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Abstract Microplastics (MPs) have been identified in diverse settings, including drinking water, freshwater, food, air, and marine environments. This study employed stereomicroscopic and µ-Raman techniques to analyze water samples from ten widely consumed bottled water brands, aiming to detect and characterize MPs. Additionally, the oral consumption of MPs per capita was estimated. The average abundance of MPs ranged from 9 ± 1.00 MPs/L to 3 ± 1.73 MPs/L across all brands. Various MPs shapes were observed, including fibers, fragments, films, and pellets, with fibers being predominant (58.928%). MPs were categorized by color into five groups (red, blue, black, yellow, and transparent), with red comprising approximately 35.714% of the total count. All identified MPs were less than 500 µm in size. µ-Raman analysis validated the presence of eight different polymer types in the samples, namely Polypropylene (PP) (37.5%), Polymethyl methacrylate (PMMA) (3.571%), polystyrene (PS) (33.928%), polycarbonate (PC) (3.571%), polybutylene1 (PB1) (14.2%), Isotactic polypropylene (iPP) (7.142), Nylone 6-α polymorph (αNY6) (5.357%), and polyvinyl alcohol (PVOH) (1.785%). The estimated daily intake of MPs per person was determined to be 0.42 MPs, translating to an annual intake of 153.3 MPs per person. The origin of MPs in bottled water was likely attributed to both raw water sources and packaging materials, underscoring the need for further investigation. Given the potential health implications of human exposure to drinking water MPs, careful consideration should be given to the use of plastic packaging for potable water.

The most significant threat to environmental components is the alarming increase of micro- and nano- plastics (MNPs) within the ecosystem. In addition to being produced by breaking larger plastic into fragments, MNPs are also produced for commercial uses, particularly packaging. MNPs exposure has infiltrated the food chain, environment, agroecosystems, human body, and animals. Even though technical processes to characterize MNPs are still emerging, exploring innovative remediation methods is crucial. Among the several remediation techniques available to date, microbial remediation showed better promise to degrade or sustainably remove MNPs from the environment. Microorganisms have evolved genes that impact changes in plastic pollutants under stable ecophysiological processes that depend on biotic and abiotic elements. Thus, they destroy or eliminate MNPs by using the corresponding carbon content in the pollutants as energy sources for development. The sources of MNPs and their accompanying degradation processes have been explored in this review, identifying future research needs to support the current global environmental protection initiatives.

The widespread presence of microplastics (MPs) in water raises serious concerns on a global scale due to the negative effects on human health and ecosystems. Wastewater and sludge from preliminary plants of recycled plastic pellets are a significant continuous source of MP discharged into the environment. Wastewater and sludge samples were collected from three plastic recycling plants and analyzed for MPs (size from 0.15–5 mm). The average rate of MP emission was approximately 5.8–6.6% of the total investigations. The MP in water ranged from 14.3410 to 19.3395 g/l, of which 40% with size 2–5 mm, 32% (1–2 mm), 5% (0.5–1 mm), 14% (0.15–0.5 mm), and 9% with size less than 0.15 mm in average. MP in sludge varied from 472.2031 to 644.7620 g/kg, of which, 37% with size 2–5 mm, 24% (1–2 mm), 9% (0.5–1 mm), 12% (0.15–0.5 mm) and 18% less than 0.15 mm. In average, 2,695 particles/l and 287,600 particles/kg of MP size 0.15–5 mm was found in wastewater and sludge, which may have a potential risk to aquatic fauna and humans. Therefore, control microplastic emission from those sources will contribute significantly to reducing microplastics entering the surrounding environment. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Hydrobiology is the property of Editorial Department of Journal of Hydrobiology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Research on nano- and micro-plastic particles (NMPPs) suggests their potential threat to human health. Some studies have even suggested genotoxic effects of NMPP exposure, such as micronuclei (MN) formation, while others found the opposite. To clarify the ability of NMPP to induce MN formation, we used non-malignant HaCaT keratinocytes and exposed these to a variety of polystyrene (PS) and poly methyl methacrylate (PMMA) particle types at different concentrations and three different sizes. Investigations were performed following acute (one day) and chronic exposure (five weeks) against cytotoxic (amino-modified NMPPs) and genotoxic (methyl methanesulfonate, MMS) positive controls. An optimized high-content imaging workflow was established strictly according to OECD guidelines for analysis. Algorithm-based object segmentation and MN identification led to computer-driven, unsupervised quantitative image analysis results on MN frequencies among the different conditions and thousands of cells per condition. This could only be realized using accutase, allowing for partial cell detachment for optimal identification of bi-nucleated cells. Cytotoxic amino-modified particles were not genotoxic; MMS was both. During acute and long-term studies, PS and PMMA particles were neither toxic nor increased MN formation, except for 1000 nm PS particles at the highest concentration of unphysiological 100 µg/mL. Interestingly, ROS formation was significantly decreased in this condition. Hence, most non-charged polymer particles were neither toxic nor genotoxic, while aminated particles were toxic but not genotoxic. Altogether, we present an optimized quantitative imaging workflow applied to a timely research question in environmental toxicity. [ABSTRACT FROM AUTHOR]

