LA DIMENSIONE FRATTALE DEI REEF A VERMETI

Fractal geometry can be an useful tool to describe the structural complexity of a vermetid reef. Using fractal analysis of small surfaces, the fractal dimension for the outer rim of some vermetid reefs can be established. A positive correlation between fractal values and the density of Dendropoma petraeum is evident

RESULTS OF DIFFERENT ANTHROPIC USES ON THE STRUCTURE OF VERMETID REEFS

The biogenic vermetid reef is a key habitat of coastal ecosystems that modifies the shoreline morphology and increases the local biodiversity. Despite its ecological relevance, rarely it is subjected to an accurate management and is often exposed to several human activities. This study aims to distinguish between the effects of different typologies of anthropic uses on the physical structure of the vermetid reef. A comparison between totally protected, partially protected and strongly anthropized reefs has been done and two variables have been analysed: the substratum complexity and the density of reef-building organism. Both the variables show higher values in totally and partially protected reefs, demonstrating the importance of conservation strategies for the correct management of this important bioconstruction

GLI EFFETTI DEL DISTURBO ANTROPICO SULLA TOPOGRAFIA DEL REEF A VERMETI

Intertidal vermetid reefs could be affected by many human disturbances. Using a microtopography device, the authors analysed the changes induced by the accessibility on the surface topography of the reefs. Human activities seems to be able to induce a decrease in rugosity and a surface smoothing on the outer margin of the reef. These effects are proportional to the accessibility of the site

DISTRIBUTION AND CONSERVATION NEEDS OF A NEGLECTED ECOSYSTEM: THE MEDITERRANEAN VERMETID REEF

Vermetid reefs are a key intertidal habitat in the Mediterranean. Despite recent evidence of local extinction in the Eastern Mediterranean, their role as habitat engineers and the high numbers of ecosystem services they provide, vermetid reefs are among the least known marine habitats of the Mediterranean. Here we present a literature-based study to assess for the first time their distribution inside the basin and provide evidence of a general lack of protection at Mediterranean scale

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Investigations into the development and role of a Mediterranean intertidal bioconstruction for coastal conservation: the Vermetid Reef

