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Glyphosate [N-(phosphonomethyl) glycine] and glufosinate ammonium [ammonium dl-homoalanin-4-(methyl) phosphinate] are broad-spectrum, nonselective, post-emergence herbicides extensively used in various applications for weed control in both agricultural and non-crop areas. Aminomethylphosphonic acid (AMPA) is the major degradation product of glyphosate found in plants, water, and soil. Due to glyphosate's presumed low mobility, its monitoring in European water was limited. Recently both glyphosate and AMPA have been detected in several groundwater samples in Europe, U.S, Canada, Argentina, and China. Understanding the sources of these substances in water, especially in groundwater used for drinking, becomes a priority. In the present work the occurrences and the main drives of glyphosate, AMPA, and glufosinate ammonium in the groundwater of hilly vineyards located in the North-West of Italy were evaluated. Groundwater monitoring results showed frequent detection and concentrations above EQS

Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person’s surroundings in the setting of incompatible traits and characteristics. It is true that ‘one must be born’ for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients’ safety. Empathy contributes to effective patient–physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence—the capacity to respond to one’s own and others’ emotions—was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students’ personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.

The aim of this study was to assess the level of creativity and personality traits and their mutual influence on medical students using the DECAS and BWAS. We performed a prospective descriptive study on 119 medical students from Târgu Mureș, Romania between November 2020 and July 2021, who answered questions relating to the BWAS and DECAS scales to evaluate their creativity and personality traits. Our findings pointed out a reverse correlation between age and both the original and revised BWAS (r = −0.2037, p = 0.0263, r = −0.1931, p = 0.0354). In terms of extraversion, we found a significant positive correlation for both openness (r = 0.3032, p = 0.0008) and emotional stability (r = 0.2868, p = 0.0016) and a negative correlation between extraversion and agreeability (r = −0.2394, p = 0.0087). Regarding creativity, we found positive correlations between emotional stability and both the original and revised BWAS (r = 0.20, p = 0.0279, r = 0.20, p = 0.0245). Medical students’ creativity might be positively influenced by emotional stability and seems to decrease with age. Higher extraversion scores could be related to increased openness and emotional stability as well as decreased agreeability.

Several occupational carcinogens (arsenic, cadmium) and industries (rubber production) have been associated with prostate cancer risk but most of the data are from studies conducted on screened populations. Here we explored this association in Romanian men, a population with low PSA screening test coverage. We have analyzed 468 prostate cancer cases pathologically confirmed and 495 non-cancer hospital controls, recruited in the ROMCAN project. Personal information, including occupational activity, was collected through interview. Two experts classified jobs and activities into 15 economic sectors with similar patterns of exposure. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between ever employed in each economic sector and prostate cancer risk. We observed a higher non adjusted risk for employment in electricity, gas, steam and air conditioning supply activities (OR=3.95, p=0.029), manufacturing–light industry (OR=1.88, p=0.039), financial, insurance and gambling (OR=1.44, p=0.046) and a lower risk for employment in construction industry (OR=0.62, p=0.010). After adjusting for potential confounders, only the low risk in construction workers was maintained (OR=0.55, p=0.004). Our study provides some evidence on the role of occupational factors on the prostate cancer risk but further assessments are needed. Healthy lifestyle promotion and prevention should be reinforced at workplaces.

Synthetic pesticides may have non-target effects on soil microorganisms which have been identified as a specific protection goal in pesticide environmental risk assessment. Most studies to date have focused on the effects of synthetic pesticides on soil microorganisms, whereas little is known about the response of the soil microbial community to the so-called low-risk pesticide classes. The main objective of this study was to assess the impact of a botanical (azadirachtin) and a low-dose pesticide (trifloxystrobin), applied as commercial formulations, on soil microbial functions. In a microcosm study, pesticides were applied in soil at increasing dose rates (up to ×100 the recommended dose rate). Their dissipation and the formation of the major transformation product (TP) of trifloxystrobin were determined. Enzymatic activities and the abundance of key functional microbial groups were measured via fluorometric assays, potential nitrification (PNT) and q-PCR. Trifloxystrobin and azadirachtin did not persist in soil at all dose rates with DT50s of 1.1–1.4 and 1.3 days respectively. No pesticide dose-dependent inhibitory effects on the activity of soil enzymes, the abundance of ammonia-oxidizing bacteria (AOB), ammonia-oxidizing archaea (AOA), sulfur-oxidizing bacteria (SOB) and on PNT were seen. Instead the application of both pesticides at all dose rates stimulated PNT. Trifloxystrobin was transformed to trifloxystrobin acid (TFSA), which persisted in soil. However its formation did not correlate with adverse effects on soil microbial functions. We provide first evidence that trifloxystrobin and azadirachtin do not impose unacceptable effects on soil microbial functions even at high dose rates.

