Immunotoxicity and Sensitizing Capacity of Metal Compounds Depend on Speciation

Immunotoxicity of metal compounds is an issue of great importance due to the recent industrial application of metals with unknown toxicity on the immune system and the discovery of metal intermediary compounds not sufficiently studied yet. In this report we show results of our study on the immunotoxicity of the following metals: the Platinum group elements (Platinum, Palladium, Rhodium), Titanium and Arsenic. We applied functional and non functional assays and investigated both innate and adaptive immune systems, in particular, cell proliferation, cytokine production by PBMCs and O−2 production by neutrophils. We obtained the following results: only some Ti compounds (Titanocene, Ti ascorbate and Ti oxalate) show immunotoxicity. Trivalent As compounds (Sodium arsenite and tetraphenyl arsonium chloride) are more immunotoxic than the other investigated As compounds. Genotoxicity of Pt group compounds is in the following order: Pt < Rh < Pd. Immunotoxicity of Pt group compounds is in the following order: Pd < Pt < Rh. Lymphocytes and macrophages show a different reaction of neutrophils to metal toxicity. We can conclude that these studies show that metal immunotoxicity depends on speciation. In general speciation provides additional and often essential information in evaluating metal toxicity. However, there are many difficulties in applying speciation in investigating toxico-kinetic aspects to many metals, mainly due to the lack of information about the existence and significance of species and to the lack of analytical methods for measuring species in biological samples

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

I diritti economici, sociali e culturali. Promozione e tutela nella comunit\ue0 internazionale

Il volume raccoglie gli scritti di diversi studiosi di diritto internazionale, italiani e stranieri, dedicati ai diritti fondamentali della persona nella sfera economica, sociale e culturale. I temi affrontati, pur riguardando una delle principali categorie in cui sono tradizionalmente classificati i diritti umani, hanno ricevuto a lungo un\u2019attenzione secondaria rispetto ai diritti civili e politici, e solo in tempi pi\uf9 recenti sono divenuti oggetto di studio e di approfondita riflessione nella comunit\ue0 internazionale. Attraverso l\u2019esame delle norme rilevanti e della prassi internazionale, i vari studi offrono le chiavi di lettura e gli elementi necessari per comprendere il contenuto degli obblighi e dei diritti fondamentali in quest\u2019ambito, il loro comune obiettivo di garantire la realizzazione di condizioni di vita dignitose per ogni essere umano, nonch\ue9 per cogliere le connessioni che i diritti in esame hanno non solo tra di loro ma anche con i diritti civili e politici. A tal fine, oltre ad analisi di taglio generale e sistematico, sono affrontati nel dettaglio alcuni tra i pi\uf9 rilevanti diritti nel settore in questione (il diritto all\u2019alimentazione, all\u2019istruzione, all\u2019abitazione, a un ambiente sano e i diritti in materia di lavoro). Ampio spazio \ue8 dedicato all\u2019opera dei principali soggetti cui compete la tutela internazionale in tale materia, a partire dalle organizzazioni internazionali che hanno predisposto strumenti di protezione specifici (l\u2019ONU, l\u2019Organizzazione Internazionale del Lavoro, il Consiglio d\u2019Europa, l\u2019Organizzazione degli Stati Americani). A questa prospettiva tradizionale il volume affianca l\u2019analisi del ruolo fondamentale che nella promozione dei diritti economici, sociali e culturali spetta ad altri attori dell\u2019attuale vita di relazione internazionale, quali le istituzioni finanziarie internazionali, l\u2019Unione Europea, le imprese multinazionali.The book is one of the few existing books entirely devoted to Economic Social and Cultural Rights, and includes essays of various Scholars (F. Bestagno, M. Bothe, F. Costamagna, M. Cremona, P. De Sena, C. Di Turi, C. Dordi, M. Gestri, G. Gori, G. Malinverni, Card. R. Martino, R. Pisillo Mazzeschi, S. Sanna)

Nonsurgical strategies to reduce mortality in patients undergoing cardiac surgery: An updated consensus process

Objective: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. Design: A systematic review of the literature followed by a consensus-based voting process. Setting: A web-based international consensus conference. Participants: More than 400 physicians from 52 countries participated in this web-based consensus conference. Interventions: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. Measurements and Main Results: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. Conclusions: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.Orion Pharma ; Abbott Laboratories ; Pall ; Tena

Notulae to the Italian alien vascular flora: 7

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, and status changes for Italy or for Italian administrative regions of taxa in the genera Abies, Actinidia, Aloe, Amaryllis, Anredera, Arctotheca, Bidens, Cardiospermum, Celosia, Commelina, Cotoneaster, Cyclamen, Eclipta, Euphorbia, Grevillea, Hedera, Hibiscus, Impatiens, Juglans, Kalanchoe, Koelreuteria, Lindernia, Melinis, Myriophyllum, Nandina, Nicotiana, Oenothera, Oxalis, Parthenocissus, Phoenix, Phyllanthus, Physalis, Plumbago, Pteris, Quercus, Setaria, Symphytum, Tagetes, and Washingtonia

Notulae to the Italian alien vascular flora: 7

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, and status changes for Italy or for Italian administrative regions of taxa in the genera Abies, Actinidia, Alooe, Amaryllis, Anredera, Arctotheca, Bidens, Cardiospermum, Celosia, Commelina, Cotoneaster, Cyclamen, Eclipta, Euphorbia, Grevillea, Hedera, Hibiscus, Impatiens, Juglans, Kalanchoe, Koelreuteria, Lindernia, Melinis, Myriophyllum, Nandina, Nicotiana, Oenothera, Oxalis, Parthenocissus, Phoenix, Phyllanthus, Physalis, Plumbago, Pteris, Quercus, Setaria, Symphytum, Tagetes, and Washingtonia. Nomenclatural and distribution updates, published elsewhere are provided as Suppl. material 1

Notulae to the Italian alien vascular flora: 8

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions of taxa in the genera Bunias, Calocedrus, Calycanthus, Celosia, Clerodendrum, Convolvulus, Crassula, Cyclamen, Datura, Dicliptera, Eragrostis, Erigeron, Gamochaeta, Gazania, Impatiens, Kolkwitzia, Leucaena, Ludwigia, Medicago, Muscari, Nigella, Oenothera, Opuntia, Paulownia, Petroselinum, Phyllostachys, Physalis, Pseudosasa, Quercus, Reynoutria, Roldana, Saccharum, Sedum, Semiarundinaria, Senecio, Sisyrinchium, Solanum, Sporobolus, Tulipa, Vachellia, Verbena, and Youngia. Nomenclatural and distribution updates published elsewhere are provided as Suppl. material 1

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care