A rare complication of double prosthetic valve endocarditis; reconstructive surgical treatment of mitral-aortic intervalvular fibrosa pseudoaneurysm and left atrial fistula.

Mitral aortic intervalvular fibrosa or aorto-mitral curtain is a fibrous avascular skeletal structure located between the anterior leaflet of the mitral valve and the non-coronary and left coronary cusps of the aortic valve. Mitral and aortic valve endocarditis are rarely accompanied by mitral aortic intervalvular fibrosa pseudoaneurysm and left atrial fistula of the aorta. Pseudoaneurysm of mitral aortic intervalvular fibrosa is a fatal complication that can occur after valvular surgery, valvular endocarditis, or blunt trauma. In this article, reconstructive surgical management with the Commando technique of a case who developed mitral-aortic intervalvular fibrosa pseudoaneurysm to left atrial fistula after aortic and mitral prosthetic valve endocarditis is described. The important feature of this article is that it is a first in the literature as it is accompanied by persistent left superior vena cava.

Surgical treatment of recurrent subvalvular discrete membrane and left ventricular outflow tract stenosis in an adult patient with a history of congenital cardiac surgery.

Left ventricular outflow stenosis can develop at the supravalvular, valvular, and subvalvular levels. Resection of strictures at the diffuse subvalvular level is very difficult. In such pathologies, Konno-Rastan procedure provides very successful solutions as an anterior aortoventriculoplasty method. In this article, we performed anterior aortaventriculoplasty surgical treatment for tunnel type left ventricular outflow tract stenosis, recurrent subvalvular discrete membrane, and aortic regurgitation in an adult patient with a history of partial atrioventricular septal defect repair and subvalvular discrete membrane resection operation in early childhood. The Konno-Rastan procedure, which we applied to the redo case, which is rarely used in adult patients and rarely seen in the literature, is shared.

Surgical treatment of caseous calcification of the mitral annulus causing mitral stenosis and mimicking the clinical picture of infective endocarditis: A case report.

Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus (CCMA) is a rare disease. CCMA accounts for .63% of all mitral annular calcification (MAC) cases. The pathophysiology is still unknown. The correct diagnosis and treatment of this disease is very important to prevent complications. We present a case of giant CCMA with advanced mitral stenosis and hypertrophic cardiomyopathy, presenting with symptoms of infection and therefore a preliminary diagnosis of infective endocarditis. Because of these features, we wanted to share our case as it is the 1st case in the literature.

The predictive value of internal carotid artery wall thickness in computed tomography angiography to avoid complications of plaque removal failure in modified eversion carotid endarterectomy.

AIM: The benefits of computed tomography carotid angiography (CTA) in terms of evaluating the anatomical structure of the carotid arteries, surgical planning, and evaluating possible risks were reported in previous studies. This study aimed to calculate the predictive value of internal carotid wall thickness in CTA that can predict whether a modified carotid eversion endarterectomy (MCEE) will result in a successful or not. METHOD: This study was designed in a retrospective cross-sectional format. Consecutive 83 symptomatic carotid surgery patients who were operated in our hospital and had CTA were included in this study. The wall thickness of the internal carotid artery (ICA) 20 mm distal from the carotid bifurcation was calculated in axial sections using a three-dimensional imaging technique. In addition, all patients' characteristics and laboratory findings were recorded. Patients who failed MCEE and required classical carotid endarterectomy were compared with patients who had successful MCEE. RESULTS: MCEE technique was applied to 62 patients. In 21 patients, the MCEE technique failed and the classical endarterectomy technique was required. Preoperative clinical and laboratory characteristics were similar in both groups. The mean ICA wall thickness was 0.65 mm 20 mm distal to from the carotid bifurcation and it was lower in the group with successful MCEE (1.03 ± 0.21 mm vs. 0.56 ± 0.08 mm) (p < 0.001). The critical ICA wall thickness was calculated as 0.76 mm in the group that MCEE failed and classical carotid endarterectomy was required. Cut-off analysis of ICA wall thickness was calculated as 0.755 mm in ROC analysis (p < 0.001), (95% confidence interval, curve area; 0.985). CONCLUSION: Successful carotid endarterectomy with the MCEE method is associated with distal ICA wall thickness and distal extension of the atheroma plate. The use of ICA wall thickness 20 mm distal to from the bifurcation as a predictive value for the success of the MCEE technique is beneficial to avoid serious complications.

Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy.

OBJECTIVES: Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated. METHODS: In this retrospective study, treatment and clinical outcomes of patients' who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed. RESULTS: A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation. CONCLUSION: Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological marker.

OBJECTIVE: To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA). METHODS: A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group (n = 23) and favorable outcome group (n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates. RESULTS: A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004-1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64-0.851). CONCLUSIONS: Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.

Comparison of the results of caloric and video head impulse tests in patients with Meniere's disease and vestibular migraine.

PURPOSE: To compare the results of video head impulse test (vHIT) and caloric testing (CT) in patients with vestibular migraine (VM) and Ménière's disease (MD) and to investigate the relationship between these two tests. METHODS: Patients with definite unilateral MD and VM were included in the study. All patients underwent both vHIT and CT. The vestibulo-ocular reflex (VOR) gains of lateral semicircular canals and saccadic waves in vHIT and the canal paresis factor for the CT were examined. RESULTS: CT was found abnormal in 39 (66.1%) patients with MD and in 17 (34%) patients with VM, while abnormal gain of the lateral canal was obtained in 23 MD (39%) patients and 9 (18%) VM patients. In all, 11.9% of patients with an abnormal vHIT had a normal CT, whereas 33.9% of those with an abnormal CT had a normal vHIT. CONCLUSION: Loss of VOR detected by caloric testing is more common and severe in MD than VM. Although vHIT is useful and can give complementary information, vestibular testing with the caloric test still seems more sensitive for detecting hVOR pathology.

Is Nasal Packing Necessary After Endoscopic Dacryocystorhinostomy Without Stent and Mucosal Flaps Preservation?

OBJECTIVE: This study aimed to evaluate the effect of nasal packing on the surgical success and postoperative complications of endoscopic dacryocystorhinostomy (EnDCR) without using stents and mucosal flaps. METHODS: The retrospective study comprised of 75 eyes of 65 consecutive patients undergoing EnDCR with the biting and removing technique. The patients were assigned to 2 groups depending on whether the biodegradable synthetic polyurethane foam was used or not (the packing group, 34 eyes; the nonpacking group, 41 eyes). At least 6 months after the EnDCR, the postoperative outcomes including anatomical and functional successes, and the postoperative complications such as synechia, granuloma, and bleeding were compared between the packing and nonpacking groups. RESULTS: Synechia was lower in the packing group (23.5% versus 24.4%) but it was not statistically significant (P = 0.93). There were also no significant differences in the granuloma and bleeding complications between the 2 groups (respectively, P = 0.72, P = 0.08). The success rates of anatomical and functional reached 88% in the packing group compared with 82.9%, and 75.6% in the nonpacking group (respectively, P = 0.74, P = 0.76). CONCLUSIONS: The present study findings suggest that both groups have no superiorities over each other in the surgical outcomes after the EnDCR. However, further randomized studies are recommended before the generalization can be made.

A novel one-step approach for the construction of yeast surface display Fab antibody libraries.

BACKGROUND: Yeast surface display (YSD) has proven to be a versatile platform technology for antibody discovery. However, the construction of antibody Fab libraries typically is a tedious three-step process that involves the generation of heavy chain as well as light chain display plasmids in different haploid yeast strains followed by yeast mating. RESULTS: Within this study, we aimed at implementing a focused Golden Gate Cloning approach for the generation of YSD libraries. For this, antibodies heavy and light chains were encoded on one single plasmid. Fab display on yeast cells was either mediated by a two-directional promoter system (2dir) or by ribosomal skipping (bicis). The general applicability of this methodology was proven by the functional display of a therapeutic antibody. Subsequently, we constructed large antibody libraries with heavy chain diversities derived from CEACAM5 immunized animals in combination with a common light chain. Target-specific antibodies from both display systems were readily obtained after three rounds of fluorescence activated cell sorting. Isolated variants exhibited high affinities in the nanomolar and subnanomolar range as well as appropriate biophysical properties. CONCLUSION: We demonstrated that Golden Gate Cloning appears to be a valid tool for the generation of large yeast surface display antibody Fab libraries. This procedure simplifies the hit discovery process of antibodies from immune repertoires.

Are neutrophil, platelet and eosinophil-to-lymphocyte ratio and red blood cell distribution width can be used for nasal polyposis?