The accumulation of macro-, micro- and nano-plastic wastes in the environment is a major global concern, as these materials are resilient to degradation processes. However, microorganisms have evolved their own biological means to metabolize these petroleum-derived polymers, e.g., Ideonella sakaiensis has recently been found to be capable of utilizing polyethylene terephthalate (PET) as its sole carbon source. This study aims to prove its potential capacity to biodegrade two commercial PET materials, obtained from food packaging containers. Plastic pieces of different crystallinity were simultaneously introduced to Ideonella sakaiensis during a seven-week lasting investigation. Loss in weight, appearance of plastics, as well as growth of Ideonella sakaiensis—through quantitative real-time PCR—were determined. Both plastics were found enzymatically attacked in a two-stage degradation process, reaching biodegradation capacities of up to 96%. Interestingly, the transparent, high crystallinity PET was almost fully degraded first, followed by the colored low-crystallinity PET. Results of quantitative real-time PCR-based gene copy numbers were found in line with experimental results, thus underlining its potential of this method to be applied in future studies with Ideonella sakaiensis. [ABSTRACT FROM AUTHOR]

Copyright of Inzynieria Mineralna is the property of Polskie Towarzystwo Przerobki Kopalin and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ecological risk of micro/nano-plastics (MPs/NPs) has become an important environmental issue. Microcystin -leucine-arginine (MC-LR) produced by Microcystis aeruginosa (M. aeruginosa) is the most common and toxic secondary metabolites (SM). However, the influencing mechanism of MPs and NPs exposure on MC-LR synthesis and release have still not been clearly evaluated. In this work, under both acute (4d) and long-term exposure (10d), only high-concentration (10 mg/L) exposure of amino-modified polystyrene NPs (PS-NH 2 -NPs) promoted MC-LR synthesis (32.94 % and 42.42 %) and release (27.35 % and 31.52 %), respectively. Mechanistically, PS-NH 2 -NPs inhibited algae cell density, interrupted pigment synthesis, weakened photosynthesis efficiency, and induced oxidative stress, with subsequent enhancing the MC-LR synthesis. Additionally, PS-NH 2 -NPs exposure up-regulated MC-LR synthesis pathway genes (mcy A, mcy B, mcy D, and mcy G) combined with significantly increased metabolomics (Leucine and Arginine), thereby enhancing MC-LR synthesis. PS-NH 2 -NPs exposure enhanced the MC-LR release from M. aeruginosa via up-regulated MC-LR transport pathway genes (mcy H) and the shrinkage of plasma membrane. Our results provide new insights into the long-time coexistence of NPs with algae in freshwater systems might pose a potential threat to aquatic environments and human health. [Display omitted] ● NH 2 -modified-NPs promoted MC-LR synthesis and release from Microcystis aeruginosa. ● MPs and COOH-modified-NPs had no effect on MC-LR synthesis and release. ● Enhancement of MC-LR synthesis due to the upregulation of Leucine and Arginine. ● Membrane damage and mcy H transport gene upregulation increased MC-LR release. [ABSTRACT FROM AUTHOR]