Current farm systems rely on the use of Plant Protection Products (PPP) to secure high productivity and control threats to the quality of the crops. However, PPP use may have considerable impacts on human health and the environment. A study protocol is presented aiming to determine the occurrence and levels of PPP residues in plants (crops), animals (livestock), humans and other non-target species (ecosystem representatives) for exposure modelling and impact assessment. To achieve this, we designed a cross-sectional study to compare conventional and organic farm systems across Europe. Environmental and biological samples were/are being/will be collected during the 2021 growing season, at 10 case study sites in Europe covering a range of climate zones and crops. An additional study site in Argentina will inform the impact of PPP use on growing soybean which is an important European protein-source in animal feed. We will study the impact of PPP mixtures using an integrated risk assessment methodology. The fate of PPP in environmental media (soil, water and air) and in the homes of farmers will be monitored. This will be complemented by biomonitoring to estimate PPP uptake by humans and farm animals (cow, goat, sheep and chicken), and by collection of samples from non-target species (earthworms, fish, aquatic and terrestrial macroinvertebrates, bats, and farm cats). We will use data on PPP residues in environmental and biological matrices to estimate exposures by modelling. These exposure estimates together with health and toxicity data will be used to predict the impact of PPP use on environment, plant, animal and human health. The outcome of this study will then be integrated with socio-economic information leading to an overall assessment used to identify transition pathways towards more sustainable plant protection and inform decision makers, practitioners and other stakeholders regarding farming practices and land use policy. EEA Balcarce Fil: Silva, Vera. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Alaoui, Abdallah. University of Bern. Institute of Geography. Centre for Development and Environment; Suiza. Fil: Schlünssen, Vivi. Aarhus University. Department of Public Health; Dinamarca. National Research Centre for the Working Environment; Dinamarca. Fil: Vested, Anne. Aarhus University. Department of Public Health; Dinamarca. Fil: Graumans, Martien. Radboud Institute for Health Sciences; Países Bajos. Fil: Van Dael, Maurice. Radboud Institute for Health Sciences; Países Bajos. Fil: Trevisan, Marco. Università Cattolica del Sacro Cuore. Department for Sustainable Food Process; Italia. Fil: Suciu, Nicoleta. Università Cattolica del Sacro Cuore. Department for Sustainable Food Process; Italia. Fil: Mol, Hans. Wageningen University and Research. Wageningen Food Safety Research; Países Bajos. Fil: Beekmann, Karsten. Wageningen University and Research. Wageningen Food Safety Research; Países Bajos. Fil: Figueiredo, Daniel. Utrecht University. Institute for Risk Assessment Sciences; Países Bajos. Fil: Harkes, Paula. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Hofman, Jakub. Masaryk University. Faculty of Science. Research Centre for Toxic Compounds in the Environment; Republica Checa. Fil: Kandeler, Ellen. University of Hohenheim. Institute of Soil Science and Land Evaluation; Alemania. Fil: Abrantes, Nelson. University of Aveiro. Centre for Environmental and Marine Studies and Department of Environment and Planning; Portugal. Fil: Campos, Isabel. University of Aveiro. Centre for Environmental and Marine Studies and Department of Environment and Planning; Portugal. Fil: Martínez, María Ángeles. Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas; España. Fil: Pereira, Joana Luísa. Centre for Environmental and Marine Studies and Department of Environment and Planning; Portugal. Fil: Goossens, Dirk. Wageningen University and Research. Soil Physics and Land Management Group. Países Bajos. KU Leuven Department of Earth and Environmental Sciences; Belgica. Fil: Gandrass, Juergen. Institute of Coastal Environmental Chemistry; Alemania. Fil: Debler, Freya. Institute of Coastal Environmental Chemistry; Alemania. Fil: Huerta Lwanga, Esperanza. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Jonker, Marlot. Dutch Mammal Society; Países Bajos. Fil: Van Langevelde, Frank. Wageningen University and Research. Wildlife Ecology and Conservation Group; Países Bajos. Fil: Sorensen, Martin. Aarhus University. Department of Animal Science; Dinamarca. Fil: Wells, Jerry. Wageningen University and Research. Host-Microbe Interactomics, Animal Sciences Group; Países Bajos. Fil: Boekhorst, Jos. Wageningen University and Research. Host-Microbe Interactomics, Animal Sciences Group; Países Bajos. Fil: Huss, Anke. Utrecht University. Institute for Risk Assessment Sciences; Países Bajos. Fil: Mandrioli, Daniele. Ramazzini Institute. Cesare Maltoni Cancer Research Center; Italia. Fil: Sgargi, Daria. Ramazzini Institute. Cesare Maltoni Cancer Research Center; Italia. Fil: Nathanail, Paul. Land Quality Management; Reino Unido. Fil: Nathanail, Judith. Land Quality Management; Reino Unido. Fil: Tamm, Lucius. Research Institute of Organic Agriculture; Suiza. Fil: Fantke, Peter. Technical University of Denmark. Department of Technology, Management and Economics; Dinamarca. Fil: Mark, Jennifer. Research Institute of Organic Agriculture; Suiza. Fil: Grovermann, Christian. Research Institute of Organic Agriculture; Suiza. Fil: Larsen, Ana Frelih. Ecologic Institute; Alemania. Fil: Herb, Irina. Ecologic Institute; Alemania. Fil: Chivers, Charlotte Anne. University of Gloucestershire. Countryside and Community Research Institute; Reino Unido. Fil: Mills, Jane. University of Gloucestershire. Countryside and Community Research Institute; Reino Unido. Fil: Alcon, Francisco. Universidad Politécnica de Cartagena; España. Fil: Contreras, Josefina. Universidad Politécnica de Cartagena; España. Fil: Baldi, Isabelle. Bordeaux University. INSERM U1219; Francia. Fil: Pasković, Igor. Institute of Agriculture and Tourism, Department of Agriculture and Nutrition; Croacia. Fil: Matjaz, Glavan. University of Ljubljana. Biotechnical Faculty; Eslovenia. Fil: Norgaard, Trine. Aarhus University. Department of Agroecology; Dinamarca. Fil: Aparicio, Virginia Carolina. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce; Argentina. Fil: Ritsema, Coen. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Geissen, Violette. University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Scheepers, Paul. Radboud Institute for Health Sciences; Países Bajos.

