The potential of foodwaste leachate as a phycoremediation substrate for microalgal CO 2 fixation and biodiesel production

Abstract

Foodwaste leachate (FWL) is often generated during foodwaste treatment processes. Owing to its high nutrient content, FWL has high potential for phycoremediation, a microalgal technology application for water treatment while acting as CO₂ fixation tank. Additionally, the end product of microalgal from phycoremediation can be potentially used for biodiesel production. Therefore, the phycoremediation has drawn a lot of attention in recent decades. This study evaluates the performance of microalgal foodwaste leachate treatment and the potential of utilizing FWL as medium for microalgal biodiesel production. Two microalgal species, Dunaliella tertiolecta and Cyanobacterium aponinum, were selected. For each species, two experimental levels of diluted FWL were used: 5 and 10% FWL. The partial inhibition growth model indicates that some inhibit factors such as ammonia; total suspended solids and oil and grease (O&G) content suppress the microalgal growth. Most of the nutrient such as nitrogen and phosphorus (> 80%) can be removed in the last day of phycoremediation by D. tertiolecta. C. aponinum also show considerable removal rate on total nitrogen ammonia and nitrate (> 60%). Biomass (0.4–0.5 g/L/day) of D. tertiolecta and C. aponinum can be produced though cultivated in diluted FWL. The bio-CO₂ fixation rates of the two species were 610.7 and 578.3 mg/L/day of D. tertiolecta and C. aponinum. The strains contain high content of saturated fatty acid such as C₁₆ and C₁₈ making them having potential for producing good quality biodiesel.

Eco-industrial zones in the context of sustainability development of urban areas

Abstract

Industry is one of the main activities in the city and in many cities of the world, and the dominant industrial zones are the most significant morphological forms of concentration of industrial facilities in the city and are concentrated industrial and business activity. Industrial parks combine activities related to energy and resource consumption, emissions, waste generation, economic benefits, and regional development. The focus of this work is the path of transformation between the present and the vision of a sustainable city in the future. The problem and the subject of research related to two related objects of research: the city and sustainable development. In this paper, the co-author's industrial symbiosis parks, modern tendencies of the spatial distribution of productive activities, circular economy, to attract leading corporations and open the way for new ventures while preserving the living environment in an urban area.

Assessment of heavy metal pollution risks and enzyme activity of meadow soils in urban area under tourism load: a case study from Zakopane (Poland)

Abstract

Effect of tourism, especially skiing activities, and urbanization on chemical and biochemical properties of soils in touristy town—Zakopane—was investigated. The concentration of heavy metals, nutrients, soil organic matter (SOM), dehydrogenase (DHA), invertase (IA) and urease (Ure) activities in soils from the town centre and out of the town centre was compared with the respective values of adjacent soils in protected areas (TNP). In order to evaluate a degree of contamination and risks of degradation enrichment factor (EF), ecological risk index (RI), Nemerov Pollution Index (PI_Nemerov) as well as enzyme activity index (EAI) were calculated. Soils in the centre of Zakopane were polluted with Zn, Pb, Cd and Cu in a moderate degree when those of skiing areas were polluted with Pb and Cd in a high degree. Strong positive correlation between these metals and negative correlation between them and a distance from the main roundabout in town indicated their anthropogenic origin. Soils of both locations were also enriched in P, but depleted in SOM when compared to TNP soils. Soils of touristy areas (out of the centre) were additionally enriched in N. Activity of studied enzymes was also lowered in soils of Zakopane when compared to soils of TNP. Pollution indices, RI, PI_Nemerov as well as EAI, indicated that soils of Zakopane are at risk of degradation. Soils of touristy areas are under stronger negative impact than soils of the centre because of the cumulative effect of transport of heavy metals from the city centre, pollution by skiing machinery and melting water from the artificial snow.

Ecotoxicological assessment of perchlorate using in vitro and in vivo assays

Abstract

Perchlorate is an inorganic ion widespread in the environment, generated as a natural and anthropogenic pollutant, with known endocrine disruption properties in the thyroid gland. Nonetheless, there are few reports of its ecotoxicological impact on wildlife. The aim of this study was to evaluate the adverse effects of KClO₄ exposure on different cell lines, HEK, N2a, and 3T3, as well as in ecological models such as Vibrio fischeri, Pseudokirchneriella subcapitata, Daphnia magna, and Eisenia fetida. Perchlorate exhibited similar toxicity against tested cell lines, with LC₅₀ values of 19, 15, and 19 mM for HEK, N2a, and 3T3, respectively; whereas in V. fischeri, the toxicity, examined as bioluminescence reduction, was considerably lower (EC₅₀ = 715 mM). The survival of the freshwater algae P. subcapitata was significatively impaired by perchlorate (LC₅₀ = 72 mM), and its effect on the lethality in the crustacean D. magna was prominent (LC₅₀ = 5 mM). For the earthworm E. fetida, the LC₅₀ was 56 mM in soil. In this organism, perchlorate induced avoidance behavior, weight loss, and decreased egg production and hatchling, as well as morphological and histopathological effects, such as malformations, dwarfism, and necrosis. In conclusion, perchlorate toxicity varies according to the species, although E. fetida is a sensitive model to generate information regarding the toxicological impact of KClO₄ on biota.

Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease

Abstract

Early mortality and morbidity remain high in children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa. Many children still present with advanced human immunodeficiency virus (HIV) disease. Tuberculosis, pneumonia, and severe bacterial infections are the main causes of hospital admission in HIV-infected children. In contrast to adults with advanced HIV disease, cryptococcal disease is not common in childhood, although there is a peak in infancy and adolescence. Interventions such as TB screening in symptomatic children, and isoniazid and cotrimoxazole prophylaxis should be implemented. There is evidence suggesting that rapid initiation (within 1 week) of ART in children with severe malnutrition or those with advanced HIV disease admitted to hospital is not beneficial and should be delayed until their condition has been stabilized. Research informing the prevention of severe bacterial infections, the management of pediatric immune reconstitution inflammatory syndrome, and other potential strategies to decrease morbidity and mortality in HIV-infected children are urgently needed.

Managing Advanced HIV Disease in a Public Health Approach

Abstract

In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. A package of targeted interventions to reduce mortality and morbidity was recommended, based on results of 2 recent randomized trials that both showed a mortality reduction associated with delivery of a simplified intervention package. Taking these results and existing recommendations into consideration, WHO recommends that a package of care be offered to those presenting with advanced HIV disease; depending on age and CD4 cell count, the package may include opportunistic infection screening and prophylaxis, including fluconazole preemptive therapy for those who are cryptococcal antigen positive and without evidence of meningitis. Rapid ART initiation and intensified adherence interventions should also be proposed to everyone presenting with advanced HIV disease.

Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial

Abstract

Background

In sub-Saharan Africa, 20%–25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity.

Methods

Participants started ART with a CD4 count <100 cells/µL; enhanced prophylaxis comprised cotrimoxazole plus 12 weeks of isoniazid + fluconazole, single-dose albendazole, and 5 days of azithromycin. A blinded committee adjudicated events and causes of death as (non–mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infection (SBI), other potentially azithromycin-responsive infections, other events, and unknown.

Results

Median pre-ART CD4 count was 37 cells/µL. Among 1805 participants, 225 (12.7%) died by week 48. Fatal/nonfatal events occurred early (median 4 weeks); rates then declined exponentially. One hundred fifty-four deaths had single and 71 had multiple causes, including tuberculosis in 4.5% participants, cryptococcosis in 1.1%, SBI in 1.9%, other potentially azithromycin-responsive infections in 1.3%, other events in 3.6%, and unknown in 5.0%. Enhanced prophylaxis reduced deaths from cryptococcosis and unknown causes (P < .05) but not tuberculosis, SBI, potentially azithromycin-responsive infections, or other causes (P > .3); and reduced nonfatal/fatal tuberculosis and cryptococcosis (P < .05), but not SBI, other potentially azithromycin-responsive infections, or other events (P > .2).

Conclusions

Enhanced prophylaxis reduced mortality from cryptococcosis and unknown causes and nonfatal tuberculosis and cryptococcosis. High early incidence of fatal/nonfatal events highlights the need for starting enhanced-prophylaxis with ART in advanced disease.

Clinical Trials Registration

ISRCTN43622374.

Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort

Abstract

Background

The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL) HIV disease. We assessed disease progression at entry to care using nationwide laboratory data.

Methods

We constructed a national HIV cohort using laboratory records containing HIV RNA loads and CD4 counts from 2004 to 2016 to determine entry into care. We estimated numbers and proportions of adults with the first CD4 count <100 cells/ μL or 100–199 cells/μL. We calculated relative risks of presenting with advanced disease associated with male sex.

Results

8.04 million first CD4 results were identified. From 2005 to 2011, the proportion of patients entering into care with CD4 count <200 cells/μL declined from 46.8% to 35.6%. From 2011 onward, the proportion of patients entering ART with advanced HIV disease has remained relatively unchanged. In 2016, we estimated that of 654 868 patients entering care, 32.9% had advanced HIV disease, and 16.8% had very advanced HIV disease. Men were almost twice as likely as women (23.1% vs 12.6% ) to enter care with very advanced HIV disease.

Conclusions

The proportion of patients presenting with advanced HIV disease in South Africa remains consistently high despite ART scale-up, representing a large and avoidable burden of morbidity. Early HIV diagnosis, rapid linkage to ART and approaches to attract men into early ART initiation should be prioritized.

