Input of various chemicals transported by Saharan dust and depositing at the sea surface in the Mediterranean sea

This paper reviews work on the role of Saharan dust as a contribution of various chemical to the Mediterranean basin. Both the magnitude and the mineralogical composition of atmospheric dust inputs indicate that eolian deposition is an important (50%) or even dominant (>80%) contribution to sediments in the offshore waters of the entire Mediterranean basin. The Mediterranean Sea is a semi-enclosed basin, that receives substances sporadically from the arid region of the Sahara desert. We considered the location and strength of source areas, the transport paths of material away from the desert, the number of Saharan dust transports per year, the way to be dust is deposited (wet and dry mode), the fluxes of Saharan dust, the nature of the material, and the contribution of nutrients to the sea surface. Estimates of atmospheric inputs to the Mediterranean and some coastal areas are reviewed. Model data for nutrients indicate that the atmosphere delivers the nitrogen and one-third of total phosphorus to the entire basin. Measured data in sub-basins, such as the Western Mediterranean and Eastern Mediterranean indicate an even greater proportions of atmospheric versus riverine input. New production supported by atmospheric nitrogen deposition ranges from 2–4 g C m -2 yr -1 , whereas atmospheric phosphorus deposition appears to support less than 1 g C m -2 yr -1 . In spite of the apparently small contribution of atmospheric deposition to overall production in the basin it has been suggested that certain episodic phytoplankton blooms are triggered by atmospheric deposition of N, P or Fe. Iron fluxes may be important in determining the nature and quantity of carbon fluxes from Fe-rich areas (like MED Sea), in addition to Fe-poor areas such as the extant Southern Ocean. A geophysiological model shows that iron removal from the photic zone does occur at a much higher rate than the conventional biological pump can account for and that this might release the risk of excessive phosphate scavenging

OnabotulinumtoxinA: Still the Present for Chronic Migraine

OnabotulinumtoxinA (BT-A) is one of the few drugs approved for the preventive treatment of chronic migraine (CM). Despite this, some aspects of its mechanism of action are still a matter of debate, and the precise magnitude of BT-A effects needs to be completely elucidated. BT-A acts primarily upon trigeminal and cervical nerve endings, by inhibiting the release of inflammatory mediators such as calcitonin gene-related peptide, as well as reducing the insertion of ionotropic and metabotropic receptors into the neuronal membrane. These actions increase the depolarization threshold of trigeminal and cervical nerve fibers, thus reducing their activation. The central actions of BT-A are still a matter of debate: a retrograde axonal transport has been postulated, but not clearly assessed in humans. Clinically, the efficacy of BT-A in CM has been assessed by large, randomized placebo-controlled trials, such as the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. Those results were also confirmed in a wide range of open-label studies, even for long-term periods. Recently, novel findings have led to a better understanding of its pharmacological actions and clinical usefulness in migraine prevention. This narrative review summarizes, updates and critically revises the available data on BT-A and its possible implementation in chronic migraine. Moreover, the current role of BT-A in CM treatment has been discussed

Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real-world clinical evidence in a severely impaired patient population

Background: Galcanezumab is a monoclonal antibody acting against the calcitonin gene-related peptide approved for the preventive treatment of migraine. The aim of this article is to explore its effectiveness and safety of galcanezumab in chronic migraine (CM) with medication overuse-headache (MOH). Methods: Seventy-eight patients were consecutively enrolled at the Modena headache center and followed up for 15 months. Visits were scheduled every 3 months, and the following variables were collected: the number of migraine days per month (MDM); the painkillers taken per month (PM); the number of days per month in which the patient took, at least, one painkiller; the six-item headache impact test; and the migraine disability assessment questionnaire (MIDAS) score. Demographic features of the analyzed sample were collected at the baseline and adverse events (AEs) were collected at every visit. Results: After 12 months, galcanezumab significantly reduced the MDM, the PM, the number of days on medication, the HIT-6 as well as the MIDAS scores (all p <.0001). The greatest amelioration was obtained in the first trimester of treatment. A higher MDM, a higher NRS score at the baseline, and a higher number of failed preventive treatments negatively predict the CM relief at the year of treatment. No serious AEs were registered and only one drop-out was due to AE. Conclusions: Galcanezumab is effective and safe for the treatment of patients affected by CM and MOH. Patients with a higher impairment at the baseline may found less benefits with galcanezumab

Predictors of response to erenumab after 12 months of treatment

Objective: Erenumab is a monoclonal antibody acting against calcitonin gene-related peptide receptor and approved for the preventive treatment of chronic migraine. The aim of the present study is to identify clinical predictors of good response in patients with chronic migraine and medication overuse-headache. Material and methods: This was a retrospective single-center not funded study. Enrolled patients were affected by chronic migraine and medication overuse-headache treated with erenumab monthly, up to 1 year. At 1 year, patients were classified as good responders if they displayed a ≥50% reduction in the number of headache days per months compared to the baseline. Results: After 1 year, a significant improvement in the number of headache days per months, analgesic consumption, 6-items headache impact test, and migraine disability assessment questionnaire scores were obtained compared to the baseline. Patients who obtained a ≥50% reduction in the number of headache days per month compared to the baseline displayed a longer history of medication overuse-headache, a higher number of painkillers taken per month at the baseline and a higher number of failed preventive treatments in the past. Conclusions: Patients with longer medication overuse-headache duration, higher analgesic intake, and a higher number of previous preventive treatment failures may receive less benefit with erenumab

Endothelin-1 Drives Epithelial-Mesenchymal Transition In Hypertensive Nephroangiosclerosis