INTRODUCTION: The aim of this study is to explore the relationship of neutrophil, platelet and eosinophil-to-lymphocyte ratios and red blood cell distribution width values with nasal polyposis, and whether this could be a predictive parameter that can be used for the severity and recurrence risk of the disease. METHOD: Neutrophil/lymphocyte, platelet/lymphocyte, eosinophil/lymphocyte ratios and red blood cell distribution width values were compared between nasal polyposis patients who were reviewed in a retrospective manner and the control group comparable for age and sex. Moreover, the nasal polyposis group was grouped for nasal polyposis severity and recurrence, and these subgroups were statistically compared, too. RESULTS: When the nasal polyposis patient group and the control group are compared, no statistically significant difference was found between two groups except for eosinophil/lymphocyte ratio. While only the difference between nasal polyposis severity and eosinophil/lymphocyte ratio is statistically significant, there was no parameter with statistically significant difference for recurrence. CONCLUSION: We think that caution should be exercised when using these new hematological parameters which can be affected by many factors for the presence, severity and recurrence risk of nasal polyposis, and literature data should be proven by conducting different and objective studies on this subject.

Comparison of Incidence and Severity of Chronic Postsurgical Pain Following Ear Surgery.

OBJECTIVES: Literature review shows a limited number of studies investigating chronic pain following ear surgeries. The effect of mastoidectomy on chronic postsurgical pain, however, has never been investigated. The present study investigates not only the incidence and severity of chronic pain following ear surgeries with and without mastoidectomy, but also predisposing diseases for pain. PATIENTS AND METHODS: The study was performed in a total of 150 patients who underwent tympanoplasty or tympanomastoidectomy through a retroauricular incision in a single tertiary health care center. During the routine postoperative 3rd-month examination, the patients were questioned for the presence and severity of chronic pain, as well as the diseases that might predispose the pain. RESULTS: The difference between the visual analog scale scores of the groups was not statistically significant. Comparison of pain character revealed that neuropathic pain is more prevalent in both the groups. Evaluating the relationship between concomitant diseases and chronic pain, it was observed that migraine, cervical pathology, and acute postsurgical pain were closely associated with chronic pain. CONCLUSION: It was demonstrated that mastoidectomy does not pose an additional risk for chronic postsurgical pain. However, patients with migraine, cervical pathology, and acute postsurgical pain are at risk for chronic postsurgical pain.

Assessment of the Factors That Affect the Anatomic and Functional Success of Cartilage Tympanoplasty in Children.

OBJECTIVES: Many factors may influence the surgical outcome of tympanoplasty in children, including age, the size and location of perforation, otorrhea, status of contralateral ear, surgical technique, and adenoid hypertrophy. This study aims to evaluate the outcomes of pediatric cartilage tympanoplasty and to assess the factors that affect the success of tympanoplasty in children. METHODS: Children with chronic otitis media who underwent tympanoplasty using cartilage as graft material were evaluated retrospectively. Patient age, gender, size and site of the perforation, status of the contralateral ear, preoperative and postoperative hearing levels, surgical technique, and postoperative complications were noted. RESULTS: Of the 72 patients included in the study, 27 were male and 35 were female. The average age was 13.22 ±â€Š2.64 and mean follow-up time was 18.4 ±â€Š8.62 months. Anatomic and functional success rates were 88.8% and 80.6%, respectively. Age, gender, and the status of the contralateral ear had no effect on surgical success rate. The mean preoperative and postoperative pure-tone averages were 33.2 6±â€Š10.37 and 21.00 ±â€Š13.25 dB, respectively. CONCLUSION: Anatomic and functional outcomes of cartilage tympanoplasty are quite satisfactory in pediatric patients. Chronic otitis media should be treated surgically as early as when patient cooperation is possible.

Quality of life in patients with chronic venous disease in Turkey: influence of different treatment modalities at 6-month follow-up.