The Persistent Challenge of Advanced HIV Disease and AIDS in the Era of Antiretroviral Therapy

advanced HIV diseaseAIDScryptococcal meningitistuberculosis

The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa

Abstract

Background

Antiretroviral treatment (ART) has been massively scaled up to decrease human immunodeficiency virus (HIV)–related morbidity, mortality, and HIV transmission. However, despite documented increases in ART coverage, morbidity and mortality have remained substantial. This study describes trends in the numbers and characteristics of patients with very advanced HIV disease in the Western Cape, South Africa.

Methods

Annual cross-sectional snapshots of CD4 distributions were described over 10 years, derived from a province-wide cohort of all HIV patients receiving CD4 cell count testing in the public sector. Patients with a first CD4 count <50 cells/µL in each year were characterized with respect to prior CD4 and viral load testing, ART access, and retention in ART care.

Results

Patients attending HIV care for the first time initially constituted the largest group of those with CD4 count <50 cells/µL, dropping proportionally over the decade from 60.9% to 26.7%. By contrast, the proportion who were ART experienced increased from 14.3% to 56.7%. In patients with CD4 counts <50 cells/µL in 2016, 51.8% were ART experienced, of whom 76% could be confirmed to be off ART or had recent viremia. More than half who were ART experienced with a CD4 count <50 cells/µL in 2016 were men, compared to approximately one-third of all patients on ART in the same year.

Conclusions

Ongoing HIV-associated morbidity now results largely from treatment-experienced patients not being in continuous care or not being fully virologically suppressed. Innovative interventions to retain ART patients in effective care are an essential priority for the ongoing HIV response.

Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial

Abstract

Background

Severely immunocompromised human immunodeficiency virus (HIV)–infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes.

Methods

The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts <100 cells/µL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identified using Cox regression with backwards elimination (exit P > .1).

Results

Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%–6% mortality.

Conclusions

Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up.

Clinical Trials Registration

ISRCTN43622374.

High Proportions of Patients With Advanced HIV Are Antiretroviral Therapy Experienced: Hospitalization Outcomes From 2 Sub-Saharan African Sites

Abstract

Background

Human immunodeficiency virus (HIV) remains an important cause of hospitalization and death in low- and middle- income countries. Yet morbidity and in-hospital mortality patterns remain poorly characterized, with prior antiretroviral therapy (ART) exposure and treatment failure status largely unknown.

Methods

We studied HIV-infected inpatients aged ≥13 years from cohorts in Kenya and the Democratic Republic of Congo (DRC), assessing clinical and demographic characteristics and hospitalization outcomes. Kenyan inpatients were prospectively enrolled during hospitalization; identical retrospective data were extracted for Congolese patients meeting the study criteria using routine medical information.

Results

Among 338 HIV-infected patients in Kenya and 411 in DRC, 83.7% (95% confidence interval [CI], 79.4%–87.3%) and 97.3% (95% CI, 95.2%–98.5%), were admitted with advanced disease (defined as CD4 <200 cells/µL or World Health Organization stage 3/4 illness). Among inpatients with advanced HIV, 35.4% and 21.7% were ART-naive at admission. Patients under care had a median time of 44.1 (interquartile range [IQR], 18.4–90.5) months and 55.9 (IQR, 28.1–99.6) months on treatment; 17.2% (95% CI, 13.5%–21.6%) and 29.6% (95% CI, 25.4%–34.3%) died, 25.9% (95% CI, 16.0%–39.0%) and 22.5% (95% CI, 15.8%–31.0%) of these within 48 hours.

Conclusions

Across 2 diverse clinical contexts in sub-Saharan Africa, advanced HIV inpatients were frequently admitted with low CD4 counts, often failing first-line ART. Earlier identification of treatment failure and rapid switching to second-line ART are needed.

CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis

Abstract

Background

Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts.

Methods

We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata. Prevalence estimates were pooled using random effects models.

Results

Sixty studies met our inclusion criteria. The pooled prevalence of cryptococcal antigenemia was 6.5% (95% confidence interval [CI], 5.7%–7.3%; 54 studies) among patients with CD4 count ≤100 cells/µL and 2.0% (95% CI, 1.2%–2.7%; 21 studies) among patients with CD4 count 101–200 cells/µL. Twenty-one studies provided sufficient information to compare CrAg prevalence per strata; overall, 18.6% (95% CI, 15.4%–22.2%) of the CrAg-positive cases identified at ≤200 cells/µL (n = 11823) were identified among individuals with a CD4 count 101–200 cells/µL. CrAg prevalence was higher among inpatients (9.8% [95% CI, 4.0%–15.5%]) compared with outpatients (6.3% [95% CI, 5.3%–7.4%]).

