Levels of IgE sensitization drive symptom thresholds in allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to 1 or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated with clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known. OBJECTIVE: To evaluate phenotypical differences between monosensitized and polysensitized patients with AR and to quantify their symptomatic variability. METHODS: A total of 565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. Of those, 155 were monosensitized and 410 were polysensitized. Interactions between sensitization levels and the reporting of different symptoms of AR and co-morbidities, disease duration, and impact were assessed. Furthermore, patients were stratified into monosensitized, oligosensitized, and polysensitized to assess whether the effect of sensitization on the phenotype was ranked. RESULTS: Polysensitized patients reported itchy eyes significantly more often (P = .001) and had a higher number of ocular (P = .005), itch-related (P = .036), and total symptoms (P = .007) than monosensitized patients. In addition, polysensitized adults and children more often reported wheeze (P = .015) and throat-clearing (P = .04), respectively. Polysensitization was associated with more burdensome AR based on a visual analog scale (P = .005). Increased sensitization level was reflected in more itchy eyes, a higher number of ocular, itch-related, and total number of symptoms, and disease burden. CONCLUSION: With an increasing number of sensitizations, patients with AR experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.

Spirulina-based carbon materials as adsorbents for drinking water taste and odor control: Removal efficiency and assessment of cyto-genotoxic effects.

The sensory quality of drinking water, and particularly its taste and odor (T&O) is a key determinant of consumer acceptability, as consumers evaluate water by their senses. Some of the conventional treatment processes to control compounds which impart unpleasant T&O have limitations because of their low efficiency and/or high costs. Therefore, there is a great need to develop an effective process for removing T&O compounds without secondary concerns. The primary objective of this study was to assess for the first time the effectiveness of spirulina-based carbon materials in removing geosmin (GSM) and 2-methylisoborneol (2-MIB) from water, two commonly occurring natural T&O compounds. The efficiency of the materials to remove environmentally relevant concentrations of GSM and 2-MIB (ng L-1) from ultrapure and raw water was investigated using a sensitive headspace solid-phase microextraction coupled with gas chromatography mass spectrometry (HS-SPME-GC/MS) method. Moreover, the genotoxic and cytotoxic effects of the spirulina-based materials were assessed for the first time to evaluate their safety and their potential in the treatment of water for human consumption. Based on the results, spirulina-based materials were found to be promising for drinking water treatment applications, as they did not exert geno-cytotoxic effects on human cells, while presenting high efficiency in removing GSM and 2-MIB from water.

Chemical recycling of bromine-terminated polymers synthesized by ATRP.

Chemical recycling of polymers is one of the biggest challenges in materials science. Recently, remarkable achievements have been made by utilizing polymers prepared by controlled radical polymerization to trigger low-temperature depolymerization. However, in the case of atom transfer radical polymerization (ATRP), depolymerization has nearly exclusively focused on chlorine-terminated polymers, even though the overwhelming majority of polymeric materials synthesized with this method possess a bromine end-group. Herein, we report an efficient depolymerization strategy for bromine-terminated polymethacrylates which employs an inexpensive and environmentally friendly iron catalyst (FeBr2/L). The effect of various solvents and the concentration of metal salt and ligand on the depolymerization are judiciously explored and optimized, allowing for a depolymerization efficiency of up to 86% to be achieved in just 3 minutes. Notably, the versatility of this depolymerization is exemplified by its compatibility with chlorinated and non-chlorinated solvents, and both Fe(ii) and Fe(iii) salts. This work significantly expands the scope of ATRP materials compatible with depolymerization and creates many future opportunities in applications where the depolymerization of bromine-terminated polymers is desired.

Phytochemical Profile and Evaluation of the Antioxidant, Cyto-Genotoxic, and Antigenotoxic Potential of Salvia verticillata Hydromethanolic Extract.

