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Chromium (Cr) is a toxic metal in soil-plant system, hence causing possible health risks prominently in the areas with forgoing industrial activities. Copper nanoparticles (Cu NPs) have been reported as an excellent adsorbent for pollutants. Therefore, this study investigates how copper nanoparticles enhance onion growth while decreasing chromium uptake in onion plants. Additionally, it examines the potential health risks of consuming onion plants with elevated chromium levels. The results demonstrated that the addition of CuNPs at 15 mg kg-1 significantly improved the plant height (48%), leaf length (37%), fresh weight of root (61%), root dry weight (70%), fresh weight of bulb (52%), bulb dry weight (59%), leaves fresh weight (52%) and dry weight of leaves (59%), leaf area (72%), number of onion leaves per plant (60%), Chl. a (42%), chl. b (36%), carotenoids (40%), total chlorophyll (40%), chlorophyll contents SPAD value (56%), relative water contents (35%), membrane stability index (16%), total sugars (25%), crude protein (21%), ascorbic acid (19%) and ash contents (64%) at 10 mg kg-1 Cr. Whereas, maximum decline of Cr by 46% in roots, 68% in leaves and 92% in bulb was found with application of 15 mg kg-1 of Cu NPs in onion plants under 10 mg kg-1 Cr toxicity. The health risk assessment parameters of onion plants showed minimum values 0.0028 for average daily intake (ADI), 0.001911 for Non-cancer risk (NCR), and 0.001433 for cancer risk (CR) in plants treated with Cu NPs at 15 mg kg-1 concentration grown in soil spiked with 10 mg kg-1 chromium. It is concluded that Cu NPs at 15 mg kg-1 concentration improved growth of plants in control as well as Cr contaminated soil. Therefore, use of Cu NPs at 15 mg kg-1 concentration is recommended for improving growth of plants under normal and metal contaminated soils.
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Cromo , Cobre , Nanopartículas del Metal , Cebollas , Contaminantes del Suelo , Cebollas/efectos de los fármacos , Cebollas/crecimiento & desarrollo , Cobre/toxicidad , Cromo/toxicidad , Contaminantes del Suelo/toxicidad , Raíces de Plantas/efectos de los fármacos , Raíces de Plantas/crecimiento & desarrollo , Raíces de Plantas/metabolismo , Hojas de la Planta/efectos de los fármacos , Hojas de la Planta/química , Hojas de la Planta/crecimiento & desarrollo , Clorofila/metabolismoRESUMEN
Introduction: There is a controversy in minimally invasive colorectal procedures regarding choosing optimal technique between intra-corporeal (ICA) and extra-corporeal anastomosis (ECA). Previous studies recognize the short-term benefits in right hemicolectomy with intra-corporeal approach; however, ICA can result in increased operative difficulty. The aim of this study is to understand attitudes towards teaching ICA in colorectal procedures and how this varies between subspeciality training. Methods: Active members of General Surgeons Australia were contacted through email to participate in a voluntary, unincentivized survey. Demographic details were collected and participants were asked to rate agreement for simulation-based training for increasing adoption of ICA through a Likert scale and when preferences for teaching ICA. Descriptive statistics were completed to describe frequencies and ordinal regression was completed to determine factors for Likert scale question. Results: There were 43 respondents and most participants recognized that ECA was easier to teach trainees and should be taught first. 53.5% of respondents recognized that simulation-based training would assist the adoption of ICA. Surgeons who routinely close bowel or enteric defects intra-corporeally are 354% more likely to show an interest in simulation-based training for adopting ICA, however, surgeons who are not involved in teaching trainees did not show an interest in simulation-based training. Conclusion: There is significant agreement that ECA forms the basis to learn ICA and simulation-based training would assist with the uptake of ICA. However, a multimodal approach, including expanding training avenues and providing financial incentives, would be necessary to enhance the adoption of ICA in colorectal surgery.
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Anastomosis Quirúrgica , Actitud del Personal de Salud , Humanos , Anastomosis Quirúrgica/educación , Cirujanos/educación , Cirujanos/psicología , Australia , Masculino , Encuestas y Cuestionarios , Femenino , Entrenamiento Simulado/métodos , Cirugía Colorrectal/educaciónRESUMEN
Retrosplenic colonic interposition is a rare anatomical variant which involves an aberrant positioning of the colon between the spleen and the left hemidiaphragm. Cross-sectional imaging, particularly preoperative computed tomography, plays a critical role in identifying this variant. Recognition of a retrosplenic colonic interposition is essential in certain surgical procedures for ensuring appropriate management tailored to individual patient anatomy and minimizing complications. To our knowledge, this is the first case report describing retrosplenic colonic interposition during colonic resection.
