M-mode ultrasound for assessment of the "tethered fat sign" in children: an easily performed way to certify a dynamic process as a still picture.

Background: Omental infarction is a rare pediatric disease. Ultrasound is a useful modality for a non-invasive pre-operative differential diagnosis between inflammatory conditions (as appendicitis) and omental infarction, especially by detecting immobility of the omentum adhered to the abdominal wall ("tetherd fat sign"). However, this is a dynamic sign that cannot be documented in a static image with B-mode technique. The goal of this work is to incorporate the versatile function of motion mode (M-mode) into omental infarction diagnosis to describe how the M-mode is useful in the evaluation of fat motion in children suspected of having omental infarction. In 2019 we suggested a new Ultrasound sign named "tethered fat sign" for an accurate non-invasive diagnosis of omental infarction in children. This finding was observed in 6 of the 234 seen children of our previous study with 4 laparoscopic confirmed diagnosis. Methods: From January 2019 to July 2021, we evaluated 195 children (91 boys and 104 girls, from 3 to 15 years) admitted to our Santobono-Pausilipon Children Hospital with acute right-sided abdominal pain. Abdominal ultrasound was performed to all the patients and the investigation of "tethered fat sign" was always included. Results: In 7 patients ultrasound showed the presence of a hyperechoic oval mass localized in the right upper abdominal quadrant and in 2 of these M-mode documented a normal subhepatic fat moving during respiratory movements in relation with the abdominal wall. The remaining 5 patients had an omental infarction showed as a subhepatic motionless mass tethered to the abdominal wall on M-mode. In these patients, a sonographic follow-up was performed every 15 d for 2 months showing a progressive reduction in size of the right-sided hyperechoic mass. Conclusions: In the evaluation of all children who showed the presence of the "tethered fat sign" the use of M-mode provide a certified image in diagnostic ultrasound.

Time-Trends in Air Pollution Impact on Health in Italy, 1990-2019: An Analysis From the Global Burden of Disease Study 2019.

Objectives: We explored temporal variations in disease burden of ambient particulate matter 2.5 µm or less in diameter (PM2.5) and ozone in Italy using estimates from the Global Burden of Disease Study 2019. Methods: We compared temporal changes and percent variations (95% Uncertainty Intervals [95% UI]) in rates of disability adjusted life years (DALYs), years of life lost, years lived with disability and mortality from 1990 to 2019, and variations in pollutant-attributable burden with those in the overall burden of each PM2.5- and ozone-related disease. Results: In 2019, 467,000 DALYs (95% UI: 371,000, 570,000) were attributable to PM2.5 and 39,600 (95% UI: 18,300, 61,500) to ozone. The crude DALY rate attributable to PM2.5 decreased by 47.9% (95% UI: 10.3, 65.4) from 1990 to 2019. For ozone, it declined by 37.0% (95% UI: 28.9, 44.5) during 1990-2010, but it increased by 44.8% (95% UI: 35.5, 56.3) during 2010-2019. Age-standardized rates declined more than crude ones. Conclusion: In Italy, the burden of ambient PM2.5 (but not of ozone) significantly decreased, even in concurrence with population ageing. Results suggest a positive impact of air quality regulations, fostering further regulatory efforts.

Occurrence of Phthalate Esters in Coffee and Risk Assessment.

Coffee, one of the most widely consumed beverages in the world, is commercialized as powder and beans in different types of packaging and extracted through several methods. In this regard, the present study focused on evaluating the concentration of two of the most used phthalates in plastic materials (bis(2-ethylhexyl)phthalate (DEHP) and di-butyl phthalate (DBP)) in coffee powder and beverages to assess their migration from different packaging and machines. Furthermore, the levels of exposure to these endocrine disruptors in regular coffee consumers were estimated. Samples of packaged coffee powder/beans (n = 60) from different forms of packaging (multilayer bag, aluminum tin, and paper pod) and coffee beverages (n = 40) that were differently extracted (by professional espresso machine (PEM), Moka pot (MP), and home espresso machine (HEM)) were analyzed by extraction of the lipid fraction, purification, and determination by gas chromatography-mass spectrometry (GC/MS). Risk due to consumption of coffee (1-6 cups) was assessed based on tolerable daily intake (TDI) and incremental lifetime cancer risk (ILCR). No significant differences emerged in DBP and DEHP concentrations among different types of packaging (multilayer, aluminum, and paper), whereas higher levels of DEHP were reported in beverages extracted by PEM (6.65, 2.58-11.32) than by MP (0.78, 0.59-0.91) and HEM (0.83, 0.62-0.98). The presence of higher DEHP levels in coffee beverages than in coffee powder may be due to its leaching through machine components. However, the levels of PAEs did not exceed the specific migration limits (SMLs) set out for food contact materials (FCM), and exposure to PAEs from coffee beverages was low, justifying the small risk due of its consumption. Consequently, coffee can be considered a safe beverage for exposure to some phthalic acid esters (PAEs).