PURPOSE: The main purpose of this study was to evaluate the influence of any of the four domains of the QoL score in CVD patients of classes C0-C4 and to analyze the correlation between the QoL and types of treatment modalities, and an additional aim of the present study was to compare QoL levels of patients with CVD and healthy participants and was to examine the factors associated with QoL in CVD patients. METHODS: The sample was composed of 501 patients with primary superficial venous reflux (28.5 % male and 71.5 % female) who answered 100 % of the questions in the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire. After a clinical and duplex examination, the patients were categorized as C0-C4, according to the CEAP classification. The relationships between WHOQoL-BREF domains and gender, age, occupation, BMI, the clinical classes of the CEAP classification and four different treatment modalities according to guideline were analyzed. RESULTS: For the WHOQOL-BREF test battery, the patients with CVD had worse values, as compared with the control group participants. The differences were significant for the physical (77.81 ± 12.75 vs. 59.18 ± 12.90, p < 0.001), the psychological (74.78 ± 11.37 vs. 60.21 ± 14.70, p < 0.001), the social relationships (76.56 ± 13.56 vs. 63.07 ± 21.37, p < 0.001) and the environmental (70.27 ± 13.36 vs. 50.16 ± 11.39, p < 0.001) health scores. The patients with CVD had worse WHOQOL-BREF scores at initial, compared with the 6-month follow-up scores. CONCLUSION: This study shows that in spite of undergoing therapy, the subsequent QoL scores did not improve significantly, indicating that CVD continued to negatively affect the patient's life.

An Analysis of Neuropeptides at Nasal Contact Points of Patients With Secondary Headache.

OBJECTIVES: This prospective research study was designed to analyze the surgical outcomes and the intensity of substance P (SP), neurokinin A (NA), and calcitonin gene-related peptide (CGRP) in contact and noncontact nasal mucosa of patients with headache. METHODS: Twenty adults with secondary headache and correctible nasal obstruction were included in this study. The patients had nasal contact points between the nasal septum and the middle or inferior turbinates on nasal endoscopy and computed tomography scan. During surgical procedures, sample tissues were obtained from the nasal contact point and the noncontact area of the lateral nasal wall of these patients. Fluorescein staining intensity for antibodies against SP, NA, and CGRP was analyzed using image J software. Headaches were evaluated using a visual analog scale preoperatively and postoperatively. RESULTS: The differences between the preoperative and the postoperative 3rd month (P < 0.001) and 12th month (P < 0.001) visual analog scale scores were statistically significant. However, fluorescein staining intensity for SP (P = 0.631), NA (P = 0.546), and CGRP (P = 0.683) did not show statistically significant differences between the contact mucosa and the noncontact mucosa groups. CONCLUSIONS: Although in selected patients significant relief of headache can be obtained by surgery, there is no evidence from this study that SP, NA, and CGRP are responsible for the initiation of headache.

Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate.

The aim of the study was to investigate the relationship between nasal septal deviation and the middle turbinate hypertrophy using computed tomography. In this retrospective analysis, we examined 77 patients with nasal septal deviation. The mucosal and bone structures of the middle turbinate and the angle of the septum were measured using radiological analysis. Measurements of the middle turbinate on the convex side were compared to those on the concave side. Measurements of the bony and mucosal structure area of the middle turbinate were significantly greater than those on the concave side. The dimensions of medial mucosa thickness and bone thickness were not significantly different between the convex and concave sides. No significant correlation was found between the angle of deviation and other parameters. The present findings suggest that compensatory middle turbinate hypertrophy was caused both by conchal bone growth and mucosal hypertrophy in patients with nasal septal deviation.

Sorcin antibody as a possible predictive factor in conversion from radiologically isolated syndrome to multiple sclerosis: a preliminary study.

OBJECTIVE: To identify an antibody biomarker for prediction of conversion from radiologically isolated syndrome (RIS) to relapsing remitting multiple sclerosis (RRMS). METHODS: Sera of 13 RIS patients were screened by a protein macroarray derived from human fetal brain cDNA library. RESULTS: Sequencing of a clone with the highest signal intensity revealed sorcin as a potential target autoantigen in RIS patients. ELISA studies showed high-titer sorcin-antibodies in 3 of 4 RIS patients who converted to RRMS in a 5-year follow-up period and 13 of 23 control RRMS patients. CONCLUSION: The value of sorcin antibody as a predictor of conversion from RIS to RRMS requires to be tested in larger prospective studies.

Switch-associated protein 70 antibodies in multiple sclerosis: possible association with disease progression.

