Defining the data gap: What do we know about environmental exposure, hazards and risks of pharmaceuticals in the European aquatic environment?

Active pharmaceutical ingredients (APIs) and their transformation products inevitably enter waterways where they might cause adverse effects to aquatic organisms. Identifying the potential risks of APIs in the environment is therefore a goal and current strategic direction of environmental management described in the EU Strategic Approach to Pharmaceuticals in the Environment and the Green Deal. This is challenged by a paucity of monitoring and ecotoxicity data to adequately describe risks. In this study we analyze measured environmental concentrations (MECs) of APIs from 5933 sites in 25 European countries as documented in the EMPODAT database or collected by the German Environment Agency for the time period between 1997 and 2020. These data were compared with empirical data on the ecotoxicity of APIs from the U.S. EPA ECOTOX database. Although 1763 uniquely identifiable APIs are registered with the European Medicines Agency (EMA) for sale in the European Economic Area (EEA), only 312 (17.7%) of these are included in publicly available monitoring data, 36 (1.8%) compounds have sufficient ecotoxicological data to derive a PNEC, and only 27 (1.5%) compounds meet both the hazard and exposure data requirements required to to perform an environmental risk assessment according to EMA guidelines. Four of these compounds (14.8%) had a median risk quotient (RQ) > 1. Endocrine disruptors had the highest median RQ, with 7.0 and 5.6 for 17α-ethinyl-estradiol and 17ß-estradiol respectively. A comparison of in-silico and empirical exposure data for 72 APIs demonstrated the high protectiveness of the current EMA guidelines, with predicted environmental concentrations (PECs) exceeding median MECs in 98.6% of cases, with a 100-fold median increase. This study describes the data shortfalls hindering an accurate assessment of the risk posed to European waterways by APIs, and identifies 68 APIs for prioritized inclusion in monitoring programs, and 66 APIs requiring ecotoxicity testing to fill current data gaps.

First 3D imaging characterization of Pele's hair from Kilauea volcano (Hawaii).

In this work the morphologic features of Pele's hair formed during three different eruptions of Kilauea volcano have been investigated: fountaining from Kilauea Iki's 1959 Episode 1, weak explosive activity from Halemaumau lava lake and littoral explosions at Waikupanaha (2009). Morphological studies were performed by optical, stereo- and scanning electron microscopy. For the first time 3D image analysis was carried out by synchrotron radiation X-ray computed microtomography, which allowed a high-resolution 3D reconstruction of the internal structure of each Pele's hair, highlighting several differences in terms of number density, elongation and shape of the vesicles between the samples from the three eruptions. We identified three main parameters determining these differences: initial size of the magma droplet, ejection velocity and magma viscosity. Pele's hair erupted during the Kilauea Iki's fountaining shows the highest thickness and the least elongated shape of the vesicles, though it is related to fast ejection of a low viscosity magma. We therefore suggest that the size of magma droplets is the main parameter influencing the morphology and inner textures of the Pele's hair. The comparison with Pele's hair of similar eruptions elsewhere demonstrates that there is no univocal correspondence between eruptive style and Pele's hair texture.

Cost analysis of brachial plexus injuries: variability of compensation by insurance companies before and after surgery.

Traumatic paralysis of the brachial plexus is an extremely disabling pathology. The type of trauma most frequently suffered by this group of patients is due to motorcycle injuries. It therefore affects a population of young patients. In the majority of cases, these patients receive compensation for permanent damage from insurance companies. Surgery of the brachial plexus enables various forms of functional recovery, depending on the number of roots of the brachial plexus involved in the injury. The aim of this study is to compare the functional deficit and the extent of the related compensation before and after surgical intervention, and to evaluate the saving in economic terms (understood as the cost of compensation paid by insurance companies) obtainable through surgical intervention. The authors analysed the functional recovery obtained through surgery in 134 patients divided into 4 groups on the basis of the number of injured roots. The levels of compensation payable to the patient before surgical intervention, and 3 years after, were then compared. The results showed that the saving obtainable through surgical treatment of brachial plexus injuries may exceed 65% of the economic value of the compensation that would have been attributable to the same patients if they had not undergone surgical treatment.

