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The effect of the storage conditions of light (presence; absence) and relative humidity (50%; 75% RH) on the water content and colour of Porphyridium cruentum microalga powder was studied, then two packaging materials, low-density polyethylene (PE-LD) and metallised polyethylene terephthalate with polyethylene (PETmet/PE), were used to study their effect on the water content, colour, total carotenoids and chlorophylls contents, total phenolic content (TPC), and antioxidant activity (ABTS, DPPH, ORAC) of P. cruentum during storage at 23 °C and 50% RH. An atmosphere with 50% RH is recommended to minimise the water vapour absorption and lightness loss. In addition to the expected light protection, PETmet/PE material protected P. cruentum powder also against water absorption, contrary to PE material. There were no relevant colour changes of the microalga during storage in PETmet/PE. Regarding the total content of carotenoids and the antioxidant activity of the microalga, no significant differences were found between the biomasses stored in either packaging material. The TPC and DPPH values were practically constant during two months of storage, while ABTS and ORAC decreased more than 50% and 20%, respectively, during this time. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has emerged as a transformative tool across several specialties, namely gastroenterology, where it has the potential to optimize both diagnosis and treatment as well as enhance patient care. Coloproctology, due to its highly prevalent pathologies and tremendous potential to cause significant mortality and morbidity, has drawn a lot of attention regarding AI applications. In fact, its application has yielded impressive outcomes in various domains, colonoscopy being one prominent example, where it aids in the detection of polyps and early signs of colorectal cancer with high accuracy and efficiency. With a less explored path but equivalent promise, AI-powered capsule endoscopy ensures accurate and time-efficient video readings, already detecting a wide spectrum of anomalies. High-resolution anoscopy is an area that has been growing in interest in recent years, with efforts being made to integrate AI. There are other areas, such as functional studies, that are currently in the early stages, but evidence is expected to emerge soon. According to the current state of research, AI is anticipated to empower gastroenterologists in the decision-making process, paving the way for a more precise approach to diagnosing and treating patients. This review aims to provide the state-of-the-art use of AI in coloproctology while also reflecting on future directions and perspectives.

Fucus spp. seaweeds thrive in the cold temperate waters of the northern hemisphere, specifically in the littoral and sublittoral regions along rocky shorelines. Moreover, they are known to be a rich source of bioactive compounds. This study explored the valorization of Fucus spiralis through the extraction of bioactives and polysaccharides (PSs) for food applications and biostimulant use. The bioactives were extracted using microwave hydrodiffusion and gravity (MHG), where the condition of 300 W for 20 min resulted in the highest total phenolic content and antioxidant activity of the extract. Cellular assays confirmed that the extract, at 0.5 mg/mL, was non-cytotoxic to HaCat cells. Polysaccharides (PSs) were extracted from the remaining biomass. The residue from this second extraction contained 1.5% protein and 13.35% carbohydrates. Additionally, the free amino acids and minerals profiles of both solid residues were determined. An edible film was formulated using alginate (2%), PS-rich Fucus spiralis extract (0.5%), and F. spiralis bioactive-rich extract (0.25%). The film demonstrated significant antioxidant properties, with ABTS and DPPH values of 221.460 ± 10.389 and 186.889 ± 36.062 µM TE/mg film, respectively. It also exhibited notable physical characteristics, including high water vapor permeability (11.15 ± 1.55 g.mm.m -2 .day -1 .kPa -1 ) and 100% water solubility. The residues from both extractions of Fucus spiralis exhibited biostimulant (BS) effects on seed germination and seedling growth. BSs with PSs enhanced pea germination by 48%, while BSs without PSs increased the root dry weight of rice and tomato by 53% and up to 176%, respectively, as well as the shoot dry weight by up to 38% and up to 74%, respectively. These findings underscore the potential of Fucus spiralis within the framework of a circular economy, wherein both extracted bioactives and post-extraction by-products can be used for sustainable agriculture and food applications.