This study comprises the phytochemical characterization, the evaluation of the total phenolic content (TPC) and antioxidant activity (AA), and the investigation of the cyto-genotoxic and antigenotoxic potential of hydromethanolic extract derived from Salvia verticillata L. leaves. HPLC-DAD-ESI-MS and HPLC-DAD were used for the characterization of the extract and determination of the major ingredients. Afterwards, the TPC and AA were determined. The cytotoxic and genotoxic effect of the extract on cultured human lymphocytes at concentrations of 10, 25, and 50 µg mL-1 was investigated via the Cytokinesis Block MicroNucleus (CBMN) assay. Moreover, its antigenotoxic potential against the mutagenic agent mitomycin C (MMC) was assessed using the same assay. The hydromethanolic extract comprises numerous metabolites, with rosmarinic acid being the major compound. It had a high value of TPC and exerted significant AA as shown by the results of the Ferric Reducing Antioxidant Power (FRAP) and Radical Scavenging Activity by DPPH• assays. A dose-dependent cytotoxic potential was recorded, with the highest dose (50 µg mL-1) exhibiting statistically significant cytotoxicity. None of the tested concentrations induced significant micronuclei (MN) frequencies, indicating a lack of genotoxicity. All tested concentrations reduced the MMC-mediated genotoxic effects, with the two lowest showing statistically significant antigenotoxic potential.

Enhanced synthesis of multiblock copolymers via acid-triggered RAFT polymerization.

The synthesis of multiblock copolymers has emerged as an efficient tool to not only reveal the optimal way to access complex structures and investigate polymer properties but also to ascertain the end-group fidelity of a given polymerization methodology. Although reversible addition-fragmentation chain-transfer (RAFT) polymerization is arguably the most dominant strategy employed, its success is often hampered by the unavoidable and excessive use of radical initiators which results in increased termination and loss of end-group fidelity. In this work, we employ acid in RAFT polymerization to enhance the synthesis of multiblock copolymers. By the addition of a small amount of acid, a 4-fold decrease in the overall required radical initiator concentration was achieved, enabling the synthesis of a range of well-defined multiblock copolymers with various degrees of polymerization (DP) per block. The acid enhances the propagation rate, minimizing the initiator concentration. In all cases, near-quantitative monomer conversion was obtained (>97%) for every iterative block formation step. Notably, and in contrast to conventional RAFT approaches, the tailing to low molecular weight was significantly suppressed and the dispersity was maintained nearly constant (i.e. in most cases D = 1.1-1.2), thus indicating minor termination events and side reactions during acid-enhanced synthesis. The possibility to synthesize multiblocks consisting of methacrylates, acrylates, and acrylamides was also demonstrated. This work presents an advancement in the synthesis of well-defined multiblock copolymers and more broadly, RAFT polymers with high end-group fidelity.

Extraction of High Value Products from Zingiber officinale Roscoe (Ginger) and Utilization of Residual Biomass.

Zingiber officinale Roscoe (ginger) is a plant from the Zingiberaceae family, and its extracts have been found to contain several compounds with beneficial bioactivities. Nowadays, the use of environmentally friendly and sustainable extraction methods has attracted considerable interest. The main objective of this study was to evaluate subcritical propane (scPropane), supercritical CO2 (scCO2), and supercritical CO2 with ethanol (scCO2 + EtOH) as co-solvent methods for the extraction of high value products from ginger. In addition, the reuse/recycling of the secondary biomass in a second extraction as a part of the circular economy was evaluated. Both the primary and the secondary biomass led to high yield percentages, ranging from 1.23% to 6.42%. The highest yield was observed in the scCO2 + EtOH, with biomass prior used to scCO2 extraction. All extracts presented with high similarities as far as their total phenolic contents, antioxidant capacity, and chemical composition. The most abundant compounds, identified by the two different gas chromatography-mass spectrometry (GC-MS) systems present, were a-zingiberene, ß- sesquiphellandrene, a-farnesene, ß-bisabolene, zingerone, gingerol, a-curcumene, and γ-muurolene. Interestingly, the reuse/recycling of the secondary biomass was found to be promising, as the extracts showed high antioxidant capacity and consisted of significant amounts of compounds with beneficial properties.

