Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options

Untangling the role of biotic and abiotic ageing of various environmental plastics toward the sorption of metals

Plastic particles can impact the environmental fate and bioavailability of essential inorganic micronutrients and non-essential (toxic) metals. The sorption of metals to environmental plastic has been demonstrated to be facilitated by plastic ageing, a phenomenon encompassing an array of physical, chemical, and biological processes. This study deploys a factorial experiment to untangle the role of different ageing processes in determining the sorption of metals. Plastics made of three different polymer types were aged both through abiotic (ultraviolet irradiation, UV) and biotic (through the incubation with a multispecies algal inoculum forming a biofilm) processes under controlled laboratory conditions. Pristine and aged plastic samples were characterized for their physiochemical properties through Fourier-transformed infrared spectroscopy, scanning electron microscopy and water contact angle measurements. Their sorption affinity toward aluminum (Al) and copper (Cu) in aqueous solutions was then assessed as a response variable. All ageing processes (alone or combined) influenced plastic surface properties resulting in reduced hydrophobicity, changes in surface functional groups (i.e., increase of oxygen containing functional groups after UV ageing and the appearance of marked bands as amides and polysaccharides after biofouling), as well as in nanomorphology. The sorption of Al and Cu was instead statistically dependent (p < 0.01) on the degree of biofouling covering the specimens. Biofouled plastic displayed in fact substantial affinity for metal sorption causing the depletion of up to tenfold Cu and Al compared to pristine polymers, regardless of the polymer type and presence or absence of other ageing treatments. These results confirm the hypothesis that the accumulation of metals on plastic is substantially driven by the biofilm present on environmental plastics. These findings also highlight the importance of investigating the implications of environmental plastic for metal and inorganic nutrients availability in environments impacted by this pollution

Unfolding the interaction between microplastics and (trace) elements in water: A critical review

Plastic and microplastic pollution is an environmental and societal concern. The interaction of plastic with organic chemicals in the environment has attracted scientific interest. New evidences have highlighted an unexpectedly high affinity of environmental plastics also for metal ions. The degree and typology of plastic ageing (including from mechanical, UV and biological degradations) appear as a pivotal factor determining such an interaction. These earlier evidences recently opened a new research avenue in the plastic pollution area. This review is the first to organize and critically discuss knowledge developed so far. Results from field and laboratory studies of metal accumulation on plastic are presented and the environmental factors most likely to control such an interaction are discussed. On the light of this knowledge, a generalist conceptual model useful for building hypotheses on the mechanisms at stake and directing future studies was elaborated and presented here. Furthermore, all available data on the thermodynamics of the plastic-metal interaction obtained from laboratory experiments are inventoried and discussed here, highlighting methodological and technical challenges that can potentially affect cross-comparability of data and their relevance for environmental settings. Finally, insights and recommendations on experimental approaches and analytical techniques that can help overtaking current limitations and knowledge gaps are proposed

Physicochemical and biological ageing processes of (micro)plastics in the environment: a multi-tiered study on polyethylene

Pollution by plastic and microplastic impacts the environment globally. Knowledge on the ageing mechanisms of plastics in natural settings is needed to understand their environmental fate and their reactivity in the ecosystems. Accordingly, the study of ageing processes is gaining focus in the context of the environmental sciences. However, laboratory-based experimental research has typically assessed individual ageing processes, limiting environmental applicability. In this study, we propose a multi-tiered approach to study the environmental ageing of polyethylene plastic fragments focusing on the combined assessment of physical and biological processes in sequence. The ageing protocol included ultraviolet irradiation in air and in a range of water solutions, followed by a biofouling test. Changes in surface characteristics were assessed by Fourier transform infrared spectroscopy, scanning electron microscopy, and water contact angle. UV radiation both in air and water caused a significant increase in the density of oxidized groups (i.e., hydroxyl and carbonyl) on the plastic surface, whereby water solution chemistry influenced the process both by modulating surface oxidation and morphology. Biofouling, too, was a strong determinant of surface alterations, regardless of the prior irradiation treatments. All biofouled samples present (i) specific infrared bands of new surface functional groups (e.g., amides and polysaccharides), (ii) a further increase in hydroxyl and carbonyl groups, (iii) the diffuse presence of algal biofilm on the plastic surface, and (iv) a significant decrease in surface hydrophobicity. This suggests that biological-driven alterations are not affected by the level of physicochemical ageing and may represent, in real settings, the main driver of alteration of both weathered and pristine plastics. This work highlights the potentially pivotal role of biofouling as the main process of plastic ageing, providing useful technical insights for future experimental works. These results also confirm that a multi-tiered laboratory approach permits a realistic simulation of plastic environmental ageing in controlled conditions

