Assessment of pain relief after four botulinum toxin A injection cycles in patients with post-stroke lower limb spasticity: A prospective, observational study

INTRODUCTION

Spasticity is common after a stroke and is an independent risk factor for developing pain. BotulinumtoxinA injection is the treatment of choice for focal spasticity. We examined the effect of intramuscular botulinumtoxinA on pain relief in patients in routine clinical practice who were experiencing pain as a primary complaint associated with post-stroke lower limb spasticity.

METHODS

Prospective, multicentre, post-marketing observational study. The study period was 16 months. The primary effectiveness variable was the mean change from baseline on the pain 0-10 Numerical Rating Scale after four botulinumtoxinA injection cycles. Secondary endpoints included changes from baseline on the pain 0-100 Visual Analogue Scale, Goal Attainment Scale, modified Ashworth Scale, 10-Meter Walk Test, Penn Spasm Frequency Scale, and 36-item Short-Form Health Survey.

RESULTS

Of 186 enrolled patients, 180 (96.8%) received botulinumtoxinA at least once. The mean (standard deviation) pain 0-10 Numerical Rating Scale score decreased significantly (p<0.0001) from 4.9 (2.2) at baseline to 2.5 (2.1) at study end, representing a 50% decrease in pain severity. Relief of pain due to spasticity was supported by improvement from baseline in all secondary variables except the 10-Meter Walk Test. Two adverse events (erysipelas and phlebitis) in one patient were considered likely to be related to botulinumtoxinA injection.

CONCLUSION

BotulinumtoxinA appears to provide pain relief as an additional benefit of local treatment in patients with post-stroke lower limb spasticity for whom pain relief is a primary therapeutic goal (a Lay Abstract has been provided as Appendix A).

Do weathered microplastics impact the planktonic community? A mesocosm approach in the Baltic Sea

Microplastics (MPs) are ubiquitous pollutants of increasing concern in aquatic systems. However, little is still known about the impacts of weathered MPs on plankton at the community level after long-term exposure. In this study, we investigated the effects of weathered MPs on the structure and dynamics of a Baltic Sea planktonic community during ca. 5 weeks of exposure using a mesocosm approach (2 m3) mimicking natural conditions. MPs were obtained from micronized commercial materials of polyvinyl chloride, polypropylene, polystyrene, and polyamide (nylon) previously weathered by thermal ageing and sunlight exposure. The planktonic community was exposed to 2 μg L-1 and 2 mg L-1 of MPs corresponding to measured particle concentrations (10-120 μm) of 680 MPs L-1 and 680 MPs mL-1, respectively. The abundance and composition of all size classes and groups of plankton and chlorophyll concentrations were periodically analyzed throughout the experiment. The population dynamics of the studied groups showed some variations between treatments, with negative and positive effects of MPs exhibited depending on the group and exposure time. The abundance of heterotrophic bacteria, pico- and nanophytoplankton, cryptophytes, and ciliates was lower in the treatment with the higher MP concentration than in the control at the last weeks of the exposure. The chlorophyll concentration and the abundances of heterotrophic nanoflagellates, Astromoeba, dinoflagellate, diatom, and metazooplankton were not negatively affected by the exposure to MPs and, in some cases, some groups showed even higher abundances in the MP treatments. Despite these tendencies, statistical analyses indicate that in most cases there were no statistically significant differences between treatments over the exposure period, even at very high exposure concentrations. Our results show that weathered MPs of the studied conventional plastic materials have minimal or negligible impact on planktonic communities after long-term exposure to environmentally relevant concentrations.

Performance evaluation of three versions of a convolutional neural network for object detection and segmentation using a multiclass and reduced panoramic radiograph dataset

OBJECTIVES

To evaluate the diagnostic performance of three versions of a deep-learning convolutional neural network in terms of object detection and segmentation using a multiclass panoramic radiograph dataset.

METHODS

A total of 600 orthopantomographies were randomly selected for this study and manually annotated by a single operator using an image annotation tool (COCO Annotator v.11.0.1) to establish ground truth. The annotation classes included teeth, maxilla, mandible, inferior alveolar nerve, dento- and implant-supported crowns/pontics, endodontic treatment, resin-based restorations, metallic restorations, and implants. The dataset was then divided into training, validation, and testing subsets, which were used to train versions 5, 7, and 8 of You Only Look Once (YOLO) Neural Network. Results were stored, and a posterior performance analysis was carried out by calculating the precision (P), recall (R), F1 Score, Intersection over Union (IoU), and mean average precision (mAP) at 0.5 and 0.5-0.95 thresholds. The confusion matrix and recall precision graphs were also sketched.

RESULTS

YOLOv5s showed an improvement in object detection results with an average R = 0.634, P = 0.781, mAP0.5 = 0.631, and mAP0.5-0.95 = 0.392. YOLOv7m achieved the best object detection results with average R = 0.793, P = 0.779, mAP0.5 = 0.740, and mAP0.5-0.95 = 0,481. For object segmentation, YOLOv8m obtained the best average results (R = 0.589, P = 0.755, mAP0.5 = 0.591, and mAP0.5-0.95 = 0.272).

CONCLUSIONS

YOLOv7m was better suited for object detection, while YOLOv8m demonstrated superior performance in object segmentation. The most frequent error in object detection was related to background classification. Conversely, in object segmentation, there is a tendency to misclassify True Positives across different dental treatment categories.

CLINICAL SIGNIFICANCE

General diagnostic and treatment decisions based on panoramic radiographs can be enhanced using new artificial intelligence-based tools. Nevertheless, the reliability of these neural networks should be subjected to training and validation to ensure their generalizability.

