Microplastics in the indoor environment

Microplastics are plastic particles with sizes between 100 nm and 5 mm, being consideredan emerging class of contaminants with deleterious effects on the environment and human health.Polyethylene (PE), Polyvinyl Chloride (PVC) and polyamide (PA-commonlyknown as nylon) are three of the most common polymers used in buildings and construction, packaging,personal careproducts and clothing. Due to MPs ubiquity in the environment, especiallyindoor, humans are continuously exposed. However, only a few studies regarding the contamination of the indoor environment by microplastics and their effects on health were performed to date. This work intends to develop an integrated strategy to study the microplastics present in the indoor environment and their potentialdeleterious effects.For this, the levels of MPs in airborn and house dust samples were estimated and the cytotoxicity of three different MPs (polyethylene, PVC and polyamide) was evaluated in three cell lines, namely intestinal epithelial cells (Caco-2), hepatocytes (HepG2) and dopaminergic neurons (N27).In addition, and givingthe limitations of currently existing quantification techniques, a new strategy for isolating and purifying MPs from complex samples was developed using two-phase aqueous systems made up of ionic liquids. The results obtained from the analysis of MPs in air and dust samples using sodium chloride (NaCl) density separation and digestion with hydrogen peroxide (H2O2), and subsequent microscopic visualization after Nile Red staining showed that the largest amount of MPs corresponds to samples collected in kitchens. The new procedure developed for sample preparation using ILs generally allowed to extract the MPs from the dust matrix.However, the separation in a single step of the different MPs was not achieved and requires further optimization. Nevertheless, Raman spectroscopy proved to be efficient to identify MPs in house dust samples. The cytotoxicity tests showed that the dopaminergic neuron cell line was the most sensitive to microplastics’ exposure, with polyamide being the least toxic microplastic tested and PE the most toxic. For the tested concentrations (0.01; 0.1; 1; 10; 100; 1000; 2000; 4000 mg.L-1) the toxicity of the three MPs for intestinal epithelial cells and for hepatocytes was reduced, which shows the low toxicity of these MPs when tested in its pure and isolated, that is its native form without the addition of plasticizers, colourants, flame retardants or stabilizers.Os microplásticos (MPs) definidos como sendo partículas com tamanho entre 100 nm e 5 mm, são considerados contaminantes emergentes com efeitos deletérios no ambiente e na saúde humana.O polietileno (PE), policloreto de vinilo (PVC) e a poliamida (PA, mais conhecida por nylon), são três dos polímeros mais comuns sendo utilizados,por exemplo, em materiais de construção, embalagens, produtos de higiene e cuidado pessoal e vestuário. Devido à sua ubiquidade no meio ambiente, incluindo o ambiente doméstico, os seres humanos estão constantemente expostos.No entanto, ainda existem poucos estudos relativamente à contaminação do ambiente doméstico por microplásticos e seus efeitos na saúde. Com este trabalho pretende-se desenvolver uma estratégia integrada para estudar os microplásticos presentes no ambiente doméstico e os seus possíveis efeitos deletérios. Para tal, os níveis de MPs em amostras de ar e de pó doméstico foram avaliados e a citotoxicidade de três MPs distintos (polietileno, PVC e poliamida) foi avaliada em três linhas celulares, nomeadamente em células epiteliais intestinais (Caco-2), em hepatócitos (HepG2) e em neurónios dopaminérgicos (N27). Adicionalmente, e dadas as limitações das técnicas de quantificação de MPs atualmente existentes, foi desenvolvida uma nova estratégia de isolamento e purificação de MPs de amostras complexas recorrendo a sistemas aquosos bifásicos constituídos por líquidos iónicos. Os resultados obtidos da análise de MPs,em amostras de ar e de pó recorrendo a separação por densidade com cloreto de sódio (NaCl) e digestão com peróxido de hidrogénio (H2O2) e posterior visualização microscópica após coloração com vermelho do nilo, demostraram que a maior quantidade de MPs corresponde às amostrasrecolhidas na cozinha. O novo método desenvolvido para o tratamento das amostras, utilizando líquidos iónicos, permitiu extrair os MPs da matriz de pó.Contudo a separação dos diferentes MPs não foi possível e, por isso, esta técnica ainda precisa de ser otimizada. Ainda assim, a espetroscopia de Raman mostrou ser uma técnica eficiente para identificar MPs em amostras de pó doméstico. Os ensaios de citotoxicidade demostraram que a linha celular de neurónios dopaminérgicos foi a mais sensível à exposição a microplásticos, sendo a poliamida o microplástico testado menos tóxico e o PE o mais tóxico. Para as concentrações testadas (0,01; 0,1; 1; 10; 100; 1000; 2000; 4000 mg.L-1) a toxicidade dos três MPs para as células epiteliais intestinais e para hepatócitos foi reduzida oque demostra a baixa toxicidade destes MPs quando testados na sua versão pura e isoladamente, isto é, a sua forma mais nativa sem a adição de plastificantes, corantes, retardantes de chama ou estabilizadores

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research