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Abstract Introduction Multiple sclerosis (MS) is a chronic neurodegenerative disease that leads to impaired cognitive function and accumulation of disability, with significant socioeconomic burden. Serious unmet need in the context of managing MS has given rise to ongoing research efforts, leading to the launch of new drugs planned for the near future, and subsequent concerns about the sustainability of healthcare systems. This study assessed the changes in the Italian MS market and their impact on the expenditures of the Italian National Healthcare Service between 2023 and 2028. Methods A horizon-scanning model was developed to estimate annual expenditure from 2023 to 2028. Annual expenditure for MS was calculated by combining the number of patients treated with each product (clinical inputs) and the yearly costs of therapy (economic inputs). Baseline inputs (2020–2022) were collected from IQVIA® real-world data, while input estimation for the 5-year forecast was integrated with analog analyses and the insights of clinicians and former payers. Results The number of equivalent patients treated in 2028 in Italy was estimated at around 67,000, with an increase of 10% versus 2022. In terms of treatment pattern evolution, first-line treatments are expected to reduce their shares from 47% in 2022 to 27% in 2028, and Bruton tyrosine kinase inhibitors are expected to reach 23% of patient shares. Overall, expenditure for MS is estimated to decrease from €721 million in 2022 to €551 million in 2028, mainly due to losses of exclusivity and renegotiation of drug prices. Conclusion Despite the increase in the number of patients treated for MS and the launch of new molecules that will reach high market penetration, the model confirmed sustainability for the Italian National Healthcare Service.

The Mediterranean flora is characterized by a high number of narrow endemic plant species that are often restricted to a few small populations. One of these species, Valeriana amazonum, a perennial plant occurring only in the Supramontes region of central eastern Sardinia, is categorized as Critically Endangered on the IUCN Red List because of its restricted range, small population size and an inferred decline caused by several threats. During 2007–2022, we monitored all mature individuals of this plant annually and surveyed ecologically suitable sites for the species. We identified two previously unknown populations and also learnt of two successful translocations carried out independently by an unknown local citizen. As our monitoring data indicate there has been no decline in the number of mature individuals over the period of monitoring, the species’ conservation status requires reassessment. We recommend that V. amazonum should be recategorized as Near Threatened as it seems to be poorly known rather than highly threatened. This could also be the case with other narrow Mediterranean endemics, especially those that grow in inaccessible habitats for which long-term studies are needed to assess conservation status.

In this contribution, the conservation status assessment of three vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Aubrieta columnae subsp. sicula, Calligonum zakirovii and Santolina decumbens subsp. tisoniana at global level.

Wildfires have a significant influence on ecosystems globally, shaping vegetation, biodiversity, landscapes, soil properties, and other ecosystem processes. Despite extensive research on different aspects of wildfires, the edges of burned areas remain understudied, even though they involve complex dynamics. In this study, we analyzed the post-fire vegetation recovery across the edges of a large wildfire in a Mediterranean area. The investigations were focused on patches of woodlands that, in a previous study, showed a normalized burn ratio (NBR) decline one year after the fire. Field vegetation surveys were carried out in areas characterized by different NBR recovery rates and in areas outside the burned area as controls. Five hypotheses were tested, identifying delayed tree mortality as a key factor linked to NBR decline, particularly in low-severity fire zones in proximity to the fire edges. Delayed mortality, observed predominantly near the edges, may also affect unburned or less severely burned patches within the main fire perimeter, highlighting the need for ongoing monitoring. As these areas play a crucial role in the post-fire succession and vegetation dynamics, understanding the second-order effects of a fire is imperative for effective ecosystem management. This study underscores the importance of the long-term assessment of fire impacts, emphasizing the necessity of field surveys alongside remote sensing. Continued observation is essential to elucidate the enduring impacts of wildfires and to facilitate informed restoration strategies.

In this contribution, the conservation status assessment of three vascular plants are presented according to IUCN categories and criteria. It includes the assessment of Oryza rhizomatis D.A.Vaughan and Saxifraga facchinii W.D.J.Koch at a global level and Helianthemum caput-felis Boiss. at a regional level.

Urban natural areas provide important ecological services such as biodiversity conservation, as well as opportunities for people to connect with nature and preserve cultural heritage. However, the increasing demand for access to natural areas and the expansion of human recreational activities, such as hiking and biking, pose threats to these ecosystems, especially for animal and plant species, finally resulting in biodiversity loss. This study explores the intricate link between human trampling, plant density, and the morphological and reproductive characteristics of Globularia alypum L., a plant with a peripheral population in Sardinia restricted to a natural area within an urban context. The study examined trampling effects on 75 plots along a frequently used path crossing the plant’s core population. Similar environmental conditions were assumed, with differences attributed to human trampling intensity and plant density, and morphological and reproductive traits were measured within each plot. Our results showed that human trampling caused differences in the morphological traits of plants, whereas, in contrast, reproductive traits are less vulnerable to human trampling than morphological ones. As a result, trampled areas may experience decreased plant recruitment, which can have long-term implications for plant population dynamics. Understanding the relationship between trampling effects and the sensitivity of peripheral plant populations is crucial for effective conservation and management strategies.