Although collaborative, multi-level and adaptive governance is put forward as the right approach to manage water resources, it remains a challenge for local water managers to engage with multiple understandings and perspectives and to move towards more transdisciplinary approaches in water governance. In this research, we address this need by proposing a practical guide for water governance assessment and improvement, existing of three successive steps, i.e. (1) an assessment of water governance, (2) the implementation of a multi-actor process and (3) an evaluation of achievements. This guide is tested in the seven action labs of the WaterProtect project, which have in common that they are drinking water catchments suffering from agricultural pollution throughout Europe. By implementing the guide in the different action labs, we find that water managers appreciated the integrated approach of the guide, helping them in the efficient organization of the water governance process while taking into account the human dimension. Furthermore action lab leaders evaluated the governance guide as being hands-on and practical, allowing them to redirect and open up the governance process. Despite this, they welcomed the presence of a facilitator, who boosted the local action lab leaders' confidence and motivation to put things into motion. Looking at the results, we find that over the different action labs a lot of progress has been made towards intermediary goals, however that an improvement of the water quality cannot be expected in the short time frame of a project. We therefore recommend improving the design of the guide with insights from transition management, which will allow local water managers to better address change at different time-scale levels.

Publisher's version (útgefin grein), Two familial forms of colorectal cancer (CRC), Lynch syndrome (LS) and familial adenomatous polyposis (FAP), are caused by rare mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2) and the genes APC and MUTYH, respectively. No information is available on the presence of high‐risk CRC mutations in the Romanian population. We performed whole‐genome sequencing of 61 Romanian CRC cases with a family history of cancer and/or early onset of disease, focusing the analysis on candidate variants in the LS and FAP genes. The frequencies of all candidate variants were assessed in a cohort of 688 CRC cases and 4567 controls. Immunohistochemical (IHC) staining for MLH1, MSH2, MSH6, and PMS2 was performed on tumour tissue. We identified 11 candidate variants in 11 cases; six variants in MLH1, one in MSH6, one in PMS2, and three in APC. Combining information on the predicted impact of the variants on the proteins, IHC results and previous reports, we found three novel pathogenic variants (MLH1:p.Lys84ThrfsTer4, MLH1:p.Ala586CysfsTer7, PMS2:p.Arg211ThrfsTer38), and two novel variants that are unlikely to be pathogenic. Also, we confirmed three previously published pathogenic LS variants and suggest to reclassify a previously reported variant of uncertain significance to pathogenic (MLH1:c.1559‐1G>C)., This study was funded in part by the European Union FP7 Program (ProMark project 202059) and by the EEA grant (ROMCAN project RO14‐0017; EEAJRP‐RO‐NO‐20131‐10191). We thank the study participants, the staff at deCODE Genetics Iceland and Landspitali University Hospital.

Background Organic food is generally considered as having healthier properties as consequence of the environmental-friendly management if compared with conventional food. However, there is a lack of strong scientific evidences that organic food is significantly different from the conventional regarding nutritional properties, environmental and human health impacts. Scope and approach The main scope of the present review is to assess the differences between the organic and conventional food in terms of nutritional properties, environmental impact and consumer perception and to identify future research needed. Key findings and conclusions Nutritional properties, the “environmental friendly” concept and the consumer perception aspects were analyzed to compare organic and conventional food. In general, non-significant differences in nutrient properties and carbon food prints between organic and conventional food have been observed, even if for the both aspects significant sensitivity and uncertainty are present and specific analysis to assess them are mandatory. Consumers perceive the organic food more valued even if relatively higher prices and poorer availability of organic products compared with their conventional counterparts could limit the purchase and the quality perception.

The aim of our study was to evaluate the cleaning effect of nickel-titanium (Ni-Ti) rotary files on the smear layer formed on the radicular dentine walls during endodontic procedures. We used 50 freshly extracted maxillary permanent teeth divided in two study groups according to the instruments used for cleaning: Group 1 with ProTaper Ni-Ti rotary files, Group 2 with manual Ni-Ti files. Longitudinal sections of root canals from each group were evaluated by scanning electron microscopy (SEM) in the apical, middle and coronal sections. Representative microphotographs were taken and double blind scoring was performed by calibrated examiners. The amount of smear layer was measured according to Hulsmann scoring system and the data were statistically analyzed. There were statistically significant differences between instruments in the apical root canal sections (p[0.05), where the manual Ni-Ti files gave the best cleaning scores. There were no differences between groups for the middle and coronal thirds. In conclusion, the best approach for an effective removal of smear layer is to combine manual files with rotary Ni-Ti instruments during the endodontic treatment.

To find sequence variants affecting prostate cancer (PCA) susceptibility in an unscreened Romanian population we use a genome‐wide association study (GWAS). The study population included 990 unrelated pathologically confirmed PCA cases and 1034 male controls. DNA was genotyped using Illumina SNP arrays, and 24.295.558 variants were imputed using the 1000 Genomes data set. An association test was performed between the imputed markers and PCA. A systematic literature review for variants associated with PCA risk identified 115 unique variants that were tested in the Romanian sample set. Thirty of the previously reported SNPs replicated (P‐value < 0.05), with the strongest associations observed at: 8q24.21, 11q13.3, 6q25.3, 5p15.33, 22q13.2, 17q12 and 3q13.2. The replicated variants showing the most significant association in Romania are rs1016343 at 8q24.21 (P = 2.2 × 10−4), rs7929962 at 11q13.3 (P = 2.7 × 10−4) and rs9364554 at 6q25.2 (P = 4.7 × 10−4). None of the variants tested in the Romanian GWAS reached genome‐wide significance (P‐value, This study was funded in part by the European Union FP7 Program (ProMark project 202059) and by the EEA grant (ROMCAN project RO14-0017; EEAJRPRO-NO-20131-10191).

