulted severely reduced and fragmented.

Riparian vegetation plastic monitoring: A harmonized protocol for sampling macrolitter in vegetated riverine habitats.

Many studies highlighted that rivers transported land-based plastics to the sea. However, most of the litter remains stuck in the fluvial ecosystem, also blocked by vegetation. To date, research on riverine macrolitter focused on floating and riverbank monitoring, thus methods to sample riverbank and floating litter have been developed. Concerning rivers, few recent studies highlighted the role of riparian vegetation in entrapping plastics. Given that vegetation represents a large part of riverine ecosystems and that the dynamics of plastics entrapped by vegetation are neglected, it appears pivotal to study in more detail how vegetation contributes to plastic retention. However, as current protocols and guidelines considered only floating and riverbank plastics without providing standardized and updated strategies to monitor litter in vegetation, here we aimed to develop a new standardized protocol and tools to assess plastics in vegetation. Specifically, we focused on unveiling the three-tridimensional structure of vegetation in relation to plastic occurrence, while considering seasonal and hydromorphological aspects. To investigate the trapping effect of vegetation, we developed a three-dimensional vegetation structure index (3DVI) related to plastics. The 3DVI index considers plant structure (i.e., number of branches) and diversity (i.e., species). To test the 3DVI, we conducted an in-situ case study in central Italy. We found that both primary and secondary riparian vegetation blocked plastic litter. In detail, 3DVI correlated with the number of plastics, highlighting that the densest and most diverse communities trap more plastics. Furthermore, we provided for the first time the assessment of seasonality for the macroplastic entrapment by riparian vegetation and a preliminary quantification of wind-blown plastics. Our results should be of interest to promote the development of standardized and harmonized monitoring strategies for riparian habitat management and conservation.

Life on bottles: Colonisation of macroplastics by freshwater biota.

While rivers are known to be the main vectors of plastics to the sea, it seems surprising that studies on interactions (e.g. colonisation/entrapment and drift) between macroplastics and biota continue to remain largely neglected, notwithstanding they represent unexpected threats to freshwater biota and riverine habitats. To fill these gaps, here we focused on the colonisation of plastic bottles by freshwater biota. To do so, we collected 100 plastic bottles from the River Tiber in summer 2021. Overall, 95 bottles were colonised externally and 23 internally. Specifically, biota mainly occurred within and outside the bottles rather than plastic pieces and organic debris. Moreover, while bottles were externally covered mainly by vegetal organisms (i.e. macrophytes), they internally entrapped more animal organisms (i.e. invertebrates). The taxa most occurring within and outside the bottles belonged to pool and low water quality-associated taxa (e.g. Lemna sp., Gastropoda, and Diptera). In addition to biota and organic debris, plastic particles also occurred on bottles reporting the first observation of 'metaplastics' (i.e. plastics encrusted on bottles). Furthermore, we observed a significant positive correlation between the colonising taxa abundance and the bottle degree degradation. In this regard, we discussed how bottle buoyancy may change due to the organic matter on the bottle, affecting bottle sinking and transport along rivers. Our findings might be crucial for understanding the underrepresented topic of riverine plastics and their colonisation by biota, given that these plastics may act as vectors and cause biogeographical, environmental, and conservation issues to freshwater habitats.

Aquatic plants entrap different size of plastics in indoor flume experiments.

Plastics accumulate in the environment affecting biota and ecosystems. Although rivers are vectors of land-based plastics to the sea, macroplastics and microplastics in rivers are recently studied. Most studies focused on floating plastic transport to the sea through rivers considering only abiotic hydromorphological factors. In this view, among biotic factors, vegetation has recently been found to entrap plastics. Indeed, the role of vegetation is pivotal in affecting riverine plastic transport. While marine vegetation blocking plastics has been studied, research in freshwater ecosystems is neglected. Since hydrological factors have a pivotal role in riverine plastic transport and few is known on plant entrapment, the interaction between hydrological variables and plastic entrapment by vegetation has not yet been investigated. Given that the composition, transport, and fate of "submerged" plastics in the water column are neglected, we aimed at investigating the behaviour of plants in entrapping plastics within a specific laboratory flume tank. Specifically, we assessed whether (i) aquatic plants block different plastic sizes within the water column and (ii) different factors (e.g. water level, density of plants) affect plastic entrapment. Our results showed that, according to plant density, the higher the plant density the higher the entrapment of plastics by plants - independently of plastic size. Considering the water level, macro-, meso-, and microplastics were trapped similarly. Moreover, Potamogeton crispus blocked fewer microplastics compared with Myriophyllum spicatum. Our results might have impact as plants acted as temporary plastic trappers and can be used as tools for mitigating plastic pollution. Future research might investigate if this laboratory approach can be applied in field for recollecting plastics and consequently mitigating the problem. In conclusion, good management of plants in watercourses, canals, and rivers should be ideal for enhancing river functionality and ecosystem services for human well-being (i.e. the plastic entrapment service by plants).

Carpobrotus spp. patches as trap for litter: Evidence from a Mediterranean beach.