Conclusions

The findings of this review support current recommendations to screen all PLHIV who have a CD4 count ≤100 cells/µL for CrAg and suggest that screening may be considered at CD4 cell count ≤200 cells/µL.

Readiness of US General Surgery Residents for Independent Practice: Erratum

No abstract available

Questions Regarding Statistical Inferences, Quality of Life, and Conclusions From the COBRA Study

No abstract available

Autologous Myoblasts for the Treatment of Fecal Incontinence: Results of a Phase 2 Randomized Placebo-controlled Study (MIAS)

Objective: The aim of this study was to evaluate the efficacy of intrasphincteric injections of autologous myoblasts (AMs) in fecal incontinence (FI) in a controlled study. Summary of Background Data: Adult stem cell therapy is expected to definitively cure FI by regenerating damaged sphincter. Preclinical data and results of open-label trials suggest that myoblast therapy may represent a noninvasive treatment option. Methods: We conducted a phase 2 randomized, double-blind, placebo-controlled study of intrasphincteric injections of AM in 24 patients. The study compared outcome after AM (n = 12) or placebo (n = 12) injection using Cleveland Clinic Incontinence (CCI), score at 6 and 12 months. Patients in the placebo group were eligible to receive frozen AM after 1 year. Results: At 6 months, the median CCI score significantly decreased from baseline in both the AM (9 vs 15, P = 0.02) and placebo (10 vs 15, P = 0.01) groups. Hence, no significant difference was found between the 2 groups (primary endpoint) at 6 months. At 12 months, the median CCI score continued to ameliorate in the AM group (6.5 vs 15, P = 0.006), while effect was lost in the placebo group (14 vs 15, P = 0.35). Consequently, there was a higher response rate at 12 months in the treated than the placebo arm (58% vs 8%, P = 0.03). After delayed frozen AM injection in the placebo group, the response rate was 60% (6/10) at 12 months. Conclusions: Intrasphincteric AM injections in FI patients have shown tolerance, safety, and clinical benefit at 12 months despite a transient placebo effect at 6 months.

Prevent the Bleed: How Surgeons Can Lead the National Conversation About Firearm Safety Forward

In the 5 years since the Sandy Hook elementary school shooting that claimed the lives of 20 children and 6 of their teachers, we have witnessed intolerably more mass shooting events. In the intervening years, over 150,000 Americans have died because of firearm violence, 3 times the number who lost their lives during the Revolutionary war. In the last 2 months, we have been left reflecting on 2 more tragedies. The first came on October 1 in Las Vegas, at the Route 91 music festival where 58 were killed and over 500 injured by a single gunman. The second, on November 5, took place in Sutherland Springs, Texas (population 600) near San Antonio and claimed the lives of 26 men women and children while they prayed. As was witnessed in Orlando and San Bernardino, these most recent mass casualty incidents strained first responders, law enforcement, and the state's trauma systems to their breaking point. Once again, we were left searching for the reasons behind these tragedies asking predictable questions: who did this and why? Was it part of a terrorist plot or a lone psychopath with a grudge? Were the weapons obtained legally, and why would anyone need so many? How can we stop this from happening again?

Dissecting Surgeon Behavior: Leveraging the Theoretical Domains Framework to Facilitate Evidence-based Surgical Practice

No abstract available

A British Perspective on the American College of Surgeons Conversation About Firearm Safety

No abstract available

Randomized Controlled Trial of Liberal Versus Restricted Fluid Management in Patients Undergoing Pancreatectomy: Erratum

No abstract available

Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery

Objective: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult. Background: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery. Methods: Using a modified RAND-UCLA Appropriateness Methodology, 44 of 58 CQGS Stakeholders twice rated validity (primary outcome) and feasibility for 308 standards, ranging from goals and decision-making, pre-operative assessment and optimization, perioperative and postoperative care, to transitions of care beyond the acute care hospital. Results: Three hundred six of 308 (99%) standards were rated as valid to improve quality of geriatric surgery. There were 4 sections. Section 1 included 157 (57%) standards and focused on goals and decision-making, preoperative optimization, and transitions into and out of the hospital. Section 2 included 84 (27.3%) standards focused on in-hospital care, across the immediate preoperative, intraoperative, and postoperative phases. Section 3 included 59 (19.1%) standards about program management, including personnel and committee structure, credentialing, and education. Section 4 included 8 (2.6%) standards establishing overarching concepts for data collection and patient follow-up. Two hundred ninety of 308 standards (94.2%) were rated as feasible; 18 (5.8%) were rated as uncertain in feasibility. Conclusions: CQGS Stakeholders rated the vast majority of standards of care as highly valid (99%) and feasible (94%) for improving the quality of surgical care provided to older adults. Future work will focus on a pilot phase to better understand and address challenges to implementation of the standards.