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INTRODUCTION: Minimally invasive colonic anastomosis can be performed intracorporeally or extracorporeally with laparoscopic or robotic assistance. In colorectal surgery, choosing the optimal approach is still controversial. Mainly, the debate involves balancing the potential benefits of intracorporeal anastomosis (ICA) with increased technical difficultly with the more straightforward and widely accepted extracorporeal anastomosis (ECA). Both techniques require different skill sets, and this study aims to identify barriers that prevent adoption of ICA. METHODS: A 31-point questionnaire survey was distributed through the General Surgeons Australia (GSA) platform of active general surgeon in Australia. It was open for 2 months between July and August 2023. Statistical analysis was completed using descriptive analysis and logistic regression. RESULTS: Forty-three general surgeons completed the survey. ECA was the most performed and preferred surgical technique. It was identified that increased operative time is the biggest barrier to completing ICA followed by lack of training and no perceived benefit with ICA. Patient comorbidities did not result in choosing ICA over ECA; however, surgeons with less experience and volume in colorectal surgery were more likely complete ECA in operations with increased technical difficulty. CONCLUSION: Although ECA is the go-to technique for many Australian general surgeons, it is evident that they may be overlooking the benefits offered by ICA. Further training is required to improve operative times and confidence in the technique. Ongoing research, audits of existing techniques, and updated training will assist surgeons becoming acquainted with the latest evidence and to offer the best care to their patients.
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Neoplasias Colorrectales , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Cirujanos , Humanos , Colectomía/métodos , Anastomosis Quirúrgica/métodos , Australia , Laparoscopía/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
OBJECTIVE: To identify the patient-reported outcome measures (PROMs) after intracorporal anastomosis (ICA) during laparoscopic right hemicolectomy. STUDY DESIGN: An observational study. Place and Duration of the Study: Department of General Surgery, Griffith Base Hospital, New South Wales, Australia, from August 2022 till February 2023. METHODOLOGY: Participants who underwent laparoscopic intracorporeal right hemicolectomy were included in this study. Patients requiring emergency procedures or with a history of psychiatric illness were excluded. The Short Form-36 (SF-36); a quality of life (QoL) questionnaire employed focusing on physical health-related domains post laparoscopic intracorporeal hemicolectomy. The relationship between QoL domains and operative outcomes specific to this anastomotic technique was also assessed. RESULTS: The SF-36 scores at six weeks and six months postoperation revealed shifts in the overall QoL following ICA. Notably, physical function showed significant improvement, while bodily pain remained a significant concern. The correlation analysis found operative blood loss and the length of the extraction site to be significantly correlated with postoperative physical role. CONCLUSION: The study determined that decreased operative blood loss and a shorter extraction site were associated with improved postoperative physical role. It showed the overall QoL improved within six months of the procedure, with the bodily pain domain still an area requiring attention. Understanding the impact of laparoscopic ICA on patient-reported outcomes may help in tailoring patient-cantred approaches and enhancing the overall quality of care. KEY WORDS: Intracorporeal, Right hemicolectomy, Patient-reported outcome measures, Colorectal anastomosis.
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Neoplasias del Colon , Laparoscopía , Humanos , Calidad de Vida , Pérdida de Sangre Quirúrgica , Colectomía/métodos , Anastomosis Quirúrgica/métodos , Laparoscopía/métodos , Medición de Resultados Informados por el Paciente , Dolor , Evaluación del Resultado de la Atención al Paciente , Neoplasias del Colon/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Competency-based training (CBT) programs use procedure-based assessments (PBAs) to evaluate trainees' abilities to perform specific procedures in clinical settings, similar to Entrustable Professional Activities (EPAs). PBAs help determine trainees' readiness for advanced training levels. However, there is limited evidence on implementing colorectal-specific PBAs in surgical training schemes. This review aims to identify observed and perceived challenges to implementing PBAs in workplace settings. METHODS: A scoping review following the Joanna Briggs Institute Protocol for Scoping Reviews (JBI-ScR) was conducted. Eligible studies provided evidence on the implementation, feasibility, and challenges of PBAs in colorectal surgery, including various study designs from retrospective to prospective. RESULTS: Of the 80 screened studies, 75 were excluded based on exclusion criteria. Most of the included studies were conducted in national training institutions in the United Kingdom, assessing 778 colorectal procedures with specific PBAs. The main facilitators of implementing PBAs were structured assessments, focused assessors' training, and electronic forms usage. CONCLUSION: This review offers insight into the practicality and feasibility of implementing PBAs in colorectal surgery. Identified challenges include the need for adequate assessor training and the time-consuming nature of the assessment. These findings could improve PBA implementation in colorectal surgery and enhance surgical education quality. However, the limited number of studies and existing literature heterogeneity call for more research to identify other gaps.
