Comment on "The static evolution of the new Italian code of medical ethics"

The manuscript by Montanari Vergallo et al. appears primarily important because it resubmits the discussion on the relationshi between law and ethica norm in medical practice, as being responsible for promoting professional conduct or slowing it down and depriving it of its meaning

Evaluation of total and bioavailable heavy metals and other soilrelated variables in a rice paddy after the application of defecation lime

A two-year experiment was carried out in a paddy field to investigate the effects of the use of defecation lime derived from treated sewage sludge on soil total and soil phytoavailable heavy metals concentration. Heavy metals concentration was determined also in raw rice. Four treatments were arranged in a completely randomized block design: not fertilised (T0), organic fertilisation + chemical fertilisers (T1), defecation lime + chemical fertilisers (T2), defecation lime at pre-sowing (T3). For T3, the pH value increased significantly at the end of the second year, increasing from 5.8 to 6.11. T3 resulted in the highest soil organic carbon content (9.4 g kg-1), suggesting the potential of defecation lime both as soil corrective material and soil amendment. The application of defecation lime in the paddy field did not result in an increased phytoavailable amount of heavy metals in soil

How to assess appearance distress and motivation in plastic surgery candidates: Italian validation of Derriford Appearance Scale 59 (DAS 59)

The Derriford Appearance Scale (DAS) 59 was specifically designed to measure psychosocial adjustment in patients with appearance problems. Previous studies using the DAS59 have proven it to be a reliable method of assessing the appearance-related quality of life after plastic surgery procedures. The aim of this study was to develop a valid and reliable Italian version of the DAS59

A proposal for limited criminal liability in high-accuracy endoscopic sinus surgery

Lo studio ha lo scopo di sollecitare una riforma della responsabilità penale che preveda una riduzione di responsabilità legale per la chirurgia ad alta precisione, per quella ad alto rischio, come per esempio la chirurgia endoscopica sinusale (ESS). Il contributo comprende una revisione della letteratura medica, concentrandosi sullidentificazione e sullesame dei motivi per cui la tecnica di ESS corre un rischio molto elevato di produrre gravi complicazioni dovute a manovre chirurgiche inesatte. Tale contributo, prevede anche una revisione della teoria del diritto e della giurisprudenza britannica e italiana in merito alla negligenza medica, soprattutto con riferimento alla L. italiana n. 189 del 2012 (Decreto Balduzzi). Si è constatato che gravi complicanze dovute a manovre chirurgiche non corrette di ESS possono verificarsi, indipendentemente dalla prudenza/diligenza del chirurgo. La soggettività in termini giuridici risulta essenziale per la negligenza medica, soprattutto con riferimento alla chirurgia ad alta precisione. La legge italiana 189/2012 rappresenta una buona base per la limitazione della responsabilità penale derivante da manovre imprecise in chirurgia ad alta precisione, come appunto lESS. In conclusione, si considera che i chirurghi che eseguono ESS dovrebbero essere esonerati da responsabilità penale in caso di negligenza lieve sopravvenuta nonostante il rispetto delle line guida emanate

Medical-grade silicone coated with rhamnolipid R89 is effective against Staphylococcus spp. Biofilms

Staphylococcus aureus and Staphylococcus epidermidis are considered two of the most important pathogens, and their biofilms frequently cause device-associated infections. Microbial biosurfactants recently emerged as a new generation of anti-adhesive and anti-biofilm agents for coating implantable devices to preserve biocompatibility. In this study, R89 biosurfactant (R89BS) was evaluated as an anti-biofilm coating on medical-grade silicone. R89BS is composed of homologues of the mono- (75%) and di-rhamnolipid (25%) families, as evidenced by mass spectrometry analysis. The antimicrobial activity against Staphylococcus spp. planktonic and sessile cells was evaluated by microdilution and metabolic activity assays. R89BS inhibited S. aureus and S. epidermidis growth with minimal inhibitory concentrations (MIC99) of 0.06 and 0.12 mg/mL, respectively and dispersed their pre-formed biofilms up to 93%. Silicone elastomeric discs (SEDs) coated by R89BS simple adsorption significantly counteracted Staphylococcus spp. biofilm formation, in terms of both built-up biomass (up to 60% inhibition at 72 h) and cell metabolic activity (up to 68% inhibition at 72 h). SEM analysis revealed significant inhibition of the amount of biofilm-covered surface. No cytotoxic effect on eukaryotic cells was detected at concentrations up to 0.2 mg/mL. R89BS-coated SEDs satisfy biocompatibility requirements for leaching products. Results indicate that rhamnolipid coatings are effective anti-biofilm treatments and represent a promising strategy for the prevention of infection associated with implantable devices

