Tool for the identification and implementation of Environmental Indicators in Ports (TEIP)

In this paper, the concept of environmental indicator is reviewed as a relevant element used in the environmental management of any organisation. The importance of this element within an Environmental Management System (EMS) is also justified. Although EMS standards recognise the relevance of using indicators, they do not specify any methodology to identify which indicators have to be implemented. In addition, the present research demonstrates that although there is a high percentage of European ports that have already implemented performance indicators, most of them do not mention the method applied to obtain the indicators. This suggests that some of the procedures used by ports to identify indicators may not necessarily be science-based or systematic in approach. For these reasons, the need to develop a new methodology able to identify the ports' most adequate indicators was detected. Therefore, a Tool for the identification and implementation of Environmental Indicators in Ports (TEIP) was developed. It aims at identifying performance indicators in ports and providing guidelines for their proper implementation. This is a computer and science-based tool (www.eports.cat/teip) that provides a quick calculation and outputs, and it is designed to be as user-friendly and practical as possible in order to facilitate its completion by the user. This new methodology is applicable to all types of ports no matter the size, geographical location or its commercial profile; it provides targeted and specific results for each one. TEIP aims at helping port managers at easily determining their significant port indicators, which provides valuable elements for the decision-making processes.Peer ReviewedPostprint (author's final draft

Evolución de la continencia y de la calidad de vida tras esfinteroplastia por incontinencia fecal de origen obstétrico

La incontinencia fecal es un síntoma de gran trascendencia social que puede incapacitar a la persona que la padece. El traumatismo obstétrico es la causa más frecuente en pacientes atendidas en una unidad de coloproctología. El 13% de las mujeres desarrollan algún grado de incontinencia o urgencia tras su primer parto vaginal. En las pacientes con lesión esfinteriana asociada a incontinencia fecal grave subsidiarias de tratamiento quirúrgico, la técnica de elección es la esfinteroplastia anterior del esfínter anal externo, descrita originalmente por Parks y Mc Partlin. Los resultados publicados a corto plazo son buenos en la mayoría de las series pero en aquellas con seguimientos mayores se evidencia un empeoramiento de los mismos. Este deterioro en los resultados ha llevado a que sea cuestionada como técnica de elección en favor de la neuromodulación de raíces sacras, técnica que ha demostrado buenos resultados en pacientes con esfínter lesionado. OBJETIVOS • Evaluar el resultado de la esfinteroplastia en la continencia de las pacientes con lesiones esfinterianas de origen obstétrico y analizar su posible deterioro clínico a largo plazo. • Determinar el valor pronóstico en dichos resultados que tienen factores como: la edad, el número de partos vaginales, las intervenciones previas, la neuropatía pudenda o la lesión concomitante del esfínter anal interno. • Valorar el impacto que el tratamiento tiene sobre la calidad de vida de las pacientes y analizar su evolución en el tiempo. METODOLOGIA Se ha realizado un estudio de cohortes de seguimiento prospectivo que incluye a las pacientes intervenidas de forma consecutiva por incontinencia fecal de origen obstétrico en el Hospital de Sagunto entre marzo de 1990 y marzo de 2004. El estudio se ha confeccionado en dos fases. En la primera de ellas realizada en 2004 se analizó el cambio en la continencia de las pacientes tras el tratamiento quirúrgico y su impacto en la calidad de vida. Por otro lado se estudio el valor pronóstico de diversos factores como: la edad, el número de partos vaginales, las intervenciones previas, la neuropatía pudenda o la lesión concomitante del esfínter anal interno. En la segunda fase, realizada seis años después, se ha estudiado la evolución de la continencia y de la calidad de vida a largo plazo. Para la evaluación de los aspectos anatómicos, clínicos y funcionales se realizó valoración clínica, manometría anal, ecografía endoanal y electroestimulación pudenda. Para la obtención de información específica acerca de la función intestinal habitual de las pacientes se les ha entregado, en las diferentes fases del estudio, un diario evacuatorio a cumplimentar durante 4 semanas. El grado de incontinencia ha sido valorado mediante el Cleveland Clinic Score (CCS), donde 0 representa la continencia anal completa y 20 el grado máximo de incontinencia. Para la valoración de la calidad de vida se ha utilizado la Fecal Incontinence Quality of Life Scale (FIQLS) validada para la lengua española. BIBLIOGRAFIA BASICA • Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartman CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993; 329: 1905–11. • Parks AG, McPartlin JF. Late repair of injuries of the anal sphincter. Proc R Soc Med 1971; 64: 1187–9. • Malouf AJ, Norton CS, Engel AF, Nichols RJ, Kamm MA. Long-term results of overlapping anterior anal sphincter repair for obstetric trauma. Lancet 2000; 355: 260–5. • Fornell EU, Matthiesen L, Sjodahl R, Berg G. Obstetric anal sphincter injury ten years after: subjective and objective long term effects. Br J Obstet Gynaecol 2005; 112: 312–6. • Jarrett ME, Dudding TC, Nicholls RJ, Vaizey CJ, Cohen CR, Kamm MA. Sacral nerve stimulation for fecal incontinence related to obstetric anal sphincter damage. Dis Colon Rectum 2008; 51: 531-53. • Brouwer R, Duthie G. Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum 2010; 53: 273-278 • Pla-Martí V, Moro-Valdezate D, Alos-Company R, Solana-Bueno A, Roig-Vila JV. The effect of surgery on quality of life in patients with faecal incontinence of obstetric origin. Colorectal Dis 2007; 9: 90-95. • Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36: 77–97. • Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC. Fecal incontinence quality of life scale. Quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43: 9–17. • Minguez M, Garriges V, Soria MJ, Andreu M, Mearin F, Clave P. adaptation to spanish lenguaje and validation of fecal incontinence quality of life scale. Dis Colon Rectum 2006; 49: 490-9. • Rothbarth J, Bemelman WA, Wilhemus J et al. What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 2001; 44: 67–71. • Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long-term results of anterior sphincteroplasty. Dis Colon Rectum 2004; 47: 727-731; discussion 731-732 • Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum 2009; 52: 1681-1687 • Matzel KE, Lux P, Heuer S, Besendörfer M, Zhang W. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis 2009; 11: 636-641 • Altomare DF, De Fazio M, Giuliani RT, Catalano G, Cuccia F. Sphincteroplasty for fecal incontinence in the era of sacral nerve modulation. World J Gastroenterol 2010;16(42): 5267-527

Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies

Wound complications are an important cause of postoperative morbidity among patients with gynaecologic malignancies. We evaluated whether the placement of closed-incisional negative pressure therapy (ciNPT) at the time of laparotomy for gynaecologic cancer surgery reduced wound complication rates. A retrospective cohort study with primary wound closure performed by a gynaecologic oncologist was carried out. We evaluated two cohorts of patients who underwent surgery in 2017 with standard closure and patients who underwent surgery in 2019 with the placement of prophylactic ciNPT. Postoperative outcomes were examined. A total of 143 patients were included, 85 (59.4%) vs 58 (40.6%) with standard closure and ciNPT, respectively. The total complication rate in our sample was 38.71%. The rate of surgical complications in patients treated with ciNPT was 6.9% compared with 31.8% (P = .000) in patients treated with standard closure. In the analysis of complications, a significant reduction in infections (17.1%), seromas (15.4%), and wound dehiscence (17.1%) were observed when ciNPT was applied. The median hospital stay was 8 vs 6 days in the standard closure vs ciNPT groups (P = .048). The use of the prophylactic ciNPT following a laparotomy may decrease wound complications and hospital stays in oncological patients. ciNPT could be considered as part of clinical practice in patients at high risk of wound complications, such as patients with gynaecological malignancies

Transcranial diffuse optical assessment of the microvascular reperfusion after thrombolysis for acute ischemic stroke

In this pilot study, we have evaluated bedside diffuse optical monitoring combining diffuse correlation spectroscopy and near-infrared diffuse optical spectroscopy to assess the effect of thrombolysis with an intravenous recombinant tissue plasminogen activator (rtPA) on cerebral hemodynamics in an acute ischemic stroke. Frontal lobes of five patients with an acute middle cerebral artery occlusion were measured bilaterally during rtPA treatment. Both ipsilesional and contralesional hemispheres showed significant increases in cerebral blood flow, total hemoglobin concentration and oxy-hemoglobin concentration during the first 2.5 hours after rtPA bolus. The increases were faster and higher in the ipsilesional hemisphere. The results show that bedside optical monitoring can detect the effect of reperfusion therapy for ischemic stroke in real-time.Peer ReviewedPostprint (published version

Fungal bioremediation of agricultural wastewater in a long-term treatment : biomass stabilization by immobilization strategy

Acord transformatiu CRUE-CSICFungal bioremediation emerges as an effective technology for pesticide treatment, but its successful implementation depends on overcoming the problem of microbial contamination. In this regard, fungal immobilization on wood seems to be a promising strategy, but there are two main drawbacks: the predominant removal of pesticides by sorption and fungal detachment. In this study, agricultural wastewater with pesticides was treated by Trametes versicolor immobilized on wood chips in a rotary drum bioreactor (RDB) for 225 days, achieving fungal consolidation and high pesticide biodegradation through two main improvements: the use of a more favorable substrate and the modification of operating conditions. Fungal community dynamic was assessed by denaturing gradient gel electrophoresis (DGGE) analysis and subsequent prominent band sequencing, showing a quite stable community in the RDB, mainly attributed to the presence of T. versicolor. Pesticide removals were up to 54 % diuron and 48 % bentazon throughout the treatment. Afterwards, pesticide-contaminated wood chips were treated by T. versicolor in a solid biopile-like system. Hence, these results demonstrate that the microbial contamination constraint has definitely been overcome, and fungal bioremediation technology is ready to be implemented on a larger scale

Tissue engineering by decellularization and 3D bioprinting

Discarded human donor organs have been shown to provide decellularized extracellular matrix (dECM) scaffolds suitable for organ engineering. The quest for appropriate cell sources to satisfy the need of multiple cells types in order to fully repopulate human organ-derived dECM scaffolds has opened new venues for the use of human pluripotent stem cells (hPSCs) for recellularization. In addition, three-dimensional (3D) bioprinting techniques are advancing towards the fabrication of biomimetic cell-laden biomaterial constructs. Here, we review recent progress in decellularization/recellularization and 3D bioprinting technologies, aiming to fabricate autologous tissue grafts and organs with an impact in regenerative medicine