Microplastic and mesoplastic pollution in surface waters and beaches of the Canary Islands: A review

The Canary Archipelago is a group of volcanic islands located in the North Atlantic Ocean with high marine biodiversity. This archipelago intercepts the Canary Current, the easternmost branch of the Azores Current in the North Atlantic Subtropical Gyre, which brings large amounts of litter from remote sources via oceanic transportation. It is, therefore, particularly vulnerable to marine plastic pollution. Here, we present a review of the available studies on mesoplastics and microplastics in the Canary Islands over the last decade to evaluate the level and distribution of plastic pollution in this archipelago. Specifically, we focused on data from beaches and surface waters to assess the pollution level among the different islands as well as between windward and leeward zones, and the main characteristics (size, type, colour, and polymer) of the plastics found in the Canary Islands. The concentrations of meso- and MPs on beaches ranged from 1.5 to 2972 items/m2 with a mean of 381 ± 721 items/m2. The concentration of MPs (>200 μm) in surface waters was highly variable with mean values of 998 × 103 ± 3364 × 103 items/km2 and 10 ± 31 items/m3. Plastic pollution in windward beaches was one order of magnitude significantly higher than in leeward beaches. The accumulation of MPs in surface waters was higher in the leeward zones of the high-elevation islands, corresponding to the Special Areas of Conservation (ZECs) and where the presence of marine litter windrows (MLW) has been reported. Microplastic fragments of polyethylene of the colour category "white/clear/uncoloured" were the most common type of plastic reported in both beaches and surface waters. More studies on the occurrence of MLW in ZECS and plastic pollution in the water column and sediments, including small-size fractions (<200 μm), are needed to better assess the level of plastic pollution and its fate in the Canary Islands. Overall, this review confirms that the Canary Archipelago is a hotspot of oceanic plastic pollution, with concentrations of MPs in surface waters in the highest range reported for oceanic islands and one of the highest recorded mean concentrations of beached meso- and microplastics in the world.

Lagrangian tracking of long-lasting plastic tags: From lobster fisheries in the USA and Canada to Macaronesia

Plastic waste from the fishing industry, particularly lobster trap identification tags from the USA and Canada, poses a significant threat to marine ecosystems due to its resilience. This study unveils a novel link between North American fisheries and the appearance of these plastic tags in Macaronesia. Collected in the Azores and Canary Islands, these tags offer a unique insight into the sources and spatio-temporal scales of marine plastic pollution. Ocean model data indicates the Labrador Current and Gulf Stream as key forces transporting these tags. Virtual particle simulations show a small fraction reaching Macaronesia (4.12 % in the Azores, 0.76 % in the Canary Islands), suggesting real ocean drift. The Azores, with more collected tags, are more susceptible, and tags can reach Macaronesia in under a year. These findings underscore the urgency of better waste management and emphasize the role of citizen science in monitoring and combating marine pollution.

A nationwide monitoring of atmospheric microplastic deposition

Plastic production continues to increase every year, yet it is widely acknowledged that a significant portion of this material ends up in ecosystems as microplastics (MPs). Among all the environmental compartments affected by MPs, the atmosphere remains the least well-known. Here, we conducted a one-year simultaneous monitoring of atmospheric MPs deposition in ten urban areas, each with different population sizes, economic activities, and climates. The objective was to assess the role of the atmosphere in the fate of MPs by conducting a nationwide quantification of atmospheric MP deposition. To achieve this, we deployed collectors in ten different urban areas across continental Spain and the Canary Islands. We implemented a systematic sampling methodology with rigorous quality control/quality assurance, along with particle-oriented identification and quantification of anthropogenic particle deposition, which included MPs and industrially processed natural fibres. Among the sampled MPs, polyester fibres were the most abundant, followed by acrylic polymers, polypropylene, and alkyd resins. Their equivalent sizes ranged from 22 μm to 398 μm, with a median value of 71 μm. The particle size distribution of MPs showed fewer large particles than expected from a three-dimensional fractal fragmentation pattern, which was attributed to the higher mobility of small particles, especially fibres. The atmospheric deposition rate of MPs ranged from 5.6 to 78.6 MPs m-2 day-1, with the higher values observed in densely populated areas such as Barcelona and Madrid. Additionally, we detected natural polymers, mostly cellulosic fibres with evidence of industrial processing, with a deposition rate ranging from 6.4 to 58.6 particles m-2 day-1. There was a positive correlation was found between the population of the study area and the median of atmospheric MP deposition, supporting the hypothesis that urban areas act as sources of atmospheric MPs. Our study presents a systematic methodology for monitoring atmospheric MP deposition.

Prognostic Significance of Positron Emission Tomography Delta Radiomics Following Bridging Therapy in Patients with Large B-Cell Lymphoma Undergoing CAR T-Cell Therapy

PURPOSE/OBJECTIVE(S)

CAR T-cell therapy is routinely used as a treatment option for relapsed/refractory large B-cell lymphoma (LBCL). Bridging therapy radiation therapy (bRT) is increasingly being utilized prior to chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL). It is unknown how the extent of debulking as a result of bRT impacts outcomes following CAR T-cell infusion. We hypothesized that the extent of debulking is prognostic of overall response to therapy.

MATERIALS/METHODS

We reviewed patients with LBCL treated with bRT followed by commercially available CAR T-cell therapy between 2017 and 2022. Patients required a F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scan prior to bRT and between completion of bRT and CAR T-cell infusion. On each scan, metabolic tumor volume (MTV), maximum standardized uptake value (SUVmax), SUVmean, and total lesion glycolysis (TLG) were determined. Delta-radiomics based on changes of these values between scans in patients overall and irradiated sites were then calculated. Optimal cut points were determined using maximally selected log-rank. The primary endpoints were progression-free survival (PFS) and local control (LC), measured from CAR T-cell infusion by Kaplan-Meier and Fine-Gray competing risk survival analyses, respectively.

