L-Poly(lactic acid) Production by Microwave Irradiation of Lactic Acid Obtained from Lignocellulosic Wastes.

L-polylactic acid (PLA), a semi-crystalline aliphatic polyester, is one of the most manufactured biodegradable plastics worldwide. The objective of the study was to obtain L-polylactic acid (PLA) from lignocellulosic plum biomass. Initially, the biomass was processed via pressurized hot water pretreatment at a temperature of 180 °C for 30 min at 10 MPa for carbohydrate separation. Cellulase and the beta-glucosidase enzymes were then added, and the mixture was fermented with Lacticaseibacillus rhamnosus ATCC 7469. The resulting lactic acid was concentrated and purified after ammonium sulphate and n-butanol extraction. The productivity of L-lactic acid was 2.04 ± 0.18 g/L/h. Then, the PLA was synthesized in two stages. Firstly, lactic acid was subjected to azeotropic dehydration at 140 °C for 24 h in the presence of xylene, using SnCl2 (0.4 wt.%) as a catalyst, resulting in lactide (CPLA). Secondly, microwave-assisted polymerization was carried out at 140 °C for 30 min with 0.4 wt.% SnCl2. The resulting powder was purified with methanol to produce PLA with 92.1% yield. The obtained PLA was confirmed using electrospray ionization mass spectrometry, nuclear magnetic resonance, thermogravimetric analysis, Fourier transform infrared spectroscopy, scanning electron microscopy, and X-ray diffraction. Overall, the resulting PLA can successfully replace the traditional synthetic polymers used in the packaging industry.

Aortoesophageal fistula as a fatal complication of esophageal perforation.

Aortoesophageal fistula is a very rare cause of upper gastrointestinal bleeding, however its interest lies in the high mortality rate associated with it. Due to this, early diagnosis and treatment of this entity is essential to increase survival. The typical symptoms known as the Chiari´s triad are only present in 45% of reported cases. We present the case of a patient with upper gastrointestinal bleeding due to an aortoesophageal fistula as well as the importance of endoscopic use for its differential diagnosis.

Optimization of Lipid Extraction from Spirulina spp. by Ultrasound Application and Mechanical Stirring Using the Taguchi Method of Experimental Design.

The present study uses the Taguchi method of experimental design to optimize lipid extraction from Spirulina spp. by ultrasound application and mechanical stirring. A Taguchi L9 orthogonal array was used to optimize various parameters, such as methanol: chloroform (M:C) ratio, biomass: solvent ratio, and extraction time for lipid extraction. The results were analyzed using the signal-to-noise (S/N) ratio and analysis of variance (ANOVA). The biomass: solvent ratio significantly influenced lipid content (p < 0.05) with 92.1% and 92.3% contributions to the lipid and S/N ratio data, respectively. The extraction time presented a contribution value of 5.0%, while the M:C ratio presented the most negligible contribution of 0.4% for S/N data. The optimum extraction conditions were: M:C ratio of 1:1, biomass: solvent ratio of 1:60, and extraction time of 30 min. The predominant fatty acids were palmitic acid (44.5%), linoleic acid (14.9%), and gamma-linolenic acid (13.4%). The confirmation experiments indicated a lipid content of 8.7%, within a 95% confidence interval, proving the Taguchi method's effectiveness in optimizing the process parameters for lipid extraction.

Optimization of High-Pressure Extraction Process of Antioxidant Compounds from Feteasca regala Leaves Using Response Surface Methodology.

Circular economy principles are based on the use of by-products from one operation as the raw materials in another. The aim of this work is to obtain extracts with high antioxidant capacity and resveratrol content for the superior capitalization of the biomass of Feteasca regala leaves obtained during vineyard horticultural operations in spring. In order to obtain a high-quality extract at an industrial level, an optimal extraction process is needed. Central composite design (CCD) was used for the experiment design, which contained three independent variables: the ratio of extraction solvent to solid matter, temperature (°C) and time (minutes). The evaluation of extracts was done by measuring the total antioxidant capacity of the extracts using photo-chemiluminescent techniques, and the resveratrol content using liquid chromatography. Process optimization was done using response surface methodology (RSM). Minitab software version 17.0 was used for the design of experiments and data analysis. Regression analysis showed that the model predicts 87.5% of the variation for resveratrol and 96% for total antioxidant capacity (TAC). The temperature had the biggest influence on the extraction yield. The optimal operational conditions for the extraction method applied had the following conditions: ratio e/m 2.92; 43.23 °C and 55.4 min. A maximum value of 34,623 µg ascorbic acid equivalent (AAE) /mL total antioxidant capacity and 182.4 µg/mL resveratrol content were obtained when the optimal extraction parameters where used. The values obtained in experiments proved that by using RSM an accurate model can be obtained for extraction of Feteasca regala leaves.