Epilepsy is a brain pathology that consists in the development of recurrent epileptic seizures, and more than half of the cases present the onset during childhood. We present the case of a 3-year-old male patient, with heredocollateral antecedents of epilepsy and personal history of neuropsychomotor retardation, who was admitted in our clinic presenting generalized tonic clonic seizures, initially febrile and afterwards afebrile. The laboratory tests and the neuroimagistic ones did not identify an underlying cause. The initial EEG did not point out anything pathological. Despite the anticonvulsant treatment, the patient’s evolution was unfavorable, presenting multiple short term recurrences, being readmitted multiple times in our clinic. Once we introduced the second anticonvulsant drug, levetiracetam, in his treatment, the seizures disappeared, and the patient presented long term favorable evolution. The case particularity consists in the development of generalized tonic clonic seizures in a patient with significant family history, and personal history of neuropsychomotor retardation that appear initial under febrile context, and afterwards in the lack of fever, repeating cyclic, with unfavorable evolution despite the treatment with valproic acid that disappear only after initiating treatment with levetiracetam.

Ventriculomegalia reprezintă dilatarea ventriculilor cerebrali peste 10 mm, fiind clasificată în uşoară sau „borderline“ (10-12 mm), moderată (13-15 mm) şi severă (peste 15 mm). Incidenţa variază foarte mult în funcţie de tehnica utilizată şi de vârsta gestaţională. Locul de elecţie pentru măsurarea cea mai exactă a diametrului ventricular este la nivelul glomusului plexului coroid. RMN-ul este o altă metodă de evaluare a creierului fetal care permite, de asemenea, vizualizarea suprafeţei cerebrale. Ventriculomegalia unilaterală este cauzată de obstrucţia morfologică, fizică sau funcţională a orificiului Monro. Ventriculomegalia „borderline“ poate fi asociată cu anomalii cromozomiale, infecţii congenitale, accidente vasculare cerebrale sau hemoragie, precum şi cu alte anomalii extracerebrale. Factori care influenţează prognosticul copiilor diagnosticaţi cu ventriculomegalie uşoară sunt: sexul, vârsta gestaţională, dimensiunea ventriculilor, afectarea uni- sau bilaterală, ventriculomegalie bilaterală simetrică sau asimetrică, progresia ventriculomegaliei – probabil cel mai important factor al prognosticului, regresia ventriculomegaliei. Părinţii trebuie informaţi despre faptul că există limitări ultrasonografice în diferenţierea unei ventriculomegalii „borderline“ izolate şi ventriculomegalie asociată unor altor anomalii oculte, care nu pot fi identificate iniţial în vederea luării unei decizii adecvate. Ecografia fetală de control este de preferat a se efectuat după aproximativ 1-2 săptămâni de la diagnosticul iniţial de „ventriculomegalie“.

Pneumonia reprezintă o inflamaţie a parenchimului pulmonar care, în ciuda multiplelor clase de antibiotice disponibile şi în ciuda progreselor medicinei, deţine încă o rată crescută de mortalitate, mai ales în cazul copiilor. Deltfia acidovorans şi Stenotrophomonas maltofilia sunt bacili Gram-negativi care pot determina infecţii respiratorii. Prezentăm cazul unui pacient de sex masculin, în vârstă de 2 ani şi 3 luni, internat în clinica noastră pentru următoarele motive: tuse productivă, febră şi inapetenţă. Pe baza examenului obiectiv, a analizelor de laborator şi a investigaţiilor imagistice, am stabilit diagnosticul de pneumonie dreaptă asociată cu pleurezie şi am instituit antibioterapie cu spectru larg. Evoluţia a fost însă nefavorabilă, pacientul necesitând pleurostomie şi drenaj. Din lichidul pleural au fost izolaţi Delftia acidovorans şi Stenotrophomonas maltophilia. Am modificat schema de tratament conform antibiogramei, cu evoluţie ulterioară lent favorabilă. Particularitatea cazului constă în diagnosticarea unei pneumonii cu pleurezie la un copil în vârstă de 2 ani şi 3 luni, cu un episod de pneumonie în antecedente, fără factori de risc, care a necesitat pleurostomie cu drenaj toracic, la care cultura din lichidul pleural a evidenţiat doi germeni întâlniţi de obicei la persoanele imunocompromise, cu evoluţie favorabilă după iniţierea antibioterapiei conform antibiogramei.

Pneumonia represents an inflammation of the pulmonary parenchyma that despite the multiple antibiotic classes available and despite the medical progresses, still leads to an increased mortality rate, especially in children. Deltfia acidovorans and Stenotrophomonas maltophilia are Gram-negative bacilli that can lead to respiratory infections. We present the case of a 2 years and 3-month old male patient, admitted in our clinic for the following reasons: productive cough, fever and loss of appetite. Based on the clinical exam, laboratory and paraclinical investigations, we established the diagnosis of right pneumonia associated with pleural effusion and we administered wide spectrum antibiotics. Nevertheless, the evolution was unfavorable, needing pleurotomy and drainage. From the pleural fluid, there were isolated two strains of bacteria, Delftia acidovorans and Stenotrophomonas maltophilia. We adjusted the antibiotic regimen according to antibiogram, with afterwards slowly favorable evolution. The particularity of the case consists in diagnosing a pneumonia with pleural effusion in a 2 years and 3-month-old child, without risk factors, who needed pleurotomy with thoracic drainage, in whom the pleural fluid revealed 2 germs usually encountered in immunocompromised individuals, with favorable evolution after the initiation of antibiotics regimen according to the antibiogram.