RESULTS

Twenty-three patients with LBCL with 33 irradiated sites were reviewed. All metabolically active disease was treated in 10 patients. Median equivalent dose in 2 Gy fractions (EQD2) was 26 Gy (14-44). Median interval from bRT to PET was 9 days (2-30). Following bRT, 2 patients achieved complete responses, 16 had partial responses, and 5 had progressive disease. Five irradiated sites progressed through bRT. No local failures were observed when EQD2>32.5 Gy was given. LC was improved with EQD2>20 Gy (24 mo LC: 94.5% vs 68.6%; p = 0.075). Following BRT, median overall decreases in MTV, SUVmax, SUVmean, and TLG were 22.2 cc (63.1%), 8.9 (36.8%), 3.4 (31.1%), and 297.9 cc (75.8%), respectively. Median decreases in MTV, SUVmax, SUVmean, and TLG in irradiated sites were 15.6 cc (91.1%), 17.0 (74.6%), 6.8 (55.3%), and 157.0 cc (94.6%), respectively. PFS was significantly improved in patients with reductions of MTV of at least 36 cc (24 mo PFS: 69.2% vs 0%; p = 0.047) or SUVmax of at least 15 (24-mo PFS: 80.0% vs 28.1%; p < 0.001). LC was significantly improved in lesions with reductions of SUVmax of at least 14 (24-mo LC: 100% vs 67.3%; p < 0.001) or SUVmean of at least 7 (24-mo LC: 100% vs 74.4%; p < 0.001).

CONCLUSION

bRT led to significant reductions in MTV, SUVmax, SUVmean, and TLG. The extent of these decreases correlated with improved PFS and LC. There appears to be a dose-response relationship. Larger cohorts should validate the value of interim PET following bRT, and associated changes in disease burden as a means of prognosticating patients. Future work might evaluate whether escalation of BT in patients with suboptimal response, using either systemic therapy or higher radiation doses, has an impact on outcomes.

Long Term Evaluation of Cardiac Events and Outcomes Following Breast Cancer Irradiation

PURPOSE/OBJECTIVE(S)

Although whole heart dose has been associated with cardiac toxicity in patients receiving radiation therapy for breast cancer, data detailing the clinical significance of cardiac substructures, particularly the left anterior descending artery (LAD), are limited. We investigated whether dose to the LAD correlates with adverse cardiac events and death.

MATERIALS/METHODS

We identified 190 female patients treated from 2002 to 2019 who received breast or chest wall irradiation, with or without regional nodal irradiation. Ninety-three patients were treated on their right side, 95 on their left, and two were bilateral. Medical records were queried in healthcare software to identify cardiac events after radiation therapy. Mean and maximum LAD and heart doses, as well as V15LAD, were calculated. Univariate and multivariate Cox regression analyses were performed to determine their association with cardiac toxicity as well as death. Cumulative incidence curves for death and cardiac toxicity were also calculated for the patient population.

RESULTS

Median follow-up time was 68 months. Thirty patients experienced a cardiac event (15.7%), with three of these being grade 3 or higher. On univariate analyses, left side (hazard ratio 8, P<0.001), increased Mean LAD Dose per cGy (1.001, P = 0.01), Mean Heart Dose (1.16, P = 0.01), and anatomic stage (3.5, P = 0.003) were statistically significant predictors of death but not of adverse cardiac events. Statistically significant predictors of adverse cardiac events were the receipt of chemotherapy (2.68, p = 0.046) which remained significant even after adjusting for radiation parameters. There was no association with hormonal therapy use. Cumulative incidence curves predicted a 14.11% probability of a cardiac event 5 years after treatment and a 25.7% probability at 10 years after treatment. They also predicted a 9.43% probability of death at both 5- and 10-years post-treatment.

CONCLUSION

On this long-term analysis, doses to the heart seemed to negatively impact survival, but did not have a clear association between cardiac events. In contrast, utilizing cytotoxic systemic therapy seemed have an association, even when adjusted for on multivariable models for cardiac events.

Searching for hotspots of neustonic microplastics in the Canary Islands

In this study, we investigated the concentration, distribution, and characteristics of neustonic MPs in the Canary Islands, with a particular focus on the island leeward zones, where a high accumulation of floating marine microplastics is expected. Samples were collected with a manta net at 15 different sites from Alegranza to La Gomera during the IMPLAMAC expedition. The microplastic concentration in surface waters ranged from 0.27 MPs/m³ in Alegranza to 136.7 MPs/m³ in the south of Gran Canaria. The highest concentration of MPs found was due to the presence of a sea-surface slick, also called "marine litter windrow", formed in the south of Gran Canaria. The most abundant zooplankton group in the neuston was copepods, except at the marine litter windrow where fish larvae and eggs predominated. This indicates that coastal areas where marine litter windrows are formed have a high risk of MP ingestion and potential adverse effects on biota.

Trophic transfer of DDE, BP-3 and chlorpyrifos from microplastics to tissues in Dicentrarchus labrax

Microplastic pollution and associated chemical contaminants is a topic of growing interest. In recent years, the number of publications reporting the presence of microplastics (MPs) in marine organisms has increased exponentially. However, there is a gap in knowledge about the trophic transfer of contaminants from microplastics to animal tissues, as well as possible health effects. In this study we analyzed the trophic transfer and biomagnification of three chemical pollutants present in microplastics: dichlorodiphenyldichloroethylene (DDE-p,p'), benzophenone 3 (BP-3) and chlorpyrifos (CPS). The reference values used were concentrations found in environmental microplastics in the Canary Islands (minimum and maximum). European seabass (Dicentrarchus labrax) were fed for 60 days with 5 different treatments: A) feed; B) feed with chemical pollutants at maximum concentration; C) feed + 10 % virgin MPs; D) feed + 10 % MPs with chemical pollutants at minimum concentration; E) feed + 10 % MPs with chemical pollutants at maximum concentration. We detected trophic transfer of DDE-p,p', CPS and BP-3 from the feed (treatment B) to the muscle and liver of fish. In the case of DDE-p,p', transfer to liver and muscle was also observed in the treatments consisting of feed plus plastics with different levels of contamination (C, D and E). No effect of the experimental treatments on fish condition indices was observed.