BackgroundRecent evidence has shown a significant association between menopause and multiple sclerosis (MS) progression. This study investigated the possible role of menopause in influencing MS from clinical and neuroradiological perspectives. Notably, the possible association between menopause and brain atrophy has been evaluated.Materials and methodsThis study included women with MS whose ages ranged from 45 to 55 years. Demographic and clinical characteristics were collected, and the reproductive phase was defined as non-menopausal or menopausal based on the final menstrual period. Thus, MS activity over the past year was reported as the annualised relapse rate (ARR), and MRI activity (defined as new T2 lesions and/or the presence of gadolinium-enhancing lesions at the last MRI assessment in comparison with the MRI performed within the previous 12 months) were compared between non-menopausal women (non-MW) and menopausal women (MW). Volume measurements of the whole brain (WB), white matter (WM), grey matter (GM), and cortical GM were estimated using the SIENAX software, and the possible relationship with menopausal status was assessed by regression analysis.ResultsThe study included 147 women with MS. Eighty-four (57.1%) were MW, with a mean age of 48.5 ± 4.3 years at menopause onset and a mean duration of menopause of 4.1 ± 1.1 years. When compared for ARR, MW reported a lower rate than the non-MW (ARR of 0.29 ± 0.4 vs. 0.52 ± 0.5; p

In this contribution, the conservation status assessment of three vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Allium ravenii F.O.Khass., Shomuradov & Kadyrov and Centaurea seguenzae (Lacaita) Brullo, Marcenò & Siracusa at global level and Haloxylon persicum Bunge ex Boiss. & Buhse at regional level.

In this contribution, the conservation status assessment of two vascular plants according to IUCN categories and criteria are presented. It includes the global assessment of Isoëtes todaroana Troìa & Raimondo and Moluccella bucharica (B.Fedtsch.) Ryding.

Abnormal deposition of α-synuclein is a key feature and biomarker of Parkinson's disease. α-Synuclein aggregates can propagate themselves by a prion-like seeding-based mechanism within and between tissues and are hypothesized to move between the intestine and brain. α-Synuclein RT-QuIC seed amplification assays have detected Parkinson's-associated α-synuclein in multiple biospecimens including post-mortem colon samples. Here we show intra vitam detection of seeds in duodenum biopsies from 22/23 Parkinson's patients, but not in 6 healthy controls by RT-QuICR. In contrast, no tau seeding activity was detected in any of the biopsies. Our seed amplifications provide evidence that the upper intestine contains a form(s) of α-synuclein with self-propagating activity. The diagnostic sensitivity and specificity for PD in this biopsy panel were 95.7% and 100% respectively. End-point dilution analysis indicated up to 106 SD50 seeding units per mg of tissue with positivity in two contemporaneous biopsies from individual patients suggesting widespread distribution within the superior and descending parts of duodenum. Our detection of α-synuclein seeding activity in duodenum biopsies of Parkinson's disease patients suggests not only that such analyses may be useful in ante-mortem diagnosis, but also that the duodenum may be a source or a destination for pathological, self-propagating α-synuclein assemblies.

From the perspective of precision medicine, the challenge for the future is to improve the accuracy of diagnosis, prognosis, and prediction of therapeutic responses through the identification of biomarkers. In this framework, the omics sciences (genomics, transcriptomics, proteomics, and metabolomics) and their combined use represent innovative approaches for the exploration of the complexity and heterogeneity of multiple sclerosis (MS). This review examines the evidence currently available on the application of omics sciences to MS, analyses the methods, their limitations, the samples used, and their characteristics, with a particular focus on biomarkers associated with the disease state, exposure to disease-modifying treatments (DMTs), and drug efficacies and safety profiles.

The ‘Habitats’ Directive (HD 92/43/EEC) is one of the primary legal tools aiming at conserving nature in Europe. Due to the complex iter to revise it, the habitats listed in the Annex I have been seldom updated after the HD adoption. Basing on already available information and expert knowledge, this paper presents a preliminary list of relevant habitats occurring in Sardinia, not yet considered and worth to be placed in the Annex I. Two new habitat proposals, one habitat new for Italy, and nine new subtypes of already existing HD habitats are here described. Most of the proposed new habitats and subtypes have a limited distribution range, due to the high number of narrow, often endangered, endemic species that characterize them. Being neglected, they are consequently poorly investigated, inconstantly monitored and unprotected. Thus, the main aim of this paper is to promote their conservation through implementation of HD and its interpretation manuals.

In this contribution, the conservation status assessment of two vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Genista nuragica Bacch., Brullo & Giusso and Jacobaea incana (L.) Veldkamp at global level.

Multiple sclerosis (MS), neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are inflammatory diseases of the central nervous system (CNS) with a multifactorial aetiology. Environmental factors are important for their development and microorganisms could play a determining role. They can directly damage the CNS, but their interaction with the immune system is even more important. The possible mechanisms involved include molecular mimicry, epitope spreading, bystander activation and the dual cell receptor theory. The role of Epstein–Barr virus (EBV) in MS has been definitely established, since being seropositive is a necessary condition for the onset of MS. EBV interacts with genetic and environmental factors, such as low levels of vitamin D and human endogenous retrovirus (HERV), another microorganism implicated in the disease. Many cases of onset or exacerbation of neuromyelitis optica spectrum disorder (NMOSD) have been described after infection with Mycobacterium tuberculosis, EBV and human immunodeficiency virus; however, no definite association with a virus has been found. A possible role has been suggested for Helicobacter pylori, in particular in individuals with aquaporin 4 antibodies. The onset of MOGAD could occur after an infection, mainly in the monophasic course of the disease. A role for the HERV in MOGAD has been hypothesized. In this review, we examined the current understanding of the involvement of infectious factors in MS, NMO and MOGAD. Our objective was to elucidate the roles of each microorganism in initiating the diseases and influencing their clinical progression. We aimed to discuss both the infectious factors that have a well-established role and those that have yielded conflicting results across various studies.