Sonocatalytic degradation of Bisphenol A from aquatic matrices over Pd/CeO2 nanoparticles: Kinetics study, transformation products, and toxicity.

In this work, different ratios of palladium - cerium oxide (Pd/CeO2) catalyst were synthesized and characterized, while their sonocatalytic activity was evaluated for the degradation of the xenobiotic Bisphenol A (BPA) from aqueous solutions. Sonocatalytic activity expressed as BPA decomposition exhibited a volcano-type behavior in relation to the Pd loading, and the 0.25Pd/CeO2 catalyst characterized by the maximum Pd dispersion and lower crystallite size demonstrated the higher activity. Using 500 mg/L of 0.25 % Pd/CeO2 increased the kinetic constant for BPA destruction by more than two times compared to sonolysis alone (20 kHz at 71 W/L). Meanwhile, the simultaneous use of ultrasound and a catalyst enhanced the efficiency by 50.1 % compared to the sum of the individual processes, resulting in 95 % BPA degradation in 60 min. The sonocatalytic degradation of BPA followed pseudo-first-order kinetics, and the apparent kinetic constant was increased with ultrasound power and catalyst loading, while the efficiency was decreased in bottled water and secondary effluent. From the experiments that were conducted using appropriate scavengers, it was revealed that the degradation mainly occurred on the bubble/liquid interface of the formed cavities, while the reactive species produced from the thermal or light excitation of the prepared semiconductor also participated in the reaction. Five first-stage and four late-stage transformation products were identified using UHPLC/TOF-MS, and a pathway for the sonocatalytic degradation of BPA was proposed. According to ECOSAR software prediction, most transformation by-products (TBPs) present lower ecotoxicity than the parent compound, although some remain toxic to the indicators chosen.

Evidence on the genotoxic and ecotoxic effects of PFOA, PFOS and their mixture on human lymphocytes and bacteria.

Considering that the PFOA and PFOS are widely spread chemicals with harmful effects in human and environmental health as well as the increasing interest of the scientific community in the implications that might present especially when they co-exist, this study aims to assess their harmful impacts, both individually and as a mixture on human lymphocytes and aquatic microorganisms. The cytokinesis-block micronucleus (CBMN) assay was used to examine their potential for cytotoxicity and genotoxicity towards human cells, and Microtox assay using Aliivibrio fischeri assay was used to estimate the environmental risk. Regarding the human lymphocytes, the tested concentrations ranged between 250 and 1000 µg L-1, for all cases. PFOA increased slightly the frequency of micronuclei (MN) but without statistical significance. In the case of PFOS, our results showed a dose-dependent increase in the frequency of micronuclei which showed a statistically significant difference (p < 0.001) at 1000 µg L-1, which is the highest studied concentration. Regarding the CBPI index, statistically significant (p < 0.05, p < 0.01, and p < 0.001 respectively) differences were observed at all studied concentrations of PFOS, compared to the control. The mixture was found to be more cytotoxic and genotoxic than the individual tested compounds, causing a higher decrease at the CBPI index even in lower concentrations and increase at the MN frequencies. Aliivibrio fischeri was exposed to various concentrations in the range of 0.5 µg L-1- 20 mg L-1, for 5 and 15 min and significant increase in the inhibition percentage at the highest tested concentration of their mixture after 15 min was observed.

Traumatic lumbar hernia: A systematic review of the literature.

PURPOSE: Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases. METHODS: A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0. RESULTS: A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%. CONCLUSIONS: TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.

Current state of knowledge of environmental occurrence, toxic effects, and advanced treatment of PFOS and PFOA.