Microplastics ingestion and chemical pollutants in seabirds of Gran Canaria (Canary Islands, Spain)

Plastic pollution constitutes an environmental problem in the Canary Islands nowadays. Nevertheless, studies evaluating the impact of plastics on its avifauna are still scarce. Gastrointestinal tracts of 88 birds belonging to 14 species were studied for the presence of plastics. Moreover, their livers were analyzed for the determination of bromodiphenyl ethers (BDEs), polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs). Among Cory's shearwaters (n = 45), the frequency of occurrence of plastic ingestion was considerably high (88.89 %). This species had the highest mean value of items (7.22 ± 5.66) and most of them were compatible with lines derived from fishing gear. PCBs and PAHs were detected in all of the samples and OCPs in the great majority of them (98.86 %). Our results highlight the problems that plastic debris (mainly for seabirds) and organic pollutants pose to these species.

P-481 Characterization of the gene expression profile of breast cancer tumours in patients undergoing ovarian stimulation for fertility preservation purposes

Study question

Could controlled ovarian stimulation (COS) protocols with letrozole supplementation induce changes in the molecular footprints of estrogen receptor-positive (ER+) breast cancer (BC) women?

Summary answer

Ovarian stimulation with letrozole and gonadotropins does not change the gene expression profile of estrogen receptor-positive (ER+) breast malignant tumours as compared to non-stimulated patients.

What is known already

Fertility preservation (FP) strategies in ER+ BC patients involve modifications of the classical COS protocols to minimise the impact of estrogen levels during ovarian stimulation. The most common approaches are using the aromatase inhibitor letrozole to block the conversion of testosterone into estradiol in the granulosa cells or the use of tamoxifen to block the ER in the breast tissue. Although retrospective studies suggest that these strategies will have no impact on patient’s survival and disease progression, little is known regarding the effect of the ovarian stimulation on the genomic fingerprints of the exposed cancerous tissue.

Study design, size, duration

Retrospective, non-randomized, comparative study. Gene expression profiles were compared in biopsies at diagnosis and during excision surgery in two groups of ER+ BC patients: Patients undergoing COS for FP before surgery (COS group, n = 10) and patients not undergoing any type of COS (Control group, n = 11). The former received letrozole (5mg/day) supplements during COS. The latter included 7 patients not doing FP and 4 undergoing ovarian cortex cryopreservation. Patients were recruited between 2009 and 2021.

Participants/materials, setting, methods

Single 5-µm sections of formalin-fixed, paraffin-embedded (FFPE) needle core biopsy (NCB) and breast surgery (BS) tumour samples were obtained prior to starting gonadotoxic therapies. Differential gene expression and gene set analysis (GSA) was performed in tumour samples before (NCB-sample) and after COS (BS-sample). Simultaneous, quantitative detection of 2549 genes associated with tumour biology was performed with the HTG EdgeSeq Oncology Biomarker Panel. Tumour cell proliferation was also assessed by Ki67 staining.

Main results and the role of chance

Patients were younger in the COS group (COS: 30.2±3.4 vs Control: 34.5±2.3; p = 0.004). None of the patients experienced any relapse during the observation period. The length of COS was 11.5±3.5 days and 10.6±6.8 MII oocytes were vitrified. The exploratory analysis using principal component analysis revealed no relationships between the two BC biopsy samples and gene expression levels in the experimental groups. The differential expression analysis just revealed 6 genes significantly over-expressed after ovarian stimulation (DUSP1, FOS, EGFR1, NR4A1, JUN and CYR61). From these, DUSP1, FOS, and NR4A1 were also significantly upregulated in the unstimulated group. The GSA showed the cytochrome P450 pathway was significantly enriched after COS. No pathways related to cell proliferation were differentially expressed between groups. However, in unstimulated patients, 6 KEGG pathways were upregulated, with the cytokine-cytokine receptor interaction and the Jak-STAT signalling pathway being the most enriched. Ki67 immunostaining showed no differences in cell proliferation after COS (22.8±7.2 vs 24.0±6.9, p = 0.723). The rate of cell proliferation also remained constant in unstimulated patients (22.9±8.4 vs 25.1±8.1, p = 0.560).

Limitations, reasons for caution

The main limitations of the present study are the retrospective design and the associated risk of bias, although the population is very homogeneous when it comes to clinical characteristics; and the fact that molecular footprints are only interim markers of survival/response to the treatment.

Wider implications of the findings

The present study provides molecular evidence supporting the safety of COS using letrozole for oocyte vitrification in young BC patients undergoing ovarian stimulation. This information is crucial to support patient guidance during discussions about fertility preservation.

Trial registration number

Not applicable

Bioaccumulation of additives and chemical contaminants from environmental microplastics in European seabass (Dicentrarchus labrax)

Marine microplastic pollution is one of the biggest environmental problems we face. The growth of plastic production has not ceased since the 1950s and it is currently estimated that 368 tons of plastic were produced in 2019 (PlascticsEurope, 2020). Geyer et al. (2017) estimate that 79% of the plastic produced in the world still remains in the environment; this plastic due to the effect of degradation and subsequent fragmentation, is present in the form of microplastics in all oceans and, due to its small size can be ingested by fish and filter-feeding organisms. In addition, microplastics have additives and chemical contaminants associated with them, and the potential effect of microplastic ingestion on marine organisms, and through them, the potential risk to humans, is unknown. In the present study, European seabass (Dicentrarchus labrax) were fed for 60 days with three treatments: Control (feed), MP (feed with 10% virgin microplastics) and EMP (feed with 10% environmental microplastics), being the first study to evaluate long-term accumulation of contaminants due to ingestion of environmental microplastics (EMP) in fish. Both plastic additives such as PBDEs, and chemical contaminants adsorbed from the environment such as PCBs and DDE, were analyzed in the EMP, feed and liver. The concentration of microplastics in the feed was calculated based on the MPs/zooplankton wet weight (WW) ratio of 0.1 found in an area of maximum accumulation in the Canary Islands. Therefore, it is an experiment that simulates real conditions, but in the worst-case scenario, using both, concentrations based on data obtained in oceanographic campaigns and microplastics collected from the environment. Our results show that in this scenario, additives and chemical contaminants adsorbed on EMPs bioaccumulate in fish liver due to long-term ingestion of microplastics.

