Carbon sequestration in a bamboo plantation:a case study in a Mediterranean area

In the Mediterranean region,despite bamboo being an alien species that can seriously alter plant and ani-mal biocoenosis,the area occupied by bamboo plantations continues to increase,especially for the purpose to seques-ter carbon(C).However,the C dynamics in the soil-plant system when bamboo is grown outside its native area are poorly understood.Here we investigated the C mitigation potential of the fast-growing Moso bamboo(Phyllostachys edulis)introduced in Italy for climate-change mitigation.We analyzed aboveground(AGB)and belowground(as root/shoot ratio)biomass,litter and soil organic C(SOC)at O-15-and 15-30-cm depths in a 4-year-old bamboo plantation in comparison with the former annual cropland on which the bamboo was established.To have an idea of the maximum C stored at an ecosystem level,a natural forest adjacent the two sites was also considered.In the plantation,C accumulation as AGB was stimulated,with 14.8±3.1 Mg C ha^(-1) stored in 3 years;because thinning was done to remove culms from the first year,the mean sequestration rate was 4.9 Mg C ha^(-1) a^(-1).The sequestration rates were high but comparable to other fast-growing tree species in Italy(e.g.,Pinus nigra).SOC was significantly higher in the bamboo plantation than in the cropland only at the 0-15 cm depth,but SOC stock did not differ.Possibly 4 years were not enough time for a clear increase in SOC,or the high nutrient uptake by bamboos might have depleted the soil nutrients,thus inhibiting the soil organic matter formation by bacteria.In comparison,the natural forest had significantly higher C levels in all the pools.For C dynamics at an ecosystem level,the bamboo plantation on the former annual cropland led to substantial C removal from the atmosphere(about 12 Mg C ha^(-1) a^(-1)).However,despite the promising C sequestration rates by bamboo,its introduction should be carefully considered due to potential ecological problems caused by this species in overexploited environments such as the Mediterranean area.

Review of trans-Mediterranean power grid interconnection:a regional roadmap towards energy sector decarbonization

Climate change is becoming an important issue in all fields of infrastructure development.Electricity plays a core role in the decarbonized energy system’s path to a regional zero-emission pattern.A well-built trans-Mediterranean backbone grid can hedge the profound evolution of regional power generation,transmission,and consumption.To date,only Turkey and the Maghreb countries(i.e.,Morocco,Algeria,and Tunisia)are connected with the Continental European Synchronous Area.Other south-and east-shore countries have insufficient interconnection infrastructures and synchronization difficulties that have proven to be major hurdles to the implementation of large-scale solar and wind projects and achievement of climate goals.This study analyzes the current trans-boundary grid interconnections and power and carbon emission portfolios in the Mediterranean region.To align with the recently launched new climate target‘Fit for 55’program and the accelerated large-scale renewables target,a holistic review of projected trans-Mediterranean grids and their market,technical,and financial obstacles of implementation was conducted.For south-and east-shore countries,major legal and regulatory barriers encompassing non-liberalized market structure,regulation gaps of taxation and transmission tariffs,and the private sector’s access rights need to be removed.Enhancement of domestic grids,substations,and harmonized grid codes and frequency,voltage,and communication technology standards among all trans-Mediterranean countries are physical prerequisites for implementing the Trans-Mediterranean Electricity Market.In addition,the mobilization of capital instruments along with private and international investments is indispensable for the realization of supranational transmission projects.As the final section of the decarbonization roadmap,the development of electric appliances,equipment,and vehicles with higher efficiency is inevitable in the decarbonized building,transportation,and industry sectors.