Zinc oxide nanoparticles (ZnO NPs) have been investigated due to their distinct properties, variety of structures and sizes, and mainly for their antimicrobial activity. They have received a positive safety evaluation from the European Food Safety Authority (EFSA) for packaging applications as transparent ultraviolet (UV) light absorbers based on the absence of significant migration of zinc oxide in particulate form. ZnO NPs with different morphologies (spherical, flower, and sheet) have been synthesized via different sol-gel methods and extensively characterized by several solid-state techniques, namely vibrational spectroscopy, powder X-ray diffraction (XRD), scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS), Fourier Transform Infrared Spectroscopy (FTIR), ultraviolet-visible spectroscopy (UV-VIS), electron paramagnetic resonance (EPR), and nitrogen adsorption-desorption isotherms. The ZnO NPs were assessed for their antibacterial activity against Escherichia coli (gram-negative bacteria) and Staphylococcus aureus (gram-positive bacteria) to study the influence of morphology and size on efficacy. ZnO NPs with different morphologies and sizes demonstrated antimicrobial activity against both bacteria. The highest microbial cell reduction rate (7-8 log CFU mL -1 for E. coli and 6-7 log CFU mL -1 for S. aureus ) was obtained for the sheet- and spherical-shaped NPs as a result of the high specific surface area. In fact, the higher surface areas of the sheet- and spherical-shaped nanoparticles (18.5 and 13.4 m 2 g -1 , respectively), compared to the flower-shaped NPs (5.3 m 2 g -1 ), seem to promote more efficient bacterial cell reduction. The spherical-shaped particles were also smaller (31 nm) compared with the flower-shaped (233 × 249 nm) ones. The flower ZnO NP resulted in a 4-5 log CFU mL -1 reduction for E. coli and 3-4 log CFU mL -1 reduction for S. aureus . The lower apparent antibacterial activity of the flower-shaped could be associated with either the lack of defects on the particle core or the shape shielding effect. Compared to S. aureus , E. coli seems to be less resistant to ZnO NPs, which may be explained by the characteristics of its cell membrane. With simple synthesis techniques, which do not allow the size and shape of the nanoparticles to be controlled simultaneously, it is a challenge to elucidate the effect of each of these two parameters on antibacterial performance.

Purpose: Polidocanol foam sclerotherapy (SP) versus doppler-guided hemorrhoidal artery ligation with recto-anal repair (HAL-RAR) in the treatment of hemorrhoidal disease (HD) was analyzed., Methods: A prospective, randomized study including patients with HD grades II and III was performed. Participants were randomly assigned (1:1) into SP or HAL-RAR, during a recruitment period between September 2019 and February 2020. Therapeutic success (Sodergren's and bleeding scores) was the primary outcome. Other outcomes evaluated included complications and implication in the professional life. Efficacy and safety outcomes were evaluated during the 8 weeks after surgery or the final SP session., Results: Forty-six patients were allocated either to SP (n=22) or HAL-RAR (n=24). Most patients achieved therapeutic success (SP 100% vs. HAL-RAR 90.9%, p=0.131). Complete success was higher in the SP group (91.7% vs. 68.2%, p=0.045) and SP patients had less complications (25% vs. 68.2%, p=0.003). HAL-RAR had a greater negative impact on work activity of the patient., Conclusion: SP was more effective and safer than HAL-RAR. SP patients had less impact on their work activity. Clinical trials identifier NCT04675177.

Background: EU policies towards a circular economy address plastic packaging as one of the significant concerns and sets ambitious recycling targets. Polyolefins (POs) cannot be recycled for food contact using conventional polyethylene terephthalate (PET) recycling approaches. Thermal degradation prevents the use of high temperatures and, consequently, decontamination of POs may be insufficient when using lower temperatures. Polypropylene (PP) beverage cups were decontaminated using supercritical fluid extraction with carbon dioxide (scCO 2 ). Decontamination efficiencies (DEs) of selected markers were determined in challenge tests following European Food Safety Authority guidelines. The effects of time (10-60 min) for PET, polylactic acid (PLA), and PP and temperature (60-80 °C) for PP were studied at constant pressure. The physical properties, sensorial properties, and overall migration of treated scCO 2 PP were analysed and compared with virgin PP., Results: PP showed the highest average DE, and PET the lowest, for all the surrogates and in all time conditions. A relative increase in the DE with the increase in process time, particularly for PET and to some extent for PLA, was seen. For PP, no significant impact of time and temperature was observed under the conditions tested. The DE of volatile surrogates was higher than that of semi-volatiles. Results indicate that the scCO 2 treatment did not affect the physical and sensorial properties, nor the overall migration of PP, although it contributes to a considerable reduction in extractable n < C24 alkanes., Conclusions: Results indicate that scCO 2 can be used to decontaminate post-consumption PP beverage cups with higher DEs than those for PET and PLA, applying mild processing conditions. © 2022 Society of Chemical Industry., (© 2022 Society of Chemical Industry.)

