"Mushrooms (and a cow) are A Means of Survival for Us": Dissimilar Ethnomycological Perspectives among Hutsuls and Romanians Living Across The Ukrainian-Romanian Border

Sustainable forest management highlights the multipurpose use of all forest resources, including the use of wild mushrooms, by a variety of forest users and especially for rural livelihoods. To achieve sustainable forest management, among others, decision-makers and forest managers need to identify the important elements for the livelihoods of local communities dependent on forests. Therefore, our aim is to analyse the importance of contemporary use of wild mushrooms for daily livelihoods in rural areas of the Carpathian Mountains by comparing two ethnic groups, Hutsuls and Romanians, living in a similar ecological environment and formerly belonging to the historical region of Bukovina, but currently split by the border between Ukraine and Romania which have different governments and economic situations. One hundred and twenty-one face-to-face semi-structured interviews were conducted in the summers of 2018 and 2019. We compared the Traditional Ecological Knowledge (TEK) of Romanians and Hutsuls living, respectively, in lowlands and mountain areas on both sides of the border. Our results demonstrated the homogenous use of mushroom species for cultural purposes (e.g. ritual foods). Yet, we detected a remarkable difference in the role mushrooms play in providing income: Hutsuls in Ukraine use forest products as a main (rarely additional) source of income, while Romanian Hutsuls use them solely as additional income. Romanians on both sides considered mushrooms mainly as food and did not sell them (probably due in part to less abundance in the area). We also documented the fear of local residents that forest management and protected areas could suppress the right to collect wild mushrooms. The use of mushrooms is an important aspect of local TEK and needs to be considered as a part of sustainable forest management and as a means of poverty reduction in the region.

Just beautiful green herbs: use of plants in cultural practices in Bukovina and Roztochya, Western Ukraine

BACKGROUND

The use of plants in rituals is a little explored corner of biocultural diversity which has developed through time within a complex socio-ecological system. Indeed, rituals are complex interactions between humans and biodiversity shaped by history, culture, and ethnic belonging. Yet, in Western Ukraine, such rituals were forbidden for over 50 years (1939-1991). The current revival of rituals by rural inhabitants is an untapped reservoir of local ecological knowledge. The aim of the present study was to identify the ritual use of wild and cultivated plants in two regions of Western Ukraine, Bukovina and Roztochya, and to compare the findings with historical data. Moreover, we analyzed attitudes toward the ritual use of plants and interactions with the local environment.

METHODS

We conducted 31 in-depth semi-structured interviews among Orthodox Hutsuls of Bukovina and 16 interviews among Greek Catholic rural inhabitants of Roztochya during summer 2018 focusing on the ritual uses of plants.

RESULTS

We documented  28 plant taxa among Bukovinian Hutsuls and 58 plant taxa among inhabitants in Roztochya that were used in 7 religious festivals (of which two were celebrated differently in the two communities). Plants were mainly used in bouquets, but also for decorating churches and houses or in fruit baskets. In both communities, almost 25% of the interviewees could not name the plants they collected for bouquets, but rather referred to "just beautiful green herbs" one can get in meadows, forests, and gardens. Comparison with historical data shows a smaller number of taxa currently used (wild taxa have been lost), yet the persistence of 18 taxa used both now and a century ago.

CONCLUSIONS

Contemporary practices concerning the use of plants in Christian rituals in Bukovina and Roztochya can be contextualized in the broader phenomenon of the revitalization of traditional environmental knowledge and practices that have characterized Europe over the past 30 years and in particular Eastern Europe after socialism. The current religious use of plants is to a certain extent the revitalization of historical rituals supported by various internal (knowledge from older generations) and external (church authorities and fashion in the region) drivers. Further research should address changes in regions with longer and more severe prohibition of religious practices and their revival.