Nitrogen losses from intensive agricultural production may end up as high nitrate (NO3−) concentrations in groundwater, with a long-term impact on groundwater quality. The main objective of this study was to evaluate the impact of fertilization practices used for grape cultivation on groundwater quality of Tidone Valley, northwest of Italy, following an integrated socio-hydrogeological approach that consists on (i) the involvement of 175 farmers in the description of agricultural and fertilization practices, using a survey of ad hoc questionnaires, (ii) the evaluation of NO3− occurrence in groundwater and (iii) the identification of NO3− sources through isotopic and hydrochemical analysis. In this area, as for certain particular Apennines shallow aquifers, groundwater is of reduced interest due to its limited storage capacity and there are insufficient wells currently monitored by the local Environmental Agency (ARPAE) to evaluate the impact of agricultural fertilization on existing local aquifers. Farmers' questionnaires results highlighted an extensive use of inorganic nitrogen fertilization and a tendency of farmers to follow their own experience for fertilization. Chemical analyses revealed high variability of major and trace elements concentrations isotope data. NO3− concentrations were significantly higher in deeper wells with respects to shallow wells. Isotopic results indicated that groundwater NO3− origin is inorganic, in agreement with the land use and the declared viticultural practices. Comparing groundwater NO3− occurrence from the studied area with values of entire Emilia-Romagna Region, only 7.7% of groundwater samples showed values above the EQS. (50 mg NO3−/L) between Nov 2017 and Sept 2018, while in the entire region 11.5% of groundwater samples showed values above the EQS in the same period. Considering that the vineyards surface in the studied area represents almost 75% of the entire regional vineyard surface, the obtained results suggest a low to moderate impact of viticulture on NO3−concentration of regional groundwater.

Despite an improvement of water quality across Europe there are many pollution hotspots for both nitrates and PPPs, mainly due to agricultural activities. The BMPs and MMs to reduce pollution from agriculture are well known, and there are policy instruments in place to ensure drinking water standards, but the current approach has not been efficient enough. Within the H2020 Water Protect project the premise was that there is a need for a multi-actor, participatory approach to tackle the issue from a new angle, and to assess why the uptake of known BMPs and MMs was not better among farmers. Seven “Action Labs” were selected that represent major physical, socio-economical, cultural and farming settings across Europe. A methodology of multi-actor engagement was chosen but with different approaches due to the local context. Initially the level of farmers' awareness about water quality issues was matched to the observed uptake rates of BMPs and MMs. In a second survey barriers hindering the uptake of measures were identified. The first survey revealed a low general awareness on the potential pollution to drinking water sources. Despite this, between 24% to 88% of the surveyed farmers per Action Lab were already voluntarily adopting one quarter of the selected BMPs and MMs. The second survey demonstrated the need to address organisational, legislative, sociological and technical barriers. The lack of coordination between different institutional bodies promoting measures and the financial incentives needed to invest and operate these often-costly measures need to be considered. The multi-actor, participatory approach with its improved awareness and collaboration made it possible to identify the crucial factors for improvement - to build a social acceptance among all actors and communicate the issues and solutions from the start., This research is part of the WaterProtect project and has received funding from the European Union's Horizon 2020 Research and Innovation Program under grant agreement No. 727450. The authors and the entire WaterProtect team would like to thank all the actors across the seven Action Labs for their commitment and enthusiasm for engaging with the WaterProtect project.

The adoption of pesticide mitigation measures and innovation at farm level, are seen as a drivers to reach the sustainable water policy objectives. With the aim to prevent the pesticide pressure of hilly vineyards on groundwater contamination, a stepwise approach in Tidone Valley was applied using different consultation mechanisms and involvement strategies throughout the overall process. Face to face meetings, direct surveys, participatory monitoring and planning of several activities aiming to inform, educate, improve skills, change of individual behaviour or raise awareness, or even initiatives to build institutional trust or support for new investment in innovation are some examples. These activities allowed us to involve key actors of water use and governance (such as farmers, advisors, representatives of drinking water management, farmer's associations, Winemaking cooperatives, local Health Authority), and to have a deeper knowledge of the context agricultural practices, of farmer's knowledge and skills concerning factors influencing water contamination and also to promote the most suitable Best Management Practices aimed at limiting the pesticide occurrence in groundwater. Indeed, the surveys results highlighted that the majority of the farms are small (64% of vineyards10 ha), that most of the farmers (62%) are not aware of the current legislation on water, even if 64% of them declare to participate regularly to training courses for the prevention of water contamination and that there is a low to moderate level of adoption of Best Practices able to prevent contamination by pesticides. At the end of the overall process, it can be stated that the multi-actor approach and engagement strategy adopted were successful in improving attitudes to more sustainable practices. This is supported also by the monitoring data that show in 2019 a decrease by 44% of pesticides occurrences and a fall by 68% of values above EQS

The diagnosis of fetal cerebral hemorrhage (HCF) is less reported (0,9/1000 births) in comparison to the postpartum one. We presented 2 cases of fetal intraventricular hemorrhages diagnosed. Case 1: HCF diagnosed by ultrasound at the gestational age of 28 weeks and confirmed after birth by the presence of erythrocytes (significant number, pathological aspect) in the spinal fluid and by the modifications signaled by the transfontanellar ultrasound (severe internal hydrocephaly, minimum cerebral tissue). The death occurred after 24 hours postpartum (pathological exam: intraventricular cerebral hemorrhage). We mention the apparent lack of maternal risk factors, negative TORCH tests. Case 2: internal hydrocephaly at the age of 37 gestational weeks and confirmed in newborn (after cesarean section) by the clinical characteristic modifications, severe neurological impairment with modification at the transfontanellar ultrasound and the hemorrhagic and hypertensive aspect of the spinal fluid. We did not encounter maternal risk factors. Also, apparently, there were not any fetal risks: weight 2,820 grams at 37 gestational weeks, negative TORCH tests, negative cultures and CRP. The hydrocephaly had a progressive evolution imposing ventriculostomies and cysternotomies; the placement of a ventriculoperitoneal shunt during the third neurosurgical intervention improved the vital prognosis. Conclusions. The presence of hydrocephaly was a faithful ultrasound sign for the diagnosis of HCF. The evolution and the prognosis are influenced by the severity of hemorrhage and the gestational age. The survivors benefit from neurosurgical treatment. The multifactorial etiology, of the HCF incompletely elucidated leads to difficulties in establishing a target group of screening, in order to identify this lesion.