Dynamics of mediterranean pine forests reforested after fires

Forest fires are frequent under a Mediterranean climate and have shaped the landscape of the region but are currently altered by human action and climate change.Fires have historically conditioned the presence of pine forests,depending on severity and forest regeneration.Regeneration of Mediterranean pine forests is not always successful,and a transition to shrublands or stands of resprouting species can occur,even after reforestation.This study analyses vegetation changes in two Mediterranean pine forests after severe fires and both reforested.The pines had difficulty to regenerate,even despite post-fire reforestation.The problem is the difficulty of young seedlings to survive,possibly due to increased summer drought.Problems are greater in pine species at the limit of their ecological tolerance:Pinus pinea had a much better recovery success while P.sylvestris and P.nigra virtually disappeared.Pinus pinaster had intermediate results but recovery was generally poor.A transition has taken place in many burnt areas to scrubland or to thickets of the resprouting Quercus rotundifolia,although it is not possible to know whether they will evolve into forests or remain in a sub climatic state.Resprouting species may increase fire severity but facilitates post-fire colonisation.Post-fire recovery difficulties are closely linked to issues of natural regeneration.Fire could initiate the disappearance of pine forests,but even in the absence of fire they may disappear in the long-term due to the lack of regeneration.Action is needed to increase the resilience of these forests,ensuring natural regeneration,and incorporating resprouting species in the understorey.

The Role of Mediterranean Spotted Fever in the Spectrum of Pediatric Fever with Rashes

When febrile illnesses develop a rash in children, parents are very concerned about a serious disease. Many rashes associated with fever are caused by infectious diseases. Rashes are generally nonspecific and play a supportive role in differential diagnosis, but for some diseases, the appearance of the rash is essential in making a diagnosis. Here is presented the case of a 4-year-old boy with high fever, headache, abdominal pain, vomiting, diarrhea, and a generalized maculo-papular rash including palms and soles. On physical examination were found a black eschar, cervical lymphadenopathy, and hepatosplenomegaly. Laboratory findings resulted in moderate leukocytosis and moderate involvement of the liver and renal function. Based on this finding, a diagnosis of Mediterranean Spotted Fever was performed. The child recovered after medication with azithromycin. Because there is no reliable test that can confirm MSF in its early stages, the diagnosis is commonly made on the basis of clinical findings, so a high index of suspicion should be maintained while evaluating a child with fever and rash.

Pulsed export of carbon in the north-western Mediterranean Sea

The short term(hourly scale)variability of heterotrophic prokaryote(HP)vertical distribution and respiratory activity,was investigated in the north-western(NW)Mediterranean Sea.HP vertical distribution was determined on board by flow cytometry analysis of seawater samples collected by series of CTD casts.Cell counts and viability were determined for all samples.HP respiratory rates were determined later in the laboratory from filtered seawater samples(23 dm^(3))from 300-1150-m depth.The average cell viability was 94.8%±2.2%(n=240).There was no accumulation of dead cells,due to quick decay of damaged cells.In the epipelagic layer,three HP groups were distinguished,two(HNA1,HNA2)who se cells exhibited a high nucleic acid content and one(LNA)with low nucleic acid content cells.HNA2 was most populated at 50 m but not detected at 90 m and below,presumably aerobic anoxygenic photoheterotrophic bacteria(AAPs).The variability in HP abundance was mainly confined in the upper 80 m.A few secondary peaks of HP abundance were observed(80-150 m)in connection with abundance troughs in the surface layer.HP cells were continuously present in a wide layer around 500 m(mean 191×10^(3)cells/cm^(3)).Below this layer,HP abundance randomly exhibited peaks,coupled to respiratory rate peaks.The HP abundance and variability in the water column was suppressed during a strong wind event.The observed sporadic variability was tentatively interpreted through a pulsed carbon-export mechanism induced by the microorganism production of dissolved poly saccharide s,followed by flocculation and rapid sinking.This mechanism would thus contribute to(ⅰ)preventing organic matter accumulation in the epipelagic layer,(ⅱ)seeding the water column with live HP cells,and(ⅲ)supplying the aphotic water column with fre sh and labile organic matter.This important vertical flux mechanism needs further observations and modelling.

An Inventory of Some Relatively Large Marine Mammals, Reptiles, and Fishes Sighted, Caught, By-Caught, or Stranded in the Mediterranean Coast of the Gaza Strip-Palestine