First inventory of marine debris on Alegranza, an uninhabited island in the Northeast Atlantic

Alegranza is the most northerly island of the Canary Islands archipelago, the first obstacle crossed by the Canary Current. From July to October 2020, six expeditions were led to the island to make a first inventory of marine debris and its possible source and origin. In total, 3667 objects weighing 321 kg were removed, excluding wooden objects. Of these, 97.7% were plastics, the most abundant being drink bottles (25.4%). While knowing the origin, source and pathway of debris is difficult, legible labels provided valuable information. In Alegranza, 66.7% of the legible bottle labels indicated Asian countries of manufacture, which is evidence that the source is maritime traffic in the region. The lobster trap license labels from the east coast of the United States and Canada were dated from 1999 to 2018, supporting both the exogenous origin and long lifetime in the ocean of these debris.

Ingestion of polyethylene microspheres occur only in presence of prey in the jellyfish Aurelia aurita

Microplastic ingestion was studied in A. aurita, a bloom-forming, circumglobal medusa. Here, we determined whether factors such as the concentration of polyethylene microspheres (75-90 μm) or the absence/presence of prey affect the ingestion, duration of microspheres in the gastrovascular cavity (time of presence), and retention time. The presence of polyethylene microspheres' was determined by exposing medusae during 480 min to three different treatments (5000, 10,000, 20,000 particles L^-1), and was checked every 10 min to ascertain whether they had incorporated any. Preliminary results show that microsphere ingestion occurred only in the presence of prey (⁓294 Artemia nauplii L^-1). The time of presence of microbeads in A. aurita increased (103, 177, and 227 min), with increasing microplastic concentration, and the microbeads were egested within 150 min. This study initiates the understanding of the potential implications that arise of the encounter between jellyfish and microplastic agglomerates, and with perspectives for future research.

Impact of polypropylene microplastics and chemical pollutants on European sea bass (Dicentrarchus labrax) gut microbiota and health

Plastic pollution has become a global problem for marine ecosystems. Microplastics (MPs) are consumed by several marine organisms, including benthic and pelagic fish species that confuse them with food sources, thus contributing to bioaccumulation along the food chain. In addition to structural intestinal damage, ingestion of MPs represents a pathway for fish exposure to potentially hazardous chemicals, too. Most of them are endocrine disrupters, genotoxic or induce immune depression in fish. Accordingly, we assessed the combined toxicological effects of microplastics (MPs) and adsorbed pollutants by adding them to marine fish diet. European sea bass (Dicentrarchus labrax) juveniles were fed for 60 days with feeds containing polypropylene MPs, either virgin or contaminated with chemical pollutants (a blend of dichlorodiphenyldichloroethylene, chlorpyrifos, and benzophenone-3). The data demonstrated a synergic action of MPs and chemical pollutants to induce an inflammatory-like response in distal intestine of sea bass as shown by the up regulation of cytokine il-6 and tnf-α expression. Morphological analysis detected the presence of a focus of lymphocytes in anterior and posterior intestinal segments of fish fed with contaminants in the diet. With regard to microbiota, significant changes in bacterial species richness, beta diversity, and composition of gut microbiota were observed as a consequence of both pollutants and polluted MPs ingestion. These perturbations in gut microbial communities, including the reduction of beneficial lactic acid bacteria and the increase in potential pathogenic microorganism (Proteobacteria and Vibrionales), were undeniable signs of intestinal dysbiosis, which in turn confirmed the signs of inflammation caused by pollutants, especially when combined with MPs. The results obtained in this study provide, therefore, new insights into the potential risks of ingesting MPs as pollutant carriers in marine fish.

An annual study on plastic accumulation in surface water and sediment cores from the coastline of Tenerife (Canary Island, Spain)

Sediment core samples from high tide lines and in submerged zones as well as surface water samples from eight beaches of Tenerife were analysed. Sampling was conducted over a period of one year in intervals of 5 weeks. The majority of particles were found in the high tide sediment (66%), followed by water samples (23%) and finally in sediment from submerged zones (11%). Regarding the particle amount per volume (items/L), accumulation in sediment samples was statistically higher compared to water samples. Mean values of items/L were higher in high tide sediments. In high tide and water samples, mostly white and transparent particles >1 mm were found. More than 70% were represented by fragments. In sediments from submerged zones, yellow and blue microparticles (<1 mm) were predominant and 61.9% consisted of fibres. Larger particles were mainly identified as PP, PE, PS, PTFE and PVC, while polymer types of smaller particles were more variable.

Condylar morphometry in adults with sagittal intermaxillary relationship class I, II and III using Cone Beam Computed Tomography in a Colombian population

OBJECTIVE

This study established the morphometry of the mandibular condyle in individuals with complete craniofacial growth and sagittal intermaxillary relationships class I, II and III using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

Cone beam computed tomography was obtained for orthodontics diagnostic purposes. The sample was divided taking into account the ANB angle in sagittal classes I, II and III (age ranged from 18 to 40 years old). Linear measurements and shapes of 144 mandibular condyles were analyzed.

RESULTS

Statistically significant differences were found in measurements of the mediolateral diameter when compared with gender (P 0.000) being larger for males. Statistically significant differences between the mediolateral diameter and the coronal shape for the right as well as the left sides with P values of 0.000 and 0.47 respectively were found.

CONCLUSION

In this sample, it was not possible to conclusively determine the relationship between the skeletal class and the mediolateral diameter. However, more studies are required.

Microplastics in marine biota: A review

Plastics are the most important component in marine debris. In turn, within plastics, microplastics (<5 mm) are those that most affect marine biota. Thus, this review has as its main objective to show the current state of studies of microplastics, as well as to determine the groups of vertebrates most affected by microplastics, and the type and predominant color of microplastics. For this research, we review a total of 132 articles, from 2010 to May of 2020. Our results show that the group more affected are turtles with 88% of the specimens contaminated by microplastics and median of 121.73 particles/individue. The predominant type is fibers (67.3%), polymer is polyethylene (27.3%), size is less than 2 mm (73.6%), and color is blue (32.9%).

Evidence of microplastic ingestion by cultured European sea bass (Dicentrarchus labrax)

The presence of microplastics (MPs) in the marine environment is a concerning topic due to the ecotoxicological effects and possible seafood contamination. Data is needed to evaluate human exposure and assess risks, in the context of a healthy and beneficial seafood consumption. While microplastic ingestion by wild fish has been reported since the early 70's, farmed fish are rarely investigated. Here, for the first time the presence of microplastics in fish cultivated in the coastal water of Tenerife (Canary Island, Spain) was evaluated. From 83 examined individuals, 65% displayed microplastics in their gastrointestinal tracts, with averages between 0.6 ± 0.8 (SD) and 2.7 ± 1.85 (SD) particles per fish. The total number of microplastics detected was 119. Fibres (81%) and fragments (12%) were the predominant shapes. FTIR analysis showed that fibres were mostly composed by Cellulose (55%) and Nylon (27%), whereas fragments by PE (25%) and PP (25%).

Are the unreamed nails indicated in diaphyseal fractures of the lower extremity? A biomechanical study

INTRODUCTION

Intramedullary nailing is generally accepted as the first choice for the treatment of diaphyseal fractures of femur and tibia, with a gradual incease in the use of unreamed nails. Different studies during last years show controversial outcomes. Some authors strongly favor unreamed nailing, but most of the authors conclude that reamed nailing have proved to be more successful.

MATERIAL AND METHODS

This study simulates unreamed intramedullary nailing of four femoral and three tibial fracture types by means of Finite Element (FE) models, at early postoperative stages with a fraction of physiological loads, in order to determine whether sufficient stability is achieved, and if the extent of movements and strains at the fracture site may preclude proper consolidation.

RESULTS

The behavior observed in the different fracture models is very diverse. In the new biomechanical situation, loads are only transmitted through the intramedullary nail. Mean relative displacement values of fractures in the femoral bone range from 0.30 mm to 0.82 mm, depending on the fracture type. Mean relative displacement values of the tibial fractures lie between 0.18 and 0.62 mm, depending on the type of fracture. Concerning mean strains, for femoral fractures the maximum strains ranged between 12.7% and 42.3%. For tibial fractures the maximum strains ranged between 10.9% and 40.8%.

CONCLUSIONS

The results showed that unreamed nailing provides a very limited mechanical stability, taking into account that analyzed fracture patterns correspond to simple fracture without comminution. Therefore, unreamed nailing is not a correct indication in femoral fractures and should be an exceptional indication in open tibial fractures produced by high-energy mechanism.

Microplastic ingestion in jellyfish Pelagia noctiluca (Forsskal, 1775) in the North Atlantic Ocean

The present study is the first evidence-based study about the ingestion of plastic and microplastics in jellyfish Pelagia noctiluca in the North Atlantic Ocean. A bloom of this organism was collected from Gran Canaria Island coast. It was digested using KOH to quantify the plastic particles and by separating the umbrella from tentacles. About 97% of the organisms analysed showed the presence of microdebris. The majority of the microfibers were with blue or uncorrected fibre concentrations and mainly composed of cotton. Their presence in the gastrovascular cavity of the jellyfish was confirmed. These results warn about the impact of various factors such as jellyfish health, the transfer to jellyfish predators, human consumption of jelly fish, and the transport of carbon and microplastics in the water column.

Deep learning approach for automatic microplastics counting and classification

The quantification of microplastics is a needed task to monitor its evolution and model its behavior. However, it is a time demanding task traditionally performed using expensive equipment. In this paper, an architecture based on deep learning networks is presented with the aim of automatically count and classify microplastic particles in the range of 1-5 mm from pictures taken with a digital camera or a mobile phone with a resolution of 16 million pixels or higher. The proposed architecture comprises a first stage, implemented with the U-Net neural network, in charge of making the segmentation of the particles in the image. After the different particles have been isolated, a second stage based on the VGG16 neural network classifies them into three types: fragments, pellets and lines. These three types have been selected for being the most common in the range size under consideration. The experimental evaluation was carried out using images taken with two digital cameras and one mobile phone. The particles used in experiments correspond to samples collected on the beach of Playa del Poris in Tenerife Island, Spain, (28° 09' 51″ N, 16° 25' 54″ W) in August 2018. A Jaccard index value of 0.8 is achieved in the experiments of particles segmentation and an accuracy of 98.11% is obtained in the classification of the microplastic particles. The proposed architecture is remarkable faster than a similar previously published system based on traditional computer vision techniques.

Ketamine specifically reduces cognitive symptoms in depressed patients: An investigation of associated neural activation patterns

Major depressive disorder (MDD) is characterized by heterogeneous cognitive, affective and somatic symptoms. Hence, the investigation of differential treatment effects on these symptoms as well as the identification of symptom specific biomarkers might crucially contribute to the development of individualized treatment strategies. We here aimed to examine symptom specific responses to treatment with ketamine, which repeatedly demonstrated rapid antidepressant effects in severe MDD. Additionally, we investigated working memory (WM) related brain activity associated with changes in distinct symptoms in order to identify specific response predictors. In a sample of 47 MDD patients receiving a single sub-anesthetic dose of ketamine, we applied a three-factor solution of the Beck Depression Inventory (BDI) to detect symptom specific changes 24 h post-infusion. A subsample of 16 patients underwent additional fMRI scanning during an emotional working memory task prior to ketamine treatment. Since functional aberrations in the default mode network (DMN) as well as in the dorsolateral prefrontal cortex (DLPFC) have been associated with impaired cognitive and emotional processing in MDD, we investigated neural activity in these regions. Our results showed that ketamine differentially affects MDD symptoms, with the largest symptom reduction in the cognitive domain. WM related neuroimaging results indicated that a more pronounced effect of ketamine on cognitive symptoms is predicted by lower DMN deactivation and higher DLPFC activation. Findings thereby not only indicate that ketamine's antidepressant efficacy is driven by a pro-cognitive mechanism, but also suggest that this might be mediated by increased potential for adaptive adjustment in the circumscribed brain regions.