Bioethanol Production from Vineyard Waste by Autohydrolysis Pretreatment and Chlorite Delignification via Simultaneous Saccharification and Fermentation.

In this paper, the production of a second-generation bioethanol from lignocellulosic vineyard cutting wastes was investigated in order to define the optimal operating conditions of the autohydrolysis pretreatment, chlorite delignification and simultaneous saccharification and fermentation (SSF). The autohydrolysis of vine-shoot wastes resulted in liquors containing mainly a mixture of monosaccharides, degradation products and spent solids (rich in cellulose and lignin), with potential utility in obtaining valuable chemicals and bioethanol. The autohydrolysis of the vine-shoot wastes was carried out at 165 and 180 °C for 10 min residence time, and the resulted solid and liquid phases composition were analysed. The resulted liquid fraction contained hemicellulosic sugars as a mixture of alpha (α) and beta (ß) sugar anomers, and secondary by-products. The solid fraction was delignified using the sodium chlorite method for the separation of lignin and easier access of enzymes to the cellulosic sugars, and then, converted to ethanol by the SSF process. The maximum bioethanol production (6%) was obtained by autohydrolysis (165 °C), chlorite delignification and SSF process at 37 °C, 10% solid loading, 72 h. The principal component analysis was used to identify the main parameters that influence the chemical compositions of vine-shoot waste for different varieties.

Radical surgery in hepatic hydatidosis: analysis of results in an endemic area.

INTRODUCTION: radical surgery in hepatic hydatidosis is associated with less morbidity and recurrence than conservative surgery. MATERIAL AND METHODS: a retrospective observational study of patients with liver hydatid cyst surgery was performed. Seventy-one patients with 90 cysts were included between 2007 and 2017, and radical surgery was performed in 69.01 %. RESULTS: there was no difference in morbidity, mortality, biliary leakage or recurrence according to surgery. Complicated cysts were associated with a longer hospital stay and morbidity. CONCLUSION: decision-making should consider age, comorbidity, cyst characteristics and available resources. Radical surgery should be applied whenever feasible as it achieves better results with an adequate selection of patients.

Processing of Thin Films Based on Cellulose Nanocrystals and Biodegradable Polymers by Space-Confined Solvent Vapor Annealing and Morphological Characteristics.

L-poly(lactic acid), poly(3-hydroxybutyrate), and poly-hydroxybutyrate-co-hydroxyvalerate are biodegradable polymers that can be obtained from renewable biomass sources. The aim of this study was to develop three types of environmentally friendly film biocomposites of altered microstructure by combining each of the above-mentioned polymers with cellulose nanocrystal fillers and further processing the resulting materials via space-confined solvent vapor annealing. Cellulose was previously obtained from renewable biomass and further converted to cellulose nanocrystals by hydrolysis with the lactic acid. The solutions of biodegradable polymers were spin-coated onto solid substrates before and after the addition of cellulose nanocrystals. The obtained thin film composites were further processed via space-confined solvent vapor annealing to eventually favor their crystallization and, thus, to alter the final microstructure. Indeed, atomic force microscopy studies have revealed that the presence of cellulose nanocrystals within a biodegradable polymer matrix promoted the formation of large crystalline structures exhibiting fractal-, spherulitic- or needle-like morphologies.

Developing Innovative Cement Composites Containing Vine Shoot Waste and Superplasticizers.