Helicobacter pylori and Giardia lamblia are common worldwide. Helicobacter pylori is a favoring factor for the presence of Giardia lamblia in the stomach due to the neutralization of the gastric pH through the secretion of urease. We present the case of a 5-year-old child, with intermittent gastro-intestinal symptoms in the recent personal pathological history, admitted in the Pediatrics Clinic 1 Târgu Mureș for abdominal pain, nausea, loss of appetite and hematemesis. The superior digestive endoscopy revealed multiple hemorrhagic lesions of the gastric mucosa, and the pathological exam of the antral gastric mucosa identified the coexistence of Helicobacter pylori and Giardia lamblia. The evolution of the patient was favorable under the eradication therapy of the infection with Helicobacter pylori and the antiparasitic drugs, the control endoscopy revealing a gastric mucosa without macroscopically obvious modifications, and the pathological re-evaluation pointed out regenerative modifications of the gastric mucosa. The particularity of the case is represented by the identification of the parasite Giardia lamblia in the gastric mucosa, a physiologically acid environment, alkalinized by the urease secreted by Helicobacter pylori, therefore providing favorable conditions for the development of this parasite in a 5-year-old child, from a favorable socio-economic environment, with intermittent gastrointestinal symptoms in his recent personal pathological history.

Helicobacter pylori și Giardia lamblia sunt răspândite în întreaga lume. Helicobacter pylori este un factor favorizant pentru prezența Giardia lamblia în stomac datorită neutralizării pH-ului gastric prin secreția de urează. Prezentăm cazul unui copil în vârstă de 5 ani, cu simptome gastro-intestinale intermitente în antecedentele personale patologice recente, care s-a internat în clinica Pediatrie 1 Târgu Mureș pentru dureri abdominale, grețuri, inapetență și hematemeză. Endoscopia digestivă superioară a evidențiat multiple sufuziuni hemoragice ale mucoasei gastrice, iar examenul histopatologic al mucoasei gastrice antrale a identificat coexistența infecției cu Helicobacter pylori și Giardia lamblia. Evoluția pacientului a fost favorabilă sub terapia de eradicare a infecției cu Helicobacter pylori și tratamentul antiparazitar administrat, endoscopia de control arătând o mucoasă fără modificări vizibile macroscopic, iar reevaluare histopatologică evidențiind modificări regenerative ale mucoasei gastrice. Particularitatea cazului este reprezentată de identificarea prezenței parazitozei cu Giardia lamblia în mucoasa gastrică, mediu fiziologic acid, alcalinizat de ureaza secretată de Helicobacter pylori, asigurând astfel condiții favorabile dezvoltării acestui parazit la un copil în vârstă de 5 ani, dintr-un mediu socio-economic favorabil, cu simptome gastro-intestinale intermitente în antecedentele personale patologice recente.

MERLIN-Expo merges and integrates advanced exposure assessment methodologies, allowing the building of complex scenarios involving several pollution sources and targets. The assessment of exposure and risks to human health from chemicals is of major concern for policy and ultimately benefits all citizens. The development and operational fusion of the advanced exposure assessment methodologies envisaged in the MERLIN-Expo tool will have a significant impact in the long term on several policies dealing with chemical safety management. There are more than 30 agencies in Europe related to exposure and risk evaluation of chemicals, which have an important role in implementing EU policies, having especially tasks of technical, scientific, operational and/or regulatory nature. The main purpose of the present paper is to introduce MERLIN-Expo and to highlight its potential for being effectively integrated within the group of tools available to assess the risk and exposure of chemicals for EU policy. The main results show that the tool is highly suitable for use in site-specific or local impact assessment, with minor modifications it can also be used for Plant Protection Products (PPPs), biocides and REACH, while major additions would be required for a comprehensive application in the field of consumer and worker exposure assessment.

Epilepsia este o patologie cerebrală care constă în apariţia convulsiilor epileptice recurente, iar mai mult de jumătate din cazuri prezintă debutul în timpul copilăriei. Prezentăm cazul unui pacient în vârstă de 3 ani, cu antecedente heredocolaterale de epilepsie şi istoric de retard în dezvoltarea neuropsihomotorie, care s-a internat în clinica noastră prezentând convulsii tonicoclonice generalizate, iniţial în context febril, iar ulterior în afebrilitate. Analizele de laborator şi cele neuroimagistice nu au identificat existenţa unei cauze subiacente. EEG iniţială nu a evidenţiat traseu patologic. În ciuda tratamentului anticonvulsivant instituit, evoluţia pacientului a fost nefavorabilă, prezentând multiple recurenţe pe termen scurt, fiind reinternat de mai multe ori în clinica noastră. O dată cu introducerea celui de-al doilea medicament antiepileptic, levetiracetam, în tratament, convulsiile s-au remis, iar pacientul a prezentat evoluţie favorabilă pe termen lung. Particularitatea cazului constă în apariţia unor crize tonicoclonice generalizate la un pacient cu antecedente heredocolaterale semnificative şi istoric de retard în dezvoltarea neuropsihomotorie, care apar iniţial în context febril, iar apoi în afebrilitate, repetându-se la ciclic, cu evoluţie nefavorabilă în ciuda tratamentului cu acid valproic, care se remit doar după iniţierea tratamentului cu levetiracetam.

