Comment on "The static evolution of the new Italian code of medical ethics"

The manuscript by Montanari Vergallo et al. appears primarily important because it resubmits the discussion on the relationshi between law and ethica norm in medical practice, as being responsible for promoting professional conduct or slowing it down and depriving it of its meaning

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Spinal anaesthesia is the most preferred anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8–T11 spinal cord ischaemia following L2–L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8–T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice

How to assess appearance distress and motivation in plastic surgery candidates: Italian validation of Derriford Appearance Scale 59 (DAS 59)

The Derriford Appearance Scale (DAS) 59 was specifically designed to measure psychosocial adjustment in patients with appearance problems. Previous studies using the DAS59 have proven it to be a reliable method of assessing the appearance-related quality of life after plastic surgery procedures. The aim of this study was to develop a valid and reliable Italian version of the DAS59

A proposal for limited criminal liability in high-accuracy endoscopic sinus surgery

Lo studio ha lo scopo di sollecitare una riforma della responsabilità penale che preveda una riduzione di responsabilità legale per la chirurgia ad alta precisione, per quella ad alto rischio, come per esempio la chirurgia endoscopica sinusale (ESS). Il contributo comprende una revisione della letteratura medica, concentrandosi sullidentificazione e sullesame dei motivi per cui la tecnica di ESS corre un rischio molto elevato di produrre gravi complicazioni dovute a manovre chirurgiche inesatte. Tale contributo, prevede anche una revisione della teoria del diritto e della giurisprudenza britannica e italiana in merito alla negligenza medica, soprattutto con riferimento alla L. italiana n. 189 del 2012 (Decreto Balduzzi). Si è constatato che gravi complicanze dovute a manovre chirurgiche non corrette di ESS possono verificarsi, indipendentemente dalla prudenza/diligenza del chirurgo. La soggettività in termini giuridici risulta essenziale per la negligenza medica, soprattutto con riferimento alla chirurgia ad alta precisione. La legge italiana 189/2012 rappresenta una buona base per la limitazione della responsabilità penale derivante da manovre imprecise in chirurgia ad alta precisione, come appunto lESS. In conclusione, si considera che i chirurghi che eseguono ESS dovrebbero essere esonerati da responsabilità penale in caso di negligenza lieve sopravvenuta nonostante il rispetto delle line guida emanate

Medical-grade silicone coated with rhamnolipid R89 is effective against Staphylococcus spp. Biofilms

Staphylococcus aureus and Staphylococcus epidermidis are considered two of the most important pathogens, and their biofilms frequently cause device-associated infections. Microbial biosurfactants recently emerged as a new generation of anti-adhesive and anti-biofilm agents for coating implantable devices to preserve biocompatibility. In this study, R89 biosurfactant (R89BS) was evaluated as an anti-biofilm coating on medical-grade silicone. R89BS is composed of homologues of the mono- (75%) and di-rhamnolipid (25%) families, as evidenced by mass spectrometry analysis. The antimicrobial activity against Staphylococcus spp. planktonic and sessile cells was evaluated by microdilution and metabolic activity assays. R89BS inhibited S. aureus and S. epidermidis growth with minimal inhibitory concentrations (MIC99) of 0.06 and 0.12 mg/mL, respectively and dispersed their pre-formed biofilms up to 93%. Silicone elastomeric discs (SEDs) coated by R89BS simple adsorption significantly counteracted Staphylococcus spp. biofilm formation, in terms of both built-up biomass (up to 60% inhibition at 72 h) and cell metabolic activity (up to 68% inhibition at 72 h). SEM analysis revealed significant inhibition of the amount of biofilm-covered surface. No cytotoxic effect on eukaryotic cells was detected at concentrations up to 0.2 mg/mL. R89BS-coated SEDs satisfy biocompatibility requirements for leaching products. Results indicate that rhamnolipid coatings are effective anti-biofilm treatments and represent a promising strategy for the prevention of infection associated with implantable devices

Use of biosurfactants from urban wastes compost in textile dyeing and soil remediation

A compost isolated humic acid-like (cHAL) material was pointed out in previous work for its potential as auxiliary in chemical technology. Its potential is based on its relatively low 0.4 g L-1 critical micellar concentration (cmc) in water, which enables cHAL to enhance the water solubility of hydrophobic substances, like phenanthrene, when used at higher concentrations than 0.4 g L-1. This material could be obtained from a 1:1 v/v mixture of municipal solid and lignocellulosic wastes composted for 15 days. The compost, containing 69.3% volatile solids, 39.6% total organic C and 21 C/N ratio, was extracted for 24 h at 65 °C under N2 with aqueous 0.1 mol L-1 NaOH and 0.1 mol L-1 Na4P2O7, and the solution was acidified to separate the precipitated cHAL in 12% yield from soluble carbohydrates and other humic and non-humic substances. In this work two typical applications of surfactants, i.e., textile dyeing (TD) and soil remediation by washing (SW), were chosen as grounds for testing the performance of the cHAL biosurfactant against the one of sodium dodecylsulfate (SDS), which is a well established commercial synthetic surfactant. The TD trials were carried out with nylon 6 microfiber and a water insoluble dye, while the SW tests were performed with two soils contaminated by polycyclic aromatic hydrocarbons (PAH) for several decades. Performances were rated in the TD experiments based on the fabric colour intensity (ΔE) and uniformity (σΔE), and in the SW experiments based on the total hydrocarbons concentration (CWPAH) and on the residual surfactant (Cre) concentrations in the washing solution equilibrated with the contaminated soils. The results show that both cHAL and SDS exhibit enhanced performance when applied above their cmc values. However, while in the TD case a significant performance effect was observed at the surfactants cmc value, in the SW case the required surfactants concentration values were equivalent to 25-125 × cmc for cHAL and to 4-22 × cmc for SDS. The vis-a-vis comparison of the two surfactants gave the following results: in the TD case the cHAL biosurfactant at 0.4 g L-1 yields good colour intensity and equal colour uniformity as SDS at 5 g L-1, in the SW case cHAL was found to enhance CWPAH by a factor of 2-4 relative to SDS with one soil, whereas with the other soil the two surfactants behaved similarly. The Cre data, however, showed that both soils absorbed by far more SDS (68-95%) than cHAL (12-54%). The results point out intriguing technological and environmental perspectives deriving from the use of compost isolated biosurfactants in the place of synthetic surfactants

Solid and liquid fractionation of digestate: Mass balance, chemical characterization, and agronomic and environmental value

Solid-liquid (S/L) separation of digestate (D) represents a simple technology able to produce two fractions having different composition. The aim of this work was to study the effect of S/L separation on dry matter (DM), nitrogen (TKN), phosphorus (P2O5) and heavy metals (HM) repartition into these two fractions and to characterize them. Therefore, thirteen full-scale digestion plants were studied and D, LF and SF were collected during three seasons of the year. Results obtained indicated that unexpectedly, on a mass balance, the liquid fraction still contains the majority of DM, i.e. 67% of the total of D. LF also contained 87% and 71% of TKN and P2O5respectively. HM contents were in line with typical NP-organic fertilizers. Chemical characterization suggested that the LF can be used as a substitute for mineral N fertilizers because of its high N content, while SF can be proposed as an NP-organic fertilizer