The Mediterranean Sea is home to an interesting biodiversity. The current cumulative and descriptive study aims to enumerate some relatively large marine mammals, reptiles, and fishes that have been spotted, caught, by-caught, or stranded on the coast of the Gaza Strip, Palestine, which extends about 42 km along the Mediterranean Sea. This 20-year study from 2003 to 2022 relied much on frequent field visits, meetings, and discussions with stakeholders, following local media sites and social media pages, and photography. The study recorded at least 26 giants or relatively large marine organisms on the Mediterranean coast of the Gaza Strip, Palestine. Certainly, the coming years may bring other marine organisms of relatively large sizes. Marine mammals included three species of cetaceans with the Fin Whale (Balaenoptera physalus) being the largest mammal and even the largest animal ever recorded in this study. Marine reptiles included three species of sea turtles, the largest of which is the Leatherback Sea Turtle (Dermochelys coriacea), which is in fact the world’s largest sea turtle. The bony fishes were represented by ten species, the largest of which was the Ocean Sunfish (Mola mola), which is the largest bony fish in the world. The cartilaginous fishes included ten species with the largest specimens encountered were the Shortfin Shark (Isurus oxyrinchus), Bluntnose Sixgill Shark (Hexanchus griseus), Scalloped Hammerhead Shark (Sphyrna lewini), and Giant Devil Ray (Mobula mobular). Seabirds were not included in the study. The Alexandria Pompano (Alectis alexandrinus) and the Silver-Cheeked Toadfish (Lagocephalus sceleratus), which are bony fishes, appear to be the relatively smallest marine organisms recorded here. In conclusion, the role of the various parties must be coordinated to ensure the sustainability of human activities and their compatibility with the task of conserving local marine biota, including the gigantic or relatively large ones.

Cooperative Learning in Mediterranean European Cultural Settings:Taking Classroom Teaching in UMA as an Example

This paper provides an exploration of cooperative learning(CL) in a Mediterranean European cultural setting, taking classroom teaching in the University of Málaga(UMA) as an example. An important part of the paper is on the definitions of CL, second language acquisition(SLA) and relative literature by scholars or educators home and abroad, such as historical and contemporary views of CL, its development and application in a variety of classrooms, esp. in multi-lingual settings, in UMA. It also puts much emphasis on sociocultural aspects of CL. Besides, this paper compares the application of CL with that in SWUST,one public university in Southwest China. In views of current problems and awkward situations in the application of CL, the paper argues that the qualified teachers and quality monitoring systems are the two major decisive factors that affect the achievement of CL in Spanish institutions. This paper also analyzes the main characteristics of the classroom teaching in Mediterranean European Cultural Settings. Thus, the paper suggests that CL may be one of the most efficient approaches to improving the quality of education in UMA. Finally, the paper concludes with recommendations and suggestions that Spanish institutions train more wellqualified teachers to meet the increasing demand of CL approach in multi-contextual or multi-lingual settings.

Mediterranean diet and nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is emerging as the most common chronic liver disease, and is characterized by a wide spectrum of fat-liver disorders that can result in severe liver disease and cirrhosis. Inflammation and oxidative stress are the major risk factors involved in the pathogenesis of NAFLD. Currently, there is no consensus concerning the pharmacological treatment of NAFLD. However, lifestyle interventions based on exercise and a balanced diet for quality and quantity, are considered the cornerstone of NAFLD management. Mediterranean diet(MD), rich in polyunsaturated fats, polyphenols, vitamins and carotenoids, with their anti-inflammatory and antioxidant effects, has been suggested to be effective in preventing cardiovascular risk factors. In adults, MD has also been demonstrated to be efficacious in reducing the risk of metabolic syndrome. However, few studies are available on the effects of the MD in both adult and pediatric subjects with NAFLD. Thus, the aims of the present narrative review are to analyze the current clinical evidence on the impact of MD in patients with NAFLD, and to summarize the main mechanisms of action of MD components on this condition.

Biomass and dominance of conservative species drive above-ground biomass productivity in a mediterranean-type forest of Chile