Coastal plastic debris is a major problem affecting both sandy beaches and nearshore environments. Over several decades, plastic debris has become a global threat to the natural environment due in part to single-use culture, pervasiveness and accumulation following years of improper disposal. Despite the global research effort, in the Caribbean region, only a few studies attempt to quantify the amount and sources of debris. This paper combines coastal geomorphology and plastic debris collection with GIS spatial analysis at Maracas Beach, Trinidad between 2015 and 2016. Overall, 567 separate plastic items were captured and classified from within two 30 m wide zones at the central and eastern portions of the microtidal sandy beach. Macro- and meso-plastic debris associated with beach activity (n=233) and single use waste (n=215) were the most abundant debris. Microplastic debris (n=94) consists mainly of polystyrene granules and unidentifiable fragments from larger recreational debris that are readily lost to the environment. Using manufacturer’s information, polystyrene (n=206) was the most dominant debris. Regression models were also conducted using the average beach size and average beach angles where a weak positive linear relationship was found. Kernel density estimation was used to geovisualize the distribution of plastic items per square metre to develop a plastic debris signature. Despite current beach management activities, a large proportion of macro- and meso-sized debris can enter the environment. Studies such as these are invaluable for the Caribbean region where attempts to manage the pollution caused by plastic are limited by data. [ABSTRACT FROM AUTHOR]

Copyright of Environmental Science & Technology (10036504) is the property of Editorial Board of Environmental Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Research on nano- and micro-plastic particles (NMPPs) suggests their potential threat to human health. Some studies have even suggested genotoxic effects of NMPP exposure, such as micronuclei (MN) formation, while others found the opposite. To clarify the ability of NMPP to induce MN formation, we used non-malignant HaCaT keratinocytes and exposed these to a variety of polystyrene (PS) and poly methyl methacrylate (PMMA) particle types at different concentrations and three different sizes. Investigations were performed following acute (one day) and chronic exposure (five weeks) against cytotoxic (amino-modified NMPPs) and genotoxic (methyl methanesulfonate, MMS) positive controls. An optimized high-content imaging workflow was established strictly according to OECD guidelines for analysis. Algorithm-based object segmentation and MN identification led to computer-driven, unsupervised quantitative image analysis results on MN frequencies among the different conditions and thousands of cells per condition. This could only be realized using accutase, allowing for partial cell detachment for optimal identification of bi-nucleated cells. Cytotoxic amino-modified particles were not genotoxic; MMS was both. During acute and long-term studies, PS and PMMA particles were neither toxic nor increased MN formation, except for 1000 nm PS particles at the highest concentration of unphysiological 100 µg/mL. Interestingly, ROS formation was significantly decreased in this condition. Hence, most non-charged polymer particles were neither toxic nor genotoxic, while aminated particles were toxic but not genotoxic. Altogether, we present an optimized quantitative imaging workflow applied to a timely research question in environmental toxicity.

Contamination due to the existence of heavy metals in water and soil poses a significant hazard to the entire world as a result of the growth in industrialization and urbanization. The investigation of sustainable and environmentally friendly alternatives is prompted by the frequent failure and disruption of conventional restoration techniques. The use of plants specifically in bioremediation has been identified as a promising technique to reduce the concentration of heavy metals in wastewater or soil. The method of investigation involves the growing of particular plant species in heavy metal-contaminated soil and water, such as hyperaccumulators, which are recognized for their capacity to accumulate metals. The objective of the study is to evaluate these plants' ability to take in, store, and eliminate heavy metals, which will help clean up contaminated areas. The current study also assess the bioconcentration factor and the potential for heavy metals remediation using four plant species: Prosopis Cineraria, Indian mustard, red cabbage, and sunflower (Helianthus Annuus). The findings of the current study show that red cabbage has the highest bioconcentration factor value is 0.957, which is for arsenic at Ghaziabad location, while the lowest bioconcentration factor value is 0.412, which is for copper at Surajpur Industrial Area location. Present findings confirm the phytoremediation to be a sustainable environmental technique thereby combining the advantages of low-cost nature based and eco-friendly solutions in order to eradicate the heavy metal pollution problem from the environment. • Approach to bioremediation of plant to eliminate heavy metals and microplastics. • Four species to facilitate bioremediation of arsenic, copper, lead and chromium. • Highest bioconcentration factor is observed for arsenic at Ghaziabad location. • Findings conform the phytoremediation technique to be environmentally sustainable. • Restoring natural ecosystems is important for sustainable solutions. [ABSTRACT FROM AUTHOR]