Per- and polyfluoroalkyl substances (PFAS) are anthropogenic synthetic compounds, with high chemical and thermal stability and a persistent, stable and bioaccumulative nature that renders them a potential hazard for the environment, its organisms, and humans alike. Perfluorooctane sulfonic acid (PFOS) and Perfluorooctanoic acid (PFOA) are the most well-known substances of this category and even though they are phased out from production they are still highly detectable in several environmental matrices. As a result, they have been spread globally in water sources, soil and biota exerting toxic and detrimental effects. Therefore, up and coming technologies, namely advanced oxidation processes (AOPs) and advanced reduction processes (ARPs) are being tested for their implementation in the degradation of these pollutants. Thus, the present review compiles the current knowledge on the occurrence of PFOS and PFOA in the environment, the various toxic effects they have induced in different organisms as well as the ability of AOPs and ARPs to diminish and/or eliminate them from the environment.

Primary adrenal Ewing sarcoma: A systematic review of the literature.

BACKGROUND: Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland. AIM: To present a comprehensive review of primary adrenal ES, with emphasis on diagnosis, therapy and oncological outcomes. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. PubMed/ MEDLINE, EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor (PNET) of the adrenal gland. PubMed, Google Scholar and EMBASE medical databases were searched, combining the terms "adrenal", "ES" and "PNET". Demographic, clinical, pathological and oncological data of patients were analyzed by SPSS version 29.0. RESULTS: A total of 52 studies were included for review (47 case reports and 5 case series) with 66 patients reported to have primary adrenal ES. Mean age at diagnosis was 26.4 ± 15.4 years (37.9% males, 57.6% females, sex not reported in 3 cases). The most frequent complaint was abdominal/flank pain or discomfort (46.4%) followed by a palpable mass (25.0%), and the average duration of symptoms was 2.6 ± 3.1 mo. The imaging modality of choice was computed tomography scan (81.5%), followed by magnetic resonance imaging (20.4%). Preoperative staging revealed that 17 tumors (27.9%) were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis. Open adrenalectomy was performed in the majority of cases (80.0%), of which 27.9% required more extensive resection. Minimally invasive surgery was attempted in 8.2% of tumors. Complete surgical resection was achieved in 89.4% of the patients. Adjuvant therapy was administered to 32 patients, in the form of chemotherapy (62.5%), radiotherapy (3.1%) or combination (34.4%). Median overall survival was 15 mo and 24-mo overall survival was 40.5%. Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%. CONCLUSION: The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes. ES remains an aggressive tumor with a poor prognosis and high mortality.

Mediterranean Plants as Potential Source of Biopesticides: An Overview of Current Research and Future Trends.

The development and implementation of safe natural alternatives to synthetic pesticides are urgent needs that will provide ecological solutions for the control of plant diseases, bacteria, viruses, nematodes, pests, and weeds to ensure the economic stability of farmers and food security, as well as protection of the environment and human health. Unambiguously, production of botanical pesticides will allow for the sustainable and efficient use of natural resources and finally decrease the use of chemical inputs and burden. This is further underlined by the strict regulations on pesticide residues in agricultural products and is in harmony with the Farm to Fork strategy, which aims to reduce pesticide use by 50% by 2030. Thus, the present work aims to compile the scientific knowledge of the last 5 years (2017-February 2023) regarding the Mediterranean plants that present biopesticidal effects. The literature review revealed 40 families of Mediterranean plants with at least one species that have been investigated as potential biopesticides. However, only six families had the highest number of species, and they were reviewed comprehensively in this study. Following a systematic approach, the extraction methods, chemical composition, biopesticidal activity, and commonly used assays for evaluating the antimicrobial, pesticidal, repellant, and herbicidal activity of plant extracts, as well as the toxicological and safety aspects of biopesticide formulation, are discussed in detail. Finally, the aspects that have not yet been investigated or are under-investigated and future perspectives are highlighted.

Different isoforms of parabens into marine environment: Biological effects on the bacterium Aliivibrio fischeri and the marine mussel Mytilus galloprovincialis.