Background: Forest productivity has a pivotal role in human well-being. Vegetation quantity, niche complementarity, mass-ratio, and soil resources are alternative/complementary ecological mechanisms driving productivity. One challenge in current forest management depends on identifying and manipulating these mechanisms to enhance productivity. This study assessed the extent to which these mechanisms control aboveground biomass productivity(AGBP) of a Chilean mediterranean-type matorral. AGBP measured as tree aboveground biomass changes over a 7-years period, was estimated for twelve 25 m × 25 m plots across a wide range of matorral compositions and structures. Variables related to canopy structure, species and functional diversity, species and functional dominance, soil texture, soil water and soil nitrogen content were measured as surrogates of the four mechanisms proposed. Linear regression models were used to test the hypotheses. A multimodel inference based on the Akaike’s information criterion was used to select the best models explaining AGBP and for identifying the relative importance of each mechanism.Results: Vegetation quantity(tree density) and mass-ratio(relative biomass of Cryptocarya alba, a conservative species) were the strongest drivers increasing AGBP, while niche complementarity(richness species) and soil resources(sand, %) had a smaller effect either decreasing or increasing AGBP, respectively. This study provides the first assessment of alternative mechanisms driving AGBP in mediterranean forests of Chile. There is strong evidence suggesting that the vegetation quantity and mass-ratio mechanisms are key drivers of AGBP, such as in other tropical and temperate forests. However, in contrast with other studies from mediterranean-type forests, our results show a negative effect of species diversity and a small effect of soil resources on AGBP.Conclusion: AGBP in the Chilean matorral depends mainly on the vegetation quantity and mass-ratio mechanisms.The findings of this study have implications for matorral restoration and management for the production of timber and non-timber products and carbon sequestration.

Mediterranean diet and non-alcoholic fatty liver disease:New therapeutic option around the corner?

Non-alcoholic fatty liver disease(NAFLD)represents the most common chronic liver disease in Western countries,being considered as the hepatic manifestation of metabolic syndrome.NAFLD has a common pathogenic background to that of metabolic syndrome,and shares many risk factors such as obesity,hypertension,insulin resistance and dyslipidemia.Although there is no currently available evidence-based established treatment for NAFLD,all the recommendations from the medical associations indicate that the most effective treatment is to reduce weight through lifestyle modifications.Diet,indeed,plays a key role in the management of NAFLD patients,as both the quantity and quality of the diet have been reported to have a beneficial role in the onset and severity of the liver disease.Among all the diets that have been proposed,a Mediterranean diet was the most effective dietary option for inducing weight loss together with beneficial effects on all the risk factors associated with metabolic syndrome and NAFLD.Over the last few years,research has demonstrated a beneficial effect of a Mediterranean diet in NAFLD.In this review,we will examine all the available data on the association between diet,nutrients and the Mediterranean diet in association with onset and severity of NAFLD.

Changes in foliar carbon isotope composition and seasonal stomatal conductance reveal adaptive traits in Mediterranean coppices affected by drought

We estimated water-use efficiency and potential photosyn- thetic assimilation of Holm oak （Quercus ilex L.） on slopes of NW and SW aspects in a replicated field test examining the effects of intensifying drought in two Mediterranean coppice forests. We used standard tech- niques for quantifying gas exchange and carbon isotopes in leaves and analyzed total chlorophyll, carotenoids and nitrogen in leaves collected from Mediterranean forests managed under the coppice system. We pos- tulated that responses to drought of coppiced trees would lead to differ- ential responses in physiological traits and that these traits could be used by foresters to adapt to predicted warming and drying in the Mediterra- nean area. We observed physiological responses of the eoppiced trees that suggested acclimation in photosynthetic potential and water-use effi- ciency： （1） a significant reduction in stomatal conductance （p〈0.01） wasrecorded as the drought increased at the SW site; （2） foliar 813C increased as drought increased at the SW site （p〈0.01）; （3） variations in levels of carotenoids and foliar nitrogen, and differences in foliar morphology were recorded, and were tentatively attributed to variation in photosyn- thetic assimilation between sites. These findings increase knowledge of the capacity for acclimation of managed forests in the Mediterranean region of Europe.

Physical Activity, Mediterranean Diet and Biomarkers-Assessed Risk of Alzheimer’s: A Multi-Modality Brain Imaging Study