Here, we apply 20 MeV particle-induced X-ray emission (PIXE) to elemental analysis of microplastic samples with a diameter of approximately 2 mm, collected from the seashores of the northeastern area of Honshu in Japan. The samples were in a grain form with unwanted elements adhering to their surfaces. The PIXE measurements were conducted in a helium atmosphere. For normalization, the number of K X-rays of the residual gas argon was used instead of the directly measured beam irradiation, and the number of continuous X-rays in the PIXE spectrum was used instead of the mass of each sample. Thirteen elements were identified on the microplastics, among which were toxic chromium and lead. Thus, PIXE analysis is useful for analyzing microplastic samples. [ABSTRACT FROM AUTHOR]

This review discusses the micro-nano plastics (MNPs) and their interaction with physical, chemical and biological processes in a constructed wetland (CW) system that is typically used as a nature-based tertiary wastewater treatment for municipal as well as industrial applications. Individual components of the CW system such as substrate, microorganisms and plants were considered to assess how MNPs influence the CW processes. One of the main functions of a CW system is removal of nutrients like nitrogen (N) and phosphorus (P) and here we highlight the pathways through which the MNPs influence CW's efficacy of nutrient removal. The presence of morphologically (size and shape) and chemically different MNPs influence the growth rate of microorganisms important in N and P cycling, invertebrates, decomposers, and the plants which affect the overall efficiency of a CW treatment system. Certain plant species take up the MNPs, and some toxicity has been observed. This review focuses on two significant aspects: (1) the presence of MNPs in a significant concentration affects the efficiency of N and P removal, and (2) the removal of MNPs. Because MNPs reduce the enzyme activities in abundance and overproduction of ROS oxidizes the enzyme active sites, resulting in the depletion of proteins, ultimately inhibiting nitrogen and phosphorus removal within the substrate layer. The review found that the majority of the studies used sand-activated carbon (SAC), granular-activated carbon (GAC), rice straw, granular limestone, and calcium carbonate, as a substrate for CW treatment systems. Common plant species used in the CW include Phragmites , Arabidopsis thaliana , Lepidium sativum , Thalia dealbata , and Canna indica , which were also found to be dominant in the uptake of the MNPs in the CWs. The MNPs were found to affect earthworms such as Eisenia fetida , Caenorhabditis elegans , and, Enchytraeus crypticus , whereas Metaphire vulgaris were found unaffected. Though various mechanisms take place during the removal process, adsorption and uptake mechanism effectively emphasize the removal of MNPs and nitrogen and phosphorus in CW. The MNPs characteristics (type, size, and concentration) play a crucial role in the removal efficiency of nano-plastics (NPs) and micro-plastics (MPs). The enhanced removal efficiency of NPs compared to MPs can be attributed to their smaller size, resulting in a faster reaction rate. However, NPs dose variation showed fluctuating removal efficiency, whereas MPs dose increment reduces removal efficiency. MP and NPs dose variation also affected toxicity to plants and earthworms as observed from data. Understanding the fate and removal of microplastics in wetland systems will help determine the reuse potential of wastewater and restrict the release of microplastics. This study provides information on various aspects and highlights future gaps and needs for MNP fate study in CW systems. • SAC, GAC, and rice straw were known to be ascendancy substrates. • Phragmites and Arabidopsis thaliana plants contributed to the higher removal of MNPs. • PS NPs caused more toxicity in earthworms than PP and PE MPs. • Adsorption and uptake were found the dominant mechanism in the removal of MNPs within the CW. [ABSTRACT FROM AUTHOR]