The expansion of the construction industry requires large quantities of construction materials; therefore, the utilization of alternative raw materials that reduce the environmental impact and enhance the quality of the construction materials has received increasing interest. The comparative performance of 1% Dynamon SR3 or Dynamon SR41 superplasticizers on the properties of cement paste with 1 wt.% vine shoot waste addition (VSW) was investigated after 28 days using Fourier-transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX), and solid-state 27Al and 29Si nuclear magnetic resonance (NMR) spectroscopy. VSW does not delay the formation of calcium hydroxide and C-S-H and a slight decrease of the -OH band in samples containing superplasticizers, suggesting that free lime is converted to carbonates. The highest degree of crystallinity was remarked for the samples with superplasticizers. The structure of the cement paste with VSW and superplasticizers was corroborated with mechanical properties, showing increased strength in using VSW and superplasticizers. The results showed that adding 1% VSW and superplasticizers does not change the performance of the cement paste but reduces the water-cement ratio. The combination of VSW and superplasticizers led to cement composite with improved structural and mechanical properties suitable for construction.

Poly(3-hydroxybutyrate) Production from Lignocellulosic Wastes Using Bacillus megaterium ATCC 14581.

This study aimed to analyze the production of poly(3-hydroxybutyrate) (PHB) from lignocellulosic biomass through a series of steps, including microwave irradiation, ammonia delignification, enzymatic hydrolysis, and fermentation, using the Bacillus megaterium ATCC 14581 strain. The lignocellulosic biomass was first pretreated using microwave irradiation at different temperatures (180, 200, and 220 °C) for 10, 20, and 30 min. The optimal pretreatment conditions were determined using the central composite design (CCD) and the response surface methodology (RSM). In the second step, the pretreated biomass was subjected to ammonia delignification, followed by enzymatic hydrolysis. The yield obtained for the pretreated and enzymatically hydrolyzed biomass was lower (70.2%) compared to the pretreated, delignified, and enzymatically hydrolyzed biomass (91.4%). These hydrolysates were used as carbon substrates for the synthesis of PHB using Bacillus megaterium ATCC 14581 in batch cultures. Various analytical methods were employed, namely nuclear magnetic resonance (1H-NMR and13C-NMR), electrospray ionization mass spectrometry (EI-MS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and thermogravimetric analysis (TGA), to identify and characterize the extracted PHB. The XRD analysis confirmed the partially crystalline nature of PHB.

Recent Trends in Hydroxyapatite Supplementation for Osteoregenerative Purposes.

Bone regeneration has gained attention in the biomedical field, which has led to the development of materials and synthesis methods meant to improve osseointegration and cellular bone activity. The properties of hydroxyapatite, a type of calcium phosphate, have been researched to determine its advantages for bone tissue engineering, particularly its biocompatibility and ability to interact with bone cells. Recently, the advantages of utilizing nanomolecules of hydroxyapatite, combined with various substances, in order to enhance and combine their characteristics, have been reported in the literature. This review will outline the cellular and molecular roles of hydroxypatite, its interactions with bone cells, and its nano-combinations with various ions and natural products and their effects on bone growth, development, and bone repair.

Mercury in soil and perennial plants in a mining-affected urban area from Northwestern Romania.

The mercury (Hg) concentrations were evaluated in soils and perennial plants sampled in four districts of Baia Mare city, a historical mining and ore processing center in Northwestern Romania. The results showed that the Hg concentration exceeded the guideline value of 1.0 mg kg(-1) dry weight (dw) established by the Romanian Legislation, in 24 % of the analyzed soil samples, while the median Hg concentration (0.70 mg kg(-1) dw) was lower than the guideline value. However, Hg content in soil was generally higher than typical values in soils from residential and agricultural areas of the cities all over the world. The median Hg concentration was 0.22 mg kg(-1) dw in the perennial plants, and exceeded the maximum level of Hg (0.10 mg kg(-1)) established by European Directive 2002/32/EC for plants used in animal feed in order to prevent its transfer and further accumulation in the higher levels of food chain. No significant correlations were found between soil Hg and other analyzed metals (Cd, Cu, Pb, Zn) resulted from the non-ferrous smelting activities, probably due to the different physicochemical properties, that led to different dispersion patterns.

