Endoscopic diverticulectomy with platelet-rich plasma of intraluminal duodenal diverticulum

Background: Procedure-related bleeding remains a common complication after endoscopic diverticulectomy of intraluminal duodenal diverticulum (IDD). The optimal endoscopic approach to IDD has not been established. Platelet-rich plasma (PRP) has proven biological properties to reduce risk of bleeding. Materials and Methods: The authors describe a novel technique in which endoscopic diverticulectomy was performed with prior submucosal injection of PRP (IRB approval PT-16-002). Case Report: A 62-year-old woman with a large IDD like a “windsock” underwent endoscopic diverticulectomy with PRP obtained from a sample of patient’s blood. IDD was resected with EMR technique using a standard polypectomy snare. No immediate or delayed bleeding was noted. Follow-up endoscopy 3 months later revealed complete mucosal healing and open communication to the distal duodenum. Conclusion: Endoscopic diverticulectomy with PRP is an option in patients with IDDMedicin

Local injection of anti-cancer drugs in an experimental model of colorectal cancer

Purpose: Endoscopic resection of colorectal lesions significantly decreases the risk of colorectal cancer (CRC) incidence and death. Patients with invasive neoplasia or metastatic CRC have an evident poorer prognosis. Next step could be a more personalized treatment strategy, as a targeted therapy by direct injection of active substances in a selected lesion. The aim was to evaluate the efficacy of intratumoral injection of a drug-eluting platform (CoverGel) with different anti-cancer drugs in a rat model of azoxymethane (AOM)-induced CRC. Methods: Experimental CRC was induced in 20 rats. Animals were randomized in five groups (four each): CoverGel + Aflibercept (AFL), CoverGel + Bevacizumab (BVZ), CoverGel + Cetuximab (CTX), CoverGel + Panitumumab (PNT) and CoverGel + Irinotecan (IRT). Endoscopic, histological and necrosis score (0-3 scale) test were performed during follow-up to evaluate clinical success. Results: All animals developed invasive neoplasia (NICE 3, JNET 3), 7.2 mm as mean size (range 6 - 8). Intratumoral injection was feasible in all animals with no adverse events. AFL, an angiogenesis inhibitor agent, in comparison with the other medications (BVZ, CTX, PNT and IRT) obtained the best results: significantly reduction in tumor size (-30% vs. -10%, -3%, +2% and + 2%; p < 0.05, respectively) and significantly higher necrosis score (3 vs. 1, 0.3, 0 and 0; p < 0.05, respectively). Conclusion: Angiogenesis inhibitors medications produced the higher cell necrosis and reduction in tumor size in an experimental model of CRC. Intratumoral injection of a drug-eluting platform could open a new way to manage invasive CRC.Medicin

A survey of gastroprotective drugs: prescription-indication in hospitalized patients

La prescripción de fármacos antiulcerosos en medio hospitalario, y su influencia posterior en atención primaria, se incrementó en los últimos años y con ello el gasto farmacéutico. El objetivo del presente estudio es analizar la prevalencia de prescripción de antiulcerosos en nuestro centro hospitalario y la adecuación a las indicaciones establecidas. Se realizó un estudio observacional de prescripción-indicación con 2 cortes transversales separados en 6 meses para evitar sesgos de selección. Se constata el uso elevado de gastroprotectores, principalmente inhibidores de bomba de protones, sobre todo en profilaxis de gastropatía por antiinflamatorios no esteroideos (AINE) (17,1%), con una tasa de prescripciones incorrectas del 77,6% a pesar de la existencia de un protocolo específico elaborado por el comité de farmacia y terapéutica de nuestro centro. Destaca el número elevado de prescripciones en pacientes con corticoterapia sin asociación con AINE (25,7%). Se requieren nuevas herramientas que impliquen al facultativo y a los gestores clínicos en el uso racional de medicamentosPrescription rates of antiulcer drugs in hospitals and their spill-over to general practice have risen over the last few years, increasing pharmaceutical expenses. The aim of this study was to analyze gastroprotective drug prescription habits in our hospital by assessing both prevalence and adherence to approved indications. An observational study of prescription-indication was performed with 2 cross sections separated by 6 months to avoid selection bias. We found overprescription of gastroprotective drugs, mainly proton pump inhibitors for the prevention of non-steroidal antiinflammatory drug-induced ulcer (17.1%). Overall, 77.6% of prescriptions had no acceptable indication, despite the availability of a specific protocol produced by the Pharmacy and Therapeutics Committee in our center. There was a high prevalence of prescriptions for non-approved indications such as prophylaxis in patients administered cor-ticosteroids without non-steroidal anti-inflammatory agents (25.7%). New programs to train clinicians and clinical mana-gers in rational drug use are requiredS

Comparative study of electrical and rheological properties of different solutions used in endoscopic mucosal resection

Background and Aim: The study of electrical and rheological properties of solutions to carry out endoscopic resection procedures could determinate the best candidate. An ex vivo study with porcine stomachs was conducted to analyze electrical resistivity (R) and rheological properties (temperature, viscosity, height and lasting of the cushion) of different substances used in these techniques. Methods: Tested solutions were: 0.9% saline (S), platelet-rich plasma (PRP), Gliceol (GC), hyaluronic acid 2% (HA), Pluronic-F127 20% (PL), saline with 10% glucose (GS), Gelaspan (GP), Covergel-BiBio (TB) and PRP with TB (PRP+TB). Measurements of electrical and rheological properties were done at 0, 15, 30, 45 and 60 min after submucosal injection. Results: Solutions showed a wide variability of transepithelial R after submucosal injection. Substances able to maintain the highest R 60 min postinjection were TB (7 × 10 Ω), HA (7 × 10 Ω) and PL (7 × 10 Ω). Protective solutions against deep thermal injury (Tª lower than 60°C) were PL (47.6°C), TB (55°C) and HA (56.63°C). Shortest time to carry out resections were observed with GC (17.66″), PRP (20.3″) and GS (23.45″). Solutions with less cushion decrease (<25%) after 60 min were TB (11.74%), PL (18.63%) and PRP (22.12%). Conclusions: Covergel-BiBio, PL and HA were the best solutions with long-term protective effects (transepithelial R, lower thermal injury and less cushion decrease). Solutions with quicker resection time were GC, PRP and GS

Corrigendum : Development and Characterization of a New Endoscopic Drug-Eluting Platform With Proven Efficacy in Acute and Chronic Experimental Colitis

Aquesta és una correcció a l'article 10.3389/fmed.2020.0041

Materials Science Toolkit for Carbon Footprint Assessment: A Case Study for Endoscopic Accessories of Common Use

[EN] Ironically, healthcare systems are key agents in respiratory-related diseases and estimated deaths because of the high impact of their greenhouse gas emissions, along with industry, transportation, and housing. Based on safety requirements, hospitals and related services use an extensive number of consumables, most of which end up incinerated at the end of their life cycle. A thorough assessment of the carbon footprint of such devices typically requires knowing precise information about the manufacturing process, rarely available in detail because of the many materials, pieces and steps involved during the fabrication. And yet, tools most often used for determining the environmental impact of consumer goods just require a bunch of parameters, mainly based on the material composition of the device. Here we report a basic set of analytical methods that provide the information required by the software OpenLCA to calculate the main outcome related to environmental impact, the greenhouse gas emissions. Through thermogravimetry, calorimetry, infrared spectroscopy and elemental analysis we proved that obtaining relevant data for the calculator in the exemplifying case of endoscopy tooling or accessories is possible. This routine procedure opens the door to a broader, more accurate analysis of the environmental impact of everyday work at hospital services, offering potential alternatives to minimize it.This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI21/00193 and cofunded by the European Union. Funding: Instituto de Salud Carlos III (ISCIII), PI21/00193, cofunded by the European Union. And through the project PI2023-6 from UPV-LaFe innovation projects.Martín-Cabezuelo, R.; Vilariño-Feltrer, G.; Campillo Fernandez, AJ.; Lorenzo-Zúñiga, V.; Pons, V.; López-Muñoz, P.; Tort-Ausina, I. (2023). Materials Science Toolkit for Carbon Footprint Assessment: A Case Study for Endoscopic Accessories of Common Use. ACS Environmental Au. https://doi.org/10.1021/acsenvironau.3c0004

Potential Analysis of Mediterranean Forestry for Offsetting GHG Emissions at Regional Level: Evidence from Valencia, Spain

[EN] Forest management is an untapped tool, yet to realize its full potential to fight against climate change. The capability of forests to act as carbon sinks makes them a key resource to reduce CO2 concentration in the atmosphere. However, carbon which has been fixed can be suddenly emitted again as a consequence of disturbances such as pests or wildfires. Mediterranean plant phenology, climatic conditions, and the accumulation of fuel biomass due to abandonment of traditional forest uses generate a scenario prone to large wildfires and consequently large greenhouse gases (GHG) emissions. The abandonment could be offset by considering the economic value of forest ecosystem services, principally carbon fixation. Nevertheless, currently existing forest carbon markets consider only anthropogenic fixation based on a business as usual scenario without disturbances that cannot be applied to Mediterranean forest reality. Thus, a methodology to monetize carbon fixed has been developed and applied. A range between 55.5 and 250 million euro produced by the monetization of 16.5 million potential carbon credits has been obtained based on anthropogenic avoided emissions produced over a 10 year-period. Thereby, the potential for offsetting emissions of the pilot region was between 1.2% and 5.6% of total diffuse GHG emissions. Consequently, sustainable forest management represents an important opportunity to combat climate change, taking advantage of the margin of improvement that the Mediterranean forests currently have to avoid GHG emissions through forest fire prevention silviculture.This research was funded by EIT Climate KIC in the frame of the ValVolCar project and by Interreg SUDOE REMAS project (SOE3/P4/E0954), project co-financed by the Interreg Sudoe Program through the European Regional Development Fund (ERDF).Lorenzo-Sáez, E.; Oliver Villanueva, JV.; Lerma Arce, V.; Yagüe-Hurtado, C.; Lemus Zúñiga, LG. (2021). Potential Analysis of Mediterranean Forestry for Offsetting GHG Emissions at Regional Level: Evidence from Valencia, Spain. Sustainability. 13(8):1-17. https://doi.org/10.3390/su13084168S11713

Assessment of an air quality surveillance network through passive pollution measurement with mobile sensors

[EN] Today, about 55% of the world population lives in cities and this is foreseen to increase to 68% by 2050. The urban activities of such a large number of people in relatively small spaces can make the air quality levels in cities harmful to human health. For this reason, the European Union (EU) has established a regulatory framework to control and improve air quality levels in cities (Directive 2008/50/EC) by defining a number of fixed stations and other requirements. The aim of this work is to evaluate the air quality reported by the official fixed stations via the installation of a complementary mobile network of air quality based on passive dosimetry of NO2 measurement during the period 2017-2019. In this study, Valencia (Spain) is selected as a representative European city with seven fixed stations and a network of 424 passive dosimetry sensors distributed throughout the city. In addition, an index of impact of pollutant on population is developed to optimize the locations of air quality stations among neighbourhoods across the city based on the levels of pollution measured by mobile sensors and the population directly affected. The results obtained show that 43.7% of mobile sensors in Valencia exceeded the limit value established by the EU Directive as well as by the World Health Organization during the assessment period. This indicates that the air quality levels offered by the fixed stations are neither representative nor reliable for the air quality monitoring of the city. Thus, the fixed stations currently operating do not provide reliable information on the areas of the city where the majority of the population breathes air with the highest level of pollution. Specifically, the results show that 34.6% of citizens live in areas with an average annual value above the limit recommended for the protection of human health.Lorenzo Sáez, E.; Oliver Villanueva, JV.; Lemus Zúñiga, LG.; Coll-Aliaga, E.; Perpiñá Castillo, C.; Lavalle, C. (2021). Assessment of an air quality surveillance network through passive pollution measurement with mobile sensors. Environmental Research Letters. 16(5):1-12. https://doi.org/10.1088/1748-9326/abe43511216

Energy efficiency and GHG emissions mapping of buildings for decision-making processes against climate change at local level