Untangling the role of biotic and abiotic ageing of various environmental plastics toward the sorption of metals

Plastic particles can impact the environmental fate and bioavailability of essential inorganic micronutrients and non-essential (toxic) metals. The sorption of metals to environmental plastic has been demonstrated to be facilitated by plastic ageing, a phenomenon encompassing an array of physical, chemical, and biological processes. This study deploys a factorial experiment to untangle the role of different ageing processes in determining the sorption of metals. Plastics made of three different polymer types were aged both through abiotic (ultraviolet irradiation, UV) and biotic (through the incubation with a multispecies algal inoculum forming a biofilm) processes under controlled laboratory conditions. Pristine and aged plastic samples were characterized for their physiochemical properties through Fourier-transformed infrared spectroscopy, scanning electron microscopy and water contact angle measurements. Their sorption affinity toward aluminum (Al) and copper (Cu) in aqueous solutions was then assessed as a response variable. All ageing processes (alone or combined) influenced plastic surface properties resulting in reduced hydrophobicity, changes in surface functional groups (i.e., increase of oxygen containing functional groups after UV ageing and the appearance of marked bands as amides and polysaccharides after biofouling), as well as in nanomorphology. The sorption of Al and Cu was instead statistically dependent (p < 0.01) on the degree of biofouling covering the specimens. Biofouled plastic displayed in fact substantial affinity for metal sorption causing the depletion of up to tenfold Cu and Al compared to pristine polymers, regardless of the polymer type and presence or absence of other ageing treatments. These results confirm the hypothesis that the accumulation of metals on plastic is substantially driven by the biofilm present on environmental plastics. These findings also highlight the importance of investigating the implications of environmental plastic for metal and inorganic nutrients availability in environments impacted by this pollution.publishedVersio

Selection of the optimal extraction protocol to investigate the interaction between trace elements and environmental plastic

The interaction between environmental plastic and trace elements is an issue of concern. Understanding their interaction mechanisms is key to evaluate the potential threats for the environment. To this regard, consolidating confidence in extraction protocols can help in understanding the amount of different species present on plastic surface, as well as the potential mobility of trace elements present inside the plastic matrix (e.g., additives). Here we tested the efficacy of different reagents to mimic the elemental phases bonded to meso- and microplastic in the environment, in relation to the grade of ageing and the polymer composition. Results showed that a relatively high portion of trace elements is bonded in a weak phase and that other phases abundant in other matrices (e.g., oxides and bonded to organic matter) are only present to a limited degree in the plastic samples. The comparison of different sample types highlighted the important role of plastic ageing in governing interactions with trace elements, while the polymer composition has a limited influence on this process. Finally, the future steps toward a tailored extraction scheme for environmental plastic are proposed.publishedVersio

610 Fontan associated kidney and liver disease: can we predict organ involvement with echocardiographic assessment of systolic function and atrioventricular valve insufficiency?