Using Confidential Clinical Data Registries for Public Reporting and Pay for Performance

No abstract available

Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases—Which Is a More Suitable Standard Practice?

No abstract available

Pushing the Envelope in Perihiler Cholangiocellularcarcinoma Surgery: TIPE-ALPPS

No abstract available

Social Media as a Platform for Surgical Learning: Use and Engagement Patterns Among Robotic Surgeons

In response to technological advances and growing dispersion of surgical practice around the globe, social media platforms have emerged in recent years as channels for surgeons to share experiences, ask questions, and learn from one another. To better understand surgeons' engagement with these platforms, we analyzed data from a closed-membership Facebook group for robotic surgeons. Our analysis revealed that surgeons posted more frequently on midweek days, and further that text posts received significantly more comments, and significantly fewer "likes," than posts containing links, photos, or videos. We discuss the implications of these use and engagement patterns for the viability of social media platforms as tools for surgeons to learn vicariously from their peers' experiences and expertise.

Design Principles for Building a Leadership Development Program in a Department of Surgery

No abstract available

Magnetic Surgery: Results From First Prospective Clinical Trial in 50 Patients

Objective: To evaluate a new magnetic surgical system during reduced-port laparoscopic cholecystectomy in a prospective, multicenter clinical trial. Background: Laparoscopic instrumentation coupled by magnetic fields may enhance surgeon performance by allowing for shaft-less retraction and mobilization. The movements can be performed under direct visualization, generating different angles of traction and reducing the number of trocars to perform the procedure. This may reduce well-known associated complications of trocars, including incisional pain, scarring, infection, bowel, and vascular injuries, among others. Methods: A prospective, multicenter, single-arm, open-label study was performed to assess the safety and performance of a magnetic surgical system (Levita Magnetics' Surgical System). The investigational device was used during a 3-port laparoscopic technique. The primary endpoints evaluated were safety and feasibility of the device to adequately mobilize the gallbladder to achieve effective exposure of the targeted surgical site. Patients were followed for 30 days postprocedure. Results: Between January 2014 and March 2015, 50 patients presenting with benign gallbladder disease were recruited. Forty-five women and 5 men with an average age of 39 years (18–59), average body mass index of 27 kg/m2 (20.4–34.1) and an average abdominal wall thickness of 2.6 cm (1.8–4.6). The procedures were successfully performed in all 50 patients. No device-related serious adverse events were reported. Surgeons rated as "excellent" (90%) or "sufficient" (10%) the exposure of the surgical site. Conclusions: This clinical trial shows that this new magnetic surgical system is safe and effective in reduced-port laparoscopic cholecystectomy.

Minimally Invasive Thoracic Surgery 3.0: Lessons Learned From the History of Lung Cancer Surgery

No abstract available

Volume Increases and Shared Decision-making in Joint Replacement Bundles

No abstract available

Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review

Objective: The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery. Background: Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic surgery imposes greater ergonomic constraints on surgeons. Recent reports indicate a 73% to 88% prevalence of physical complaints among laparoscopic surgeons, which is greater than in the general working population, supporting the need to address the surgeons' physical health. Methods: To summarize the prevalence of MSDs among surgeons performing laparoscopic surgery, we performed a systematic review of studies addressing physical ergonomics as a determinant, and reporting MSD prevalence. On April 15 2016, we searched Pubmed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and PsychINFO. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. Results: We identified 35 articles, including 7112 respondents. The weighted average prevalence of complaints was 74% [95% confidence interval (95% CI) 65–83]. We found high inconsistency across study results (I2 = 98.3%) and the overall response rate was low. If all nonresponders were without complaints, the prevalence would be 22% (95% CI 16–30). Conclusions: From the available literature, we found a 74% prevalence of physical complaints among laparoscopic surgeons. However, the low response rates and the high inconsistency across studies leave some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact psychomotor performance; therefore, these results warrant further investigation. Continuous changes are enacted to increase patient safety and surgical care quality, and should also include efforts to improve surgeons' well-being.