[EN] Buildings have become a key source of greenhouse gas (GHG) emissions due to the consumption of primary energy, especially when used to achieve thermal comfort conditions. In addition, buildings play a key role for adapting societies to climate change by achieving more energy efficiency. Therefore, buildings have become a key sector to tackle climate change at the local level. However, public decision-makers do not have tools with enough spatial resolution to prioritise and focus the available resources and efforts in an efficient manner. The objective of the research is to develop an innovative methodology based on a geographic information system (GIS) for mapping primary energy consumption and GHG emissions in buildings in cities according to energy efficiency certificates. The developed methodology has been tested in a representative medium-sized city in Spain, obtaining an accurate analysis that shows 32,000 t of CO2 emissions due to primary energy consumption of 140 GWh in residential buildings with high spatial resolution at single building level. The obtained results demonstrate that the majority of residential buildings have low levels of energy efficiency and emit an average of 45 kg CO2/m(2). Compared to the national average in Spain, this obtained value is on the average, while it is slightly better at the regional level. Furthermore, the results obtained demonstrate that the developed methodology is able to directly identify city districts with highest potential for improving energy efficiency and reducing GHG emissions. Additionally, a data model adapted to the INSPIRE regulation has been developed in order to ensure interoperability and European-wide application. All these results have allowed the local authorities to better define local strategies towards a low-carbon economy and energy transition. In conclusion, public decision-makers will be supported with an innovative and user-friendly GIS-based methodology to better define local strategies towards a low-carbon economy and energy transition in a more efficient and transparent way based on metrics of high spatial resolution and accuracy.This work was supported by the City Council of Quart de Poblet (Valencia, Spain).Lorenzo-Sáez, E.; Oliver Villanueva, JV.; Coll-Aliaga, E.; Lemus Zúñiga, LG.; Lerma Arce, V.; Reig Fabado, A. (2020). Energy efficiency and GHG emissions mapping of buildings for decision-making processes against climate change at local level. Sustainability. 12(7):1-17. https://doi.org/10.3390/su12072982S1171272050 Long-Term Strategy https://ec.europa.eu/clima/policies/strategies/2050_enYang, J., McBride, J., Zhou, J., & Sun, Z. (2005). The urban forest in Beijing and its role in air pollution reduction. Urban Forestry & Urban Greening, 3(2), 65-78. doi:10.1016/j.ufug.2004.09.001Escobedo, F. J., Kroeger, T., & Wagner, J. E. (2011). Urban forests and pollution mitigation: Analyzing ecosystem services and disservices. Environmental Pollution, 159(8-9), 2078-2087. doi:10.1016/j.envpol.2011.01.010Zhao, M., Kong, Z., Escobedo, F. J., & Gao, J. (2010). Impacts of urban forests on offsetting carbon emissions from industrial energy use in Hangzhou, China. Journal of Environmental Management, 91(4), 807-813. doi:10.1016/j.jenvman.2009.10.010McPherson, E. G., Scott, K. I., & Simpson, J. R. (1998). Estimating cost effectiveness of residential yard trees for improving air quality in Sacramento, California, using existing models. Atmospheric Environment, 32(1), 75-84. doi:10.1016/s1352-2310(97)00180-5Nowak, D. J., & Crane, D. E. (2002). Carbon storage and sequestration by urban trees in the USA. Environmental Pollution, 116(3), 381-389. doi:10.1016/s0269-7491(01)00214-7Nowak, D. J., Crane, D. E., & Stevens, J. C. (2006). Air pollution removal by urban trees and shrubs in the United States. Urban Forestry & Urban Greening, 4(3-4), 115-123. doi:10.1016/j.ufug.2006.01.007Energy ec.europa.eu/energy/efficiency/buildings/buildings_en.htmGouldson, A., Colenbrander, S., Sudmant, A., Papargyropoulou, E., Kerr, N., McAnulla, F., & Hall, S. (2016). Cities and climate change mitigation: Economic opportunities and governance challenges in Asia. Cities, 54, 11-19. doi:10.1016/j.cities.2015.10.010Gouldson, A., Colenbrander, S., Sudmant, A., McAnulla, F., Kerr, N., Sakai, P., … Kuylenstierna, J. (2015). Exploring the economic case for climate action in cities. Global Environmental Change, 35, 93-105. doi:10.1016/j.gloenvcha.2015.07.009Wilson, E. (2006). Adapting to Climate Change at the Local Level: The Spatial Planning Response. Local Environment, 11(6), 609-625. doi:10.1080/13549830600853635Kavgic, M., Mavrogianni, A., Mumovic, D., Summerfield, A., Stevanovic, Z., & Djurovic-Petrovic, M. (2010). A review of bottom-up building stock models for energy consumption in the residential sector. Building and Environment, 45(7), 1683-1697. doi:10.1016/j.buildenv.2010.01.021Mastrucci, A., Baume, O., Stazi, F., & Leopold, U. (2014). Estimating energy savings for the residential building stock of an entire city: A GIS-based statistical downscaling approach applied to Rotterdam. Energy and Buildings, 75, 358-367. doi:10.1016/j.enbuild.2014.02.032Evola, G., Fichera, A., Gagliano, A., Marletta, L., Nocera, F., Pagano, A., & Palermo, V. (2016). Application of a Mapping tool to Plan Energy Saving at a Neighborhood Scale. Energy Procedia, 101, 137-144. doi:10.1016/j.egypro.2016.11.018Nouvel, R., Mastrucci, A., Leopold, U., Baume, O., Coors, V., & Eicker, U. (2015). Combining GIS-based statistical and engineering urban heat consumption models: Towards a new framework for multi-scale policy support. Energy and Buildings, 107, 204-212. doi:10.1016/j.enbuild.2015.08.021Bentzen, J., & Engsted, T. (2001). A revival of the autoregressive distributed lag model in estimating energy demand relationships. Energy, 26(1), 45-55. doi:10.1016/s0360-5442(00)00052-9Fonseca, J. A., & Schlueter, A. (2015). Integrated model for characterization of spatiotemporal building energy consumption patterns in neighborhoods and city districts. Applied Energy, 142, 247-265. doi:10.1016/j.apenergy.2014.12.068Caputo, P., Costa, G., & Ferrari, S. (2013). A supporting method for defining energy strategies in the building sector at urban scale. Energy Policy, 55, 261-270. doi:10.1016/j.enpol.2012.12.006Theodoridou, I., Karteris, M., Mallinis, G., Papadopoulos, A. M., & Hegger, M. (2012). Assessment of retrofitting measures and solar systems’ potential in urban areas using Geographical Information Systems: Application to a Mediterranean city. Renewable and Sustainable Energy Reviews, 16(8), 6239-6261. doi:10.1016/j.rser.2012.03.075Howard, B., Parshall, L., Thompson, J., Hammer, S., Dickinson, J., & Modi, V. (2012). Spatial distribution of urban building energy consumption by end use. Energy and Buildings, 45, 141-151. doi:10.1016/j.enbuild.2011.10.061Heiple, S., & Sailor, D. J. (2008). Using building energy simulation and geospatial modeling techniques to determine high resolution building sector energy consumption profiles. Energy and Buildings, 40(8), 1426-1436. doi:10.1016/j.enbuild.2008.01.005CALENER-VYP: Viviendas y Edificios Terciarios Pequeños y Medianos. Manual de Usuario https://www.idae.es/uploads/documentos/documentos_CALENER_05_VYP_Manual_Usuario_A2009_A_4c6978f8.pdfKampelis, N., Ferrante, A., Kolokotsa, D., Gobakis, K., Standardi, L., & Cristalli, C. (2017). Thermal comfort evaluation in HVAC Demand Response control. Energy Procedia, 134, 675-682. doi:10.1016/j.egypro.2017.09.587Diakaki, C., Grigoroudis, E., Kabelis, N., Kolokotsa, D., Kalaitzakis, K., & Stavrakakis, G. (2010). A multi-objective decision model for the improvement of energy efficiency in buildings. Energy, 35(12), 5483-5496. doi:10.1016/j.energy.2010.05.01