Background: Most of the current materials used in food packaging are synthetic and non-degradable, raising environmental issues derived from the accumulation of plastics in landfills/waterways. The food industry increasingly needs eco-friendly sustainable materials that meet food-packaging requirements. Bacterial nanocellulose (BNC), a biopolymer obtained by fermentation, offers very good mechanical properties and the ability to carry and deliver active substances. However, its water-vapor permeability is too high for food-packaging applications. In this work, a layered biodegradable composite based on BNC and polyhydroxyalkanoate (PHBV) was produced, attempting to improve its overall barrier properties. Polyhydroxyalkanoate is a biopolymer with high degree of hydrophobicity and biodegradability, and is also obtained by fermentation. Wet BNC membranes produced by static culture were plasticized by impregnation of solutions of either glycerol (BNC gly ) or polyethylene glycol (M W 600) (BNC PEG ). The plasticized BNC was then coated with PHBV solution dissolved in formic acid, and oven dried at 148 °C., Results: Overall, PHBV coating on plasticized BNC reduced water vapor permeability significantly (from 0.990 to 0.032 g.μm.m -2 .day -1 .Pa -1 ) under 50% relative humidity. It increased the hydrophobicity (contact angle from 10-40° to 80-90°) but decreased the stiffness (from 3.1 GPa to 1.3 Gpa) of the composite., Conclusions: Overall, the mechanical and barrier properties of the layered composite obtained were considered suitable for food-packaging applications. The plasticizing (with glycerol or polyethylene glycol) of BNC significantly improved the mechanical performance and the PHBV coating reduced the water affinity (vapor and liquid state) on BNC. © 2022 Society of Chemical Industry., (© 2022 Society of Chemical Industry.)

Background: Colorectal anastomotic leakage (CAL), a severe postoperative complication, is associated with high morbidity, hospital readmission, and overall healthcare costs. Early detection of CAL remains a challenge in clinical practice. However, some decision models have been developed to increase the diagnostic accuracy of this event., Aim: To develop a score based on easily accessible variables to detect CAL early., Methods: Based on the least absolute shrinkage and selection operator method, a predictive classification system was developed [Early ColoRectAL Leakage (E-CRALL) score] from a prospective observational, single center cohort, carried out in a colorectal division from a non-academic hospital. The score performance and CAL threshold from postoperative day (POD) 3 to POD5 were estimated. Based on a precise analytical decision model, the standard clinical practice was compared with the E-CRALL adoption on POD3, POD4, or POD5. A cost-minimization analysis was conducted, on the assumption that all alternatives delivered similar health-related effects., Results: In this study, 396 patients who underwent colorectal resection surgery with anastomosis, and 6.3% ( n = 25) developed CAL. Most of the patients who developed CAL ( n = 23; 92%) were diagnosed during the first hospital admission, with a median time of diagnosis of 9.0 ± 6.8 d. From POD3 to POD5, the area under the receiver operating characteristic curve of the E-CRALL score was 0.82, 0.84, and 0.95, respectively. On POD5, if a threshold of 8.29 was chosen, 87.4% of anastomotic failures were identified with E-CRALL adoption. Additionally, score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d, if used on POD3 and POD5, respectively. Regardless of score adoption, episode comprehensive costs were markedly greater (up to four times) in patients who developed CAL in comparison with patients who did not develop CAL. Nonetheless, the use of the E-CRALL warning score was associated with cost savings of €421442.20, with most (92.9%) of the savings from patients who did not develop CAL., Conclusion: The E-CRALL score is an accessible tool to predict CAL at an early timepoint. Additionally, E-CRALL can reduce overall healthcare costs, mainly in the reduction of hospital costs, independent of whether a patient developed CAL., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL., Methods: Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients' satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran's Q test and I 2 ., Results: Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01-2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32-2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86-1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I-III)., Conclusions: RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD., Competing Interests: The authors declare no conflicts of interest of any kind regarding the content of the manuscript., (Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.)