Increased physical activity and higher adherence to a Mediterranean-type diet (MeDi) have been independently associated with reduced risk of Alzheimer’s disease (AD). Their association has not been investigated with the use of biomarkers. This study examines whether, among cognitively normal (NL) individuals, those who are less physically active and show lower MeDi adherence have brain biomarker abnormalities consistent with AD. Methods: Forty-five NL individuals (age 54 ± 11, 71% women) with complete leisure time physical activity (LTA), dietary information, and cross-sectional 3D T1-weigthed MRI, 11C-Pittsburgh Compound B (PiB) and 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) scans were examined. Voxel-wise multivariate partial least square (PLS) regression was used to examine the effects of LTA, MeDi and their interaction on brain biomarkers. Age, gender, ethnicity, education, caloric intake, BMI, family history of AD, Apolipoprotein E (APOE) genotype, presence of hypertension and insulin resistance were examined as confounds. Subjects were dichotomized into more and less physically active (LTA+ vs. LTA-;n = 21 vs. 24), and into higher vs. lower MeDi adherence groups (n = 18 vs. 27) using published scoring methods. Spatial patterns of brain biomarkers that represented the optimal association between the images and the groups were generated for all modalities using voxel-wise multivariate Partial Least Squares (PLS) regression. Results: Groups were comparable for clinical and neuropsychological measures. Independent effects of LTA and MeDi factors were observed in AD-vulnerable brain regions for all modalities (p β load and lower glucose metabolism) were observed in LTA- compared to LTA+ subjects, and in MeDi- as compared to MeDi+ subjects. A gradient effect was observed for all modalities so that LTA+/MeDi+ subjects had the highest and LTA+/MeDi+ subjects had the lowest AD-burden (p < 0.001), although the LTA × MeDi interaction was significant only for FDG measures (p < 0.03). Adjusting for covariates did not attenuate these relationships. Conclusion: Lower physical activity and MeDi adherence were associated with increased brain AD-burden among NL individuals, in-dicating that lifestyle factors may modulate AD risk. Studies with larger samples and longitudinal evaluations are needed to determine the predictive power of the observed associations.

Impact of Drain Effluent on Surficial Sediments in the Mediterranean Coastal Wetland: Sedimentological Characteristics and Metal Pollution Status at Lake Manzala, Egypt

Surface sediments were collected from Lake Manzala, the Mediterranean coastal wetland located to the east of the Nile Delta, Egypt, to assess the effect of drain effluent on the spatial variations of sedimentary characteristics and heavy metal pollution. Grain-size compositions, textures, and heavy metal distribution patterns in sediments are presented using GIS technique. Results of the analysis of the sediment showed a clear effect of drain effluent, with an increase in fine fractions and homogeneous suspensions in transportation mode. Lake sediments were dominated by sandy mud textures, and mode of transportation was homogeneous sus- pension and rolling. Spatial distribution of heavy metals (Fe, Mn, Zn, Cu, Ni, Cr, and Pb) was studied in the lake’s surficial sediments, along with their relationship to drain effluent and their contamination status in the ecological system. Heavy metal pollution status was assessed by means of accepted sediment quality guidelines and contamination assessment methods (contamination factor, con- tamination degree, modified contamination degree, geo-accumulation, and enrichment factor). Among the determined heavy metals, Pb had the most ecological risk. Generally, the heavy metals in the surface sediments indicated pollution risk ranging from moderate to considerable, particularly, in those sites facing drains and inlets that had the highest toxic effluent. The results were interpreted by statistical means. A cluster analysis defined areas facing drain discharge and inlets as separated groups. ANOVA indicated that most of the sedimentation and studied metals directed this clustering.

Generation of Back-Arc Basins as Side Effect of Shortening Processes: Examples from the Central Mediterranean

The evolution of the Mediterranean area since the Oligocene-Lower Miocene has been driven by the convergence of the surrounding plates. This implies that the observed deformation pattern in that region must be the most convenient shortening pattern, i.e. the one controlled by the minimum action principle. To understand why the fulfilment of such condition has required a complex spatio-temporal distribution of major tectonic events, such as uplift, lateral displacement and bending of orogenic belts, consumption of large lithospheric domains and formation of back arc basins, it may be very useful to take into account a basic tectonic concept, which helps to identify the process that can minimize the resistance of tectonic forces. Such concept starts from the fact that the most convenient consumption process is the one that involves low buoyancy oceanic lithosphere (Tethyan domains). However, such process is highly favoured where the oceanic lithosphere is stressed by vertical forces, a situation that develops when orogenic wedges are forced to over thrust and load the oceanic domain to be consumed. This interpretation can provide plausible and coherent explanations for the complex pattern of the observed deformations. In this view, the generation of back arc basins is taken as a side effect of an extrusion process, as suggested by numerical and mechanical experiments.