Structural and Metabolic Profiling of Lycopersicon esculentum Rhizosphere Microbiota Artificially Exposed at Commonly Used Non-Steroidal Anti-Inflammatory Drugs.

In this study, the effect of common non-steroidal anti-inflammatory drugs on Lycopersicon esculentum rhizosphere microbiota was monitored. The experiments were performed with artificially contaminated soil with ibuprofen (0.5 mg·kg-1), ketoprofen (0.2 mg·kg-1) and diclofenac (0.7 mg·kg-1). The results evidenced that the rhizosphere microbiota abundance decreased especially under exposure to diclofenac (187-201 nmol·g-1 dry weight soil) and ibuprofen (166-183 nmol·g-1 dry weight soil) if compared with control (185-240 nmol·g-1 dry weight soil), while the fungal/bacteria ratio changed significantly with exposure to diclofenac (<27%) and ketoprofen (<18%). Compared with control samples, the average amount of the ratio of Gram-negative/Gram-positive bacteria was higher in rhizosphere soil contaminated with ibuprofen (>25%) and lower in the case of diclofenac (<46%) contamination. Carbon source consumption increased with the time of assay in case of the control samples (23%) and those contaminated with diclofenac (8%). This suggests that rhizosphere microbiota under contamination with diclofenac consume a higher amount of carbon, but they do not consume a larger variety of its sources. In the case of contamination with ibuprofen and ketoprofen, the consumption of carbon source presents a decreasing tendency after day 30 of the assay. Rhizosphere microbiota emitting volatile organic compounds were also monitored. Volatile compounds belonging to alcohol, aromatic compounds, ketone, terpene, organic acids, aldehyde, sulphur compounds, esters, alkane, nitrogen compounds, alkene and furans were detected in rhizosphere soil samples. Among these, terpene, ketone, alcohol, aromatic compounds, organic acids and alkane were the most abundant compound classes (>75%), but their percentage changed with exposure to diclofenac, ketoprofen and ibuprofen. Such changes in abundance, structure and the metabolic activity of Lycopersicon esculentum rhizosphere microbiota under exposure to common non-steroidal anti-inflammatory drugs suggest that there is a probability to also change the ecosystem services provided by rhizosphere microbiota.

Heavy metals and health risk assessment in vegetables grown in the vicinity of a former non-metallic facility located in Romania.

Soil contamination represents a serious and significant issue, especially when it comes to soil used in agricultural practices. This research was carried out in order to investigate the accumulation level of potentially toxic trace elements (Cr, Cd, Cu, Mn, Ni, Pb and Zn) in soil and vegetables (Solanum lycopersicum and Daucus carota). The transfer of the trace elements from soil to vegetables and the potential risk assessment were studied as well. Results indicated relatively high levels of heavy metals. Cd, Cu and Pb exceeded the alert limits established by the Romanian legislation. Zn was high as well. Positive correlations between the Cr, Cu and Pb indicated similar source of pollution, possibly related to the activities occurred in the non-metallic facility, nearby the study area. The heavy metals determined in the Solanum lycopersicum fruits and Daucus carota roots were below the maximum allowable concentrations, according to the WHO/FAO guideline. Slightly higher amounts of Cr and Cu were measured in tomatoes, compared to the carrots. Nevertheless, carrots were richer in Ni and Mn. The applied pollution indices indicated a contamination with heavy metals in 90% of the soil samples, with 9% probability of toxicity, the remaining 10% being classified into the precaution domain category. The plant bioconcentration of heavy metals into the Solanum lycopersicum fruits and Daucus carota roots is characterized using transfer factors. Generally, the results indicate that Daucus carota was the most susceptible to uptake Cu and Mn, while Solanum lycopersicum would rather uptake Cd and Zn. The estimated non-carcinogenic risk, based on the human health risk indices, indicates that the studied vegetables are safe for consumption with no impact on the human health. The results are lower than the critical value. Similarly, the carcinogenic risk indices results showed acceptable risks of cancer developing. It is important to assess and monitor the heavy metals levels in soil and in the vegetables intended to be consumed, in order to prevent contamination and potential negative effects on the environment and implicitly on the human health. The obtained data can be used in remediation techniques, as well as in implementing control measures of heavy metal contamination in soil and vegetables.