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Neoplasias Colorrectales , Cirugía Colorrectal , Humanos , Cirugía Colorrectal/educación , Estudios Prospectivos , Estudios Retrospectivos , Lugar de Trabajo , Competencia Clínica , Neoplasias Colorrectales/cirugíaRESUMEN
We investigated the role of ascorbic acid (AsA) to alleviate nickel (Ni) induced adverse effects on growth and concentration of Ni, copper (Cu), and manganese (Mn) in hydroponically grown wheat varieties viz. Galaxy, Punjab-2011, and FSD-08. Plants were exposed to five levels of Ni viz. 0, 5, 10, 15, and 20 mg L-1. After 1 week, AsA (1 mM) was sprayed onto the Ni-stressed plants. FSD-08 produced the maximum SDW with and without AsA compared to other varieties. FSD-08, Galaxy, and Punjab-2011 witnessed 2.61-, 2.83-, and 7.5-fold increases in SDW with AsA, respectively. Wheat plants contained the maximum Ni in shoots and roots with a Ni level of 20 mg L-1 irrespective of varieties. Nickel in shoots decreased with AsA witnessing 13, 12, and 10% decrease in FSD-08, Punjab-2011, and Galaxy, respectively. Nickel in roots of FSD-08 decreased by 18% while increased by 3.34-fold and 3.50-fold in Galaxy and Punjab-2011, respectively with AsA. Nickel decreased Cu in shoot and Mn in shoot and root while Cu in roots of all wheat varieties increased. It was concluded that AsA improved the growth of Ni-stressed and FSD-08 performed better by maintaining good growth and less Ni in shoots compared to other varieties.
Exploiting plant internal mechanisms with foliar application of different organic substances have widely been investigated to decrease metal accumulation and their adverse effects on plants. However, the differential response of different varieties to metal accumulation in response to foliar application of ascorbic acid is not well documented. This study was conducted to investigate the effect of exogenous application of ascorbic acid on growth response, the concentration of Ni, Cu, and Mn in three wheat varieties.
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Níquel , Contaminantes del Suelo , Ácido Ascórbico , Biodegradación Ambiental , Cobre/toxicidad , Manganeso/toxicidad , Níquel/toxicidad , Raíces de Plantas/química , Contaminantes del Suelo/análisis , Contaminantes del Suelo/toxicidad , TriticumRESUMEN
Contamination of soils with heavy metals, particularly cadmium (Cd), is an increasingly alarming environmental issue around the world. Application of organic and inorganic immobilizing amendments such as biochar and gravel sand in combination with metal-tolerant microbes has the potential to minimize the bioavailability of Cd to plants. The present study was designed to identify the possible additive effects of the application of Enterobacter sp. MN17 as well as biochar and gravel sand on the reduction of Cd stress in plants and improvement of growth and nutritional quality of pea (Pisum sativum) plants through the reduction of Cd uptake. Pea seeds were surface sterilized then non-inoculated seeds and seeds inoculated with Enterobacter sp. MN17 were planted in artificially Cd-polluted soil, amended with the immobilizing agents biochar and gravel sand. Application of biochar and gravel sand alone and in combination not only improved the growth and nutritional quality of pea plants by in situ immobilization but also reduced the uptake of Cd by plant roots and its transport to shoots. However, microbial inoculation further enhanced the overall plant health as well as alleviated the toxic effects of Cd on the pea plants. These soil treatments also improved rates of photosynthesis and transpiration. The combined use of biochar and gravel sand with bacterial inoculation resulted in an increase in plant height (47%), shoot dry weight (42%), root dry weight (57%), and 100 seeds weight (49%) as compared to control plants in Cd contaminated soil. Likewise, biochemical constituents of pea seeds (protein, fat, fiber, and ash) were significantly increased up to 41%, 74%, 32%, and 72%, respectively, with the combined use of these immobilizing agents and bacterium. Overall, this study demonstrated that the combined application of biochar and gravel sand, particularly in combination with Enterobacter sp. MN17, could be an efficient strategy for the remediation of Cd contaminated soil. It could support better growth and nutritional quality of pea plants.