The effect of key ecological and anthropic factors on the recruitment of the common yew (Taxus baccata L.) in Sardinia (Italy) has been analyzed. After bibliographic and cartographic research, followed by field surveys, we found 232 sites where yew grows in Sardinia (as opposed to 69 previously reported in the literature). Among them, we selected 40 sites, located in 14 different mountain chains, characterized by a number of individuals ranging from 11 to 836 adult yews with an average diameter at breast height (DBH) from 13 to 130 cm. By means of generalized linear modeling, we investigated and weighted the effect of ecological, structural, and anthropic factors on the amount of T. baccata recruitment. Our analyses showed that stand recruitment was positively correlated to shrub cover and soil moisture. In particular, shrub cover had a stronger effect, clearly showing that a thicker shrub layer, both bushy and/or spiny, corresponded to a higher number of yew seedlings and saplings. Secondarily, moister sites had a higher number of seedlings and saplings, showing that habitat suitability improved with higher humidity. On the contrary, recruitment was negatively correlated to browsing (both from livestock and wild animals). Our data confirm that the presence of a protective layer of shrubs is a crucial factor for seedling and sapling survival, mostly in relation to protection from summer drought and the browsing of large herbivores. Finally, guidelines for the conservation and restoration of T. baccata communities, referred to as the EU priority habitat 9580* (Mediterranean Taxus baccata woods), have been outlined.

In this contribution, the conservation status assessment of three vascular plants according to IUCN categories and criteria is presented. It includes the global assessment of Limonium parvifolium Tineo and Viscaria alpina (L.) G.Don, and the regional assessment of Rhazya stricta Decne. (Iraq).

Mediterranean pine woodlands are one of the most common wooded vegetation types across the Mediterranean Basin and are included in two habitats of European interest as they have great conservation importance. We studied the woodlands of the class Pinetea halepensis dominated by Pinus halepensis, P. pinaster, and P. pinea in Sardinia (Italy) with the aim to clarify their syntaxonomic position. We compiled a dataset of 66 original vegetation relevés, complemented with the holotypes of similar vegetation types formerly described for Italy and Corsica (France). We classified P. halepensis woodlands, native to the Island of San Pietro, to the association Erico arboreae-Pinetum halepensis. We classified P. halepensis woodlands growing on limestones of the south-western coast of Sardinia to the new association Smilaco asperae-Pinetum halepensis and woodlands typical of coastal dunes to the new association Asparago horridi-Pinetum halepensis. We also described the northeastern Sardinia P. pinaster woodlands as the new association Arbuto unedonis-Pinetum pinastri, of which we recognised two new subassociations, typicum and cephalantheretosum longifoliae, ecologically distinguished by the xerophilous and mesophilous conditions, respectively. Furthermore, we classified P. pinea woodlands, putatively native only to stabilised sand dunes of south-western Sardinia, in the new association Querco calliprini-Pinetum pineae. This study represents the first complete survey and classification of Sardinian pine woodlands, allowing a better understanding of their ecology, floristic composition and differences from other Mediterranean pine woodlands.

Even though plants represent an essential part of our lives offering exploitational, supporting and cultural services, we know very little about the biology of the rarest and most threatened plant species, and even less about their conservation status. Rapid changes in the environment and climate, today more pronounced than ever, affect their fitness and distribution causing rapid species declines, sometimes even before they had been discovered. Despite the high goals set by conservationists to protect native plants from further degradation and extinction, the initiatives for the conservation of threatened species in Europe are scattered and have not yielded the desired results. The main aim of this Action is to improve plant conservation in Europe through the establishment of a network of scientists and other stakeholders who deal with different aspects of plant conservation, from plant taxonomy, ecology, conservation genetics, conservation physiology and reproductive biology to protected area's managers, not forgetting social scientists, who are crucial when dealing with the general public.

Current treatment for Multiple Sclerosis (MS) consists of a multidisciplinary approach including disease-modifying therapies. The response to treatment is heterogeneous, representing a crucial challenge in the classification of patients. Metabolomics is an innovative tool that can identifies biomarkers/predictors of treatment response. We aimed to evaluate plasma metabolic changes in a group of naïve Relapsing-Remitting MS patients starting Fingolimod treatment, to find specific metabolomic features that predict the therapeutic response as well as the possible side effects. The study included 42 Relapsing-Remitting MS blood samples, of which 30 were classified as responders after two years of FINGO treatment, whereas 12 patients were Not-Responders. For fifteen patients, samples were collected at four time points: before starting the therapy; at six months after the initiation; at twelve months after; and at twenty-four months after initiation. The serum was analysed through Nuclear Magnetic Resonance and multivariate and univariate statistical analysis. Considering the single comparison between each time point, it was possible to identify a set of metabolites changing their concentrations based on the drug intake. FINGO influences aminoacidic and energy metabolisms and reduces oxidative stress and the activity of the immune system, both typical features of MS.

In this contribution, the conservation status assessment of two vascular plants according to IUCN categories and criteria is presented. It includes the regional assessment of Jasione orbiculata Griseb. ex Velen. for Italy and of Vachellia gerrardii (Benth.) P.J.H.Hurter subsp. negevensis (Zohary) Ragup., Seigler, Ebinger & Maslin for Iraq.