Pesticides are key stressors of soil microorganisms with reciprocal effects on ecosystem functioning. These effects have been mainly attributed to the parent compounds, while the impact of their transformation products (TPs) has been largely overlooked. We assessed in a meadow soil (soil A) the transformation of iprodione and its toxicity in relation to (i) the abundance of functional microbial groups, (ii) the activity of key microbial enzymes, and (iii) the diversity of bacteria, fungi, and ammonia-oxidizing microorganisms (AOM) using amplicon sequencing. 3,5-Dichloroaniline (3,5-DCA), the main iprodione TP, was identified as a key explanatory factor for the persistent reduction in enzymatic activities and potential nitrification (PN) and for the observed structural changes in the bacterial and fungal communities. The abundances of certain bacterial (Actinobacteria, Hyphomicrobiaceae, Ilumatobacter, and Solirubrobacter) and fungal (Pichiaceae) groups were negatively correlated with 3,5-DCA. A subsequent study in a fallow agricultural soil (soil B) showed limited formation of 3,5-DCA, which concurred with the lack of effects on nitrification. Direct 3,5-DCA application in soil B induced a dose-dependent reduction of PN and NO3−-N, which recovered with time. In vitro assays with terrestrial AOM verified the greater toxicity of 3,5-DCA over iprodione. “Candidatus Nitrosotalea sinensis” Nd2 was the most sensitive AOM to both compounds. Our findings build on previous evidence on the sensitivity of AOM to pesticides, reinforcing their potential utilization as indicators of the soil microbial toxicity of pesticides in pesticide environmental risk analysis and stressing the need to consider the contribution of TPs in the toxicity of pesticides on the soil microbial community. IMPORTANCE Pesticide toxicity on soil microorganisms is an emerging issue in pesticide risk assessment, dictated by the pivotal role of soil microorganisms in ecosystem services. However, the focus has traditionally been on parent compounds, while transformation products (TPs) are largely overlooked. We tested the hypothesis that TPs can be major contributors to the soil microbial toxicity of pesticides using iprodione and its main TP, 3,5-dichloroaniline, as model compounds. We demonstrated, by measuring functional and structural endpoints, that 3,5-dichloroaniline and not iprodione was associated with adverse effects on soil microorganisms, with nitrification being mostly affected. Pioneering in vitro assays with relevant ammonia-oxidizing bacteria and archaea verified the greater toxicity of 3,5-dichloroaniline. Our findings are expected to advance environmental risk assessment, highlighting the potential of ammonia-oxidizing microorganisms as indicators of the soil microbial toxicity of pesticides and stressing the need to consider the contribution of TPs to pesticide soil microbial toxicity.

Background Sewage sludge, the inevitable byproduct of municipal wastewater-treatment plant operation, is a key issue in many countries due to its increasing volume and the impacts associated with its disposal. According to the report of European Commission published in 2010, 39% of sewage sludge produced in the European Union is recycled into agriculture. Management options require extensive waste characterization, since many of them may contain compounds, which could be harmful to the ecosystem, such as heavy metals, organic pollutants, etc. The present study aims to show the results of 2 years’ sampling of sewage sludge—based on 130 samples collected from 35 wastewater-treatment plants situated in the North of Italy—and to assess its suitability as soil fertilizer regarding contents of nonylphenol (NP), nonylphenolethoxylates (NPnEOs), and phthalates (DEHP). Results An effective analytic method for organic pollutants detection in the sewage sludge has been developed, showing an excellent repeatability and recoveries. Ecotoxicological risk assessment was evaluated using risk quotients (RQs) for sludge-amended soil. Most of the analyzed samples do not contain NP, NPnEOs, and DEHP at levels higher than the limit established by the draft-working document of the European Commission on Sludge. The assessment using RQs reports that NP and NPnEOs never give values higher than 1, and for DEHP the obtained RQs exceed the value of 1 just three times. Data obtained were compared to the data from other European and Asiatic countries, showing a huge variability for all the compounds considered. Conclusions Based on the obtained results, it appears that the proposed EU limits for the selected substances on sewage sludge intended to be used as soil fertilizer in agriculture are sufficiently conservative to avoid negative effects on soil fauna.

The assessment of bioaccumulation processes plays a significant role in the evaluation of chemical risks. The awareness of long-lasting and often irreversible effects of bioaccumulative chemicals on ecological and human targets encouraged the inclusion of bioaccumulation assessment in many national and international legislative frameworks. At the same time, various experimental and modelling approaches have been developed to estimate bioaccumulation metrics such as the bioaccumulation factor (BAF) or the biomagnification factor (BMF). In this chapter, the main processes governing bioaccumulation phenomena in selected aquatic organisms (phytoplankton, invertebrate and fish) and in terrestrial mammals are described, in particular those implemented in the corresponding models available in MERLIN-Expo tool for exposure assessment. The main objective is to describe the development of bioaccumulation models for organic and inorganic contaminants which takes into account recent progresses and which satisfactorily describes bioaccumulation of contaminants along food webs including phytoplankton, invertebrate and fish species for surface waters, and mammals for terrestrial systems, and also allowing dynamic and stochastic assessment according to MERLIN-Expo modelling features. The coupling of different aquatic biota models allows to recreate aquatic food web of different dimensions and complexity, while the coupling of terrestrial mammal model with plant models available in MERLIN-Expo permits to simulate the transfer of contaminants along simplified terrestrial food chains.

Metaplazia pancreatică este definită drept apariţia ţesutului pancreatic într-o locaţie anormală şi fară conectare directă la pancreas. Ţesutul pancreatic heterotopic este cel mai frecvent observat la nivelul mucoasei antrale gastrice, în duoden şi jejun. Prezentăm cazul unei paciente în vârstă de 13 ani care s-a internat în Clinica Pediatrie 1 Târgu-Mureş pentru dureri abdominale recurente şi pirozis. Investigaţiile de laborator efectuate au evidenţiat limfocitoză (41%) cu monocitoză (8,9%), eozinofilie (4,9%), un număr crescut de reticulocite (20%), un nivel seric scăzut al trigliceridelor şi o valoare peste limita superioară a calciului şi magneziului. Ecografia abdominală nu a pus în evidenţă modificări patologice. Endoscopia digestivă superioară a evidenţiat o mucoasă gastrică granulară. Astfel, s-a prelevat un fragment de biopsie de la nivel antral, iar examenul histopatologic a evidenţiat prezenţa unui focar de metaplazie pancreatică la nivelul mucoasei antrale gastrice. Evoluţia a fost favorabilă cu dietă şi tratamentul leziunilor asociate. Particularitatea cazului constă în prezenţa metaplaziei pancreatice a mucoasei gastrice la o pacientă cu dureri abdominale recurente şi pirozis, fără antecedente heredo-colaterale sau personale semnificative.

