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IntroductionIn pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk.MethodsA prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT’s plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed.Results53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients’ characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%.ConclusionsFor PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated.Trial registration number:Dutch Trial Registry (NTR3142).

Mortality salience (MS) and self-esteem affect attitudes and behavioral intentions in various contexts, including pro-environment behavioral intentions. This study aimed to explore how MS and explicit self-esteem impact on attitude towards plastic reduction for future generations (APRFG) and intention to reduce plastic use, by integrating the Theory of Planned Behavior (TPB) and Terror Management Theory (TMT). An experimental design was employed, with 357 participants aged 20 to 70 recruited via an online platform. The participants were randomly assigned to either an MS condition, or a control condition and then measured their explicit self-esteem by the Rosenberg Self-Esteem Scale. Subsequently, the experimental group was exposed to information on the fatal health risks associated with microplastics, while the control group was reminded of their own experiences of dental pain. After a few minutes, all participants were asked to complete a self-report questionnaire, including APRFG, subjective norm, perceived behavioral control, and intention to reduce plastic use. Data were analyzed using the PROCESS macro to examine mediation and moderation effects. Our findings showed that MS significantly enhanced APRFG, subjective norm, and perceived behavioral control, which in turn led to stronger intention to reduce plastic use. Among these three factors, the mediating effect of APRFG was the most pronounced, highlighting its central role in linking MS to plastic reduction intention. MS, when combined with explicit self-esteem, significantly influences APRFG and intention to reduce plastic use. The relationships between MS and APRFG/plastic reduction intention were particularly pronounced among the participants with lower explicit self-esteem. Policymakers can leverage these insights to craft marketing messages that enhance plastic-reduction efforts, taking into account individual differences in explicit self-esteem.

IntroductionPhthalates and bisphenols, chemicals commonly used in the production of plastic products, exhibit endocrine disrupting properties linked to obesity and systemic inflammation. Given the ubiquitous use of plastic chemicals, their adverse impact on human health is of great importance. In this protocol, we describe a randomised controlled trial aimed at testing whether minimising exposure to plastics and plastic-associated chemicals (PACs) in community-dwelling adults with cardiometabolic risk factors can reduce urinary excretion of PACs and improve cardiometabolic health.Methods and analysisThe study will recruit (n=60) community-dwelling adults (18–60 years) with cardiometabolic risk factors, characterised by a body mass index of ≥30 kg/m2 and waist circumference of ≥88 cm in women and ≥102 cm in men. Participants will be randomised to a control (n=30) or an intervention group (n=30) receiving a 4-week diet and lifestyle modification designed to reduce plastic exposure, which includes the replacement of all food, kitchen utensils and equipment, personal care and cleaning products. The primary outcome is a reduction in urinary excretion of bisphenols after the 4-week intervention compared with the control arm. The secondary outcomes are the reduction in urinary excretion of low and high molecular weight phthalates. Finally, tertiary outcomes investigate improvements to cardiometabolic biomarkers, body composition, waist circumference and blood pressure. Participants will self-collect urine, stool and nasal lavage samples a day before beginning the intervention and at the end of each week. Fasting blood samples and health assessments will be collected during clinic visits: at baseline, mid-point and a day after the intervention period. Urinary PAC excretion and cardiometabolic health outcomes will be compared between the intervention and control groups.Ethics and disseminationThe PERTH Trial has ethics approval from the University of Western Australia Human Research Ethics Committee; 2021-ET001118. Results will be submitted for publication in peer-reviewed journals and presented at conferences.Trial registration numberNCT06571994.

Drug-eluting stents (DES) with biodegradable polymers have been developed to address the risk of thrombosis associated with first-generation DES. We aimed to determine the efficacy and safety of biodegradable polymer biolimus-eluting stents (BES) versus durable polymer DES. Systematic database searches of MEDLINE (1950 to June 2013), EMBASE (1966 to June 2013), the Cochrane Central Register of Controlled Trials (Issue 6 of 12, June 2013), and a review of related literature were conducted. All randomized controlled trials comparing biodegradable polymer BES versus durable polymer DES were included. Eight randomized controlled trials investigating 11,015 patients undergoing percutaneous coronary interventions were included in the meta-analysis. The risk of major adverse cardiac events did not differ significantly between the patients treated with the biodegradable polymer BES and the durable polymer DES (Relative risk [RR], 0.970; 95% CI, 0.848-1.111; p = 0.662). However, biodegradable polymer BES was associated with reduced risk of very late ST compared with the durable polymer DES, while the risk of early or late ST was similar (RR for early or late ST, 1.167; 95% CI 0.755-1.802; p = 0.487; RR 0.273; 95% CI 0.115-0.652; p = 0.003; p for interaction = 0.003). In this meta-analysis of randomized controlled trials, treatments with biodegradable polymer BES did not significantly reduce the risk of major adverse cardiac events, but demonstrated a significantly lower risk of very late ST when compared to durable polymer DES. This conclusion requires confirmation by further studies with long-term follow-up. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004364#.UnM2lfmsj6J.