Organs and content of the gastro-intestinal tract (GIT) of marine mammals are relevant for a variety of investigations and provide data to researchers from different fields. Currently used protocols applied to the GIT for specific analysis limit the possibility to execute other investigations and important information could be lost. To ensure a proper sample collection and a multidisciplinary investigation of the GIT of marine mammals, a new multi-sieves tool and a specific protocol have been developed. This new device and approach allowed the simultaneous sampling of the GIT and its content for the main investigations concerned. The samples collected during these preliminary trials were suitable to perform all the different research procedures considered in this work. The obtained results show that with a few and easy procedural adjustments, a multidisciplinary sampling and evaluation of the GIT of marine mammals is possible. This will reduce the risk of losing important data aimed at understanding the cause of death of the animal, but also biology and ecology of marine mammals, and other important data for their conservation and habitats management.

Using plastic as a “theory machine,” this article looks into the dynamics and poetics of what I call plastic literature. It argues out a case for the “plastic sea” with its properties like sinking, mineralization, scopious contamination, pervasiveness, and deep-water micro-plasticization. The translocationality of plastic represents a spatial consciousness where plastic seeps into salt, water, soil, animal and human bodies, media, and our psychosis in non-linear, non-hierarchical, fragmentary mobility and fluidity; this does not discriminate between its point of origin and eventual destination, race, ethnicities, discriminations of colour, religious affiliations, cultural heritage, and political schoolings. Thus, plastic provokes connections/comparatism with a difference that speaks of becomings, dispersions, and immanence. Is plastic behaviour and agency not close to how we think of literature in a globalized world? Working out the other areas of the material aesthetic of plastic, the article connects plastic behaviour with literary habits and thinking. It homes in on “plastic lit(t)erization” to bring about a new poetics of thinking and doing literature. The article strings corresponding coordinates as made available through our understanding of plastic sea, networks of transmission, travel and transition, gradient flow, trans-corporeality, local-global fusion, process time, sink, and the discourses around hyper sea. Plastic literature becomes our new poetics of generating literary capital and rethinking world literature. [ABSTRACT FROM AUTHOR]

Abstract Plastic pollution of South Africa's marine environment is widespread, yet limited research exists on the distribution, accumulation and transport of plastic debris around South Africa. In this paper, numerical modelling is used to provide a first approximation of the pathways and accumulation of marine micro-plastics around South Africa. To account for a range of plastic classes, particles with two different densities are considered. Low-density (LD) particles represent low- and high-density polyethylene while high-density (HD) particles are representative of Polyethylene terephthalate and Polyvinyl chloride. While the majority of micro-plastic particles that enter the ocean from the five major coastal urban-industrialised centers beach along the coastline of South Africa, a third is exported to the open ocean. LD and HD particles are primarily exported to the South Atlantic and South Indian Ocean, respectively. Particles that beach along South Africa's coastline tend to accumulate in close proximity to the coastal urban-industrialised centers. Highlights • Low-density particles are primarily exported to the South Atlantic Ocean. • High-density particles are mainly exported to the South Indian Ocean. • Particles mainly beach close to urban centers along the South African coastline. • Beached particles accumulate close to urban centers along South AfricaŠs coastline. [ABSTRACT FROM AUTHOR]

Micro-plastic and nano-particle have been the focal pollutants in environmental science. The printer toner is omitted micro-plastic and nano pollutant. It is comprised of micro polyacrylate styrene and nano-Fe 3 O 4 particles. Polyacrylate styrene and nano-metal were proved to be irreversibly toxic to biological cells. Therefore, toners have the potential environmental risk and healthy harm due to include micro plastics and nano-metal. To our knowledge, few studies provided the specific collection and treatment of micro-plastic pollutant. This paper has chosen a kind of micro-plastic and nano pollutant toxic toner and provided technical guidance and inspiration for controlling the micro-plastic and nano pollutants. The method of vacuum-gasification-condensation was adopted for controlling the micro-plastic and nano pollutant toner. We believe this review will open up a potential avenue for controlling micro-plastic and nano pollutants for environmental protection. [ABSTRACT FROM AUTHOR]

Simple Summary: Currently procedures used to obtain samples from the gastro-intestinal tract (GIT) and protocols used to perform their respective analyses do not allow a multidisciplinary approach of this system. In fact, the investigations applied on the GIT, when performed singularly, could impair or limit the other analyses, because the currently procedures do not consider the needs of other disciplines. This means that the analyses to perform must be selected a priori, sacrificing the collection of other types of data and leads to the risk of losing important information, especially for wildlife species. To solve this conflict, we implement and standardize a new methodological approach to the GIT of marine mammals, which allow the collection of samples for different disciplines at the same time, performing the respective analyses, interpret and compare their results in a multidisciplinary way. The compatibility of multiple analyses allows the gaining of more information about the cause of death of stranded marine mammals and to enhance the knowledge of their biology and ecology. Organs and content of the gastro-intestinal tract (GIT) of marine mammals are relevant for a variety of investigations and provide data to researchers from different fields. Currently used protocols applied to the GIT for specific analysis limit the possibility to execute other investigations and important information could be lost. To ensure a proper sample collection and a multidisciplinary investigation of the GIT of marine mammals, a new multi-sieves tool and a specific protocol have been developed. This new device and approach allowed the simultaneous sampling of the GIT and its content for the main investigations concerned. The samples collected during these preliminary trials were suitable to perform all the different research procedures considered in this work. The obtained results show that with a few and easy procedural adjustments, a multidisciplinary sampling and evaluation of the GIT of marine mammals is possible. This will reduce the risk of losing important data aimed at understanding the cause of death of the animal, but also biology and ecology of marine mammals, and other important data for their conservation and habitats management. [ABSTRACT FROM AUTHOR]

Plastic marine debris hyper-concentrates hydrophobic contaminants such as polycyclic aromatic hydrocarbons (PAHs) and can transfer these sorbed contaminants to biota following ingestion. PAHs are known to induce cardiotoxicity and visual toxicity at sublethal doses. Juvenile White seabass (Atractoscion nobilis) fish were fed environmentally relevant concentrations of either virgin polystyrene or benzo(a)pyrene (BaP)-sorbed polystyrene for 5 days and were monitored for changes in phototactic response, swimming behavior, and hepatic cytochrome p450 1A (CYP1A) enzyme activity. No significant differences in the monitored endpoints were recorded in fish that ingested either polystyrene or BaP-sorbed polystyrene relative to control fish following the short-term exposure. However, fish exposed to 252 μg/L BaP alone as a positive control had significantly elevated CYP1A enzyme activity (p = 0.046) and impaired phototactic response (p = 0.020), though no altered swimming behavior was observed (p = 0.843) relative to control fish. These results demonstrate that pelagic fish ingesting environmentally relevant concentrations of BaP-sorbed polystyrene for a short, 5-day duration do not demonstrate measurable changes in vision, swimming activity, nor CYP1A activity. High variability within enzyme activity and behavioral responses suggest that lack of significant effects may be due to low sample size. Image 1 • White seabass ingested virgin and BaP-sorbed polystyrene under laboratory conditions. • No change in vision, swimming, or CYP1A activity in fish fed BaP-sorbed PS. • BaP exposure alone induced CYP1A activity and impaired phototactic response. Fish fed BaP-sorbed polystyrene did not exhibit changes in photomotor response, swimming performance, or induce altered activity of CYP1A in White seabass. [ABSTRACT FROM AUTHOR]

Objectives: To explore the micro-plastic operative treatment of deviated nose combined with nasal septum deviation., Methods: We designed the incision at the caudal side of the nasal septum. The three-line reduction method for correcting nasal septum deviation was performed. The connection of the caudal nasal septum and the anterior nasal spine was reposited. The micro-plastic surgery with fixed suture was used to correct the deviated nose., Results: After the surgery, the nasal septum deviation was corrected, whose nasal function and symptoms improved without nasal adhesion, nasal septum perforation or other complications. Meanwhile, the nasal tips were in the middle place and nasal dorsums were straight. The aesthetic outcome was satisfactory., Conclusions: Compared to the traditional orthopedic technique, the micro-shaping technique can be used for the homochromous operation of crooked nose combined with nasal septum deviation with less injury and lower risk. We suggest this micro-shaping technique be used in a rational way., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)