Diagnostic accuracy of Instantaneous Wave-Free Ratio (iFR) for the assessment of myocardial ischaemia: a comparison with non-invasive stress imaging

Background

Instantaneous Wave-Free Ratio (iFR) allows for the assessment of the haemodynamic effects of epicardial coronary stenoses without the need for hyperaemia; iFR is currently recommended as a means to evaluate myocardial ischaemia.

Purpose

To assess the diagnostic accuracy of iFR with respect to the identification of coronary epicardial stenoses causing ischemia. Therefore, we combined anatomical (% stenosis at invasive coronary angiography, ICA) and functional (non-invasive imaging stress test, NIST) information to obtain a “gold standard” for the identification of stenoses causing ischaemia.

Methods

We enrolled 71 patients (52 male, 19 female; age mean 68.4±8.1 years) with chronic coronary syndrome or low-risk acute coronary syndrome without ST segment elevation who had at least a NIST and who had at least one vessel with a 50%-85% stenosis at ICA. iFR was measured in all coronary arteries with stenosis >50% and categorised according to the 0.89 threshold for ischaemia.

Results

iFR was assessed in 122 vessels. In a per-vessel analysis, in 56.7% ischaemia was present both at iFR and NIST, in 21.3% ischaemia was absent in both, while in 23.0% ischaemia was found at NIST but not confirmed by iFR. The overall accuracy of iFR with respect to NIST was 90.1%. However, when considering as the “gold standard” for coronary disease causing ischaemia the contemporary presence of an epicardial stenosis >70% at ICA and a positive NIST, the diagnostic accuracy of iFR greatly improved. The sensibility, specificity, PPV, NPV and accuracy were 96.5%, 75.0%, 73.3%, 96.7% and 84.4%, respectively. In case of discordance between NIST and iFR, revascularization was based on iFR. At a mean follow-up of 23±18 months, the composite endpoint of MACE (major adverse cardiac events, defined as the composite of all-cause death, nonfatal MI and unplanned coronary revascularization) occurred in 16.4%, while death/MI occurred in 11.9%. Stratification according to the per-patient concordance between iFR and NIST showed no significant differences in rates of MACE (p=0.50) and death/MI (p=0.20). Stratification based on iFR showed a higher death/MI rate in iFR-positive patients (11.9% vs. 0%, p=0.047) and a trend to higher MACE rate (11.9% vs. 4.47% p=0.14),

Conclusions

The diagnostic accuracy of iFR is low when compared with NIST as the reference for myocardial ischaemia, but it is very high when compared with the combined presence of epicardial stenosis and positive NIST. Therefore, iFR can accurately guide the decision to treat or defer revascularization of intermediate coronary stenoses, being most useful in patients with multivessel CAD and when non-invasive functional data are lacking or discordant with anatomy.

Funding Acknowledgement

Type of funding source: None

Practice recommendations for neurovascular ultrasound investigations of acute stroke patients in the setting of the COVID-19 pandemic: an expert consensus from the European Society of Neurosonology and Cerebral Hemodynamics

Background and purpose

Patients with acute ischemic stroke are at high‐risk for contracting COVID‐19 infection. Additionally, healthcare professionals including neurovascular ultrasound providers are also at risk of being infected by SARS‐CoV‐2 virus. Yet, preparedness to continue to guarantee hyperacute treatment is vital for patients outcome. In light of this situation, the European Society of Neurosonology and Cerebral Hemodynamic (ESNCH) appointed a task force to provide consensus recommendations for the performance of neurovascular ultrasound investigations in acute ischemic stroke during the COVID‐19 pandemic with the aim of protecting both patients and ultrasound providers.

Methods

The “ultrasound in acute stroke working group” of the ESNCH examined literature articles and reviews using the following key words: “corona virus” or “COVID‐19” or “SARS‐CoV‐2 virus”, and “acute stroke” or “cerebrovascular disease”, and “ultrasound”. Thereafter, a thorough discussion was conducted with the “education and guidelines working group” of the ESNCH.

Results

We propose rapid up‐to‐date recommendations for healthcare personnel involved in the pre‐hospital and intra‐hospital assessment of stroke patients, with a particular attention to neurovascular ultrasound performance.