Contralateral spinal accessory nerve: a suitable "new" donor nerve for heterotopic nerve transfer in total brachial plexus palsy.

Patients with complete brachial plexus palsy with avulsion of 4-5 roots often have a paucity of suitable donor nerves to provide for a proper functional recovery of the upper extremity. The spinal accessory nerve is routinely employed ipsilaterally for nerve transfer to the suprascapular nerve. The purpose of this paper is to describe the clinical use of the contralateral spinal accessory nerve as a donor nerve for brachial plexus surgery. Since 2005 the contralateral spinal accessory nerve has been used for neurotization of the axillary nerve in selected cases of total brachial plexus injuries. In this paper total plexus palsy surgical strategies, technical details and preliminary functional outcomes of a group of 6 consecutive patients with a minimum follow-up of 30 months (76-31, average 55) are described. The preliminary results are encouraging: the functional outcome of the deltoid muscle, evaluated according to the British Medical Research Council grading system, was M4 in 1 patient, M3 in 1 patient, M2 in 2 patients, M1 in 1 patient, and M0 in 1 patient. In conclusion, the use of the contralateral spinal accessory nerve shows good results in terms of functional recovery and the simplicity of the procedure.

A neglected giant subcutaneous leiomyosarcoma of the shoulder: a case report.

Superficial leiomyosarcoma is an exceeding uncommon malignant tumor, which can be located either cutaneous or subcutaneous tissues. It may occur anywhere in the body, but there is a predilection for the thighs. The distinction between cutaneous or subcutaneous, increased mass size (> 5 cm) and depth are considered to have worst prognosis in terms of recurrence and metastasis. We report a rare case of an 81-year-old woman, presented with a 20-cm leiomyosarcoma of the shoulder. The patient reported that the mass was completely asymptomatic and its growth was slow. A CT study showed a lesion closely apposed to the head of the humerus and revealed no a clear relationship with the surrounding muscles. There was no regional lymphadenopathy or the evidence of metastatic disease. After tumor resection, a large skin and soft-tissue defect was remained and the repair was performed by myocutaneous rotational free flap of latissimus dorsi. The conclusion of the histological analysis was: subcutaneous leiomyosarcoma pT2--grade 1+ (NCI system). The delayed diagnosis and the surgical treatment and giant size of soft tissue leiomyosarcoma may adversely affect the final result.

Reconstruction of the nasal dorsum with autologous rib cartilage.

The authors present their experience with the correction of deformities of the nasal saddleback using rib cartilage grafts. They present a review of international literature on this topic, analyzing 33 patients selected from 452 cases of rhinoplasties performed between January 1990 and December 2004 at the Department of Plastic and Reconstructive Surgery of the University of Rome "Tor Vergata." Nasal saddleback is one of the most complicated defects to correct surgically. It can be a consequence of nasoethmoid-orbital fractures and is in this case associated with other evident signs like telecanthus, teleorbitism, or orbital dystopia. It can be also a consequence of surgical procedures in the nasal area where a loss of bone or septal cartilaginous support has occurred. They compare the techniques employed in the reconstruction and describe the advantage of the use of cartilage from the 11th rib and evaluate the results of an engineering analysis of tension forces on the rib cartilage. Of the total number of patients treated, good cosmetic results were obtained in 84% of the cases and excellent functional results in almost all of the cases (94%).

Sublingual ranula: report of a submandibular clinical case.

Ranula is a raised mucocele on the oral floor. When the mucocele extends and passes the sublingual space and invades the submandibular space it may be called ''plunging ranula''. Its etiology is not completely known. Our clinical case is a clear example: a 10-year old formation, not painful, developed during several years and originally of small dimension located in the sublingual region. The purpose of this study is to underline that the surgical treatment of choice, in these clinical situations, is the drainage of the cavity and marsupialization rather than a radical removal.