Using a philosophical approach or deductive reasoning, we challenge the dominant clinico-radiological worldview that defines multiple sclerosis (MS) as a focal inflammatory disease of the central nervous system (CNS). We provide a range of evidence to argue that the ‘real MS’ is in fact driven primarily by a smouldering pathological disease process. In natural history studies and clinical trials, relapses and focal activity revealed by magnetic resonance imaging (MRI) in MS patients on placebo or on disease-modifying therapies (DMTs) were found to be poor predictors of long-term disease evolution and were dissociated from disability outcomes. In addition, the progressive accumulation of disability in MS can occur independently of relapse activity from early in the disease course. This scenario is underpinned by a more diffuse smouldering pathological process that may affect the entire CNS. Many putative pathological drivers of smouldering MS can be potentially modified by specific therapeutic strategies, an approach that may have major implications for the management of MS patients. We hypothesise that therapeutically targeting a state of ‘no evident inflammatory disease activity’ (NEIDA) cannot sufficiently prevent disability accumulation in MS, meaning that treatment should also focus on other brain and spinal cord pathological processes contributing to the slow loss of neurological function. This should also be complemented with a holistic approach to the management of other systemic disease processes that have been shown to worsen MS outcomes.

In this contribution, the conservation status assessment of three vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Soldanella calabrella Kress at global level, and the regional assessment of Luzula pindica (Hausskn.) Chrtek & Křísa and Romulea variicolor Mifsud (Italy).

In this contribution, the conservation status assessment of four vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Ophrys normanii J.J.Wood at global level, and the regional assessment of Genista anglica L., Helianthemum lippii (L.) Dum.Cours., and Scrophularia lucida L. (Italy).

Multiple Sclerosis (MS) is an inflammatory disease of the central nervous system. Sardinia, an Italian island, is one of the areas with the highest global prevalence of MS. Genetic factors have been widely explored to explain this greater prevalence among some populations; the genetic makeup of the Sardinians appears to make them more likely to develop autoimmune diseases. A strong association between MS and some infections have been reported globally. The most robust evidence indicating the role of infections is MS development concerns the Epstein-Barr virus (EBV). Anti-EBV antibodies in patients once infected by EBV are associated with the development of MS years later. These features have also been noted in Sardinian patients with MS. Many groups have found an increased expression of the Human endogenous retroviruses (HERV) family in patients with MS. A role in pathogenesis, prognosis, and prediction of treatment response has been proposed for HERV. A European multi-centre study has shown that their presence was variable among populations, ranging from 59% to 100% of patients, with higher HERV expression noted in Sardinian patients with MS. The mycobacterium avium subspecies paratuberculosis (MAP) DNA and antibodies against MAP2694 protein were found to be associated with MS in Sardinian patients. More recently, this association has also been reported in Japanese patients with MS. In this study, we analysed the role of infectious factors in Sardinian patients with MS and compared it with the findings reported in other populations.

In Mediterranean-climate areas, wildfires have an important ecological role, selecting organisms, influencing species composition and structure of vegetation, and shaping landscapes. However, the increase in frequency and severity of fires can cause, among others, progressive vegetation degradation, biodiversity, and ecosystem services loss. Under the climate change scenario, the frequency and severity of wildfires are expected to increase, especially in the Mediterranean Basin, recognized as among the most affected by the intensification of droughts and heat waves in the future. Therefore, from the perspective of adaptation, it is important not only to assess the sudden effects after a fire but also to investigate the ecological changes and vegetation response over time. In this framework, this study investigates the effects and the short-term vegetation response in an area struck by a megafire. The vegetation response one year after a fire has been assessed in semi-natural grasslands, shrublands, and woodlands at the landscape scale through spectral indices, and at the field scale through floristic and vegetation surveys. Our results showed that after a severe wildfire, although some areas did not exhibit vegetation regrowth, the response of natural vegetation was notable after one year. In the study area, the most resilient vegetation type was semi-natural grasslands, suggesting that this type of vegetation can be crucial for landscape recovery. The other vegetation types showed different response patterns that also prefigure possible changes in species composition and loss of plant diversity over the medium term. This study highlights the value of combining remote sensing spectral analyses and detailed floristic and vegetation surveys for understanding the direction of the early stages of post-fire vegetation dynamics.

As they represent actual or potential risks to human and environmental safety and health, abandoned mines are a major global problem. The heavy metal-polluted tailings dump of Barraxiutta (Domusnovas, southwestern Sardinia, Italy) is home to a metallicolous population of Epipactis tremolsii (Orchidaceae). A reclamation of the abandoned mine area seems to be approaching, and such an intervention may pose a serious risk for the maintenance of the unique orchid population colonizing the mine wastes. In the present work, the seed packet technique was implemented for the first time to observe orchid seed development in mine wastes. This approach allowed us to explore different seed-based conservation options for the metallicolous orchid population and to gain a deeper grasp of population dynamics and ecology. Four different sowing treatments were set up in the tailing dump and in a near unpolluted site (control site). The field phase of the experiment lasted for 10 months, a period in which the experimental seed bank preservation and incipient seed development were observed and statistically approached. Our findings observed no significant seed loss happening during the experiment, demonstrating the suitability of the seed packet technique to also explore seed bank conservation and development in extreme environmental conditions (i.e., polluted mine wastes). This field method will be a useful tool to further explore the more effective translocation and quasi in situ conservation alternatives for the E. tremolsii metallicolous population. Incipient and site-specific seed development (non-mycorrhizal stage) was observed during the experiment. A plant–soil fungus interaction at the seed level was also observed, the nature of which remains to be ascertained in further studies providing a longer duration for the field phases.