BackgroundA randomized prospective trial to compare the effects on minimizing complications using continuous negative pressure drain and intermittent suction mode in plastic surgeries.MethodsThere were 174 cases of stage II post-auricular flap expansion and ear reconstruction, 76 cases of skin expansion flap repair, 56 cases of breast augmentation surgery, 58 cases of abdominoplasty, and 76 cases with free skin grafts. Patients were randomized to intermittent suction mode group (control group) and continuous negative pressure external drain group (intervention group) stratified by surgery types. In the intervention group, different pressure levels were applied according to the surgery types. The drainage volume, the length of time of external drainage, incidence of seroma, flap necrosis, the first intending healing rate and drain-associated bleeding were recorded and compared.ResultsGenerally, fewer complications and better healing were observed in the intervention group. In patients with stage II post-auricular flap expansion and ear reconstruction, lower incidence of flap necrosis and seroma, higher first intention healing rate, greater drain volume but shorter time of drainage were observed in the intervention group (p < 0.05 for all). Similar results were shown in patients with skin expansion flap repair, breast augmentation, abdominoplasty, and free skin grafts. In patients who underwent free skin grafts, a higher graft success rate and lower graft infection rate were also observed (p < 0.01 for both). No drain-associated bleeding was observed.ConclusionsA continuous negative pressure drain was associated with better outcomes in patients underwent various plastic surgeries and is a powerful technique in the postoperative management of plastic surgery.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

There is a rising concern regarding the accumulation of floating plastic debris in the open ocean. However, the magnitude and the fate of this pollution are still open questions. Using data from the Malaspina 2010 circumnavigation, regional surveys, and previously published reports, we show a worldwide distribution of plastic on the surface of the open ocean, mostly accumulating in the convergence zones of each of the five subtropical gyres with comparable density. However, the global load of plastic on the open ocean surface was estimated to be on the order of tens of thousands of tons, far less than expected. Our observations of the size distribution of floating plastic debris point at important size-selective sinks removing millimeter-sized fragments of floating plastic on a large scale. This sink may involve a combination of fast nano-fragmentation of the microplastic into particles of microns or smaller, their transference to the ocean interior by food webs and ballasting processes, and processes yet to be discovered. Resolving the fate of the missing plastic debris is of fundamental importance to determine the nature and significance of the impacts of plastic pollution in the ocean.

In order to understand the degradation potential of plastics in the marine environment, microorganisms that preferentially colonize and interact with plastic surfaces, as opposed to generalists potentially colonising everything, need to be identified. Accordingly, it was hypothesized that i.) plastic \"specific\" microorganisms are closely attached to the polymeric surface and ii.) that specificity of plastics biofilms are rather related to members of the rare biosphere. To answer these hypotheses, a three phased experiment to stepwise uncover closely attached microbes was conducted. In Phase 1, nine chemically distinct plastic films and glass were incubated in situ for 21 months in a seawater flow through system. In Phase 2, a high-pressure water jet treatment technique was used to remove the upper biofilm layers to further, in Phase 3, enrich a plastic \"specific\" community. To proof whether microbes colonizing different plastics are distinct from each other and from other inert hard substrates, the bacterial communities of these different substrates were analysed using 16S rRNA gene tag sequencing. Our findings indicate that tightly attached microorganisms account to the rare biosphere and suggest the presence of plastic \"specific\" microorganisms/assemblages which could benefit from the given plastic properties or at least grow under limited carbon resources.

Ocean plastic can persist in sea surface waters, eventually accumulating in remote areas of the world’s oceans. Here we characterise and quantify a major ocean plastic accumulation zone formed in subtropical waters between California and Hawaii: The Great Pacific Garbage Patch (GPGP). Our model, calibrated with data from multi-vessel and aircraft surveys, predicted at least 79 (45–129) thousand tonnes of ocean plastic are floating inside an area of 1.6 million km 2 ; a figure four to sixteen times higher than previously reported. We explain this difference through the use of more robust methods to quantify larger debris. Over three-quarters of the GPGP mass was carried by debris larger than 5 cm and at least 46% was comprised of fishing nets. Microplastics accounted for 8% of the total mass but 94% of the estimated 1.8 (1.1–3.6) trillion pieces floating in the area. Plastic collected during our study has specific characteristics such as small surface-to-volume ratio, indicating that only certain types of debris have the capacity to persist and accumulate at the surface of the GPGP. Finally, our results suggest that ocean plastic pollution within the GPGP is increasing exponentially and at a faster rate than in surrounding waters.

Microplastics and nanoplastics (MNPs) are emerging as a potential risk factor for cardiovascular disease in preclinical studies. Direct evidence that this risk extends to humans is lacking. We conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens were analyzed for the presence of MNPs with the use of pyrolysis-gas chromatography-mass spectrometry, stable isotope analysis, and electron microscopy. Inflammatory biomarkers were assessed with enzyme-linked immunosorbent assay and immunohistochemical assay. The primary end point was a composite of myocardial infarction, stroke, or death from any cause among patients who had evidence of MNPs in plaque as compared with patients with plaque that showed no evidence of MNPs. A total of 304 patients were enrolled in the study, and 257 completed a mean (±SD) follow-up of 33.7±6.9 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4%), with a mean level of 21.7±24.5 μg per milligram of plaque; 31 patients (12.1%) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2±2.4 μg per milligram of plaque. Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris. Radiographic examination showed that some of these particles included chlorine. Patients in whom MNPs were detected within the atheroma were at higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27; P<0.001). In this study, patients with carotid artery plaque in which MNPs were detected had a higher risk of a composite of myocardial infarction, stroke, or death from any cause at 34 months of follow-up than those in whom MNPs were not detected. (Funded by Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale and others; ClinicalTrials.gov number, NCT05900947.).