Inhibitory effects of lipopeptides and glycolipids on C. albicans - Staphylococcus spp. dual-species biofilms

Microbial biofilms strongly resist host immune responses and antimicrobial treatments and are frequently responsible for chronic infections in peri-implant tissues. Biosurfactants (BSs) have recently gained prominence as a new generation of anti-adhesive and antimicrobial agents with great biocompatibility and were recently suggested for coating implantable materials in order to improve their anti-biofilm properties. In this study, the anti-biofilm activity of lipopeptide AC7BS, rhamnolipid R89BS and sophorolipid SL18 was evaluated against clinically relevant fungal/bacterial dual-species biofilms (Candida albicans, Staphylococcus aureus, Staphylococcus epidermidis) through quantitative and qualitative in vitro tests. C. albicans - S. aureus and C. albicans - S. epidermidis cultures were able to produce a dense biofilm on the surface of the polystyrene plates and on medical-grade silicone discs. All tested BSs demonstrated an effective inhibitory activity against dual-species biofilms formation in terms of total biomass, cell metabolic activity, microstructural architecture and cell viability, up to 72h on both these surfaces. In co-incubation conditions, in which BSs were tested in free soluble form, rhamnolipid R89BS (0.05 mg/ml) was the most effective among the tested biosurfactants against the formation of both dual-species biofilms, reducing on average 94% and 95% of biofilm biomass and metabolic activity at 72h of incubation, respectively. Similarly, rhamnolipid R89BS silicone surface coating proved to be the most effective in inhibiting the formation of both dual-species biofilms, with average reductions of 93% and 90%, respectively. Scanning Electron Microscopy observations showed areas of treated surfaces that were free of microbial cells or in which thinner and less structured biofilms were present, compared to controls. The obtained results endorse the idea that coating of implant surfaces with BSs may be a promising strategy for the prevention of C. albicans -Staphylococcus spp. colonization on medical devices, and can potentially contribute to the reduction of the high economic efforts undertaken by healthcare systems for the treatment of these complex fungal-bacterial infections

An Assessment of Contaminants in UK Road-Verge Biomass and the Implications for Use as Anaerobic Digestion Feedstock

Biomass from harvested road-verge herbage has potential value as a feedstock for anaerobic digestion (AD) energy plants. However, the proximity to road traffic related pollution sources introduces the possibility of contamination by potentially toxic elements and polycyclic aromatic hydrocarbons. Potential sources of pollution from road traffic emissions are identified and the consequent likelihood of certain contaminants being present at elevated levels is assessed. Samples of road verge biomass harvested from selected locations in Lincolnshire UK for use in AD plants were analysed to produce a set of measurements for the presence of the contaminants of interest. The measured levels of these contaminants are compared to reported background levels in UK herbage and soils to assess if there is significant increased concentration in road-verge biomass. Samples of digestate from an AD plant using the road-verge biomass as feedstock were also analysed to determine if there is notable risk of transfer and concentration of contaminants into agricultural land where the digestate may be used for fertilisation. While elevated levels of contaminants were detected, they were not found in concentrations on road verge biomass at high enough levels to cause adverse effects or concerns for its safe use as an AD feedstock

The stage of soil development modulates rhizosphere effect along a High Arctic desert chronosequence

In mature soils, plant species and soil type determine the selection of root microbiota. Which of these two factors drives rhizosphere selection in barren substrates of developing desert soils has, however, not yet been established. Chronosequences of glacier forelands provide ideal natural environments to identify primary rhizosphere selection factors along the changing edaphic conditions of a developing soil. Here, we analyze changes in bacterial diversity in bulk soils and rhizospheres of a pioneer plant across a High Arctic glacier chronosequence. We show that the developmental stage of soil strongly modulates rhizosphere community assembly, even though plant-induced selection buffers the effect of changing edaphic factors. Bulk and rhizosphere soils host distinct bacterial communities that differentially vary along the chronosequence. Cation exchange capacity, exchangeable potassium, and metabolite concentration in the soil account for the rhizosphere bacterial diversity. Although the soil fraction (bulk soil and rhizosphere) explains up to 17.2% of the variation in bacterial microbiota, the soil developmental stage explains up to 47.7% of this variation. In addition, the operational taxonomic unit (OTU) co-occurrence network of the rhizosphere, whose complexity increases along the chronosequence, is loosely structured in barren compared with mature soils, corroborating our hypothesis that soil development tunes the rhizosphere effect