In the Next Issue

No abstract available

The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies

Objective: We compared the incidence of appendicitis or appendectomy across the world and evaluated temporal trends. Summary Background Data: Population-based studies reported the incidence of appendicitis. Methods: We searched MEDLINE and EMBASE databases for population-based studies reporting the incidence of appendicitis or appendectomy. Time trends were explored using Poisson regression and reported as annual percent change (APC) with 95% confidence intervals (CI). APC were stratified by time periods and pooled using random effects models. Incidence since 2000 was pooled for regions in the Western world. Results: The search retrieved 10,247 citations with 120 studies reporting on the incidence of appendicitis or appendectomy. During the 21st century the pooled incidence of appendicitis or appendectomy (in per 100,000 person-years) was 100 (95% CI: 91, 110) in Northern America, and the estimated number of cases in 2015 was 378,614. The pooled incidence ranged from 105 in Eastern Europe to 151 in Western Europe. In Western countries, the incidence of appendectomy steadily decreased since 1990 (APC after 1989=−1.54; 95% CI: −2.22, −0.86), whereas the incidence of appendicitis stabilized (APC=−0.36; 95% CI: −0.97, 0.26) for both perforated (APC=0.95; 95% CI: −0.25, 2.17) and nonperforated appendicitis (APC=0.44; 95% CI: −0.84, 1.73). In the 21st century, the incidence of appendicitis or appendectomy is high in newly industrialized countries in Asia (South Korea pooled: 206), the Middle East (Turkey pooled: 160), and Southern America (Chile: 202). Conclusions: Appendicitis is a global disease. The incidence of appendicitis is stable in most Western countries. Data from newly industrialized countries is sparse, but suggests that appendicitis is rising rapidly.

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy: Estimates From a Retrospective Cohort Study of 6.5 Million Pregnancies

Objective: The aim of this study was to estimate the risk of adverse birth outcomes for women who underwent nonobstetric surgery during pregnancy compared with those who did not. Background: Previous research suggests that nonobstetric surgery occurs during 1% to 2% of pregnancies. However, there is limited evidence quantifying risks to the mother or pregnancy of such surgery. Methods: We examined maternity admissions using hospital administrative data collected between April 1, 2002, and March 31, 2012, and identified pregnancies wherein nonobstetric surgery occurred. We used logistic regression models to determine the adjusted relative risk, attributable risk, and number needed to harm of nonobstetric surgical procedures for adverse birth outcomes. Results: We identified 6,486,280 pregnancies. In 47,628 of these pregnancies, nonobstetric surgery had occurred. We found that nonobstetric surgery during pregnancy was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that every 287 surgical operations were associated with 1 additional stillbirth, every 31 operations associated with 1 additional preterm delivery, every 39 operations associated with 1 additional low birth weight baby, every 25 operations associated with 1 additional caesarean section, and every 50 operations associated with 1 additional long inpatient stay. Conclusions: Although we have no means of disentangling the effect of the surgery from the effect of the underlying condition, we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe. We believe that our findings improve upon previous research, and are useful reference points for any discussion of risk with prospective patients.

Heavy metals in soils and sediments from Dongting Lake in China: occurrence, sources, and spatial distribution by multivariate statistical analysis

Abstract

Heavy metal contamination in soils/sediments and its impact on human health and ecological environment have aroused wide concerns. Our study investigated 30 samples of soils and sediments around Dongting Lake to analyze the concentration of As, Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn in the samples and to distinguish the natural and anthropogenic sources. Also, the relationship between heavy metals and the physicochemical properties of samples was studied by multivariate statistical analysis. Concentration of Cd at most sampling sites were more than five times that of national environmental quality standard for soil in China (GB 15618-1995), and Pb and Zn levels exceeded one to two times. Moreover, Cr in the soil was higher than the national environmental quality standards for one to two times while in sediment was lower than the national standard. The investigation revealed that the accumulations of As, Cd, Mn, and Pb in the soils, and sediments were affected apparently by anthropogenic activities; however, Cr, Fe, and Ni levels were impacted by parent materials. Human activities around Dongting Lake mainly consisted of industrial activities, mining and smelting, sewage discharges, fossil fuel combustion, and agricultural chemicals. The spatial distribution of heavy metal in soil followed the rule of geographical gradient, whereas in sediments, it was significantly affected by the river basins and human activities. The result of principal component analysis (PCA) demonstrated that heavy metals in soils were associated with pH and total phosphorus (TP), while in sediments, As, Cr, Fe, and Ni were closely associated with cation exchange capacity (CEC) and pH, where Pb, Zn, and Cd were associated with total nitrogen (TN), TP, total carbon (TC), moisture content (MC), soil organic matter (SOM), and ignition lost (IL). Our research provides comprehensive approaches to better understand the potential sources and the fate of contaminants in lakeshore soils and sediments.

Efficacy of a new nail brace for the treatment of ingrown toenails

Summary

Background and objectives

Surgery is the mainstay of treatment for complicated ingrown toenails. However, alternative treatments using nail braces have been reported to show good efficacy. The objective of the present study was to investigate the efficacy of a new nail brace for the treatment of ingrown toenails.

Patients and methods

We conducted a retrospective study on patients with ingrown toenails treated at Wan Fang Hospital between June 1, 2015 and May 30, 2016. Ingrown toenails were classified into acute inflamed/infected (AI) and chronic dystrophic (CD) types. Using physician global assessment scores, the efficacy of nail braces for the two types of ingrown toenails was compared 1, 2, 3, and 6 months after treatment initiation and during the final visit.