In the Mediterranean Basin, a critical focal point for the conservation of plant diversity, there has been a large increase in practical conservation actions for many plant species to prevent extinction and to improve their conservation status; quantifying the effectiveness of these initiatives in reversing species declines is urgently important. In 2021, the International Union for Conservation of Nature (IUCN) launched a new tool that allows the impact of conservation actions on plant species to be assessed. The Green Status of Species is a new set of metrics under the Red List of Threatened Species that assigns species to recovery categories, complementary to the classic extinction risk categories. Crucially, the Green Status of Species provides methods to evaluate the impact of past conservation, and the potential for future conservation impact, on species status and recovery in a standardized way. Considering the efforts made so far for the conservation of Mediterranean threatened plants, using the Green Status of Species would be highly useful to direct future conservation policies. We, therefore, encourage botanists and practitioners working on threatened plants in the Mediterranean area to use this new assessment tool to inform conservation and recovery programs.

Objectives: The aim of this study was to characterize multiple sclerosis (MS) patients exposed to dimethyl fumarate (DMF) and to evaluate the predictors of therapeutic response. In addition, the study offers a picture of how DMF use has changed over the past few years in naive or switcher patients.Methods: In this observational monocentric study, we examined the prescription flow of DMF in MS patients categorized as naive or switchers (for safety/tolerability, ineffectiveness, and de-escalation strategy) from 2015 to 2019. Clinical and magnetic resonance imaging data of DMF-treated patients were analyzed, and NEDA-3 status at 24 months was evaluated by the three assessment components (absence of clinical relapses, no Expanded Disability Status Scale progression, no radiological activity). Determinants of therapeutic response were also evaluated using regression analysis.Results: The sample included 595 MS patients exposed to DMF categorized as naive (158; 26.5%) and switchers for reasons of safety/tolerability (198; 33.3%), inefficacy (175; 29.4%), and de-escalation strategy (64; 10.8%). A 15% increase in DMF use in naive and horizontal shift groups was observed in the last 3 years of observation, whereas there was a drop, with prescription passed from ~20% to

Understanding how functional traits influence community assemblage and functioning is crucial for assessing the effects of global change on vegetation composition. We studied the functional composition (i.e., plant size (SIZE), leaf area (LA), specific leaf area (SLA), and leaf dry matter content (LDMC)) of a xerophile pasture and a mesophile grassland in southern Italy, and recorded species richness (SR), plant cover (COV) and flowering rates (FLOW) over a 7-year period. Both communities revealed the dominance of stress-tolerators, probably reflecting an adaptation to the Mediterranean climate. The functional classification of species distinguished three groups. Species from the mesophile community had larger SIZE and LA, while those from the xerophile pasture showed higher LDMC; SLA was not connected to the source community. Community-level analyses confirmed such patterns, but with higher SLA in the mesophile grassland. While SR was comparable, COV and FLOW varied between the communities. At the species level, LDMC was positively related to FLOW and the inter-annual variability of COV and FLOW. At the community level, SIZE, LA and SLA were positively related to COV, while LDMC was positively related to FLOW. Trait variations can significantly contribute to the xerophile–mesophile shift in Mediterranean mountain vegetation, by regulating the productivity of species and communities in the two contexts and, possibly, their responsiveness to global change.

Many thousands of tree species are declining in the world, for which conservation actions are urgent. This dramatic situation is particularly evident for trees closely related to freshwater ecosystems, considered the environments most threatened by global change. In extremely arid environments such as deserts, where the few plant species present are able to survive by exploiting the little water available, the situation is extremely critical. A representative case is Vachellia gerrardii subsp. negevensis, a tree with a wide distribution range but locally restricted to small and isolated populations. Knowledge about this tree is incomplete in Iraq and, to fill this gap, several surveys were conducted in the Al-Najaf desert over three years (2019–2021). In each locality where this species was found, several ecological and population parameters were recorded. Our results indicate that Vachellia gerrardii subsp. negevensis was restricted to a single population, fragmented into five subpopulations confined in extremely peculiar ecological niches. Several threats related to anthropogenic activities and climate change affect the population, causing a significant reduction in the population size combined with a continuous decline in habitat quality and number of mature plants. Despite this critical situation, there are no conservation measures for this species. The establishment of a national preserve or part would be important and constitutes the fundamental prerequisite for the conservation of multiple species.

Background: Cognitive impairment (CI) is common in people with multiple sclerosis (pwMS). The assessment of CI is based on neuropsychological tests and accurate anamnesis, involving the patients and caregivers (CG). This study aimed to assess the complex interplay between self-perception of CI, objective CI and the brain atrophy of MS patients, also exploring the possible differences with CI evaluated by caregivers.Methods: Relapsing pwMS were enrolled in this study. Subjects underwent neuropsychological examination using the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) and evaluation of self-reported cognitive status using the patient-version of the Multiple Sclerosis Neuropsychological Questionnaire (p-MSNQ). Depression and anxiety were also evaluated using the Back Depression Inventory-version II (BDI-II) and Zung Anxiety Scale. Brain MRI images were acquired and brain volumes estimated. For each patient that was enrolled, we spoke to a caregiver and collected their perception of the patient's CI using the MSNQ- Caregiver version.Results: Ninety-five MS subjects with their caregivers were enrolled. CI was detected in 51 (53.7%) patients. We found a significant correlation (p < 0.001) between BICAMS T scores and lower whole brain (Rho = 0.51), gray matter (Rho = 0.54), cortical gray matter (Rho = 0.51) volumes and lower p-MSNQ (Rho = 0.31), and cg-MSNQ (Rho = 0.41) scores. Multivariate logistic regression showed that p-MSNQ is related to a patient's anxiety to evaluate by Zung Score (p < 0.001) while cg-MSNQ to patient's brain volume (p = 0.01).Conclusion: Our data confirm that neuropsychological evaluation results are related to the perception of CI and brain volume measures and highlight the importance of the caregiver's perception for cognitive assessment of pwMS.