Coffee Silverskin: Chemical and Biological Risk Assessment and Health Profile for Its Potential Use in Functional Foods.

The coffee supply chain is characterized by a complex network with many critical and unsustainable points producing a huge amount of waste products. Among these, coffee silverskin (CS), the only by-product of the coffee roasting phase, has an interesting chemical profile that suggests potential use as a food ingredient. However, few data on its safety are available. For this reason, the purpose of the study was to assess the occurrence of chemical and biological contaminants in CS, and the resulting risk due to its potential consumption. Essential, toxic, and rare earth elements, polycyclic aromatic hydrocarbons (PAHs), process contaminants, ochratoxin A (OTA), and pesticides residues were analyzed in three classes of samples (Coffea arabica CS, Coffea robusta CS, and their blend). Furthermore, total mesophilic bacteria count (TMBC) at 30 °C, Enterobacteriaceae, yeasts, and molds was evaluated. The risk assessment was based upon the hazard index (HI) and lifetime cancer risk (LTCR). In all varieties and blends, rare earth elements, pesticides, process contaminants, OTA, and PAHs were not detected except for chrysene, phenanthrene, and fluoranthene, which were reported at low concentrations only in the arabica CS sample. Among essential and toxic elements, As was usually the most representative in all samples. Microorganisms reported a low load, although arabica and robusta CS showed lower contamination than mixed CS. Instead, the risk assessment based on the potential consumption of CS as a food ingredient did not show either non-carcinogenic or carcinogenic risk. Overall, this study provides adequate evidence to support the safety of this by-product for its potential use in functional foods.

Effects of Covid-19 pandemic lockdown and environmental pollution assessment in Campania region (Italy) through the analysis of heavy metals in honeybees.

The Covid-19 outbreak had a critical impact on a massive amount of human activities as well as the global health system. On the other hand, the lockdown and related suspension of working activities reduced pollution emissions. The use of biomonitoring is an efficient and quite recent tool to assess environmental pollution through the analysis of a proper bioindicator, such as bees. This study set out to ascertain the impact of the Covid-19 pandemic lockdown on the environmental occurrence of eleven heavy metals in the Campania region (Italy) by analyzing bees and bee products. A further aim of this study was the assessment of the Honeybee Contamination Index (HCI) in three different areas of the Campania region and its comparison with other Italian areas to depict the current environmental pollutants levels of heavy metals. The results showed that the levels of heavy metals bioaccumulated by bees during the pandemic lockdown (T1) were statistically lower than the sampling times after Covid-19 restrictions and the resumption of some or all activities (T2 and T3). A comparable trend was observed in wax and pollen. However, bee, pollen, and wax showed higher levels of Cd and Hg in T1 than T2 and T3. The analysis of the HCI showed a low contamination level of the sampling sites for Cd and Pb, and an intermediate-high level as regards Ni and Cr. The biomonitoring study highlighted a decrease of heavy metals in the environmental compartments due to the intense pandemic restrictions. Therefore, Apis mellifera and other bee products remain a reliable and alternative tool for environmental pollution assessment.

Assessment of a collaborative concussion management strategy in a school-based sport program: Prospective cohort study.

OBJECTIVE: To analyze the implementation of a concussion management protocol in which a team physiotherapist is involved in the identification of concussions and return-to-play (RTP) decisions. DESIGN: A prospective injury surveillance cohort study in a school-based Canadian football program (4 teams; grades 8 to 12) over 4 years. For years 1 to 2, the team physician made all RTP decisions; over years 3 to 4, the team physiotherapist was allowed to make some RTP decisions using pre-established criteria defined in the protocol. SETTING: A high school in Québec, Que. PARTICIPANTS: Male student athletes between 11 and 17 years old. MAIN OUTCOME MEASURES: Same-season recurrence (SSR) of concussion symptoms following RTP. RESULTS: A total of 119 concussions were identified (55 during the first 2 years and 64 during the last 2 years) during 27,741 athlete-exposures in 672 athlete-years for an incidence rate of 4.3 per 1000 athlete-exposures. During years 1 to 3, no SSR was observed following RTP clearance. During year 4 there was 1 case of SSR that occurred 11 days after clearance. The overall SSR rate of concussion symptoms following RTP clearance was 0.8%. CONCLUSION: A very low rate of SSR was achieved whether the team physician made all RTP decisions or the team physiotherapist was allowed to make some of the RTP decisions through the terms of the protocol.

