Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Spinal anaesthesia is the most preferred anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8–T11 spinal cord ischaemia following L2–L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8–T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice

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

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

Use of biosurfactants from urban wastes compost in textile dyeing and soil remediation

A compost isolated humic acid-like (cHAL) material was pointed out in previous work for its potential as auxiliary in chemical technology. Its potential is based on its relatively low 0.4 g L-1 critical micellar concentration (cmc) in water, which enables cHAL to enhance the water solubility of hydrophobic substances, like phenanthrene, when used at higher concentrations than 0.4 g L-1. This material could be obtained from a 1:1 v/v mixture of municipal solid and lignocellulosic wastes composted for 15 days. The compost, containing 69.3% volatile solids, 39.6% total organic C and 21 C/N ratio, was extracted for 24 h at 65 °C under N2 with aqueous 0.1 mol L-1 NaOH and 0.1 mol L-1 Na4P2O7, and the solution was acidified to separate the precipitated cHAL in 12% yield from soluble carbohydrates and other humic and non-humic substances. In this work two typical applications of surfactants, i.e., textile dyeing (TD) and soil remediation by washing (SW), were chosen as grounds for testing the performance of the cHAL biosurfactant against the one of sodium dodecylsulfate (SDS), which is a well established commercial synthetic surfactant. The TD trials were carried out with nylon 6 microfiber and a water insoluble dye, while the SW tests were performed with two soils contaminated by polycyclic aromatic hydrocarbons (PAH) for several decades. Performances were rated in the TD experiments based on the fabric colour intensity (ΔE) and uniformity (σΔE), and in the SW experiments based on the total hydrocarbons concentration (CWPAH) and on the residual surfactant (Cre) concentrations in the washing solution equilibrated with the contaminated soils. The results show that both cHAL and SDS exhibit enhanced performance when applied above their cmc values. However, while in the TD case a significant performance effect was observed at the surfactants cmc value, in the SW case the required surfactants concentration values were equivalent to 25-125 × cmc for cHAL and to 4-22 × cmc for SDS. The vis-a-vis comparison of the two surfactants gave the following results: in the TD case the cHAL biosurfactant at 0.4 g L-1 yields good colour intensity and equal colour uniformity as SDS at 5 g L-1, in the SW case cHAL was found to enhance CWPAH by a factor of 2-4 relative to SDS with one soil, whereas with the other soil the two surfactants behaved similarly. The Cre data, however, showed that both soils absorbed by far more SDS (68-95%) than cHAL (12-54%). The results point out intriguing technological and environmental perspectives deriving from the use of compost isolated biosurfactants in the place of synthetic surfactants

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

Compost effect on soil humic acid : a NMR study

The humic acid (HA) fraction of a food and vegetable residues compost (CM) was taken as indicator to trace the fate of CM organic matter in four years CM amended soil. H-1 and C-13 NMR spectroscopy were used to investigate the nature of the HA isolates from CM, control Soil (S-4) and amended soil. The result indicated a significant structural difference between CM HA and S-4 HA, and supported the presence of both HA fractions in soil at the end of the amendment trials. However, the nature and content of CM HA in soil did not fully explain the increase of soil cation exchange capacity (CEC) after amendment. All CM humic fractions (i.e., fulvic acid, humic acid and humin) were found to contribute to the change of the soil organic matter composition. It is concluded that although CM HA is a suitable indicator of the survival of compost organic matter in soil during amendment, all three humic fractions should be monitored and analyzed to fully understand changes in the composition and properties of amended soil. (c) 2006 Elsevier Ltd. All rights reserved

Modification of soil humic matter after 4 years of compost application

Two soil plots, 1ha each, were amended yearly for 4 years, respectively, with 35.8 and 71.6Mgha(-1)yr(-1) of mature compost (CM) obtained from food and vegetable residues. The compost, amended soils, and a control soil plot after 4 years (S(4)), were analyzed for humin (HUC), humic acid (HAC), fulvic acid (FAC), and non-humic carbon (NHC) content. Compared to S(4), the amended soil contained more humified C (HAC, FAC and HUC) and less NHC. Further evidence of the effect of compost on soil organic matter was obtained by the analysis of the humic acid (HA) fractions isolated from both the compost and the soils. These were characterized by elemental analyses and Diffuse Reflectance Infrared Fourier Transformed spectroscopy. The HAs isolated from CM and from S(4) were significantly different. The HAs isolated from the amended plots were more similar to HA isolated from CM than to HA isolated from S(4). The experimental data of this work indicate that the compost application may affect significantly the soil organic matter composition, and that the approach used in this work allows one to trace the fate of compost organic matter in soil