BACKGROUND: Tubulointerstitial fibrosis, the final outcome of most kidney diseases, involves activation of epithelial mesenchymal transition (EMT). Endothelin‐1 (ET‐1) activates EMT in cancer cells, but it is not known whether it drives EMT in the kidney. We therefore tested the hypothesis that tubulointerstitial fibrosis involves EMT driven by ET‐1. METHODS AND RESULTS: Transgenic TG[mRen2]27 (TGRen2) rats developing fulminant angiotensin II–dependent hypertension with prominent cardiovascular and renal damage were submitted to drug treatments targeted to ET‐1 and/or angiotensin II receptor or left untreated (controls). Expressional changes of E‐cadherin and α‐smooth muscle actin (αSMA) were examined as markers of renal EMT. In human kidney HK‐2 proximal tubular cells expressing the ET(B) receptor subtype, the effects of ET‐1 with or without ET‐1 antagonists were also investigated. The occurrence of renal fibrosis was associated with EMT in control TGRen2 rats, as evidenced by decreased E‐cadherin and increased αSMA expression. Irbesartan and the mixed ET‐1 receptor antagonist bosentan prevented these changes in a blood pressure–independent fashion (P < 0.001 for both versus controls). In HK‐2 cells ET‐1 blunted E‐cadherin expression, increased αSMA expression (both P < 0.01), collagen synthesis, and metalloproteinase activity (P < 0.005, all versus untreated cells). All changes were prevented by the selective ET(B) receptor antagonist BQ‐788. Evidence for involvement of the Rho‐kinase signaling pathway and dephosphorylation of Yes‐associated protein in EMT was also found. CONCLUSIONS: In angiotensin II–dependent hypertension, ET‐1 acting via ET(B) receptors and the Rho‐kinase and Yes‐associated protein induces EMT and thereby renal fibrosis

Saharan dust inputs to the W Mediterranean Sea: depositional patterns, geochemistry and sedimentological implications.

Data are presented for a number of parameters for aerosols and rainwaters collected at a station on Sardinia. The findings are interpreted with special reference to Saharan dusts, and are compared to other data on these dusts obtained from a variety of sites around the Mediterranean Sea. At the Sardinia site the particle size distribution of the Saharan outbreaks exhibits a bimodal structure, the two modes being between 1 and 2 µm and 20-25 µm. The presence of giant particles strongly affects the deposition velocities of the Saharan aerosols. Source markers for the Saharan dusts are palygorskite, kaolinite, calcite, dolomite and rounded quartz grains. The input of Saharan dust has important effects on the chemistry of the Mediterranean aerosols. These include: (i) increases in the atmospheric concentrations and sea surface fluxes of crust-controlled trace metals (e.g.; Al, Fe); (ii) decreases in the EFcrust values of non-crust-controlled trace metals (e.g.; Cu, Zn and Pb) in the aerosols, and (iii) changes in the solid state speciation of Cu, Zn, and Pb, which decrease their solubilities in sea water. The Saharan dusts also affect the composition of rainwater by raising the pH, following the dissolution of calcium, and by decreasing the solubility of trace metals such as Cu, Zn and Pb. Wet deposition controls the flux of Saharan dust to the Mediterranean Sea, but dry deposition can also be important. The dust transport occurs in the form of "pulses", and the annual dust flux can be controlled by few episodes of Saharan outbreaks; e.g. sometimes a single outbreak can account for 40-80 % of the flux. Saharan dust deposition fluxes range from 2 to 25 g m-2 (average; ~ 10) in the W Mediterranean between 39° and 42° N, between 6 and 46 g m-2 (avg. ~ 20) in the E Mediterranean, and 0.4 to1.0 g m-2 over the Alps on continental Europe. The present day Saharan dust fluxes (~ 1 mg cm-2 yr-1) account for about 10-20% of the recent deep-sea sedimentation in the Western Mediterranean (3-15 mg cm-2 yr-1)

Contribution of Saharan dust to the Central Mediterranean basin

The Mediterranean Basin receives sedimentary contributions from several sources with different geological characteristics. The most important natural source of dust is the Saharan desert. Data from aerosol dust samples collected in a remote site in the Central Mediterranean Basin were used to investigate incursions of Saharan dust during a seven-month period (October through April). This work is an attempt to trace source areas and transport of dust plumes by means of grain-size, mineralogical, and chemical analyses. Two sets of aerosol samples typical of "desert-dominated" and "anthropogenic- dominated" air masses were studied. We propose a model for assessing the effects of latitude on the chemistry and mineralogy of the Central Mediterranean aerosol. Calculations and measurements of insoluble fluxes, in particular for Al (80 μg/cm2 yr-1) and Ca (28μg/cm2 yr-1), were performed, and results were compared with fluxes from the literature calculated in other stations in the Mediterranean Basin

Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers. A case-control study.

Background The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. Methods and findings We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. Conclusions Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers

Geochemistry of natural and anthropogenic fall-out (aerosol and precipitation) collected in NW Mediterranean: two different multivariate statistical approaches

The chemical characteristics of the mineral fractions of aerosol and precipitation collected in Sardinia (NW Mediterranean) are highlighted by means of two multivariate statistical approaches. Two different combinations of classification and statistical methods for geochemical data are presented. It is shown that the application of cluster analysis subsequent to Q-Factor analysis better distinguishes among Saharan dust, Background pollution (Europe-Mediterranean) and Local aerosol from various source regions (Sardinia). Conversely, the application of simple cluster analysis was able to distinguish only between aerosols and precipitation particles, without assigning the sources (local or distant) to the aerosol. This method also highlighted the fact that crust-enriched precipitation is similar to desert-derived aerosol. Major elements (Al, Na) and trace metal (Pb) turn out to be the most discriminating elements of the analysed data set. Independent use of mineralogical, granulometric and meteorological data confirmed the results derived from the statistical methods employed