Analytical Performance and Validation of a Reliable Method Based on Graphite Furnace Atomic Absorption Spectrometry for the Determination of Gold Nanoparticles in Biological Tissues.

Gold nanoparticles (AuNPs) have a wide-ranging application and are widespread in samples with complex matrices; thus, efficient analytical procedures are necessary to identify and characterize this analyte. A sensitive analytical method for determination of AuNPs content in biological tissues, based on microwave-assisted acid wet digestion and graphite furnace atomic absorption spectrometry (GFAAS) validated in accordance with the requirements of Eurachem guideline and ISO 17025 standard, is presented in this study. The digestion procedure was optimized, and the figures of merit such as selectivity, limit of detection (0.43 µg L-1), limit of quantification (1.29 µg L-1, corresponding to 12.9 µg kg-1 in tissue sample, considering the digestion), working range, linearity, repeatability ((RSDr 4.15%), intermediate precision (RSDR 8.07%), recovery in accuracy study (97%), were methodically evaluated. The measurement uncertainty was assessed considering the main sources of uncertainties and the calculated relative expanded uncertainty (k = 2) was 12.5%. The method was applied for the determination of AuNPs in six biological tissues (liver, small intestine, heart, lungs, brain and kidneys) and the found concentrations were generally at low levels, close or lower than LOQ.

Advanced Mg, Zn, Sr, Si Multi-Substituted Hydroxyapatites for Bone Regeneration.

PURPOSE: Compositional tailoring is gaining more attention in the development of advanced biomimetic nanomaterials. In this study, we aimed to prepare advanced multi-substituted hydroxyapatites (ms-HAPs), which show similarity with the inorganic phase of bones and might have therapeutic potential for bone regeneration. MATERIALS: Novel nano hydroxyapatites substituted simultaneously with divalent cations: Mg2+ (1.5%), Zn2+ (0.2%), Sr2+ (5% and 10%), and Si (0.2%) as orthosilicate (SiO4 4-) were designed and successfully synthesized for the first time. METHODS: The ms-HAPs were obtained via a wet-chemistry precipitation route without the use of surfactants, which is a safe and ecologically friendly method. The composition of synthesized materials was determined by inductively coupled plasma optical emission spectrometry (ICP-OES). The materials were characterized by X-ray powder diffraction (XRD), FT-IR and FT-Raman spectroscopy, BET measurements and by imaging techniques using high-resolution TEM (HR-TEM), FE-SEM coupled with EDX, and atomic force microscopy (AFM). The ion release was measured in water and in simulated body fluid (SBF). RESULTS: Characterization methods confirmed the presence of the unique phase of pure stoichiometric HAP structure and high compositional purity of all synthesized nanomaterials. The doping elements influenced the crystallite size, the crystallinity, lattice parameters, morphology, particle size and shape, specific surface area, and porosity. Results showed a decrease in both nanoparticle size and crystallinity degree, coupled with an increase in specific surface area of these advanced ms-HAP materials, in comparison with pure stoichiometric HAP. The release of biologically important ions was confirmed in different liquid media, both in static and simulated dynamic conditions. CONCLUSION: The incorporation of the four substituting elements into the HAP structure is demonstrated. Synthesized nanostructured ms-HAP materials might inherit the in vivo effects of substituting functional elements and properties of hydroxyapatite for bone healing and regeneration. Results revealed a rational tailoring approach for the design of a next generation of bioactive ms-HAPs as promising candidates for bone regeneration.

Kinetic, Equilibrium and Phytotoxicity Studies for Dyes Removal by Low Cost Natural Activated Plant-Based Carbon.

The capacity of commercial natural activated plant-based carbon (CNAC) to remove different dyes such as methylene blue (MB), eosin yellow (EY) and rhodamine B (RB) was studied. Also, the germination index (GI) was calculated in order to examine the dyes toxicity on various plant seeds by recording and measuring the number of germinated seeds and root length, respectively. Generally, the results showed that high concentrations of dyes inhibit the seed germination by changing their colors and affecting their growth. The inhibition of corn seeds germination in RB was very low in the studied range of concentration. The adsorption behavior of dyes onto CNAC surface was investigated through isotherm and kinetics modeling. The parameters predicted from the Langmuir and Freundlich isotherms suggested a favorable adsorption of the considered dyes onto CNAC surface. The kinetic studies showed that the adsorption followed pseudo-second-order kinetic model for MB and RB removal, but was not adequate for EY removal.

