Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Clinical evaluation of marginal bone level change around multiple adjacent implants restored with splinted and nonsplinted restorations: a 10-year randomized controlled trial

The management of occlusal forces on implant restorations may influence their long-term prosthetic success. The purpose of this randomized controlled trial was to compare marginal bone level changes around adjacent splinted and nonsplinted implants, functionally loaded with cemented restorations, up to 10 years in maxillae

Analysis of high frame-rate movies by variational methods

The object of this study was the recognition of Regions Of Interest(ROIs)in a time series of digital images of two specific laboratory experiments. It concernsthe identification of objects in a tissue surface by high-resolution and high-speedad-hoc systems for morphological dynamic image analysis. The protocols and thealgorithms implemented are developed to retrieve biomechanical properties of twodifferentin vitrosystems; the solid filament X-MET (eX-vivo Muscle EngineeredTissue) to measure its reaction to a different frequency stimulation, and a planarsystem of co-culture of skeletal and cardiac muscle cells, where myotubes and car-diomyocytes coexist, to discriminate the interaction between different cell’s type,of its spontaneous pulse. The results of the stimulated X-MET from solid culturesystem are frequency dependent points of the macroscopic muscular strength andits contractile response. The results for the co-culture planar board measure thecorrelation of the pulsed movements of the different parts of the tissue

Nasal and Tracheal Microbial Colonization in Laryngectomized Patients

Complete separation of upper and lower respiratory tract after total laryngectomy results in loss of physiological nasal functions and presence of "unconditioned" inspired air in lower airways. Aim of this study is evaluating the presence of a microbial colonization of nasal cavities and trachea in laryngectomized long-term survivors.METHODS: Twenty-five laryngectomized patients underwent symptoms' anamnestic evaluation, endoscopic fiber optic nasal and tracheal examination, specimen collection for microbiological exam, and culture. Enrolled patients had at least a 2-year follow-up period in order to evaluate long-term microflora. RESULTS: Gram positive polimicrobic flora represented the main finding in nasal cavities and trachea (92% and 48% of patients, respectively). Other bacteria were non-fermenters Gram negative bacteria, Enterobacteriaceae and Staphylococcus aureus. The same microflora was demonstrated in nasal cavity and trachea in 5 patients (20%), while sterile nasal cavity and trachea were seen in 3 (12%) and 4 (16%) cases, respectively. No fungi were observed in nasal cavity and trachea. CONCLUSION: Nasal cavities and trachea of laryngectomized patients are colonized by nonpathogenic and/or potentially pathogenic bacteria, in absence of signs and symptoms of infection. Colonizer microflora should be kept in mind when a culture from nasal or tracheal swabs is needed in daily practice

Outbreak of porcine epidemic diarrhoea virus (PEDV) in Abruzzi region, central-Italy

Here we report and characterize a porcine epidemic diarrhea (PED) outbreak which occurred in a swine fattening farm in the province of Teramo, Abruzzi region (central Italy), in January 2016. PED virus (PEDV) identification was determined by real-time RT-PCR performed on RNAs purified from fecal samples collected from two symptomatic pigs. Whole genome sequence (PEDV 1842/2016) was also obtained by next generation sequencing straight from RNA purified from one fecal sample. Genome comparison with extant global PEDV strains revealed a high nucleotide identity with recently reported European and American S-INDEL PEDVs. Efficient sequencing, share of genomic data combined with the implementation of epidemiological tools would be the ideal approach for study and analysis of transboundary infectious diseases as PED

Biocompatible graft copolymers from bacterial poly(gamma-glutamic acid) and poly(lactic acid)

We report a novel approach for the modular and convergent construction of biocompatible graft copolymers starting from bacterial poly(¿-glutamic acid)(¿-PGA) and incorporating poly(lactic acid) (PLA). This synthesis strategy is controlled at different levels: (a) the choice of a suitable initiator for the ring-opening polymerization of lactide; (b) the chemical elaboration of the polylactic fragments; and (c) their convergent “grafting to” functionalization of bacterial ¿-PGA propargyl ester using copper(I)-catalyzed alkyne–azide cycloaddition (CuAAC) click chemistry. The graft copolymers are characterized in terms of their thermal and macromolecular properties, their conformational preferences through molecular modelling, and their cytotoxicity.Peer ReviewedObjectius de Desenvolupament Sostenible::11 - Ciutats i Comunitats SosteniblesPostprint (author's final draft