Conclusion

The ESNCH provides a guidance summary for the performance of neurovascular ultrasound investigations in acute ischemic stroke in the time of COVID‐19.

Combining olfactory test and motion analysis sensors in Parkinson's disease preclinical diagnosis: a pilot study

OBJECTIVES

Preclinical diagnosis of Parkinson's disease (PD) is nowadays a topic of interest as the neuropathological process could begin years before the appearance of motor symptoms. Several symptoms, among them hyposmia, could precede motor features in PD. In the preclinical phase of PD, a subclinical reduction in motor skills is highly likely. In this pilot study, we investigate a step-by-step method to achieve preclinical PD diagnosis.

MATERIAL AND METHODS

We used the IOIT (Italian Olfactory Identification Test) to screen a population of healthy subjects. We identified 20 subjects with idiopathic hyposmia. Hyposmic subjects underwent an evaluation of motor skills, at baseline and after 1 year, using motion analysis sensors previously created by us.

RESULTS

One subject showed significant worsening in motor measurements. In this subject, we further conducted a dopaminergic challenge test monitored with the same sensors and, finally, he underwent [¹²³ I]-FP/CIT (DaTscan) SPECT brain imaging. The results show that he is probably affected by preclinical PD.

CONCLUSIONS

Our pilot study suggests that the combined use of an olfactory test and motor sensors for motion analysis could be useful for a screening of healthy subjects to identify those at a high risk of developing PD.

Medicinal plants in the Mediterranean area: synthesis of the results of the project Rubia

AIM OF STUDY

Within the scope of the European project RUBIA (ICA3-2002-10023), research has been performed on the traditional use and handling of plant species in several Mediterranean countries, Albania, Algeria, Cyprus, Egypt, Italy, Morocco, and Spain. This paper synthesises the chief results related to the medicinal utilization of those plants.

MATERIAL AND METHODS

The information has been gathered by means of semi-structured interviews (1256) and techniques of participant observation with 803 informants. In each of the participating countries the study areas were selected by means of uniform criteria defined at the beginning of the study.

RESULTS AND CONCLUSIONS

A total of 985 species have been catalogued, of which 406 have medicinal use. This work constitutes the first comparative study performed with ethnobotanical data gathered by a coordinated methodology in the Mediterranean area. An exhaustive list is provided for the species catalogued, indicating the regions where each plant was mentioned.

ETHNOPHARMACOLOGICAL RELEVANCE

This information underlines the ethnobotanical richness of the region and the need to broaden this study to other areas of the Mediterranean. Furthermore, this constitutes a base for future phytochemical and pharmacological studies which could lead to new therapeutic products.

[Pilot study of professional exposure and hearing functionality of orchestra musicians of a national lyric theatre]

The sound exposure of classic orchestra musicians is not well assessed in Italy even though the protectionistic law includes all the working environments, as stated in the European Directive 2003/10/EC relative to the protection of workers against noise-induced damage. Scientific data in the literature show that the musicians are exposed to high daily personal exposure levels. These levels can systematically exceed the 85 dB(A) in the case of percussionists. In this study, preliminary results are shown relative to an experimental campaign performed in a lyric National Theatre. The aim of the study was the assessment of the risk due to high sound level in the theatre musicians and their cochlear functionality. The noise levels were measured by using wearable phonometers and multichannel sound analyzers. The signals were recorded during the whole working time in the rehearsal hall and in the fossa. The cochlear functionality was monitored before and immediately after rehearsal in a sample of volunteers by means of otoacoustic emission tests. Both TEOAE and DPOAE were measured using the ILO292 portable system. The data show that OAE-based tests can effectively discriminate between different classes of exposure. A good correlation was found between the daily exposure level and the DPOAE level.