In this contribution, the conservation status assessment of four vascular plants according to IUCN categories and criteria are presented. It includes the assessments of Aurinia leucadea (Guss.) K.Koch, Chondrilla chondrilloides (Ard.) H.Karst., Daphne cneorum L., and Ophioglossum azoricum C.Presl at regional level (Italy).

In situ conservation is widely considered a primary conservation strategy. Plant translocation, specifically, represents an important tool for reducing the extinction risk of threatened species. However, thus far, few documented translocations have been carried out in the Mediterranean islands. The Care-Mediflora project, carried out on six Mediterranean islands, tackles both short- and long-term needs for the insular endangered plants through in situ and ex situ conservation actions. The project approach is based on using ex situ activities as a tool to improve in situ conservation of threatened plant species. Fifty island plants (representing 45 taxa) were selected for translocations using common criteria. During the translocations, several approaches were used, which differed in site selection method, origin of genetic material, type of propagative material, planting method, and more. Although only preliminary data are available, some general lessons can be learned from the experience of the Care-Mediflora project. Among the factors restricting the implementation of translocations, limited financial resources appear to be the most important. Specific preliminary management actions, sometimes to be reiterated after translocation, increase the overall cost, but often are necessary for translocation success. Translocation using juvenile/reproductive plants produces better results over the short term, although seeds may provide good results over the long run (to be assessed in the future). Regardless, plant translocation success can only be detected over long periods; therefore, proper evaluation of plant translocations requires a long-term monitoring protocol. Care-Mediflora project represents the first attempt to combine the existing approaches in a common plant conservation strategy specifically focusing on the Mediterranean islands. Keywords: Care-Mediflora project, ex situ conservation, in situ conservation, Insular flora, Threatened plant populations

Small standing-Water Ecosystems (SWEs), despite their pivotal ecological role due to their participation in hydrogeological processes and their richness in biodiversity, seem to be often overlooked by the scientific community. In this study, the vascular plant diversity in some representative SWEs, that host a peculiar assemblage of plant and animal species, was investigated in relation to the disturbance effects of a wild horse population. A total of 50 plots, equally distributed in small and large SWEs, were surveyed and a level of disturbance was attributed to each plot. We found greater species richness in small and undisturbed SWEs, which suggests the negative impact of horse grazing on the richness of plant species in this type of habitat. Significant differences in plant assemblage were found according to the disturbance level, whereas, contrary to what was observed for species richness, no differences were detected based on their size. The diversity indices, used to evaluate the richness and diversity in these areas, recorded the highest values for small and undisturbed areas. This result highlights that the disturbance of the horse grazing plays a pivotal role in affecting the diversity and richness of species in the SWEs. These findings suggest that SWE systems should be analyzed considering these areas as unique in order to allow the conservation of the plant richness and biodiversity of the SWE systems in conjunction with the protection of horses.

In this contribution, the conservation status assessment of four vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Epipactis maricae (Croce, Bongiorni, De Vivo & Fori) Presser & S.Hertel at global level, and the regional assessment of Cerinthe retorta Sm. (Italy), Platanthera kuenkelei H.Baumann subsp. kuenkelei (Europe) and Typha elephantina Roxb. (Egypt).

In a global climate change scenario “Extreme climatic events” are expected to widely affect flora and vegetation in Med-regions, especially “Extremes Rainfall Events” which will have impacts on riparian environments. Aiming to provide an in-depth picture on the effects of these events on the riparian flora and vegetation in the Mediterranean Basin, especially focusing on islands, a bibliographic search was performed in the main international databases, which led to 571 articles published from 2000 to 2021. Most studies have analyzed these phenomena from the climatic point of view identifying three main topics “Rainfall”, “Global/Climate change”, and “Flood”. 81 papers concerned effects of extreme events on Mediterranean woodland formations and cultivated plants. A further analysis focused on European countries and Mediterranean bioregion using “Extreme rainfall events” and “Extreme rainfall and floods” as keywords. A low number of records relating to Mediterranean island regions was found, having Sicily as the study area. Moreover, seven articles had Sardinia as a study area, four of which referred to flora and vegetation. A lack of studies on the effects of extreme rainfall events on riparian flora and vegetation were highlighted. This review constitutes a call for researchers to explore extreme phenomena that have become recurrent in the Mediterranean Basin.

The vascular flora of Sardinia has been investigated for more than 250 years, with particular attention to the endemic component due to their phylogeographic and conservation interest. However, continuous changes in the floristic composition through natural processes, anthropogenic drivers or modified taxonomical attributions require constant updating. We checked all available literature, web sources, field, and unpublished data from the authors and acknowledged external experts to compile an updated checklist of vascular plants endemic to Sardinia. Life and chorological forms as well as the conservation status of the updated taxa list were reported. Sardinia hosts 341 taxa (15% of the total native flora) endemic to the Tyrrhenian Islands and other limited continental territories; 195 of these (8% of the total native flora) are exclusive to Sardinia. Asteraceae (50 taxa) and Plumbaginaceae (42 taxa) are the most representative families, while the most frequent life forms are hemicryptophytes (118 taxa) and chamaephytes (106 taxa). The global conservation status, available for 201 taxa, indicates that most endemics are under the ‘Critically Endangered’ (25 taxa), ‘Endangered’ (31 taxa), or ‘Least Concern’ (90 taxa) IUCN categories. This research provides an updated basis for future biosystematics, taxonomic, biogeographical, and ecological studies and in supporting more integrated and efficient policy tools.

