Endoscopic submucosal dissection in colorectal neoplasia performed with a waterjet system-assisted knife: higher resection rate than conventional technique

Background/Aims Colorectal endoscopic submucosal dissection (ESD) is burdened by its associated high risk of adverse events and long procedure time. Recently, a waterjet-assisted knife was introduced to simplify and speed up the procedure. The aim of this study was to evaluate the efficacy and safety of waterjet-assisted ESD (WESD) compared to that of the conventional ESD (CESD) technique. Methods The charts of 254 consecutive patients who underwent colorectal ESD between January 2014 and February 2021 for colorectal neoplasms were analyzed. The primary outcome was the en-bloc resection rate. Secondary outcomes were complete and curative resection rates, the need to switch to a hybrid ESD, procedure speed, the adverse event rates, and the recurrence rates. Results Approximately 174 neoplasias were considered, of which, 123 were removed by WESD and 51 by CESD. The en-bloc resection rate was higher in the WESD group (94.3% vs. 84.3%). Complete resection rates and curative resection rates were similar. The need to switch to a hybrid ESD was greater during CESD (39.2% vs. 13.8%). Procedure speed and adverse event rates were similar. During follow-up, one recurrence occurred after a WESD. Conclusions WESD allows a high rate of en-bloc resections and less frequently requires a rescue switch to the hybrid ESD compared to CESD

Air pollution survey across the western Mediterranean Sea: overview on oxygenated volatile hydrocarbons (OVOCs) and other gaseous pollutants

Despite the Mediterranean Sea basin is among the most sensitive areas over the world for climate change and air quality issues, it still remains less studied than the oceanic regions. The domain investigated by the research ship Minerva Uno cruise in Summer 2015 was the Tyrrhenian Sea. An overview on the marine boundary layer (MBL) concentration levels of carbonyl compounds, ozone (O3), and sulfur dioxide (SO2) is reported. The north-western Tyrrhenian Sea samples showed a statistically significant difference in acetone and SO2 concentrations when compared to the south-eastern ones. Acetone and SO2 values were higher in the southern part of the basin; presumably, a blend of natural (including volcanism) and anthropogenic (shipping) sources caused this difference. The mean acetone concentration reached 5.4 μg/m3; formaldehyde and acetaldehyde means were equal to 1.1 μg/m3 and 0.38 μg/m3, respectively. Maximums of 3.0 μg/m3 for formaldehyde and 1.0 μg/m3 for acetaldehyde were detected along the route from Civitavecchia to Fiumicino. These two compounds were also present at levels above the average in proximity of petrol-refining plants on the coast; in fact, formaldehyde reached 1.56 μg/m3 and 1.60 μg/m3, respectively, near Milazzo and Augusta harbors; meanwhile, acetaldehyde was as high as 0.75 μg/m3 at both sites. The levels of formaldehyde agreed with previously reported measurements over Mediterranean Sea and elsewhere; besides, a day/night trend was observed, confirming the importance of photochemical formation for this pollutant. According to this study, Mediterranean Sea basin, which is a closed sea, was confirmed to suffer a high anthropic pressure impacting with diffuse emissions, while natural contribution to pollution could come from volcanic activity, particularly in the south-eastern Tyrrhenian Sea regio

The BEMA Project. Fluxes of Biogenic VOC from Mediterranean Vegetation by Trap Enrichment Relaxed Eddy Accumulation.

Results are presented of the application of a modified relaxed eddy accumulation system for the determination of VOC fluxes in the atmosphere (TREA). At first system design, performances and testing against eddy covariance carbon dioxide fluxes is presented. Subsequently the capability of TREA to discriminate between biogenic and antropogenic VOC fluxes is discussed with some examples. TREA fluxes are also compared with the majorb biogenic VOC fluxes calculated with the gradient method and the relative merits and problems of the two techniques are discussed.JRC.(EI)-Environment Institut

ESWL for difficult bile duct stones: A 15-year single centre experience

AIM: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) for the management of refractory bile duct cholelithiasis in a third level referral centre

The Management of Gastroprotection in Patients Receiving Antiplatelet Agents – Focus on Clopidogrel and PPI

Abstract: Clopidogrel as an adjunct to aspirin has improved outcomes after acute coronary syndromes and coronary stent implantation. Patients with CV co-morbidities, receiving antiplatelet agents because of their usefulness in primary or secondary cardiovascular prevention, present a significantly increased GI risk; therefore in those patients gastroprotective agents are useful to reduce this risk. Laboratory studies suggested a reduced antiplatelet effect when proton pump inhibitors (PPIs) are co-administered; those data were corroborated from large retrospective studies.Strong evidence from RCTs and systematic review evaluating the clinical interaction between PPI and clopidogrel failed to demonstrate difference in cardiovascular outcomes, confirming a significant reduction in gastrointestinal bleeding in PPI users.To date, the available evidences do not support the warning that PPI prescription could worsen clinical outcome of patients receiving clopidogrel

The BEMA-Project. Biogenic Emissions from the Mediterranean Pseudosteppe Ecosystem Present at Castelporziano.

Emission rates and fluxes of biogenic components emitted by a Mediterranean Pseudsteppe were measured in the BEMA test site of Castelporziano during the 1993 and 1994 field campaigns. Enclosure and micrometeorological techniques were used. Although the emission was comprised of isoprene, semi-volatile aldehydes, acetic acid and monterpenes at trace levels, the most relevant compound in air was isoprene.JRC.(EI)-Environment Institut