Decline and dieback of cork oak(Quercus suber L.)forests in the Mediterranean basin:a case study of Kroumirie,Northwest Tunisia

Assessing the vulnerability of forest ecosystems in the climate change context is a challenging task as the mechanisms that determine this vulnerability cannot be directly observed.Based on the ecological interrelationships between forests and climate,the present review focused on providing current information about vulnerability assessments of cork oak(Quercus suber L.)forests in the Mediterranean basin,especially,in the Kroumirie region(northwest Tunisia),currently under historic extreme drought conditions.From comparing recent findings in this region,we synthesized data on cork oak decline and mortality collected during the historic drought years 1988–1995 period.Climate change impacts cork forest decline,with special interest shown in elevated temperatures and drought;cork oak forest regeneration,and the adaptation of the Kroumirie forest to climate change,are reviewed herein.The studied region has been influenced largely by frequent prolonged drought periods,especially from 1988 to 1995.Droughts were found to consistently have a more detrimental impact on the growth and mortality rates of cork oak populations.Cork oak mortality was recorded for up to 63,622 trees.In the future,more research studies and observational data will be needed,which could represent an important key to understand ecosystem processes,and to facilitate the development of better models that project climate change impacts and vulnerability.The study is useful for researchers and forestry decision makers to develop the appropriate strategies to restore and protect ecosystems,and to help anticipate potential future droughts and climate change.

Fluoride distribution and the effect of some ions along Alexandria coastal Mediterranean seawater of Egypt

The coastal seawater of Mediterranean of Alexandria receives large amount of discharged waters containing industrial wastes, sewage, and agricultural and domestic drainage. Fluoride and some parameters were(chemical and physical) determined. The data gave indication that the content and the amount of the discharged water largely affect the chemical composition of the coastal water. Stepwise regression analysis was highly significant and the model was very fruitful, where the observed and calculated values were mostly concordant. This may indicated that there was a relation between fluoride content in coastal seawater and its content in the discharged water.

Contribution of the Sea Surface Temperature over the Mediterranean-Black Sea to the Decadal Shift of the Summer North Atlantic Oscillation

Recent observational study has shown that the southern center of the summer North Atlantic Oscillation （SNAO） was located farther eastward after the late 1970s compared to before. In this study, the cause for this phenomenon is explored. The result shows that the eastward shift of the SNAO southern center after the late 1970s is related to the variability of the Mediterranean-Black Sea （MBS） SST. A warm MBS SST can heat and moisten its overlying atmosphere, consequently producing a negative sea level pressure （SLP） departure over the MBS region. Because the MBS SST is negatively correlated with the SNAO, the negative SLP departure can enhance the eastern part of the negative-phase of the SNAO southern center, consequently producing an eastward SNAO southern center shift. Similarly, a cold MBS SST produces an eastward positive-phase SNAO southern center shift. The reason for why the MBS SST has an impact on the SNAO after the late 1970s but why it is not the case beforehand is also discussed. It is found that this instable relationship is likely to be attributed to the change of the variability of the MBS SST on the decadal time-scale. In 1951 1975, the variability of the MBS SST is quite weak, but in 1978 2002, it becomes more active. The active SST can enhance the interaction between the sea and its overlying atmosphere, thus strengthening the connection between the MBS SST and the SNAO after the late 1970s. The above observational analysis results are further confirmed by sensitivity experiments.

Mediterranean diet and diabetes prevention:Myth or fact?

Type 2 diabetes is a major, non-communicable disease with increasing prevalence at a global level. Therefore, in order to prevent this condition action should be taken regarding the modifiable factors that influence its development - lifestyle and dietary habits. As the Mediterranean dietary pattern has beneficial effects on both human health and regarding the development and treatment of type 2 diabetes, promoting adherence to this pattern is of considerable public health importance.