A Role of Circuit Clotting and Strategies to Prevent It during Blood Purification Therapy with oXiris Membrane: An Observational Multicenter Study

Introduction: Membrane fouling is a significant complication potentially reducing clinical effects of extracorporeal blood purification (EBP) in critically ill septic patients with acute kidney injury. Although fascinating, the effect of heparin coating in preventing membrane fouling is currently unknown. This multicenter prospective study aims to preliminary describe the incidence, associated factors, and clinical consequences of premature circuit clotting in a cohort of adult critically ill septic patients treated with EBP using a high biocompatible heparin-coated hemodiafilter characterized by advanced adsorption properties. Methods: This study was a retrospective analysis of prospectively entered data in the oXirisNet Registry; overall, 97 septic patients undergoing EBP with oXiris between May 2019 and March 2020 were enrolled in this study. Patients were divided into two groups according to the occurrence of filter clotting (premature vs. nonpremature). Logistic regression analysis was used to identify factors associated with premature circuit clotting. Results: Premature clotting occurred in 18 (18.6%) patients. Results of the multivariate logistic regression analysis demonstrated that hematocrit (p = 0.02, odds ratio [OR] 1.15 [1.05; 1.30]), serum procalcitonin (PCT) (p = 0.03, OR 1.1 [1.05; 1.2]), and anticoagulation strategy (p = 0.05 at Wald's test) were independent predictors of circuit clotting. Systemic anticoagulation (p = 0.02, OR 0.03 [0.01; 0.52]) and regional citrate anticoagulation (p = 0.10, OR 0.23 [0.04; 1.50]) were both protective factors if compared to no-anticoagulation strategy. Patients with nonpremature circuit clotting showed more rapid recovery from hemodynamic instability, pulmonary hypo-oxygenation, and electrolyte disorders and greater improvement of inflammatory markers and SOFA scores. Conclusion: Although in this study the incidence of premature circuit clotting was relatively low (18.6%) compared to previously reported values (54%), membrane clotting in adult critically ill septic patients could cause clinically relevant interferences with treatment performances. Prevention of clotting should be based on avoiding higher patients' hematocrit, high serum PCT, and no-anticoagulation strategy which resulted as independent predictors of circuit clotting

Internal- vs external-connection single implants: A retrospective study in an italian population treated by certified prosthodontists

Purpose: The design of an implant connection that allows prosthetic suprastructures to be attached to implants has long been debated in the dental literature. The goal of this retrospective study was to evaluate the 5-year clinical results for a large number of single implants restored by certified prosthodontists in an attempt to establish whether different clinical outcomes could be detected for external- or internalconnection implants. Materials and Methods: All single implants with internal or external connections inserted in 27 private dental practices from January 1, 2003 to December 31, 2007 were evaluated. An initial statistical analysis was performed to describe the sample population at baseline and then to compare the two types of implant-abutment connection configurations and their clinical outcomes. All data were statistically analyzed with STATA12 (StataCorp). Results: Twenty-eight of the 85 active members of the Italian Academy of Prosthetic Dentistry (AIOP) participated in this study. The sample included 1,159 patients and 2,010 implants. Of the implants, 75 were dropped because there was no information about follow-up. Of the remaining implants, 1,431 (74.0%) were followed for at least 5 years, and 332 implants (17.2%) were followed for more than 8 years. Nearly 99% (98.9%) of the implants survived. The difference between the survival frequencies of the two types of implant-abutment connection configurations was not significant for each negative event (log-rank test, P > .05). There was no difference between the two types of implants regarding restoration fracture, implant screw loosening, and peri-implant disease. Conclusion: Within the limitations of this study, it can be suggested that there is no difference in clinical outcomes of single restorations joined to internal- or external-connection implants