Results

Twenty-one patients (42 sites) had CD-type ingrown toenails; 25 patients (36 sites) had ingrown toenails of the AI type. Of the affected sites, 81 %, 94 %, and 100 % showed an excellent or fair outcome at 1, 3, and 6 months, respectively. Recurrence rates were 10.3 %; complication rates, 7.7 %. While, in the first three months, AI-type ingrown toenails tended to achieve excellent results more rapidly than CD-type nails, outcomes were similar at six months.

Conclusions

Nail braces are an effective therapeutic option, particularly for CD-type ingrown toenails.

A tale of two “half tongues”

Allergic myocardial infarction (Kounis syndrome) after cefuroxime with side-chain cross-reactivity

Publication date: Available online 8 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Magdalena Absmaier, Tilo Biedermann, Knut Brockow

The B antigen protects against the development of red meat allergy

Publication date: Available online 3 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Jonathan R. Brestoff, Merih T. Tesfazghi, Mark A. Zaydman, Ronald Jackups, Brian S. Kim, Mitchell G. Scott, Ann M. Gronowski, Brenda J. Grossman

Therapeutic management of classic lichen planopilaris: a systematic review

Political liberalism and children

Abstract

In this article, I highlight some core ideas that are important for understanding the parent-child relationship within the framework of political liberalism. I stress that, although some ideal or conception of the family is part of most, if not all, comprehensive doctrines, for political liberals, the state's interest in the family is as a social-political institution in which certain needs of persons as free and equal citizens are met. I discuss the main needs and interests of children and parents in the parent-child relationship. I consider that many children are cared for by multiple people, and I discuss how the state should address the recognition of multiple legal parents. I discuss some contexts in which conflicts arise between the interests of children and caregivers and address how such conflicts should be resolved in the politically liberal state. Although Rawls failed to offer an acceptable account of the family as part of the basic structure and did not adequately address the role of caring relationships in a just society, I hope that this article helps to show how political liberals can offer a plausible account.

Assessing resident awareness on e-waste management in Bangalore, India: a preliminary case study

Abstract

The generation of e-waste has increased significantly in India, and the informal recycling of e-waste has adverse effects on environment and public health. In this article, the E-waste management is evaluated in accordance from the resident's awareness perspective in Bangalore city, India. The survey data revealed that about 58% male and 42% female responded and 35% of the participants belong to age range between 18 and 25 years. About 60% of respondent's education level was either graduate or post graduate, 27% high school to higher school, 10% higher educated (> post graduate), and 3% primary to middle. Only 30% of the respondents were confident with e-waste rules and regulation, while 39% of the respondents were of very little information. Indian e-waste management has been improving for the last few years and it continues to develop. Therefore, the findings can be valuable for better understanding the resident's awareness for e-waste management and also need to promote the environmentally sound management of e-waste in Bangalore, India.

Application of new instruments for beginner lymphatic supermicrosurgeon

Publication date: Available online 2 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nana Yamamoto, Takumi Yamamoto, Rhohei Ishiura

‘The kids are alright’: political liberalism, leisure time, and childhood

Abstract

Interest in the nature and importance of 'childhood goods' recently has emerged within philosophy. Childhood goods, roughly, are things (including kinds of activities) that are good for persons qua children independent of any contribution to the good of persons qua adults (although they may also be valuable in this way). According to Colin Macleod, John Rawls's political conception of justice as fairness rests upon an adult-centered 'agency assumption' and thus is incapable of incorporating childhood goods into its content. Macleod concludes that because of this, justice as fairness cannot be regarded as a complete conception of distributive justice. In this paper I provide a political liberal response to Macleod's argument by advancing three claims. First, I propose that political liberalism should treat leisure time as a distinct 'primary good.' Second, I suggest that leisure time should be distributed via (a) the 'basic needs principle' and (b) the 'difference principle' for all citizens over the course of their complete lives, including their childhoods. Third, the provision of leisure time in this way supports the realization of childhood goods for citizens.

The Use of Vibrational Energy to Isolate Adipose-Derived Stem Cells

Background: Adipose-derived stem cell (ADSC)–based treatments have the potential to treat numerous soft-tissue pathologies. It would be beneficial to develop an efficient and reliable intraoperative, nonenzymatic method of isolating ADSCs for clinical use. This study aims to determine the (1) viability and proliferative capacity of ADSCs after exposure to vibrational energies and (2) efficacy of vibrational energy as a method of ADSC isolation from surgically harvested infrapatellar fat pad (IFP). Methods: Cultured ADSCs were exposed to 15 minutes of vibration (60 Hz) with displacements ranging from 0 to 2.5 mm to assess cell viability and proliferation. Then, arthroscopically harvested adipose tissue (IFP; n = 5 patients) was filtered and centrifuged to separate the stromal vascular fraction, which was exposed to 15 minutes of vibration (60 Hz; 1.3 mm or 2.5 mm displacement). A viability analysis was then performed along with proliferation and apoptosis assays. Results: Vibration treatment at all displacements had no effect on the viability or proliferation of the cultured ADSCs compared with controls. There was an increased apoptosis rate between the 2.5 mm displacement group (7.53%) and controls (5.17%; P