Adherence to Mediterranean diet and advanced glycation endproducts in patients with diabetes

BACKGROUND In recent years,American Diabetes Association started to strongly advocate the Mediterranean diet(MD)over other diets in patients with diabetes mellitus(DM)because of its beneficial effects on glycemic control and cardiovascular(CV)risk factors.Tissue levels of advanced glycation endproducts(AGEs)emerged as an indicator of CV risk in DM.Skin biopsy being invasive,the use of AGE Reader has been shown to reflect tissue AGEs reliably.AIM To examine the association between adherence to MD and AGEs in patients with DM type II.METHODS This cross-sectional study was conducted on 273 patients with DM type II.A survey questionnaire was composed of 3 separate sections.The first part of the questionnaire included general data and the habits of the participants.The second part aimed to assess the basic parameters of participants’diseases and associated conditions.The third part of the questionnaire was the Croatian version of the 14-item MD service score(MDSS).AGEs levels and associated CV risk were measured using AGE Reader(DiagnOptics Technologies BV,Groningen,The Netherlands).RESULTS A total of 27(9.9%)patients fulfilled criteria for adherence to MD,with a median score of 8.0(6.0-10.0).Patients with none/limited CV risk had significantly higher percentage of MD adherence in comparison to patients with increased/definite CV risk(15.2%vs 6.9%,P=0.028),as well as better adherence to guidelines for nuts(23.2%vs 12.6%,P=0.023)and legumes(40.4%vs 25.9%,P=0.013)consumption.Higher number of patients with glycated hemoglobin(HbA1c)<7%adhered to MD when compared to patients with HbA1c>7%(14.9%vs 7.3%,P=0.045).Moreover,those patients followed the MDSS guidelines for eggs(33.0%vs 46.8%,P=0.025)and wine(15.6%vs 29.8%,P=0.006)consumption more frequently.MDSS score had significant positive correlation with disease duration(r=0.179,P=0.003)and negative correlation with body mass index(BMI)values(r=-0.159,P=0.008).In the multiple linear regression model,BMI(β±SE,-0.09±0.04,P=0.037)and disease duration(β±SE,0.07±0.02,P<0.001)remained significant independent correlates of the MDSS score.Patients with HbA1c>7%think that educational programs on nutrition would be useful for patients in significantly more cases than patients with HbA1c<7%(98.9%vs 92.6%,P=0.009).CONCLUSION Although adherence to MD was very low among people with diabetes,we demonstrated that adherence to MD is greater in patients with lower CV risk,longer disease duration,and well-controlled glycaemia.

Role of Mediterranean diet in preventing platinum based gastrointestinal toxicity in gynecolocological malignancies: A single Institution experience

BACKGROUND Gynecological malignancies represent a major cause of death in women and are often treated with platinum-based regimens.Patients undergoing chemotherapy suffer from alterations in nutritional status which may worsen gastrointestinal(GI)toxicities,quality of life and affect the overall prognosis.Indeed,assuring a good nutritional status and limiting toxicities during treatment are still major goals for clinicians.AIM To assess the role of Mediterranean Diet(MD)in reducing GI toxicities in patients with gynecological cancers treated with platinum-based regimens.METHODS We conducted an observational study on 22 patients with gynecological tumors treated with a platinum-based chemotherapy at Candiolo Cancer Institute FPO/IRCCS between January 2018 and June 2018.The food and frequency(FFQ)and the Patient-Reported Outcomes Common Terminology Criteria For Adverse Events(PRO-CTCAE)questionnaires were administered at baseline and at every Day 1 of each cycle.To evaluate the differences in GI toxicities the study population was divided in two groups according to the currently validated Mediterranean Diet Serving Score(MDSS)at baseline.RESULTS Patients with high MDSS reported a trend toward lower GI toxicities according to PRO-CTCAE at each timepoint(first evaluation:P=0.7;second:P=0.52;third:P=0.01).In particular,difference in nausea frequency and gravity(P<0.001),stomach pain frequency and gravity(P=0.01 and P=0.02),abdomen bloating frequency and gravity(P=0.02 and P=0.03),and interference with daily activities(P=0.02)were highly statistically significant at the end of treatment.More than 60%of patients changed their food habits during chemotherapy mainly because of GI toxicities.A higher reduction of food intake,both in terms of caloric(P=0.29)and of single nutrients emerged in the group experiencing higher toxicity.CONCLUSION Our results show that adherence to MD possibly reduces GI toxicity and prevents nutritional status impairment during chemotherapy treatment.Bigger studies are needed to confirm our results.