Acrylamide levels in smoke from conventional cigarettes and heated tobacco products and exposure assessment in habitual smokers.

Acrylamide (AA) is a neurotoxic, genotoxic, and carcinogenic compound developed during heating at high temperatures. Foods such as potatoes, biscuits, bread and coffee are the main foodstuffs containing AA. Cigarette smoke may be a significant additional source of exposure. However, AA content may vary among different types of cigarettes. The study aimed to evaluate the AA content in conventional cigarettes (CC) and heated tobacco products (HTP) and its resulting exposure through their use. AA levels from the two types of cigarettes were determined by GC-MS and the daily exposure to AA was also ascertained. The margin of exposure (MOE) was calculated for neurotoxic and carcinogenic risk based on benchmark dose lower confidence limit for a 10% response (BMDL10) of 0.43 and 0.17, 0.30, and 1.13 mg/kgbw/day. AA level in CC ranged from 235 to 897 ng/cigarette, whereas HTP reported AA levels in the range of 99-187 ng/cigarette. The data showed a low neurotoxic risk for either CC or HTP, whereas a carcinogenic risk emerged through the smoking of CC based on different Benchmark doses. The carcinogenic risk for CC based on the highest Benchmark dose that was considered showed unsafe levels, as little as 10 CC cigarettes/day, whereas it was almost always of low concern for HTP. Another approach based upon the incremental lifetime cancer risk (ILCR) analysis led to similar results, exceeding, in some cases, the safety value of 10-4, as far as CC are concerned. Overall, the results confirmed that CC are a significant source of AA, and its levels were five times higher than in HTP.

The "reverse air leak test": a new technique for the assessment of low colorectal anastomosis.

PURPOSE: Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis was assessed transanally through the intrarectal irrigation of a few mL of saline solution. METHODS: From October 2014 to November 2019, 11 patients with low rectal cancer (type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of indocyanine green was performed in order to evaluate the perfusion of the anastomosis. RESULTS: The reverse air leak test was positive in 4 cases (36.4%). The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed no perfusion defect (grade 0) in low colorectal anastomosis. No postoperative fistula was detected in cohort study. A protective stoma was performed in 10 patients. On day 90, there were no complications and stoma closure was performed as planned. CONCLUSION: The reverse air leak test is a simple, feasible, and effective procedure to identify anastomotic leaks in low colorectal anastomoses.

Acrylamide in Baby Foods: A Probabilistic Exposure Assessment.

Acrylamide (also known as 2-propenamide) (AA) is a toxicant that develops in food during high-temperature cooking, and its occurrence is common in biscuits and baked snacks. AA is known for its in vivo neurotoxic and carcinogenic effects, and it is considered a potential carcinogen for humans. Infants may be exposed to AA as early as during weaning through baked food such as biscuits. This study set out to ascertain the concentration of AA in food products intended for infants to assess the dietary exposure to this food contaminant. AA levels were determined through GC/MS and bromination, and dietary exposure was evaluated by a probabilistic method based on Monte Carlo simulation. The results showed that the probability of a carcinogenic exposure is 94%, 92%, and 87%, respectively, for 6-, 12-, and 18-months infants, suggesting the need to delay the introduction of baked products in the diet of weaned infants. It should be noted, however, that these conclusions were drawn considering the biscuits as the primary source of exposure.

Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries.

This study aims to investigate the association between gross domestic product (GDP), mortality rate (MR) and current healthcare expenditure (CHE) in 31 high-income countries. We used panel data from 2000 to 2017 collected from WHO and OECD databases. The association between CHE, GDP and MR was investigated through a random-effects model. To control for reverse causality, we adopted a test of Granger causality. The model shows that the MR has a statistically significant and negative effect on CHE and that an increase in GDP is associated with an increase of CHE (p < 0.001). The Granger causality analysis shows that all the variables exhibit a bidirectional causality. We found a two-way relationship between GDP and CHE. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources, this evidence should be taken into due consideration.