Different isoforms of alkyl esters of p-Hydroxybenzoic acid, also known as parabens, are of great concern due to their widespread presence into the aquatic environment, their high concentrations in wastewater discharges, as well as their ability to induce adverse effects on aquatic organisms. Considering the imperative need for assessing their fate and risk to aquatic environment, the present study investigated the biological effects of two isoforms of parabens, methyl- (MeP) and propyl- (PrP), on the bacterium Aliivibrio fischeri (using the Bioluminescence Inhibition/Microtox® bioassay) and the mussel Mytilus galloprovincialis (in terms of mussel mortality, cellular, oxidative and genotoxic stress indices). The assessment of MeP and PrP behavior into aquatic media (artificial sea water/ASW and 2 % NaCl), primarily performed by UHPLC-UV-MS analysis, showed only a slight hydrolysis of PrP to 4-Hydrobenzoic acid (4-HBA). Furthermore, exposure of both species to different concentrations of each paraben revealed differences among their toxic potential, as well as their ability to cause cellular, oxidative and genotoxic effects on hemocytes of challenged mussels. Interestingly, the Microtox® bioassay showed that PrP mediated toxicity in A. fischeri were more pronounced than MeP, as revealed by the estimated toxic endpoints (in terms of concentration that promote 50 % of bioluminescence inhibition, EC50). Similarly, in challenged mussels, a significant disturbance of mussel hemocytes' lysosomal membrane integrity, as well as enhanced levels of superoxides, nitric oxides, lipid peroxidation byproducts, and micronuclei formation were observed. These findings are of great interest, since MeP and PrP differential toxic potential, as well their ability to induce pre-pathological alterations in marine species, like mussels, give new evidence for their risk to aquatic biota.

Photocatalytic degradation of organic micropollutants under UV-A and visible light irradiation by exfoliated g-C3N4 catalysts.

In the present study, the photocatalytic performance of exfoliated graphitic carbon nitride (g-C3N4) catalysts, with enhanced properties and response in UV and visible light irradiation, was evaluated for the removal of selected contaminants i.e., diuron, bisphenol A and ethyl paraben. Commercial TiO2 Degussa P25 was also used as a reference photocatalyst. The g-C3N4 catalysts demonstrated good photocatalytic activity which in some cases is comparable to TiO2 Degussa P25 leading to high removal percentages of the studied micropollutants under UV-A light irradiation. In contrast to TiO2 Degussa P25, g-C3N4 catalysts were also able to degrade the studied micropollutants under visible light irradiation. For all the studied g-C3N4 catalysts under both UV-A and visible light irradiation, the overall degradation rate decreases in the order of bisphenol A > diuron > ethyl paraben. Among the studied g-C3N4, the chemically exfoliated catalyst (g-C3N4-CHEM) showed superior photocatalytic activity under UV-A light irradiation due to its enhanced characteristics, such as pore volume and specific surface area and ~ 82.0 % in 6 min, ~75.7 % in 15 min and ~ 96.3 % in 40 min removals were achieved for BPA, DIU and EP, respectively. Under visible light irradiation, the thermally exfoliated catalyst (g-C3N4-THERM) demonstrated the best photocatalytic performance and the degradation ranged from ~29.5 to 59.4 % after 120 min. EPR data revealed that the three g-C3N4 semiconductors generate mainly O2•-, whereas TiO2 Degussa P25 generates both HO• and O2•-, the latter only under UV-A light irradiation. Nevertheless, the indirect formation of HO• in the case of g-C3N4 should also be considered. Hydroxylation, oxidation, dealkylation, dechlorination and ring opening were the main degradation pathways. The process proceeded without significant alterations in toxicity levels. Based on the results, heterogeneous photocatalysis using g-C3N4 catalysts is a promising method for the removal of organic micropollutants without the formation of harmful transformation products.

Phytochemical Analysis and Genotoxicological Evaluation of Prickly Pear Peel Extracts.