Introduction and Objectives: Immune Checkpoint Inhibitors (ICI) have shifted the paradigm of cancer therapy treatment. Despite their efficacy, ICIs may induce immune-related adverse events (irAE), which can affect various organs, namely the liver. This study intends to perform a comprehensive clinical description of the hepatic irAEs associated with ICI in a Portuguese population of a tertiary hospital centre., Materials and Methods: A retrospective analysis of patients who developed immune-mediated liver injury (IMLI), among a cohort of patients treated with ICIs between March 15 th of 2015 and December 15 th of 2019 in a tertiary hospital. We used both Common Terminology Criteria for Adverse Events (CTCAE) and Drug-Induced Liver Injury Network (DILIN) criteria to define liver injury., Results: Among 151 patients, eight (5.3%) patients developed liver injury grade ≥3, of which five had hepatic metastasis. As such, only 3 cases were classified as IMLI. All IMLI presented with cholestasis pattern; the median duration from ICI initiation to IMLI was 84 days and/or 4 ICI cycles; one patient registered IMLI one month after nivolumab suspension; all were treated with steroids and one was successfully submitted to ICI re-challenge; a favourable outcome was seen in all patients; the median time to hepatic biochemistries normalization was 150 days. Among 10 patients with previous hepatic conditions, only one developed liver injury grade 2., Conclusions: Clinically significant ICI-related hepatotoxicity was uncommon; Immune-mediated liver injury may present a cholestatic pattern predominance. There was a low rate of liver injury of any kind in patients with previous hepatic disease while on ICI., Competing Interests: Conflicts of interest The authors declare that they have no conflict of interest., (Copyright © 2021 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

The food industry is increasingly demanding advanced and eco-friendly sustainable packaging materials with improved physical, mechanical and barrier properties. The currently used materials are synthetic and non-degradable, therefore raising environmental concerns. Consequently, research efforts have been made in recent years towards the development of bio-based sustainable packaging materials. In this review, the potential of nanocelluloses as nanofillers or as coatings for the development of bio-based nanocomposites is discussed, namely: (i) the physico-chemical interaction of nanocellulose with the adjacent polymeric phase, (ii) the effect of nanocellulose modification/functionalization on the final properties of the composites, (iii) the production methods for such composites, and (iv) the effect of nanocellulose on the overall migration, toxicity, and the potential risk to human health. Lastly, the technology readiness level of nanocellulose and nanocellulose based composites for the market of food packaging is discussed.

Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients' quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients., Competing Interests: P. Salgueiro and P. Amaro received fees as speakers from Angelini Farmacêutica Lda., (Copyright © 2019 by S. Karger AG, Basel.)

Background: rectal cancer staging using rigid probes or echoendoscopes has some limitations. The aim of the study was to compare rectal cancer preoperative staging using conventional endoluminal ultrasonography with three-dimensional endoscopic ultrasonography and miniprobes., Materials and Methods: sixty patients were included and evaluated with: a) a conventional echoendoscope (7.5 and 12 MHz); b) miniprobes (12 MHz); and c) the Easy 3D Freescan software for three-dimensional endoscopic ultrasonography. The reference or gold standard was conventional endoluminal ultrasonography in all cases and pathological assessment for those without preoperative therapy. The differences in T and N staging accuracy in both longitudinal and circumferential extension were evaluated., Results: with regard to T staging, conventional endoluminal ultrasonography had an accuracy of 85% (compared to pathological analysis), and the agreement between miniprobes vs conventional endoluminal ultrasonography (kappa = 0.81) and three-dimensional endoscopic ultrasonography vs conventional endoluminal ultrasonography (k = 0.87) was significant. In addition, miniprobes had an accuracy of 82% and three-dimensional endoscopic ultrasonography had a higher accuracy (96%). With regard to N staging, conventional endoluminal ultrasonography had an accuracy of 91% with a sensitivity of 78%. However, the agreement between miniprobes and conventional endoluminal ultrasonography and three-dimensional endoscopic ultrasonography and conventional endoluminal ultrasonography (k = 0.70) was lower. Interestingly, miniprobes had a lower accuracy of 81% whereas three-dimensional endoscopic ultrasonography had an accuracy of 100% without any false negative. No false positives were observed in any of the techniques. Accuracy for T and N staging was not influenced by longitudinal or circumferential extensions of the tumor in all types of endoscopic ultrasonography analyzed., Conclusions: miniprobes and especially three-dimensional endoscopic ultrasonography may be relevant during rectal cancer staging.