Narrow endemic plants constitute a pivotal group for conservation, being often reduced to a small contingent of individuals and frequently threatened. However, effective conservation actions require reliable basic information about distribution range, ecological requirements, and population traits. Nevertheless, such knowledge results are incomplete or even completely missing for some neglected or recently described plants, such as Cirsium alpis-lunae, a thistle exclusive to the N-Apennines (Italy). To fill this gap, all sites where C. alpis-lunae grow were monitored, and data on the site and population traits were collected. Our results indicated that this plant is restricted to 16 scattered sites, varied in surface area and number of individuals. Reproductive and juvenile plants showed to be affected by roughly the same variables, in particular the surface of the site, the slope aspect, and the canopy cover. The narrow ecological niche of C. alpis-lunae was mainly determined by the canopy cover, and where coverage increases, the number of individuals decreases. The individuals only grow at forest edges, where the peculiar ecological conditions are limiting factors for the development of forestry cover; some other factors (i.e., high inclination and instability of the substrate) contribute to limiting the development of forestry vegetation and guarantee the persistence of these ecotones. Despite the great difficulties in accessing the sites where this species grows, this study presents, for the first time, a complete picture of the C. alpis-lunae population and yielded important data to identify effective conservation measures.

Abstract Background The principal biomarker of neurodegeneration in multiple sclerosis (MS) is believed to be brain volume, which is associated with cognitive functions and retinal nerve fibre layer (RNFL). A cross-sectional and longitudinal assessment of the relationship between RNFL, cognitive functions and brain volume. Methods At baseline, relapsing patients and healthy controls underwent 1.5 T MRI to estimate the normalized volume of brain (NBV), grey (NGV), white (NWV) and peripheral grey (pNGV) matter. Cognitive functions were evaluated by BICAMS, RNFL by Spectral-Domain OCT. Patients were re-evaluated after 12 months. Results Cognitive functions, brain volume, and RNFL differed between the group of 66 patients and that of 16 healthy controls. In the MS group, at baseline, an association was found between: p-NGV and symbol-digit (SDMT) (p = 0.022); temporal-RNFL and NBV (p = 0.007), NWV (p = 0.012), NGV (p = 0.048), and p-NGV (p = 0.021); papillo-macular bundle-RNFL and NBV (p = 0.013), NWV (p = 0.02), NGV (p = 0.049), and p-NGV (p = 0.032). Over the observational period, we found a reduction of brain volume (p

In this contribution, the conservation status of four vascular plants according to IUCN categories and criteria are presented. It includes the assessment of Arceuthobium oxycedri (DC.) M.Bieb., Ionopsidium albiflorum Durieu, Trifolium latinum Sebast., and Vicia incisa M.Bieb. at a Regional level (Italy).

In this contribution, the conservation status assessments of three vascular plants are presented following to IUCN categories and criteria. It includes the assessment at global level of Saxifraga caprariae Mannocci, Ferretti, Mazzoncini & Viciani and S. montis-christi Mannocci, Ferretti, Mazzoncini & Viciani and the regional assessment of Halocnemum cruciatum (Forssk.) Tod. (Spain).

The distribution of the threatened fern Ophioglossum vulgatum L., a plant with extremely small populations (PSESPs) in Sardinia, is characterized by small disjunct populations with only a few individuals, and little is known about its status in the wild. To provide information for the conservation of O. vulgatum and with the aim to develop an in situ conservation strategy, we investigated its distribution, population size, and habitat. Field surveys confirmed that the species grows in only five localities. Two representative populations were selected for this study (Funtanamela and Gedili), and in each population, all plants were mapped and monitored monthly from April to August over an 8-year period. During the study, the populations had a very low number of reproductive plants and the populations appeared to be in decline, with the total number of plants per population slightly decreased in Gedili while a sharp reduction was recorded in Funtanamela due to wild boar threat. A fence was built in order to protect the site from further damage, but no noticeable signals of recovery were observed. The most urgent conservation requirement for this species is to preserve the threatened habitat of the remnant populations. Further field surveys and research are also required for an improved understanding of the species’ status.

In this contribution, the conservation status assessment of four vascular plants are presented according to IUCN categories and criteria. It includes the assessment at global level of Crepis lacera Ten subsp. titani (Pamp.) Roma-Marzio, G.Astuti & Peruzzi and Anthyllis hermanniae L. subsp. sicula Brullo & Giusso and the regional assessment of Commicarpus plumbagineus (Cav.) Standl. (Spain and Europe) and Ambrosia maritima L. (Italy).

In this contribution the conservation status assessment of six plant species according to IUCN categories and criteria are presented. It includes the assessment at global level of Charybdis glaucophylla Bacch., Brullo, D’Emerico, Pontec. & Salmeri, Euphorbia nicaeensis All. subsp. japygica (Ten.) Arcang., Hieracium australe Fr. subsp. australe, Limonium multiforme Pignatti, Onosma helvetica Boiss. em. Teppner subsp. lucana (Lacaita) Peruzzi, Aquaro & Cesca and the assessment at national level (Italy) of Lathyrus laxiflorus (Desf.) Kuntze subsp. laxiflorus.