OBJECTIVE: This study was conducted to identify a biomarker for multiple sclerosis (MS) that can be used as a predictor of relapse and disability. MATERIALS AND METHODS: Sera of 26 consecutive relapsing-remitting MS (RRMS) patients were screened for switch-associated protein 70 (SWAP-70) antibody, which was previously identified by protein macroarray. The serum levels of several cytokines, chemokines and soluble adhesion molecules related to MS attacks were measured by enzyme-linked immunosorbent assay (ELISA). A possible correlation was sought among levels of SWAP-70 antibody, measured humoral factors and disability scores. RESULTS: ELISA studies showed high-titre SWAP-70 antibodies in 16 (61.5%) RRMS sera obtained during the attack period and 9 (34.6%) sera obtained during remission. There was a significant inverse correlation between SWAP-70 antibody levels and expanded disability status scale scores, CXCL10, soluble VCAM-1, CXCL13 and soluble VLA-4 levels. CONCLUSION: Our results showed that SWAP-70 antibodies could potentially be utilized as relapse and prognostic biomarkers in MS. Whether or not SWAP-70 antibodies have any effect on disease mechanisms requires further investigation.

Prevalence of allergic fungal rhinosinusitis among patients with chronic rhinosinusitis with or without nasal polyposis who underwent endonasal sinus surgery in northwestern Turkey.

OBJECTIVES: This study aims to evaluate the prevalence of allergic fungal rhinosinusitis in chronic rhinosinusitis patients in the northwest of Turkey. PATIENTS AND METHODS: Eighty-seven patients diagnosed with chronic rhinosinusitis and who were planned endonasal sinus surgery were enrolled in this prospective study. Patients were evaluated by detailed clinical examination, computed tomography, skin test against allergens, total serum immunoglobulin E (IgE) antibody, fungal-specific IgE antibody, and histopathologic and mycologic monitoring. RESULTS: Fungal elements showing tissue invasiveness were detected in only four patients. These patients had specific IgE against Aspergillus fumigatus (4.6%). Skin tests were positive for at least one allergen in 16 patients (18.3%). CONCLUSION: None of the patients met diagnostic criteria for allergic fungal rhinosinusitis. This result may be due to the diversity in disease prevalence based on geographical location or diagnostic methods.

Engineering hydrophobicity and manufacturability for optimized biparatopic antibody-drug conjugates targeting c-MET.

Optimal combinations of paratopes assembled into a biparatopic antibody have the capacity to mediate high-grade target cross-linking on cell membranes, leading to degradation of the target, as well as antibody and payload delivery in the case of an antibody-drug conjugate (ADC). In the work presented here, molecular docking suggested a suitable paratope combination targeting c-MET, but hydrophobic patches in essential binding regions of one moiety necessitated engineering. In addition to rational design of HCDR2 and HCDR3 mutations, site-specific spiking libraries were generated and screened in yeast and mammalian surface display approaches. Comparative analyses revealed similar positions amendable for hydrophobicity reduction, with a broad combinatorial diversity obtained from library outputs. Optimized variants showed high stability, strongly reduced hydrophobicity, retained affinities supporting the desired functionality and enhanced producibility. The resulting biparatopic anti-c-MET ADCs were comparably active on c-MET expressing tumor cell lines as REGN5093 exatecan DAR6 ADC. Structural molecular modeling of paratope combinations for preferential inter-target binding combined with protein engineering for manufacturability yielded deep insights into the capabilities of rational and library approaches. The methodologies of in silico hydrophobicity identification and sequence optimization could serve as a blueprint for rapid development of optimal biparatopic ADCs targeting further tumor-associated antigens in the future.

Analyzing the relationship between product waste footprints and environmental damage - A life cycle analysis of 1,400+ products.

A major problem for the circular economy is monitoring improvements in environmental sustainability. Measuring how much waste reduction efforts contribute to the decrease of environmental impact is difficult, because knowledge on whether life cycle waste amounts correlate with environmental damage is limited. In this article, product waste footprints are used to explore structural similarities and differences in associations with environmental damage. Using the waste flows linked to the production system of 1487 reference products from the Ecoinvent database, we found significant regression equations with R2 of 0.75-0.89 between product waste footprints and potential impact on ecosystem diversity, human health and resource availability using log-transformed variables. For each 1 % increase in solid waste, potential impact on the environment increased by 0.75-0.84 %. This strong association between pre-consumer waste and environmental damage is particularly important for advocating for circular economy efforts at the point of consumption, where life cycle waste is invisible to consumers.