Vermetid reefs are intertidal biogenic habitats created by a dense aggregation of mollusks, frequently cemented by calcareous algae, and are typical of sub-tropical and warm–temperate rocky shores. These bioconstructions are valuable key-habitats of the coastal zones, increasing their productivity and biological value. In the Mediterranean, the main vermetid reef builders belong to the genus Dendropoma and are associated to encrusting coralline red algae. These organisms are ecosystem engineers protected under international European Legislation, although vermetid reef conservation is limited by a lack of biological and ecological knowledge. The two-way interactions between biota and the physical environment have not been previously studied for these reefs, further limiting understanding of the ecological value and function of this habitat. Phases of the Dendropoma life cycle are also understudied, making the key-processes during the reef development unclear. In an integrated coastal zone management framework, all of this knowledge is fundamental to strengthen vermetid reef conservation and management in the Mediterranean. This thesis aims to further understanding of traits of the Dendropoma reef system, undertaking novel themes of research, and by using an interdisciplinary approach. The research project has two main goals: 1) To describe which contribution the reef provide in preserving rock substrate from physical alteration 2) To understand which cues may promote Dendropoma reef formation A set of laboratory and field experiments and observations has been used to fulfill these aims. The study was conducted in Sicily, central Mediterranean, where the main reef builder species is Dendropoma cristatum (Biondi, 1857), associated with the coralline algae Neogoniolithon brassica-florida (Harvey) Setchell & Mason 1943. In detail, topic 1 aims to describe the bio-protective role of the Dendropoma encrustation on the underneath rock substrate. Bioprotection is described as the contribution that biological layers give to the conservation of the substratum they colonize, by mediating the deteriorative action of other factors, such as physical, chemical and biological weathering. In this study, internal temperature variations and salt weathering have been considered as rock physical stressors that are particularly relevant in the coastal zone, and which may be mediated by the Dendropoma encrustation. Lab experiments and analysis have been employed to describe subsurface variations of temperature and salt content inside rock cores covered by live and dead vermetids vs bare rocks. The experiments have demonstrated that the Dendropoma encrustation exerts a control on the factors responsible for rock weathering. Topic 2 aims to detect which physical and biological factors may promote D. cristatum settlement and recruitment, with implications for the reef development.D. cristatum recruitment and settlement have been measured in the field and in different conditions. A seasonal pattern of recruitment has been described for the Sicilian species D. cristatum, and the hydrodynamic regime has been showed do not affect this pattern within a range of Km. Aside, at a small spatial scale (from mm to cm), biogenic surface have been shown to affect the settlement dynamics of the crawling larvae of Dendropoma cristatum, more than physical complexity of the substratum. In detail, biological cues provided by a layer of crustose coralline algae or by a microbial film, may positively affect settlement dynamic, indicating suitable site for larvae attachment and having an influence on the early stages of Dendropoma cristatum development. In conclusion, this research has contributed to the description of some ecological traits of the reef-builder Dendropomacristatumand provided a wider view of the two-way interactions between this ecosystem engineer and the surrounding physical and biological environment. Within the perspective to improve Dendropoma reef management at Mediterranean scale, the gaining of information about the ecological functioning and role of this coastal systems may provide a valuable contribution.Vermetid reefs are intertidal biogenic habitats created by a dense aggregation of mollusks, frequently cemented by calcareous algae, and are typical of sub-tropical and warm–temperate rocky shores. These bioconstructions are valuable key-habitats of the coastal zones, increasing their productivity and biological value. In the Mediterranean, the main vermetid reef builders belong to the genus Dendropoma and are associated to encrusting coralline red algae. These organisms are ecosystem engineers protected under international European Legislation, although vermetid reef conservation is limited by a lack of biological and ecological knowledge. The two-way interactions between biota and the physical environment have not been previously studied for these reefs, further limiting understanding of the ecological value and function of this habitat. Phases of the Dendropoma life cycle are also understudied, making the key-processes during the reef development unclear. In an integrated coastal zone management framework, all of this knowledge is fundamental to strengthen vermetid reef conservation and management in the Mediterranean. This thesis aims to further understanding of traits of the Dendropoma reef system, undertaking novel themes of research, and by using an interdisciplinary approach. The research project has two main goals: 1) To describe which contribution the reef provide in preserving rock substrate from physical alteration 2) To understand which cues may promote Dendropoma reef formation A set of laboratory and field experiments and observations has been used to fulfill these aims. The study was conducted in Sicily, central Mediterranean, where the main reef builder species is Dendropoma cristatum (Biondi, 1857), associated with the coralline algae Neogoniolithon brassica-florida (Harvey) Setchell & Mason 1943. In detail, topic 1 aims to describe the bio-protective role of the Dendropoma encrustation on the underneath rock substrate. Bioprotection is described as the contribution that biological layers give to the conservation of the substratum they colonize, by mediating the deteriorative action of other factors, such as physical, chemical and biological weathering. In this study, internal temperature variations and salt weathering have been considered as rock physical stressors that are particularly relevant in the coastal zone, and which may be mediated by the Dendropoma encrustation. Lab experiments and analysis have been employed to describe subsurface variations of temperature and salt content inside rock cores covered by live and dead vermetids vs bare rocks. The experiments have demonstrated that the Dendropoma encrustation exerts a control on the factors responsible for rock weathering. Topic 2 aims to detect which physical and biological factors may promote D. cristatum settlement and recruitment, with implications for the reef development.D. cristatum recruitment and settlement have been measured in the field and in different conditions. A seasonal pattern of recruitment has been described for the Sicilian species D. cristatum, and the hydrodynamic regime has been showed do not affect this pattern within a range of Km. Aside, at a small spatial scale (from mm to cm), biogenic surface have been shown to affect the settlement dynamics of the crawling larvae of Dendropoma cristatum, more than physical complexity of the substratum. In detail, biological cues provided by a layer of crustose coralline algae or by a microbial film, may positively affect settlement dynamic, indicating suitable site for larvae attachment and having an influence on the early stages of Dendropoma cristatum development. In conclusion, this research has contributed to the description of some ecological traits of the reef-builder Dendropomacristatumand provided a wider view of the two-way interactions between this ecosystem engineer and the surrounding physical and biological environment. Within the perspective to improve Dendropoma reef management at Mediterranean scale, the gaining of information about the ecological functioning and role of this coastal systems may provide a valuable contribution