Abstract Aims Fontan operation represents the surgical palliative option for congenital heart disease with single ventricle physiology. With the improvement of surgical and percutaneous technique, we are facing a growing population of patients with an unique pathophysiology and potential complications. Methods and results Patients that underwent Fontan palliation in our centre between 1993 and 2016 were included in this prospective study. We excluded patients with major congenital renal anomalies, those that underwent cardiac transplantation, and redo-Fontan patients. All the subjects underwent clinical evaluation, laboratory exams with complete renal and hepatic function, transient hepatic elastography, and complete cardiac evaluation. We used Schwartz equation for estimating glomerular filtration rate in patients younger than 18 years, and CDK-EPI equation for adult patients. We enrolled 35 patients, 46% female (N = 16), and 54% male (N = 19). Medium age was 17 years old, median age 15 years old (range: 10–31 years old). Medium time from Fontan completion was 160 months (range: 57–340 months). Regarding to cardiac anatomy, 10 patients had functional single left ventricle (FSLV, 28.5%) and 21 a functional single right ventricle (FSRV, 60%); 4 patients had undetermined single ventricle (11.5%). Total cavo-pulmonary connection (TCPC) with intracardiac lateral tunnel was performed in 7 patients (20%, N = 7), whereas 28 patients had TCPC with external conduit (80%). Data from echocardiographic evaluation showed a medium EF established with Simpson's method of 60% in patients with FSLV; patients with a FSRV or undetermined single ventricle had a medium FAC of 41.1%, with 15.1% having a reduced FAC &lt; 35%. No FSLV patients had an EF &lt; 50%. When using creatinine-based formula, data about renal function in our population showed a stage 2 chronic kidney disease (eGFR: 60–89 ml/min 1.73 mq) in 11% of total population (N = 4), that became 26% when using cystatin C-based equation (N = 9), with one patient showing a moderate reduced loss of kidney function (eGFR: 40–59 ml/min 1.73 mq). Urinalysis showed 29% (N = 10) of patients having microalbuminuria (microalbumin/creatinine ratio between 30 and 300 mg/g). Statistical analysis demonstrated a negative correlation between systolic function (TAPSE for FSRV) and cystatin C blood levels (Pearson's R −0.428, P = 0.053), and between systolic function (FAC and Simpson) and microalbuminuria (Pearson's R −0.414 with P = 0.049 and Pearson's R −0.754 with P = 0.019, respectively). Transient elastography reported 10 patients (29.4%) with abnormal hepatic stiffness for Fontan patients. That condition appeared to be more frequent in patients with higher grade of AV valve insufficiency (P &lt; 0.05). Conclusions Our population showed an higher prevalence of FSRV Fontan patients, with an expected lower systolic function compared with FSLV. 2D evaluation of systolic function showed a linear inverse correlation with renal function, suggesting that Fontan patients need a closer renal monitoring. Hepatic stiffness, which is a warning sign of potential hepatic cirrhosis need to be monitored in all Fontan patients, especially those with a worse AV valve insufficiency

Tackling the Challenging Determination of Trace Elements in Ultrapure Silicon Carbide by LA-ICP-MS

The goal of accurately quantifying trace elements in ultrapure silicon carbide (SiC) with a purity target of 5N (99.999% purity) was addressed. The unsuitability of microwave-assisted acid digestion followed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis was proved to depend mainly on the contamination induced by memory effects of PTFE microwave vessels and by the purity levels of acids, even if highly pure ones were used in a clean environment. A new analytical protocol for the direct analysis of the solid material by laser ablation coupled with ICP-MS (LA-ICP-MS) was then exploited. Different samples were studied; the best results were obtained by embedding SiC (powders or grains) in epoxy resin. This technique has the great advantage of avoiding any source of external contamination, as grinding, pressing and sintering pretreatments are totally unnecessary. Two different laser wavelengths (266 and 193 nm) were tested, and best results were obtained with the 266 nm laser. The optimized protocol allows the determination of elements down to the sub-mg/kg level with a good accuracy level

Clinical Study A Noninvasive Neuroprosthesis Augments Hand Grasp Force in Individuals with Cervical Spinal Cord Injury: The Functional and Therapeutic Effects

Objectives. The primary purpose of this study was to evaluate myoelectrically controlled functional electrical stimulation (MeCFES) for enhancing the tenodesis grip in people with tetraplegia. The second aim was to estimate the potential number of candidates for the MeCFES device. The application of MeCFES provides the user with direct control of the grasp force as opposed to triggered FES systems. Methods. Screening 253 medical records of C5 to C7 spinal cord injury resulted in 27 participants who trained activities of daily living for 12 × 2 hours, using the MeCFES. Hand function was evaluated by the Action Research Arm Test (ARAT). Primary outcome was the ARAT change score with/without the device, before/after the intervention period. Secondary outcome was the number of positive or clinically relevant change scores with respect to the cohort. Results. The MeCFES improved hand test score in 63% of the subjects at first application. Training resulted in a significant therapeutic effect, which resulted in an overall increase of hand function in 89% of the participants and 30% experienced a clinically relevant change (6 points or more). Conclusions. Clinical relevance was found both as an assistive aid and as a therapeutic tool in rehabilitation. The therapeutic effect deserves further investigation in clinical studies

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3–4.8), 3.9% (2.6–5.1) and 3.6% (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9– 2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0%), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay