Life Cycle Assessment of an Avocado: Grown in South Africa-Enjoyed in Europe.

Food production is known to have significant environmental impacts, with the main contributors residing in the farming and transportation life cycle phases. Of the various food products transported around the world, avocados have increasingly gained attention as a high-commodity superfood. Avocados require specific climatic and agricultural conditions for farming, with the most fertile land and conditions located outside Europe. Consequently, most avocados consumed in Europe are imported over vast geographical distances, with little information available to quantify the environmental impacts of this imported superfood. This paper aims to present the most detailed life cycle assessment results of an avocado cultivated, grown and harvested in the Limpopo Province of South Africa and exported to the European market for sale and consumption. A life cycle assessment was developed for the farming, harvesting, handling, packaging, ripening, transportation, and carbon sequestration potential of the avocado, and it was used to conduct a holistic life cycle assessment. Input data was obtained through an 18-month data collection campaign across the relevant stakeholders. A baseline 'business-as-usual' scenario is focused on throughout this study, and scope for optimisation is identified for each life cycle phase where applicable, accompanied by uncertainty analyses. Results show a total carbon input of 904.85 kg CO2e/tonne. Mitigating this, 521.88 kg CO2e/tonne is offset, resulting in a net carbon footprint of 382.97 kg CO2e/tonne with uncertainty ranges of -23.22 to +58.69 kg CO2e/tonne, normalised to 57.45 g CO2e/avocado grown in South Africa and sold in Europe. The environmental impacts of the avocado industry under consideration are largely mitigated by the "nature first" philosophy of the farming and logistics enterprises, which have made significant investments in reducing emissions. Sensitivity analyses indicate that implementing large-scale renewable energy, using alternative packaging instead of cardboard, and selling avocados unripened could further enable the farming enterprise to achieve Net Zero objectives. These measures could reduce baseline emissions from 382.97 kg CO2e/tonne to a theoretical -68.54 kg CO2e/tonne, representing a 117.9% decrease. Although this study does not quantify climate change impacts, qualitative analyses suggest that climate change will have a net negative effect on the avocado industry in South Africa. These regions, typically located in micro-climates, are projected to become wetter and warmer, adversely affecting crop phenology, pest control, road conditions, management complexity, farmer livelihoods, and food security. The study recommends large-scale implementation of the optimisation strategies identified to achieve Net Zero objectives and the development of proactive climate change mitigation strategies to enhance the resilience of avocado supply chains to future stressors. These insights are crucial for policymakers, industry stakeholders, and consumers aiming to promote sustainability in the avocado market.

Addition of sodium malonate alters the morphology and increases the critical flux during tangential flow filtration of precipitated immunoglobulins.

Recent studies have demonstrated that one can control the packing density, and in turn the filterability, of protein precipitates by changing the pH and buffer composition of the precipitating solution to increase the structure/order within the precipitate. The objective of this study was to examine the effect of sodium malonate, which is known to enhance protein crystallizability, on the morphology of immunoglobulin precipitates formed using a combination of ZnCl2 and polyethylene glycol. The addition of sodium malonate significantly stabilized the precipitate particles as shown by an increase in melting temperature, as determined by differential scanning calorimetry, and an increase in the enthalpy of interaction, as determined by isothermal titration calorimetry. The sodium malonate also increased the selectivity of the precipitation, significantly reducing the coprecipitation of DNA from a clarified cell culture fluid. The resulting precipitate had a greater packing density and improved filterability, enabling continuous tangential flow filtration with minimal membrane fouling relative to precipitates formed under otherwise identical conditions but in the absence of sodium malonate. These results provide important insights into strategies for controlling precipitate morphology to enhance the performance of precipitation-filtration processes for the purification of therapeutic proteins.

Histogram analysis in the differentiation between adrenal adenomas and pheochromocytomas: the value of a single measurement.

Objective: To assess the diagnostic accuracy of histogram analysis on unenhanced computed tomography (CT) for differentiating between adrenal adenomas and pheochromocytomas (PCCs). Materials and Methods: We retrospectively identified patients with proven PCCs who had undergone CT examinations between January 2009 and July 2019 at one of two institutions. For each PCC, we selected one or two adenomas diagnosed within two weeks of the date of diagnosis of the PCC. For each lesion, two readers scored the size, determined the mean attenuation, and generated a voxel histogram. The 10th percentile (P10) was obtained from the conventional histogram analysis, as well as being calculated with the following formula: P10 = mean attenuation - (1.282 × standard deviation). The mean attenuation threshold, histogram analysis (observed) P10, and calculated P10 (calcP10) were compared in terms of their diagnostic accuracy. Results: We included 52 adenomas and 29 PCCs. The sensitivity, specificity, and accuracy of the mean attenuation threshold were 75.0%, 100.0%, and 82.5%, respectively, for reader 1, whereas they were 71.5%, 100.0%, and 81.5%, respectively, for reader 2. The sensitivity, specificity, and accuracy of the observed P10 and calcP10 were equal for both readers: 90.4%, 96.5%, and 92.6%, respectively, for reader 1; and 92.3%, 93.1%, and 92.6%, respectively, for reader 2. The increase in sensitivity was significant for both readers (p = 0.009 and p = 0.005, respectively). Conclusion: For differentiating between adenomas and PCCs, the histogram analysis (observed P10 and calcP10) appears to outperform the mean attenuation threshold as a diagnostic criterion.

Objetivo: Avaliar a acurácia diagnóstica da análise por histograma na tomografia computadorizada (TC) sem contraste para a diferenciação entre adenomas adrenais e feocromocitomas (FCCs). Materiais e Métodos: Identificamos, retrospectivamente, pacientes com diagnóstico de FCC confirmado que foram submetidos a exames de TC entre janeiro de 2009 e julho de 2019 em duas instituições distintas. Para cada FCC, selecionamos um ou dois adenomas diagnosticados em até duas semanas da data do diagnóstico do FCC. Para cada lesão, dois leitores pontuaram o tamanho, determinaram a atenuação média e geraram um histograma com os voxels das imagens. O percentil 10 (P10) foi obtido a partir da análise convencional do histograma, além de ser calculado com a seguinte fórmula: P10 = atenuação média - (1,282 × desvio-padrão). O limiar de atenuação média, o P10 da análise por histograma (P10 observado) e o P10 calculado (P10calc) foram comparados em termos de acurácia diagnóstica. Resultados: Foram incluídos 52 adenomas e 29 FCCs. A sensibilidade, especificidade e acurácia do limiar de atenuação média foram de 75,0%, 100,0% e 82,5% para o leitor 1, respectivamente, e de 71,5%, 100,0% e 81,5% para o leitor 2, respectivamente. A sensibilidade, especificidade e acurácia do P10 observado e do P10calc foram idênticas para os dois leitores: 90,4%, 96,5% e 92,6%, respectivamente, para o leitor 1; e 92,3%, 93,1% e 92,6%, respectivamente, para o leitor 2. O aumento da sensibilidade foi significativo para ambos os leitores (p = 0,009 e p = 0,005, respectivamente). Conclusão: Para a diferenciação entre adenomas e FCCs, a análise por histograma (P10 observado ou P10calc) parece superar o limiar de atenuação média como critério diagnóstico.

Prevalence of Vas Deferens Calcifications on Abdominal CT Examinations and Association With Systemic Conditions.

OBJECTIVE. The purpose of this study was to describe the prevalence of vas deferens (VD) calcifications on abdominal CT examinations and the associations between VD calcifications and several systemic conditions. MATERIALS AND METHODS. The CT examinations of male patients from January 2010 to December 2011 were retrospectively reviewed. After exclusions, the records of 1915 consecutively identified patients were analyzed. Five readers, 3rd- and 4th-year radiology residents, recorded the presence and laterality of VD calcifications and of vascular calcifications presumed due to atherosclerosis. A sixth reader parsed the patient records for diagnoses of type 2 diabetes mellitus (DM) and chronic kidney disease (CKD). RESULTS. The mean age of the entire sample population was 52.9 ± 18.9 years (range, 1-93 years). The mean age of patients with VD calcifications was 59.3 ± 12.0 (SD) years and of the group without VD calcifications was 52.9 ± 19.1 years (p = 0.17). The prevalence of VD calcification was 1.61% (31 patients): 21 (67.7%) of the patients had bilateral calcification; seven (22.6%), right-sided only; and three, (9.7%) left-sided. The frequency of DM was 28.8% (551/1915), of CKD was 7.58% (150/1915), and of atherosclerosis, 60.4% (1156/1915). The mean caliber of calcified VDs was 5.31 ± 1.29 mm versus 3.63 ± 0.63 mm for patients without calcification or any chronic condition (p < 0.0001). Among age, atherosclerosis, DM, and CKD in univariate regression analysis, only DM was associated with VD calcification (p = 0.006). However, because age (p = 0.063) and atherosclerosis (p = 0.057) were close to significant, they were included in the multivariate analysis, which also showed only DM associated with VD calcification (odds ratio, 2.14 ± 0.85). CONCLUSION. In the large cohort in this study, the prevalence of VD calcification was 1.61%. VD calcification was strongly associated with DM. The pathologic implications of VD calcification remain unclear and warrant further investigation in prospective longitudinal studies.

Costs and outcomes of phacoemulsification for cataracts performed by residents.

PURPOSE: To describe costs and outcomes of phacoemulsification for cataracts performed by ophthalmology residents. METHODS: We obtained medical records from patients operated on in 2011 by third year residents (R3) using phacoemulsification (n=576). Our expenses estimation included professionals' and hospital costs (fees, materials, medications, and equipment). The study outcomes included spectacle-corrected visual acuities before and six months after the operation, rate of intraoperative complications, and total number of postoperative visits. We compared outcome variables with those from extracapsular cataract extraction procedures (n=274) performed by R3 residents in 1997. RESULTS: The mean total cost for phacoemulsification was US$ 416, while an overall estimation indicated the extracapsular cataract extraction cost at US$ 284 (as of December 30, 2011). The mean preoperative spectacle-corrected visual acuity was worse for eyes scheduled for extracapsular cataract extraction (1.73 ± 0.62), than for eyes scheduled for phacoemulsification (0.74 ± 0.54 logMAR) (p<0.01); the mean postoperative visual acuity was better for phacoemulsification (0.21 ± 0.36 logMAR), than for extracapsular cataract extraction (0.63 ± 0.63 logMAR) (p<0.01). Most patients undergoing phacoemulsification (85%) achieved postoperative spectacle-corrected visual acuities ≥0.30 logMAR, while only 45% of those undergoing extracapsular cataract extractions achieved the same postoperative visual acuity (p<0.01). The rate of intraoperative complications was significantly higher after extracapsular cataract extractions (21%) than it was after phacoemulsifications (7.6%) (p<0.01), and the mean number of postoperative visits was also higher after extracapsular cataract extractions (5.6 ± 2.3) than after phacoemulsifications (4.5 ± 2.4) (p<0.01). CONCLUSION: These data indicate that cataract surgery performed by in-training ophthalmologists using phacoemulsification is expensive, but compared to extracapsular cataract extraction results, teaching phacoemulsification leads to an approximate three-fold lower complication rate, smaller number of postoperative visits and, most importantly, better visual acuities.

Diagnostic imaging of injuries caused by venomous and traumatogenic catfish.

Injuries caused by fish are common in marine and freshwater environments. Catfish of the Ariidae and Pimelodidae families cause about 80% of those injuries. One of the complications of injuries caused by fish is the retention of fragments of the stinger in the wounds. Here we report five cases (of a total of 127 injuries caused by catfish in the Brazilian coast) in which the retained fragments were detected by radiological examination. Retained fragments should be considered in patients stung by catfish. A simple X-ray is sufficient to detect fragments of stingers in the wounds.

Patient with a Starr-Edwards prosthesis in the aortic position for 40 years.

Herein is reported the case of a patient who presented initially with aortic insufficiency and a fistula between the sinus of Valsalva and right atrium when aged 31 years. Closure of the fistula and replacement of the aortic valve with a Starr-Edwards A-9 caged-ball prosthesis was performed in 1972, since when the valve has survived for 40 years without dysfunction. This is one of the longest follow ups of the Starr-Edwards prosthesis reported, and highlights the possibility of acceptable valve performance over long periods of time.

Revascularizaçäo do miocárdio: anastomose término-terminal: ponte intercoronariana: relato de 2 casos / Myocardial revascularization: termino-terminal anastomosis: intercoronarian anastomosis: report of 2 cases

Desde o início do tratamento cirúrgico da doença coronária obstrutiva com Vineberg até os dias atuais com o emprego de vários tipos de enxertos, os cirurgioes procuram aumentar a sobrevida bem como melhorar a qualidade de vida dos pacientes. Paciente de 60 anos de idade, com angina e síncope, cujo estudo hemodinâmico mostrou lesao de 90 por cento no ramo interventricular anterior (RIA) e 99 por cento na coronária direita (CD) (Figura 1). Foi revascularizado com artéria torácica interna esquerda (ATIE) para o RIA e ressecçao da lesao da CD, seguida de anastomose dos cotos (Figura 2). Paciente de 40 anos, com lesao de 80 por cento da CD e de 99 por cento do RIA foi igualmente revascularizado com enxerto livre de ATIE para o RIA e um segmento de 4 cm de ATIE em ponte coronária-coronária sobre o segmento lesado (Figura 3). Ambos os pacientes evoluíram bem na fase hospitalar. Após um ano, permanecem assintomáticos, com teste ergométrico negativo.

BAU de 1- grau reversível associado a vasculite leucocitoclástica: relato de caso / Reversible 1st-degree BAU associated with leukocytoclastic vasculitis: case report

Os autores apresentam um caso de vasculite leucocitoclástica em jovem de 29 anos, sexo masculino, com envolvimento sistêmico manifestado por púrpura, hematúria macroscópica, dor articular, moderada cardiomegalia e bloqueio atrioventricular de 1- grau, alteraçöes que desapareceram com a regressäo do surto, sem uso de medicamentos. Conjuntamente, é apresentada uma revisäo sobre a doença e as manifestaçöes do comprometimento cardíaco