Antioxidant activity of five vegetables traditionally consumed by south-Asian migrants in Bradford, Yorkshire, UK

Five vegetables traditionally consumed among South-Asian migrants in Bradford (Yorkshire, UK) were tested for their free radical scavenging activity (FRSA) in the DPPH (1,1-diphenyl-2-picrylhydrazil radical) screening assay (using extracts prepared both by cold maceration and also by boiling the plant in the solvent under reflux) and for their in vitro non-enzymatic inhibition of bovine brain lipid peroxidation. In both antioxidant assays a strong activity was shown by extracts derived from okra (Abelmoschus esculentus, Malvaceae) fruits and charungli (Caralluma edulis, Asclepiadaceae) aerial parts. Extracts from bitter melon (Momordica charantia, Cucurbitaceae) and angular loofah (Luffa acutangula) showed a significant difference in the FRSA between the extract obtained by using cold maceration and that prepared by boiling the plant in the solvent under reflux, suggesting the chemical composition of the plant changed during the heating process, leading to an increase in the amount of antioxidant components. These findings confirm the great interest of the nutraceutical sciences in extracts of Caralluma edulis, whose phytochemistry and phytopharmacology should be investigated further in order to detect possible phytotherapeutic uses in the prevention of ageing related diseases (ARDs) and Alzheimer disease (AD).

Natural Remedies and Nutraceuticals Used in Ethnoveterinary Practices in Inland Southern Italy

Traditional animal health practices are today only rarely used in Europe, as many natural remedies applied for the treatment of animals have been replaced by modern pharmaceuticals. Modern institutionalized veterinary services tend to cover every aspect of animal health care, and influence most of the veterinary practices carried out by shepherds and farmers. However, in some areas, particularly of the Mediterranean, such traditional practices persist. Few ethnoveterinary studies have been conducted in the Mediterranean. In this survey, we analysed the natural remedies that are still in use or were used until very recently to treat animals in central Lucania (inland southern Italy). Plants constitute the mainstay of the folk-veterinary regimen (about 40 preparations), but there are also a few animal- and mineral-derived preparations. Among them, the veterinary use of Cistus incanus, Colutea arborescens, Daphne laureola, and Erigeron acer is reported for the first time. Moreover, the study identified diverse traditional plant nutraceuticals used to improve animal health, as well as the quality of milk and dairy products. An important potential output of this study may be the development of eco-sustainable integrated projects focused on the maintenance of traditional animal breeding and healthcare systems. Pharmacological and toxicological considerations relating to possible applications of the recorded traditional knowledge in modern evidence-based veterinary medicine are also discussed.

Antimicrobial activity of extracts of Clematis vitalba towards pathogenic yeast and yeast-like microorganisms

A broad activity against pathogenic yeast and yeast-like microorganisms was shown in crude extracts of young shoots of Clematis vitalba. MICs ranging from 1.4 to 12.3 microg/ml were observed. After fractionating with petroleum ether, ethyl acetate and methanol, antimycotic activity has been observed only in methanol fractions.

In vitro antioxidant activity of non-cultivated vegetables of ethnic Albanians in southern Italy

A total of 27 extracts from non-cultivated and weedy vegetables traditionally consumed by ethnic Albanians (Arbëreshë) in the Vulture area (southern Italy) were tested for their free radical scavenging activity (FRSA) in the DPPH (1,1-diphenyl-2-picrylhydrazil radical) screening assay, for their in vitro non-enzymatic inhibition of bovine brain lipid peroxidation and for their inhibition of xanthine oxidase (XO). In both antioxidant assays strong activity was shown for Leopoldia comosa (bulbs, syn.: Muscari comosum) and Centaurea calcitrapa (young whorls). In the lipid peroxidation assay, extracts from leaves of Origanum heracleoticum, Urtica dioica and Tordylium apulum showed a remarkable inhibitory activity (> 50%), too. In the case of Leopoldia comosa and Origanum heracleoticum this activity was comparable to quercetin (at a concentration of 50 microM) and Rhodiola rosea extract. Extracts from non-cultivated Cichorium intybus, Chondrilla juncea and Stellaria media showed strong in vitro inhibition of xanthine oxidase, with an activity higher than that of a reference extract from Ledum groenlandicum. These findings suggest that weedy vegetables may be useful antioxidants of interest in the prevention of ageing related diseases, CNS disorders and as potential sources of phytomedicines against hyperuricaemia and gout.