This study investigated the beneficial properties of prickly pear peel (PPP) extracts from Opuntia ficus-indica (L.) Mill. Extracts were obtained via the Soxhlet extraction method using methanol (P1), ethanol (P2) and ethanol-water (P3) as extraction solvents. Their total phenolic and flavonoid content (TPC and TFC, respectively) and their antioxidant activity (AA) were determined. The PPP extracts were characterized in detail using mass spectrometry techniques. Their cyto-genotoxic effect and antigenotoxic potential against mitomycin C were evaluated via the cytokinesis block micronucleus (CBMN) assay on human lymphocytes. Enhanced TPC, TFC and AA values were recorded for all the extracts. Moreover, P1 and P2 were cytotoxic only at the highest concentrations, whereas P3 was found to be cytotoxic in all cases. No significant micronucleus induction was observed in the tested extracts. The PPP extracts contain bioactive compounds such as flavonoids, carboxylic acids, alkaloids, fatty acids and minerals (mainly K, Si, Mg, Ca, P and Zn). The results showed that all three extracts exerted high antigenotoxic activity. Our findings confirm the beneficial and genoprotective properties of PPP extracts and further studies on the bioactive compounds of Opuntia ficus-indica (L.) Mill. are recommended, as it constitutes a promising plant in pharmaceutical applications.

Beneficial properties of Drimia numidica leaf methanolic extract against the cytogenotoxic effects of mitomycin C on human lymphocytes.

This study investigated the phytochemical profile of Drimia numidica leaf methanolic extract, as well as its cyto-genotoxic and cyto/genoprotective potential against mitomycin C (MMC) mediated effects on healthy human lymphocytes. Photosynthetic pigments, trace elements, and secondary metabolites were estimated and/or identified in methanolic extract of mature leaves, and the latter was further used for assessing its in vitro biological effects on MMC-free and/or MMC-treated human lymphocytes (at low, non-toxic concentrations of 0.001 and 0.01% v/v). The results showed that D. numidica leaf methanolic extract, being rich in carotenoids, phenolics, flavonoids, organic acids and bufadienolides, could be protective against MMC mediated cyto/genotoxic potential in healthy human lymphocytes. Biomolecules possessing antioxidant and antitumor potential, such as beta-carotene and lutein among others, chlorogenic acid, caffeic acid and their derivatives, minerals such as Si, as well as apigenin- and luteolin-derived glycosides, either individual or in a mixture, could be beneficial rather than harmful, at least at the extract concentrations tested. Although further in vitro and in vivo studies are still needed for elucidating the beneficial (individual and/or additive/synergistic) role of those compounds, the results of the present study are quite promising, thus encouraging new challenges for the appropriate utilization of D. numidica leaf extract.

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives.

BACKGROUND: The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives. METHOD: We systematically reviewed the literature (1995-2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI). RESULTS: 150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail-out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS-related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors). CONCLUSION: Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail-out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.

Genotoxic and Toxic Effects of The Flame Retardant Tris(Chloropropyl) Phosphate (TCPP) in Human Lymphocytes, Microalgae and Bacteria.