Introduction: Autoimmune pancreatitis is a rare entity of unknown etiology that can mimic pancreatic cancer and whose diagnosis involves clinical, serological, imagiological, and histological findings. There are two types of autoimmune pancreatitis: type 1, in which the pancreas is involved as one part of a systemic immunoglobulin G4-related disease, and type 2, generally without immunoglobulin G4-positive cells and without systemic involvement., Case: We report the case of a 45-year-old female, who underwent an abdominal magnetic resonance imaging for etiological study of a solid liver lesion, which revealed a tail pancreatic mass. Laboratory analyses showed normal levels of immunoglobulin G4 and negative antinuclear antibodies. Endoscopic ultrasound revealed a homogeneous and hypoechogenic lesion in the pancreatic tail with a "sausage-like" appearance. Endoscopic ultrasound-guided fine needle aspiration was inconclusive and the patient underwent a laparoscopic distal pancreatectomy. Histopathology examination confirmed the diagnosis of type 2 autoimmune pancreatitis., Conclusion: This case highlights the challenge in the diagnostic approach of a pancreatic mass, particularly in distinguishing benign from malignant disease.

Survival improvement in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT) is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. The ability to predict tumor response before treatment may significantly have impact the selection of patients for nCRT in rectal cancer. The aim is to identify potential predictive pretreatment factors for Mandard response and build a clinical predictive model design. 167 patients with locally advanced rectal cancer were treated with nCRT and curative surgery. Blood cell counts in peripheral blood were analyzed. Pretreatment biopsies expression of cyclin D1, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and protein 21 were assessed. A total of 61 single nucleotide polymorphisms were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard TRG. The patients were divided as: "good responders" (Mandard TRG1-2) and "poor responders" (Mandard TGR3-5). We examined predictive factors for Mandard response and performed statistical analysis. In univariate analysis, distance from anal verge, neutrophil lymphocyte ratio (NLR), cyclin D1, VEGF, EGFR, protein 21 and rs1810871 interleukin 10 (IL10) gene polymorphism are the pretreatment variables with predictive value for Mandard response. In multivariable analysis, NLR, cyclin D1, protein 21 and rs1800871 in IL10 gene maintain predictive value, allowing a clinical model design., Conclusion: It seems possible to use pretreatment expression of blood and tissue biomarkers, and build a model of tumor response prediction to neoadjuvant chemoradiation in rectal cancer., Competing Interests: CONFLICTS OF INTEREST All authors state that they have no conflicts of interest.

Aim: To evaluate the prognostic significance and potential therapeutic implication of genetic variability in prostaglandin E 2 pathway genes in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery., Materials and Methods: This cohort study included 167 patients with LARC, treated with nCRT followed by surgery. A total of 61 single nucleotide polymorphisms (SNPs) were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard tumor regression grade (TRG). The patients were divided as 'good responders' (Mandard TGR1-2) and 'poor responders' (Mandard TRG3-5). We examined prognostic value of polymorphisms studied to determine if they are related to Mandard response., Results: Mandard tumor response and rs17268122 in ATP binding cassette subfamily C member (ABCC4) gene were the only two parameters with independent prognostic significance for disease-free survival., Conclusion: tagSNP ABCC4 rs17268122 appears to be a prognostic factor in LARC treated with nCRT and surgery, independently of response to nCRT. The screening of ABCC4 rs17268122 tagSNP and the Mandard tumor response in clinical practice may help to identify patients with different rectal cancer prognosis and contribute to an individualized therapeutic decision tree., (Copyright© 2017 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)