An ethnopharmacological study on common privet (Ligustrum vulgare) and phillyrea (Phillyrea latifolia)

Ligustrum vulgare and Phillyrea latifolia leaves were well known in the Mediterranean historical medicine for their oropharyngeal anti-inflammatory effects. At the present time a popular phytotheraputical use of these species remains only in a few isolated southern European areas. Phytochemical and phytopharmacological studies of the methanolic extractives of their leaves were carried out. Flavonoidic fractions as well as different isolates, apigenin and luteolin derivatives showed significant in vitro complement inhibiting effects on the classical pathway of the complement system. A possible phytoceutical utilisation of the aerial parts of these species could represent (especially regarding the genus Phillyrea) an interesting perspective for many semi-arid Mediterranean regions.

Medicinal plants and food medicines in the folk traditions of the upper Lucca Province, Italy

An ethnopharmacobotanical survey of the medicinal plants and food medicines of the northern part of Lucca Province, north-west Tuscany, central Italy, was carried out. The geographical isolation of this area has permitted the survival of a rich folk phytotherapy involving medicinal herbs and also vegetable resources used by locals as food medicine. Among these are the uncommon use of Ballota nigra leaves as a trophic protective; the use of Lilium candidum bulbs as an antiviral to treat shingles (Herpes zoster); Parmelia sp. as a cholagogue; Crocus napolitanus flowers as antiseptic; Prunus laurocerasus drupes as a hypotensive; and the consumption of chestnut flour polenta cooked with new wine as bechic. Many wild gathered greens are eaten raw in salads, or in boiled mixtures, as 'blood cleansing' and 'intestine cleansing' agents. Of particular interest is the persistence of the archaic use of Bryonia dioica root against sciatica, and the use of ritual plant therapeuticals as good omens, or against the 'evil eye.' Over 120 species represent the heritage of the local folk pharmacopoeia in upper Garfagnana. Anthropological and ethnopharmacological considerations of the collected data are also discussed.

Studies on anti-complementary activity of extracts and isolated flavones from Ligustrum vulgare and Phillyrea latifolia leaves (Oleaceae)

Polar fractions and flavones isolated from methanolic extracts of the leaves of Ligustrum vulgare and Phillyrea latifolia (Oleaceae), whose popular use as an anti-inflammatory is well-known in Mediterranean historical medicine and ethnobotany, showed significant in vitro complement inhibiting effect on the classical pathway of the complement system. Among the isolated flavonoidic structures, apigenin-7-O-glucoside, apigenin-7-O-rutinoside, luteolin-4'-O-glucoside, luteolin-7-O-glucoside and ligustroflavone presented remarkable activity.

Isolation and structure elucidation of ligustroflavone, a new apigenin triglycoside from the leaves of Ligustrum vulgare L

A new flavone, apigenin-7-O-beta-(2",6"-di-alpha-rhamnopyranosyl)-glucopyranoside , named ligustroflavone, was isolated from the leaves of common privet (Ligustrum vulgare L., Oleaceae), whose popular use was well known in the Mediterranean historical medicine and ethnomedicine as anti-inflammatory. The structures of other five apigenin and luteolin derivates, isolated from the polar fractions of the methanolic leaf extracts, were elucidated.

In vitro anti-complementary activity of flavonoids from olive (Olea europaea L.) leaves

From extracts of olive (Olea europaea L., Oleaceae) leaves showing anti-complementary activity, the flavonoids apigenin, apigenin-4'-O-rhamnosylglucoside, apigenin-7-O-glucoside, luteolin, luteolin-4'-O-glucoside, luteolin-7-O-glucoside, chrysoeriol, chrysoeriol-7-O-glucoside and quercetin-3-O-rhamnoside were isolated. Major isolated constituents strongly inhibited the classical pathway of the complement system.