Long-term outcome of patients wih distal ulcerative colitis and inflammation of the appendiceal orifice

Background & Aims: Skip inflammation of the appendiceal orifice has been described in distal UC (UC-IAO) but long-term clinical outcomes are poorly established. Our aim was to evaluate the long-term clinical outcomes of UC-IAO as compared to classic distal UC. Methods: Patients with UC-IAO were identified from the local IBD database. Disease outcome and therapeutic requirements during follow-up were accurately collected, and compared with a control group of patients with distal UC without periappendiceal involvement matched by disease extent (proctitis/distal), smoking habit, and date and age at diagnosis. Results: Fourteen UC patients were found to have UC-IAO, most of them with initial extent of UC limited to the rectum. All patients were initially managed with mesalazine administered orally (28.5%), topically (28.5%), or in combination (43%). After a median follow-up of 78 months (interquartile range - IQR 45-123) most UC-IAO patients were successfully managed with oral and/or topical aminosalycilates. Only one of them developed proximal disease progression. As compared to controls, no differences in clinical outcomes or therapeutic requirements were found. Conclusions: Patients with UC-IAO tend to present a mild course, with a low probability to develop proximal progression of disease extent or to require immunosuppressive therapy or colectomy.CIBERehd of Fondo de Investigación Sanitaria of the Instituto de Salud Carlos III, from the Spanish Ministry of HealthMedicin