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Although the most common cause of cholecystitis is gallstones, other conditions may present as acute cholecystitis. We describe a case of eosinophilic cholecystitis with common bile duct stricture. A 36-year-old woman initially had generalised abdominal pain and peripheral eosinophilia. Diagnostic laparoscopy showed eosinophilic ascites and necrotic nodules on the posterior abdominal wall. She was treated with anthelminthics on presumption of toxacara infection based on borderline positivity of serological tests. She later presented with acute cholecystitis and had a cholecystectomy and choledocotomy. Day 9 T-tube cholangiogram showed irregular narrowing of the distal common bile duct. The patient's symptoms were improved with steroids and the T-tube was subsequently removed.
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Colecistitis/cirugía , Conducto Colédoco/patología , Conducto Colédoco/cirugía , Adulto , Colecistectomía/instrumentación , Colecistitis/tratamiento farmacológico , Colecistitis/etiología , Constricción Patológica/tratamiento farmacológico , Constricción Patológica/cirugía , Femenino , Humanos , Enfermedades Raras , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
INTRODUCTION: Cytomegalovirus (CMV) is predominantly an opportunistic infection in the immunocompromised patients. Though, there are few cases of CMV colitis being reported in the immunocompetent individuals, CMV enteritis is exceedingly rare and enteritis leading into small bowel ischemia has never been reported yet. PRESENTATION OF CASE: A-78-year-old male patient presented with distal small obstruction for 4 days duration. Clinical examination revealed a distended abdomen and localised peritonism in right iliac fossa. An initial computed tomography (CT) scan revealed distended small bowel loops up to the thickened inflammed terminal illeum with no free fluid or gas and a normal appendix. No immunosuppressive risk factors such as human immunodeficiency virus, transplant procedures, or steroid therapy were present. Hematologic investigations showed leucocytosis with neutrophilia. Diagnostic laparoscopy confirmed a thickened terminal ileum causing small bowel obstruction. Laparoscopy converted to laparotomy and right hemicolectomy was performed. Histology showed isolated small bowel ischemia with ulcerative changes and cytomegalovirus inclusions. The patient was started on ganciclovir therapy and subsequently had an uneventful recovery and discharged after 16 days. DISCUSSION: Cytomegalovirus enteritis was initially not suspected in our patient. In this case CMV caused ischemia of the small bowel without evidence of colonic involvement. Even in elderly patients, the small bowel remains resilient to the ischemic changes because of the copious blood supply. CONCLUSION: We report possibly the first case of isolated small bowel ischaemia caused by cytomegalovirus in immunocompetent individuals, needed surgical resection.
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INTRODUCTION: Superior mesenteric artery (SMA) syndrome is a relatively rare aetiology of proximal intestinal obstruction. This is caused by narrowing of vascular angle of SMA and aorta compressing the third part of the duodenum (D3). Predisposing factors may include precipitous weight loss, corrective spinal surgery or repair of an aortic aneurysm. PRESENTATION OF CASE: A 53 year old male presented to our department with worsening post-prandial vomiting and epigastric pain for last three months. One examination, epigastric region was distended with succussion splash on abdominal auscultation. History did not include any predisposing factor. CT scan showed narrow angle of 12.77° between SMA and aorta owing to the compression of D3. Since onset of vomiting and resultant poor oral intake, he had lost 11 kg of his usual body weight. After gastric decompression, nasojejunal enteral feeding was started. Diet was progressed to oral feedings gradually and following return to his baseline weight, he continued to be free of symptoms in follow-up visits. DISCUSSION: Although there are recognised predisposing factors but sometimes aetiology remains idiopathic. SMA syndrome should initially be managed non-operatively with gastric decompression, correction of water and electrolyte imbalance, and hemodynamic instability. Regaining weight helps increasing vascular space between SMA and D3 thus relieving obstruction. Persistence of symptoms beyond 3-4 weeks warrants surgical intervention. CONCLUSION: Non operative management with nutritional supplementation remains the first line of therapy.