Residual myocardial perfusion in reversibly damaged myocardium by dipyridamole contrast echocardiography

In patients with previous myocardial infarction and left ventricular asynergy, dipyridamole infusion may have the capacity to unmask myocardial viability through transient recovery of contractile function in asynergic segments. The purpose of this study was to assess simultaneous changes in myocardial perfusion and LV function--elicited by dipyridamole infusion--in infarcted, asynergic segments. The echo contrast agent Albunex was injected into the left coronary artery of 19 patients (17 males, age 49-70 years) with previous myocardial infarction and baseline left ventricular asynergy, both before and after dipyridamole infusion (up to 0.56 mg.kg-1, i.v.). Analysis was not possible in three patients due to inadequate image quality and in two due to weak contrast. There were no major adverse events, or changes in vital signs or demonstrated on the electrocardiogram. After dipyridamole, 7/14 patients, showed an improvement in regional function of asynergic segments ('responders'), whereas seven patients did not ('non-responders'). Among non-responders, five had a myocardial perfusion deficit corresponding to 41% of the total left ventricular area before dipyridamole and to 38% after dipyridamole. No baseline perfusion deficits were observed in the remaining two non-responders; one of these, however, developed transient asynergy and perfusion deficit after dipyridamole. Among responders, five showed a normal perfusion pattern, both before and after dipyridamole, while the remaining two showed a perfusion deficit which markedly decreased after dipyridamole (from 32% to 13% of total left ventricular area). Thus, residual contractile reserve of asynergic, infarcted ventricular segments appears to be associated with myocardial perfusion either preserved at baseline or recruitable by a coronary dilator stimulus.

[Use of ultrasonography to estimate fetal weight in premature infants. Development of a new mathematical formula]

In 73 pregnant patients at a gestational age under 36 weeks, who gave birth within 72 hours from the last US examination, mathematical equations were elaborated. The equations were aimed at predicting fetal weight by measuring the main US biometric parameters; the results were compared to the actual birth weight. A statistical analysis was performed using the "backward elimination" method. The linear equation that has provided with the best estimation of fetal weight is the following: fetal weight = 12.9875 BPD +29.5642 AD +28.8023 FL -3496.1265. According to this equation, about 95.22% of the variability of the unknown quantity (i.e. birth weight) can be ascribed to its correlation to the variables: biparietal diameter (BPD), abdominal diameter (AD) and femur length (FL). Estimated fetal weight by US, as calculated on the basis of biparietal diameter, abdominal diameter and femur length measurements, showed, in our study, a standard error of 143 g (9.02%) (R = 0.95).

Antibiotic prophylaxis in gynecological surgery

A randomized prospective study was undertaken at the Obstetrics and Gynecology Clinic of the Catholic University of Rome in order to evaluate the effectiveness of two wide spectrum antibiotics: mezlocillin and cefotetan. Both drugs were administered 2 g i.v. 15 to 20 minutes preoperatively to allow optimal serum and tissue levels of antibiotic at the moment of bacterial innoculation. 184 patients undergoing elective gynecological surgery for nonmalignant disease were considered eligible for the study (124 pts abdominal hysterectomy, 58 pts vaginal hysterectomy). We found no statistically significant differences between the results obtained with the two drugs.

[Ultrasonic study of the predictability of fetal macrosomia]

Main fetal echobiometric parameters have been considered in 643 pregnant patients and evaluated for fetal macrosomia predictivity. Deliveries occurs within seven days after ultrasound examination. Malformative or other pathologic conditions with could have interfered with a correct ultrasound evaluation of the disease have been excluded. The single parameters are not reliable for a screening of fetal macrosomia. The A. suggest, for a greater accuracy, sequential ultrasound examination during pregnancy or mathematical correlation of several echobiometric parameters.