Lack of association of delta-aminolevulinate dehydratase polymorphisms with blood lead levels and hemoglobin in Romanian women from a lead-contaminated region.

As part of a project on environmental pollution, this study aimed to evaluate associations between blood lead (BPb) levels, hemoglobin (Hb) content, and single-nucleotide polymorphisms (SNPs) of delta-aminolevulinic acid dehydratase (ALAD) gene in 129 unrelated women from Romania. Five SNPs (rs1805313, rs2228083, rs1805312, rs1800435, rs1139488) were analyzed with respect to haplotype structure and impact on BPb levels and Hb content with proportional odds and analysis of covariance models. Combinations of SNPs were rare (16%). Low haplotype diversity was found with seven haplotypes. One rare haplotype implied the C allele of rs1800435, often referred to as the ALAD2 allele (frequency 8.6%). The putative risk genotype (CC) occurred in only one woman with BPb below 0.5 microg/dl. Median BPb was 4.8 microg/dl and differed markedly by community with a level of 12.5 microg/dl near a mining-spill region. Hb was regular (interquartile range 12.3-13.7 g/dl) and not correlated with BPb, although quantitatively lower in women living near the spill region. No significant associations were found for BPb or Hb with SNPs, haplotypes, or diplotypes. BPb levels were higher in this region than in populations from industrialized countries but without hematotoxic effects. An impact of ALAD2 on BPb or Hb was not seen in these women.

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users.

CONCLUSIONS: The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development. Objective The assessment of gait performance in pre-lingual deaf children with cochlear implant (CI). METHODS: Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10-16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n = 14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation. RESULTS: (1) GV in CG was lower in DT than with EN (p = .019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p = .006; DT, p = .0001; CI-OFF, p = .03). (3) CIU had slower GV walking with EN (p = .037) and with DT (p = .022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.

G.I.S. Surveillance of Chronic Non-occupational Exposure to Heavy Metals as Oncogenic Risk.

INTRODUCTION: The potential oncogenic effect of some heavy metals in people occupationally and non-occupationally exposed to such heavy metals is already well demonstrated. This study seeks to clarify the potential role of these heavy metals in the living environment, in this case in non-occupational multifactorial aetiology of malignancies in the inhabitants of areas with increased prevalent environmental levels of heavy metals. METHODS: Using a multidisciplinary approach throughout a complex epidemiological study, we investigated the potential oncogenic role of non-occupational environmental exposure to some heavy metals [chrome (Cr), nickel (Ni), copper (Cu), zinc (Zn), cadmium (Cd), lead (Pb) and arsenic (As)-in soil, drinking water, and food, as significant components of the environment] in populations living in areas with different environmental levels (high vs. low) of the above-mentioned heavy metals. The exposures were evaluated by identifying the exposed populations, the critical elements of the ecosystems, and as according to the means of identifying the types of exposure. The results were interpreted both epidemiologically (causal inference, statistical significance, mathematical modelling) and by using a GIS approach, which enabled indirect surveillance of oncogenic risks in each population. RESULTS: The exposure to the investigated heavy metals provides significant risk factors of cancer in exposed populations, in both urban and rural areas [ χ2 test (p < 0.05)]. The GIS approach enables indirect surveillance of oncogenic risk in populations. CONCLUSIONS: The role of non-occupational environmental exposure to some heavy metals in daily life is among the more significant oncogenic risk factors in exposed populations. The statistically significant associations between environmental exposure to such heavy metals and frequency of neoplasia in exposed populations become obvious when demonstrated on maps using the GIS system. Environmental surveillance of heavy metals pollution using GIS should be identified as an important element of surveillance, early detection, and control of neoplastic risks in populations, at the level of a single locality, but even on a wider geographical scale.