Tris(chloropropyl) phosphate (TCPP) is a characteristic and widely used organophosphorus flame retardant. TCPP is comprised of four isomers and the most abundant is tris(1-chloro-2-propyl) phosphate. TCPP can be released into the environment, with potential impacts on living organisms and humans due to its extensive industrial use. Aiming to assess the potential risks of TCPP on human health and the environment, its toxic and genotoxic effects-using organisms from different trophic levels, i.e., bacteria, green microalgae, and human cells-were investigated. TCPP exposure at nominal concentrations of 10, 20, 30 and 40 µg mL-1 was studied to identify the potential risk of inducing genotoxic effects in cultured human lymphocytes. Treatment with 30 and 40 µg mL-1 of TCPP induced marginally significant micronuclei (MN) frequencies as well as cytotoxic effects. Freshwater microalgae species treated with TCPP (0.5, 1, 10, 20 and 50 µg L-1) showed different growth rates over time. All the tested microalgae species were adversely affected after exposure to TCPP during the first 24 h. However, differences among the microalgae species' sensitivities were observed. In the case of the freshwater species, the most sensitive was found to be Chlorococcum sp. The marine algal species Dunaliella tertiolecta and Tisochrysis lutea were significantly affected after exposure to TCPP. The effects of TCPP on Aliivibrio fischeri that were observed can classify this flame retardant as a "harmful" compound. Our results suggest a potential risk to aquatic organisms and humans from the wide utilization of TCPP and its consequent release into the environment. These results highlight that further research should be conducted to investigate the effects of TCPP individually and in combination with other organophosphorus flame retardants in various organisms. In addition, the concern induced by TCPP points out that measures to control the introduction of TCPP into the environment should be taken.

Critical View of Safety in Laparoscopic Cholecystectomy: A Word of Caution in Cases of Aberrant Anatomy.

Introduction To avoid vasculobiliary injuries, the Critical View of Safety (CVS) technique is strongly recommended during dissection of the hepatocystic triangle. It entails three basic steps as follows: (1) complete clearance of the hepatocystic triangle of fibrofatty tissue, (2) separation of the lower part of the gallbladder from the cystic plate, so that (3) two and only two structures are seen entering the gallbladder. Case History In this video vignette, we present the case of an aberrant hepatic artery, coursing subserosally parallel to the gallbladder wall. Despite presumably achieving all three CVS requirements, the surgeon did not proceed to clipping and dividing the two structures, preventing a major vascular injury. Due to its unusually large caliber, the artery was carefully dissected, and multiple smaller branches to the gallbladder were ligated instead, until it was definitively identified entering into the hepatic parenchyma of segments IVb-V. Discussion The CVS approach was originally conceived as a means for the conclusive recognition of the cystic duct and artery to prevent misidentification errors. However, in such cases of extreme anatomical variations, the CVS may indeed have certain limitations. Therefore the surgeon should always maintain a high degree of suspicion and a low threshold for alternative bail-out options.

Patient consultations during SARS-CoV-2 pandemic: a mixed-method cross-sectional study in 16 European countries.

INTRODUCTION: Remote consultations help reduce contact between people and prevent cross-contamination. Little is known about the changes in consultation in European rural primary care during the SARS-CoV-2 (COVID-19) pandemic. The purpose of this mixed-methods cross-sectional study was to find out more about the effects of the pandemic on changes in patient consultations in European rural primary care. METHODS: A key informant survey from 16 member countries of the European Rural and Isolated Practitioners Association (EURIPA) was undertaken using a self-developed questionnaire. The steering committee of this project, called EURIPA Covid-19 study, developed a semi-structured questionnaire with 68 questions, 21 of which included free-text comments. Proportions were calculated for dichotomized or categorized data, and means were calculated for continuous data. Multivariate analysis by logistic regression model was used to assess the association of multiple variables. RESULTS: A total of 406 questionnaires from primary care providers (PCPs) in 16 European countries were collected; 245 respondents (60.5%) were females, 152 PCPs were rural (37.5%), 124 semi-rural (30.5%). Mean age of the respondents was 45.9 years (standard deviation (SD) 11.30) while mean seniority (length of experience) was 18.2 years (SD 11.6). A total of 381 (93.8%) respondents were medical doctors. Significant differences were found between countries in adopting alternative arrangements to face-to-face consultation: remote teleconsultation is well appreciated by both healthcare professionals and patients, but the most common way of remote consultation remains telephone consultation. A factor significantly inversely associated with the adoption of video consultation was the seniority of the PCP (odds ratio 1.19, 95% confidence interval 1.02-1.40, p=0.03). CONCLUSION: Telephone consultation is the most common form of remote consultation. The adoption of video-consultation is inversely related to the seniority of the informants.