Diagnosticul antepartum al hemoragiei cerebrale fetale (HCF) este mai puţin raportat (0,9/1.000 naşteri) comparativ cu cel postpartum. Sunt prezentate două cazuri de hemoragie intraventriculară fetală, diagnosticate ecografic antepartum. Cazul 1: HCF diagnosticată ecografic la vârsta gestaţională de 28 de săptamâni de gestaţie şi confirmată postnatal prin prezenţa în LCR a hematiilor (număr semnificativ, ratatinate) şi a modificărilor semnalate de ecografia transfontanelară (hidrocefalie internă severă, ţesut cerebral minim). Decesul a survenit la 24 de ore postpartum (ex. histopatologic: hemoragie cerebrală intraventriculară). Menţionăm absenţa aparentă a factorilor de risc materni, negativitatea testelor TORCH. Cazul 2: hidrocefalie internă la vârsta de 37 de săptămâni de gestaţie şi confirmată la nou-născut (după cezariană) de modificările clinice caracteristice, suferinţa neurologică severă asociată cu modificări la ecografia transfontanelară şi aspectul hemoragic şi hipertensiv al LCR. Nu au fost depistaţi factori de risc materni. De asemenea, aparent nu au existat riscuri fetale: greutatea 2.820 g la 37 de săptămâni de gestaţie, teste TORCH negative, culturi şi CRP negative. Hidrocefalia a avut o evoluţie progresivă impunând ventriculotomii şi cisternotomii; plasarea unui şunt ventriculo-peritoneal în timpul celei de-a treia intervenţii neurochirurgicale a ameliorat prognosticul vital. Concluzii. Prezenţa hidrocefaliei a fost un semn ecografic fidel pentru diagnosticul HCF. Evoluţia şi prognosticul sunt influenţate de severitatea hemoragiei şi de vârsta gestaţională. Supravieţuitorii beneficiază de tratamentul neurochirurgical. Etiopatogenia plurifactorială, incomplet descifrată a HCF conduce la dificultăţi în stabilirea unui grup ţintă de screening, în scopul identificării acestei leziuni.

The interest for environmental issues and the concern resulting from the potential exposure to contaminants were the starting point to develop methodologies in order to evaluate the consequences that those might have over both the environment and human health. Considering the feature of POPs, including PBDEs, such as bioaccumulation, biomagnification, long-range transport and adverse effects even long time after exposure, risk assessment of POPs requires specific approaches and tools. In this particular context, the MERLIN-Expo tool was used to assess the aquatic environmental exposure of Adige River to PBDEs and the accumulation of PBDEs in humans through the consumption of possible contaminated local aquatic food. The aquatic food web models provided as output of the deterministic simulation the time trend of concentrations for twenty years of BDE-47 and total PBDEs, expressed using the physico-chemical properties of BDE-47, in aquatic organisms of the food web of Adige River. For BDE-47, the highest accumulated concentrations were detected for two benthic species: Thymallus thymallus and Squalius cephalus whereas the lowest concentrations were obtained for the pelagic specie Salmo trutta marmoratus. The trend obtained for the total PBDEs, calculated using the physico-chemical properties of BDE-47, follows the one of BDE-47. For human exposure, different BDE-47 and total PBDEs concentration trends between children, adolescent, adults and elderly were observed, probably correlated with the human intake of fish products in the daily diet and the ability to metabolize these contaminants. In detail, for the adolescents, adults and elderly a continuous accumulation of the target contaminants during the simulation's years was observed, whereas for children a plateau at the end of the simulation period was perceived.

Human Health Risk Assessment (HHRA) and Environmental Risk Assessment (ERA) are well-established regulatory and scientific research fields that support regulatory decision-making in the European Union (EU) and are undergoing constant development. HHRA and ERA are crucial steps for reaching the objectives of Europe 2020, a strategy put forward by the Commission that sets out a vision of Europe’s social market economy for the twenty-first century. This chapter aims to describe the basic principles, the evolution and the future challenges of HHRA and ERA.

The MERLIN-Expo tool was evaluated using a SWOT analysis, which was based on expert judgement and literature review. A list of criteria was set up containing the major model characteristics, which were divided in general model criteria and relevance model criteria. Relevance model criteria were defined as criteria, which are highly depending on the regulatory framework the model is used in. From the analysis presented above, it appeared that certain regulatory chemical frameworks (e.g. REACH, biocides) are stricter towards their requirements compared to others (e.g. site-specific/local regulatory frameworks). Based on expert judgement, the MERLIN-Expo tool was evaluated using the general and relevance criteria. MERLIN-Expo has many advanced functionalities (such as uncertainty analysis, modular approach, dynamic model, combines environmental fate with pharmacokinetics) and models (many fate processes and environmental compartments, different human populations). At the same time, the threat is that current (regulatory) applicability frameworks do not always require these advanced assessment functionalities. The MERLIN-Expo tool appeared to be most suitable for the site-specific assessment as this is the most flexible framework. Based on this analysis, weaknesses of the MERLIN-Expo tool for its use in a certain regulatory framework could also be identified. These weaknesses are at the same time further development opportunities for MERLIN-Expo. On general model characteristics, MERLIN-Expo was identified as a highly documented (both for novice and expert level), transparent, user-friendly tool with regular trainings. Its main treat now is to ensure continuing support and mechanisms for future developmental work and updates.