Micro and Nano-Plastics in the Environment: Research Priorities for the Near Future

Plastic litter dispersed in the different environmental compartments represents one of the most concerning problems associated with human activities. Specifically, plastic particles in the micro and nano size scale are ubiquitous and represent a threat to human health and the environment. In the last few decades, a huge amount of research has been devoted to evaluate several aspects of micro/nano-plastic contamination: origin and emissions, presence in different compartments, environmental fate, effects on human health and the environment, transfer in the food web and the role of associated chemicals and microorganisms. Nevertheless, despite the bulk of information produced, several knowledge gaps still exist. The objective of this paper is to highlight the most important of these knowledge gaps and to provide suggestions for the main research needs required to describe and understand the most controversial points to better orient the research efforts for the near future. Some of the major issues that need further efforts to improve our knowledge on the exposure, effects and risk of micro/nano-plastics are: harmonization of sampling procedures; development of more accurate, less expensive and less time-consuming analytical methods; assessment of degradation patterns and environmental fate of fragments; evaluating the capabilities for bioaccumulation and transfer to the food web; and evaluating the fate and the impact of chemicals and microorganisms associated with micro/nano-plastics. The major gaps in all sectors of our knowledge, from exposure to potentially harmful effects, refer to small size microplastics and, particularly, to the occurrence, fate and effects of nanoplastics.

First evaluation of neustonic microplastics in the Macaronesian region, NE Atlantic

Marine microplastic pollution is an issue of great concern nowadays since high concentrations have been detected in the ocean, mainly in the subtropical gyres that accumulate this type of debris. The long-term effects of this pollution on ecosystems and marine biota are still unknown. The aim of this study is to quantify and characterise microplastics and neustonic zooplankton in sub-surface waters of the Macaronesian region, an area that has been little studied to date. Our results show a great variability in the concentration of microplastics with values between 15,283 items/km² in Los Gigantes (Tenerife, Canary Islands) and 1,007,872 items/km² in Las Canteras (Gran Canaria, Canary Islands). The main types of debris found were plastic fragments and fibres. The abundances of neustonic zooplankton were also very variable between the different sampling areas, being the main components copepods and eggs. Regarding the microplastics-zooplankton ratio, values were obtained between 0.002 and 0.22. In Las Canteras, the highest accumulation zone, was found twice as much microplastics as zooplankton for the 1-5 mm fraction in dry weight. These values highlight the potential hazard of microplastics - and its associated chemical contaminants - for marine biota, especially for large filter feeders.

Biomechanical analysis of the stability of anterograde reamed intramedullary nails in femoral spiral fractures

Femoral shaft fractures present high morbidity and important complications and consequences, being spiral fractures the most complicated from a biomechanical point of view, being unstable and without possibility of getting a good contact between nail and femoral endosteum. Femoral diaphyseal fractures are treated, usually, by means of intramedullary nailing. So, it is necessary to know the osteosynthesis stability and which locking screws combination is optimal. This work studies the use of reamed locked intramedullary nails in spiral femoral fractures located along zones 2 and 4 of wiss, depending on the spire length, corresponding to 32-A spiral type in AO/OTA classification, which represent a percentage of 23% within the total of diaphyseal fractures. A three-dimensional finite element model of the femur was developed, modeling a spiral fracture with different spiral lengths and gaps. A femoral nail was used, considering two transversal screws both at the proximal and the distal parts. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. Reamed intramedullary blocked nails provide appropriate stability of femoral spiral fractures, considering global mobility of femoral head with respect to femoral condyles, relative displacements between fragments at fracture site, stresses at nail and locking screws, and stresses at cortical bone. The obtained results show that the use of blocked reamed nails in spiral femoral fractures can be considered as an appropriate surgical technique, providing sufficient stability in order to obtain an adequate fracture healing.

Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery

Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.

Study of plastic pollution and its potential sources on Gran Canaria Island beaches (Canary Islands, Spain)

In order to understand the origin of plastic debris pollutants that accumulate in the Canary Islands coastline, six beaches of Gran Canaria Island were studied during different seasons to estimate the abundance and the types of two microplastics fraction sizes (0.01-1 mm and 1-5 mm) and mesoplastics fraction (5-25 mm). For the larger fraction of microplastics and mesoplastics, a high percentage of fragments and foams were found; moreover, both fractions show the same accumulation pattern in relation with the wave, wind, and current. The debris was checked for exogenous and local origins. Moreover, for the smaller fraction of microplastics, only natural, semi-synthetic, and synthetic fibres were found, showing a totally different spatial distribution from the others fractions. This result suggests a possible endogenous origin of the contamination, in relation to the type and amount of wastewater discharges and beach users.

Plastic pollution on eight beaches of Tenerife (Canary Islands, Spain): An annual study

Stranded marine debris from eight beaches of Tenerife (Canary Islands, Spain) was analyzed. Sampling was conducted along the high tide line every 35 m over the whole lengths in periods of 5 weeks for one year. Evaluated particles included all materials bigger than 2 mm, which were subdivided in Mesoparticles (2-10 mm) and Macroparticles (>10 mm). There was a great variability of plastic abundance regarding the locations and the sampling dates. In contrast, the occurrence of debris along the beaches showed consistency and even zones of high and low accumulation. The most polluted beach was Poris, which is indeed infrequently visited, but highly affected by the main current. Plastic particles were principally mesoparticles and white/transparent color. This study not only confirms, that the Canary Islands are highly affected by the marine plastic pollution, but also for the first time shows, that stranded plastic accumulates in restricted areas of sandy coastlines.