Dunal plants may affect the patterns of deposition of beach litter. In this study, we aimed at evaluating if Carpobrotus spp. patches may act as a litter trap in coastal dune systems. To do so, we counted the number of macrolitter occurring in both Carpobrotus and control (embryo dune vegetation) patches classifying each item into categories according to the Marine Strategy. Totally, we observed a significant difference between litter trapped in Carpobrotus (331 items, representing 62.4% of the total beach litter) and control (199, 37.6%). Plastic fragments were the most trapped items by both Carpobrotus (46.2%) and control patches (47.2%). We also calculated the item co-occurrence, obtaining a random aggregated 'litter community'. The main emerging output is that Carpobrotus patches act as filter in respect to different anthropogenic materials (overall plastics), suggesting that alien plant management actions may contribute to solve beach litter issues as well.

Outcome of cancer patients receiving home parenteral nutrition. Italian Society of Parenteral and Enteral Nutrition (S.I.N.P.E.).

BACKGROUND: Indication for home parenteral nutrition (HPN) in cancer patients is controversial because intestinal failure and malnutrition are often only two of the many problems found in such patients that may deserve priority of treatment. METHODS: This was a retrospective study of 75 cancer patients from nine institutions included in the Italian HPN Registry. The patients had a mean weight loss of 12.5%, serum albumin of 3.1 g/dL, lymphocyte count of 1150/mm3, and serum total iron-binding capacity of 190 micrograms/dL. The main indication for HPN was intestinal obstruction (66%); 72% of the patients had metastatic disease. A series of demographic, oncologic, and nutritional characteristics were analyzed in an attempt to predict a possible benefit of HPN. RESULTS: A total of 9897 days of HPN were delivered to 75 cancer patients, for a median of 4 months (range 1 to 15 months) per patient. Sixty-nine patients died while receiving HPN, five had a remission of their intestinal failure, and one chose to stop the treatment. Complications related to parenteral nutrition were as follows: 19 cases of sepsis, 6 catheter occlusions, 4 catheter dislocations, and 2 metabolic imbalances. HPN preserved nutritional status and slightly improved weight, lymphocyte count, serum albumin, and Karnofsky performance status in patients who survived > 3 months. Quality of life during HPN was judged by the clinicians to have improved in only 9% of those who survived < 3 months, but in 68% of the patients who survived for > 3 months. Karnofsky performance status > 50 at the start of HPN was correlated with longer survival (p = .02). CONCLUSIONS: Our study demonstrated a positive effect of HPN on nutritional status and quality of life in patients who survived > 3 months and suggests that HPN should be avoided when Karnofsky performance status is < 50.

Protein-sparing therapy after major abdominal surgery: lack of clinical effects. Protein-Sparing Therapy Study Group.

OBJECTIVE: A prospective multicenter randomized trial was designed to evaluate the clinical efficacy of postoperative protein-sparing therapy. SUMMARY BACKGROUND DATA: The metabolic effect of postoperative protein-sparing therapy has been shown by several studies, but the clinical utility of this treatment has not been investigated by large prospective trials. METHODS: Six hundred seventy-eight patients undergoing major elective abdominal surgery were randomly assigned to receive either protein-sparing therapy after surgery (protein-sparing therapy group) or conventional therapy (control group). The patients were monitored for postoperative complications and mortality. RESULTS: The rate of major postoperative complications was similar in both groups (protein-sparing therapy group, 19.5%; control group, 20.9%; p=0.66) as were the overall postoperative mortality rates (4.7% and 3.5%, respectively; p=0.43). CONCLUSIONS: The present study indicates that routine protein-sparing therapy for patients normonourished or mildly malnourished undergoing major abdominal surgery is not clinically justified.

[The late complications and nutritional follow-up in 96 patients who underwent a total gastrectomy]. / Complicanze tardive e follow-up nutrizionale in 96 pazienti sottoposti a gastrectomia totale.

Clinical and nutritional follow-up was performed in 96 patients who had undergone total gastrectomy. We studied the incidence of clinical complications and alterations of nutritional parameters in those patients who had undergone curative resection and were alive and free of neoplastic disease 1 year (36 patients) and 2 years (26 patients) after operation. We observed a very low incidence of late complications, and nutritional parameters, 1 year and 2 years after operation, were normal in almost all the patients. We obtained these results because we performed a Roux en Y esophagojejunostomy using an at least 60 cm-loop; we also adopted a strict and rigorous follow-up, able to guarantee an adequate daily calorie intake. In fact, a close relationship between calorie intake and the variations of nutritional parameters was observed.

The 99mTc-HMPAO leukocyte scan: an alternative to radiology and endoscopy in evaluating the extent and the activity of inflammatory bowel disease.

Seventy-eight patients, 47 with Crohn's disease and 31 with ulcerative colitis, were studied using 99mTc-HMPAO-labelled leukocytes, in order to assess the reliability of the scan in evaluating the location and activity of the disease. The granulocyte integrity was assessed by evaluating the lung wash-out and the early liver and spleen uptake using a 20 minute initial dynamic study. The results of the leukocyte scan revealed a high correlation with radiological and endoscopic findings in the diagnosis of the inflamed bowel segments. The disease activity correlated well with uptake in the bowel, graded from 0 to 3. The leukocyte scan exactly documented the activity in the 9 cases of Crohn's disease located in the ileum and in 5 cases in which the endoscopic exploration was hampered by scarring. Four fistulae were correctly visualized. Moreover, the change in activity after therapy in 6 patients was documented. This technique provides images of excellent quality, superior to those obtainable with indium-111.