Occurrence of Acrylamide in Italian Baked Products and Dietary Exposure Assessment.

Acrylamide (AA) is a neo-formed toxic compound that develops in foods during cooking at temperatures above 120 °C. AA shows in vivo neurotoxic and carcinogenic effects, and it is potentially carcinogenic for humans. Its occurrence is common in baked food, such as bread and similar products. This study set out to analyze bread and sweets from the Italian market to evaluate the effects of the benchmark thresholds set by EU Regulation 2017/2158 and to ascertain the exposure of the Italian population to AA, across three age groups, through the consumption of baked products, according to the margin of exposure (MOE) approach. Two hundred samples were tested, and the content of AA ranged from 31 to 454 µg/kg for bread and products thereof and from 204 to 400 µg/kg for the sweets category. The exposure data did not show any neurotoxic health concern, whereas the MOE related to the carcinogenic endpoint is well below the minimum safety value of 10,000.

Assessment of the relative sensitivity of the copepods Acartia tonsa and Acartia clausi exposed to sediment-derived elutriates from the Bagnoli-Coroglio industrial area.

The sensitivity of the copepods Acartia tonsa, commonly used in standardized tests for environmental risk assessment and A. clausi, the dominant autochthonous congener species in the Mediterranean Sea, was assessed using sediment-derived elutriates from the industrial area of Bagnoli-Coroglio and nickel chloride as referent toxicant. Acute A. clausi naupliar immobilization test showed EC50 for elutriates E25, E56 and E84 of 23.3%, 80.5% and >100%, respectively, compared to 59.5%, 66.6% and >100% in A. tonsa. In the 7 day sublethal test, a reduction in A. clausi egg production rates was observed in all elutriates, but only in E56 for A. tonsa. Elutriate 56, which contained the highest amount of polycyclic aromatic hydrocarbons, also induced 70% mortality in A. clausi females. Although A. clausi was more sensitive than A. tonsa, the two species had convergent responses to the three elutriates, thus opening the venue for a potential use of A. clausi in standardized ecotoxicity tests.

Determination of acrylamide levels in potato crisps and other snacks and exposure risk assessment through a Margin of Exposure approach.

Potato crisps, corn-based extruded snacks and other savoury snacks are very popular products especially among younger generations. These products could be a potential source of acrylamide (AA), a toxic compound which could develop during frying and baking processes. The purpose of this study was the assessment of the dietary intake to AA across six groups of consumers divided according to age through the consumption of potato crisps and other snacks, in order to eventually evaluate the margin of exposure (MOE) related to neurotoxic and carcinogenic critical endpoints. Different brands of potato crisps and other popular snacks were analyzed through a matrix solid-phase dispersion method followed by a bromination step and GC-MS quantification. The concentration of detected AA ranged from 21 to 3444 ng g-1 and the highest level occurred in potato crisps samples which showed a median value of 968 ng g-1. The risk characterization through MOE assessment revealed that five out of six consumers groups showed higher exposure values associated with an augmented carcinogenic risk.

Exposure assessment to fumonisins B1, B2 and B3 through consumption of gluten-free foodstuffs intended for people affected by celiac disease.

Fumonisins are mycotoxins produced by Fusarium species and affecting maize crops. Some analogues of fumonisins are known for their toxic and possible carcinogenic effects on humans and animals. Because of their occurrence in corn-based food, diet is the main source of exposure to these mycotoxins, especially among people affected by celiac disease. Hence, the purpose of this paper was to evaluate the amount of fumonisins B1, B2 and B3 in maize-based products and to assess the exposure of people affected by celiac disease to fumonisins. The sample consisted of 154 gluten-free products analyzed according to method UNI EN 14352:2005. Results showed a heterogeneous contamination by fumoninisin B1, B2 and B3, although below limits of Commission Regulation No 1126/2007 and consistent with other European literature data. Exposure to fumonisins was evaluated for different age groups. In some cases exposure to fumonisins could not be ignored since the total intake could exceed EFSA Provisional Maximum Tolerable Intake up to 150%. Therefore, in the light of an overall contamination by fumonisins the total dietary exposure could be underrated not only in people affected by celiac disease, but also in non-celiac population.