Detection of some new Trichosporon species from the dystrophied nails of three female members of a family from North Indian State of Jammu and Kashmir

Abstract

Dermatophytes are considered as the main pathogens responsible for onychomycosis, but recently successive isolations of yeast-like fungi from the infected nails has led to consider these also as primary agents of nail infections. Trichosporon species which are non-candidal, basidiomycetous, yeast-like, anamorphic fungi are commonly isolated from soil but they are also emerging as important etiological agents of onychomycosis. Three species of Trichosporon viz., T. asahii, T. asteroides and T. faecale were isolated from the infected nails of three female members of a family from district Doda of Jammu and Kashmir State. Among the isolated species of Trichosporon, T. asahii was recovered from the nail samples of all the three members, thus confirming its recognition as a main pathogenic species of onychomycosis. So far, there is no report of T. asteroides and T. faecale causing onychomycosis and hence they constitute new additions to the list of onychomycotic fungi. Some of the predisposing factors like low socio-economic condition, poor hygiene, frequent exposure of finger nails to water and dirt, climatic conditions and nail trauma were observed to be the main causes of nail infection in these patients. However, a link between the pathogenic genus and the genetic makeup of the patients is also probable.

This article is protected by copyright. All rights reserved.

Molecular identification and susceptibility profile of Sporothrix schenckii sensu lato isolated in Argentina

Abstract

We studied 23 clinical and environmental strains of Sporothrix schenckii sensu lato collected from 1984 to 2017 in Argentina. The molecular identification (partial sequencing of a fragment of the calmodulin gene) of the strains was performed. For the yeast and mycelial phases, the in vitro susceptibility testing by a microdilution reference method was determined against eight antifungal drugs.

Strains studied were identified as S. schenckii sensu stricto 13 (56.5%), S. brasiliensis 8 (34.7%) and S. globosa 2 (8.7%).

The most active antifungal drugs tested for the yeast and mycelial phases expressed as geometric mean (GM) value of the minimal inhibitory concentration (MIC) (μg ml⁻¹) were terbinafine (0.07 and 0.24), posaconazole (0.13 and 0.58), itraconazole (0.38 and 1.10) and ketoconazole (0.22 and 0.89), while fluconazole (110.10 and 131.92) and flucytosine (2.96 and 79.03) were the less active. For voriconazole and amphotericin B the GM-MIC values were acceptably low for the yeast phase (0.39 and 0.72 μg ml⁻¹), while the mycelial phase showed values ≥2-fold higher (8.76 and 1.88 μg ml⁻¹), p < 0.05.

Here we described S. schenckii sensu stricto, S. brasiliensis and S. globosa, these species were isolated from humans, animals and soil and are circulating in Argentina since at least 1984.

This article is protected by copyright. All rights reserved.

Plant-associated bacteria mitigate drought stress in soybean

Abstract

Agriculture accounts for ~ 70% of all water use and the world population is increasing annually; soon more people will need to be fed, while also using less water. The use of plant-associated bacteria (PAB) is an eco-friendly alternative that can increase crop water use efficiency. This work aimed to study the effect of some PAB on increasing soybean tolerance to drought stress, the mechanisms of the drought tolerance process, and the effect of the PAB on promoting plant growth and on the biocontrol of Sclerotinia sclerotiorum. PAB were isolated from soybean rhizosphere and S. sclerotiorum sclerotia. The strains identified as UFGS1 (Bacillus subtilis), UFGS2 (Bacillus thuringiensis), UFGRB2 and UFGRB3 (Bacillus cereus) were selected on their ability to grow in media with reduced water activity. Soybean plants were inoculated with the PAB and evaluated for growth promotion, physiological and molecular parameters, after drought stress. Under drought stress, UFGS2 and UFGRB2 sustained potential quantum efficiency of PSII (Fv/Fm), while a decrease was found in the control plants. Moreover, UFGS2 and UFGRB3 maintained the photosynthetic rates in non-stressed conditions compared to the control. UFGS2-treated plants showed a higher stomatal conductance and higher transpiration than the control, after drought stress. Some PAB-treated plants also had other beneficial phenotypes, such as increases in fresh and dried biomass relative to the control. Differential gene expression analysis of genes involved in plant stress pathways shows changes in expression in PAB-treated plants. Results from this study suggest that PAB can mitigate drought stress in soybean and may improve water efficiency under certain conditions.