Background. In people with multiple sclerosis (pwMS), disability is generally assessed on the basis of ambulation abilities, whereas upper limb motor dysfunctions are less frequently considered. Nevertheless, they can severely affect the quality of life of pwMS. To date, it remains mostly unknown whether a relationship exists between upper and lower limb impairments. Aim. To investigate the existence of a relationship between upper and lower limb impairments in pwMS based on two fundamental motor tasks, namely walking and hand-to-mouth (HTM) movement. Methods. Twenty-eight pwMS with Expanded Disability Status Scale (EDSS) scores in the range of 1–6, and 21 healthy controls (HC) underwent a kinematic analysis of gait and HTM movement performed with a motion capture system. The spatiotemporal parameters for the two tasks were calculated and correlated using Spearman’s rank correlation coefficients. Results. The pwMS performed worse than HC on both tasks. Small to large correlations were found between the total HTM movement duration and most of the gait parameters (rho, 0.35–0.68; p

Analysis of the seed morphology is a widely used approach in ecological and taxonomic studies. In this context, intraspecific variability with respect to seed morphology (size, weight, and density) was assessed in two close Epipactis tremolsii Pau. populations sharing the same ecological conditions, except for the soil pollution distinguishing one of them. Larger and heavier seeds were found in plants growing on the heavy metal polluted site, while no differences in seed density were detected between seeds produced by plants growing on the contaminated and the control site. Moreover, seed coats and embryos varying together in their dimensions were described in the control population, while coats varying in their size independently from embryos were described in plants growing on the polluted site. Seeds from the two studied populations significantly differed in several parameters suggesting that intraspecific seed variability occurred in the case study.

In this contribution, the conservation status assessment of six plant species according to IUCN categories and criteria are presented. It includes the assessment at global level of Linaria tonzigii Lona, Allium garganicum Brullo, Pavone, Salmeri & Terrasi, Ferula arrigonii Bocchieri, Orchis patens Desf. subsp. patens and Armeria saviana Selvi and the assessment at regional level (Italy) of Viola jordanii Hanry.

The last decades have recorded an increase of plant-based drug discovery processes. Indeed, natural products possess a superior chemical diversity as compared to synthetic ones, leading to a renewal in searching for new therapeutic agents from the plant kingdom. In particular, since the structural variety of natural compounds reflects the biodiversity of their source organisms, regions of the world with high biodiversity and endemism deserve particular interest. In this context, Sardinia Island (Italy), with 290 endemic taxa (12% of the total flora), is expected to provide unique and structurally diverse phytochemicals for drug development. Several research groups built up a large program dedicated to the analysis of Sardinian endemic species, highlighting their peculiar features, both in respect of phytochemical and biological profiles. On this basis, the aim of this review is to provide an up-to-date and comprehensive overview on ethnobotanical uses, biological properties and phytoconstituents of Sardinian endemic plants in order to support their beneficial potential and to provide input for future investigations. We documented 152 articles published from 1965 to June 2020 in which a broad range of biological activities and the identification of previously undescribed compounds have been reported, supporting their great value as sources of therapeutic agents.

The Mediterranean islands represent a center of vascular plant diversity featuring a high rate of endemic richness. Such richness is highly threatened, however, with many plants facing the risk of extinction and in need of urgent protection measures. The CARE-MEDIFLORA project promoted the use of ex situ collections to experiment with in situ active actions for threatened plants. Based on common criteria, a priority list of target plant species was elaborated, and germplasm conservation, curation and storage in seed banks was carried out. Accessions were duplicated in the seed banks of the partners or other institutions. Germination experiments were carried out on a selected group of threatened species. A total of 740 accessions from 429 vascular plants were stored in seed banks, and 410 seed germination experiments for 283 plants species were completed; a total of 63 in situ conservation actions were implemented, adopting different methodological protocols. For each conservation program, a specific monitoring protocol was implemented in collaboration with local and regional authorities. This project represents the first attempt to develop common strategies and an opportunity to join methods and methodologies focused on the conservation of threatened plants in unique natural laboratories such as the Mediterranean islands.

Background: Multiple sclerosis (MS) is a chronic immunemediated disease of the central nervous system with a highly variable clinical presentation and disease progression. In this study, we investigate the metabolomics profile of patients affected by relapsing−remitting MS (RRMS)and primary progressive MS (PPMS), in order to find potential biomarkers to distinguish between the two forms. Methods: Cerebrospinal Fluid CSF and blood samples of 34 patients (RRMS n = 22, PPMS n = 12) were collected. Nuclear magnetic resonance (1H-NMR) and mass spectrometry (coupled with a gas chromatography and liquid chromatography) were used as analytical techniques. Subsequently, a multivariate statistical analysis was performed; the resulting significant variables underwent U-Mann−Whitney test and correction for multiple comparisons. Receiver Operating Characteristic ROC curves were built and the pathways analysis was conducted. Results: The analysis of the serum and the CSF of the two classes, allowed the identification of several altered metabolites (lipids, biogenic amines, and amino acids). The pathways analysis indicated the following pathways were affected: Glutathione metabolism, nitrogen metabolism, glutamine−glutamate metabolism, arginine−ornithine metabolism, phenylalanine, tyrosine and tryptophan biosynthesis etc. Conclusion: The analysis allowed the identification of a set of metabolites able to classify RRMS and PPMS patients, each of whom express different patterns of metabolites in the two biofluids.