Organic pollutants in marine plastic debris from Canary Islands beaches

Given their capacity to adsorb chemical pollutants, microplastics represent a growing environmental concern in the oceans. The levels of 81 chemical compounds in two types of beached microplastic (pellets and fragments) were monitored across the Canary Islands (Spain). The highest concentrations were found for polycyclic aromatic hydrocarbons (PAH) (52.1-17,023.6ng/g and 35.1-8725.8ng/g for pooled pellets and fragments, respectively). The polychlorinated biphenyl (PCB) concentrations were 0.9-2285.8 and 1.6-772.5ng/g for pooled pellets and fragments, respectively, whereas organochlorine pesticides (OCP) ranged from 0.4-13,488.7 and 0.4-3778.8ng/g, respectively. The sum of polychlorinated biphenyls and diphenyl-dichloro-ethane (DDT) metabolites was significantly higher in beaches on Gran Canaria, which is the most populated and industrialized island. The sum of ultraviolet filters (UV-filters) was higher in those beaches more frequented by tourists (Famara and Las Canteras), than in occasionally or very rarely visited beaches (Cuervitos and Lambra), with values ranging from 0 to 37,740.3ng/g and 3.7-2169.3ng/g for pellets and fragments, respectively. Furthermore, the sum of brominated diphenyl ethers (BDE) (0-180.58ng/g for pooled pellets and 0.06-3923.9ng/g for pooled fragments) and organophosphorus flame retardants (OPFR) (20.0-378.0ng/g for pooled pellets, and 22.6-7013.9ng/g for pooled fragments) was significantly higher in an urban beach (Las Canteras) than in the rest of the studied beaches. Finally, the concentrations of the pesticide chlorpyrifos were much higher on Gran Canaria beaches than in the rest. In this research we provide further evidence of the important role of plastic debris in the adsorption of a wide range of marine pollutants. The regional pattern of chemical contamination of plastics reveals that the sorption of many compounds probably occurs in coastal waters. Further investigation is necessary to understand the relationship between plastic types and adsorption of different pollutants, especially for emerging pollutants.

Microplastic ingestion by Atlantic chub mackerel (Scomber colias) in the Canary Islands coast

In recent years, due to the increasing concerns about their negative impact on wildlife and possible toxicity to living organisms (including humans), microplastics have become the subject of intense investigations. In the ocean, microplastics can be easily ingested by numerous marine organisms because of their small size (<5 mm). The Northwest African upwelling system is an important fishery area, and the present study is the first one in the region to reveal the presence of microplastic particles in the digestive tract of Atlantic chub mackerel (Scomber colias). From the 120 examined fish gastrointestinal tracts, 78.3% contained some type of microplastics, 74.2% contained fibres, 17.5% plastic fragments, and 16.7% paint. More studies are needed on fish, but S. colias is a candidate for being a good indicator of microplastic contamination in the region.

The impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study

PURPOSE

The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life.

METHODS

Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain.

OUTCOMES

daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture.

STATISTICS

Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range).

RESULTS

A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively.

CONCLUSIONS

Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.

A biomaterial with a channel-like pore architecture induces endochondral healing of bone defects

Biomaterials developed to treat bone defects have classically focused on bone healing via direct, intramembranous ossification. In contrast, most bones in our body develop from a cartilage template via a second pathway called endochondral ossification. The unsolved clinical challenge to regenerate large bone defects has brought endochondral ossification into discussion as an alternative approach for bone healing. However, a biomaterial strategy for the regeneration of large bone defects via endochondral ossification is missing. Here we report on a biomaterial with a channel-like pore architecture to control cell recruitment and tissue patterning in the early phase of healing. In consequence of extracellular matrix alignment, CD146+ progenitor cell accumulation and restrained vascularization, a highly organized endochondral ossification process is induced in rats. Our findings demonstrate that a pure biomaterial approach has the potential to recapitulate a developmental bone growth process for bone healing. This might motivate future strategies for biomaterial-based tissue regeneration.

The impact of advanced practice providers on the surgical resident experience: Agree to disagree?

BACKGROUND

We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams.

METHODS

Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. Statistical analysis compared responses using a Pearson chi-square test.

RESULTS

Thirty-two resident/fellows (48%) and 10 APPs (42%) responded. There was consensus that having an APP on service decreases workload, contributes to continuity of care and enhances resident-patient coordination education and agreement that there was clear communication and adequate collaboration. Both groups differed with respect to APPs contribution to resident/fellow clinical education, role definition and chain of command. The majority of trainees felt that APPs function at a PGY2 level (51.7%) compared to APPs, who felt that they functioned at a PGY4/5 (22%) or Fellow (44%) level.

CONCLUSION

APPs and resident/fellows agree that APPs impact resident workload, continuity of care and patient-coordination education.

Microplastic and tar pollution on three Canary Islands beaches: An annual study

Marine debris accumulation was analyzed from three exposed beaches of the Canary Islands (Lambra, Famara and Las Canteras). Large microplastics (1-5mm), mesoplastics (5-25mm) and tar pollution were assessed twice a month for a year. There was great spatial and temporal variability in the Canary Island coastal pollution. Seasonal patterns differed at each location, marine debris concentration depended mainly of local-scale wind and wave conditions. The most polluted beach was Lambra, a remote beach infrequently visited. The types of debris found were mainly preproduction resin pellets, plastic fragments and tar, evidencing that pollution was not of local origin, but it cames from the open sea. The levels of pollution were similar to those of highly industrialized and contaminated regions. This study corroborates that the Canary Islands are an area of accumulation of microplastics and tar rafted from the North Atlantic Ocean by the southward flowing Canary Current.

Novel methodology to isolate microplastics from vegetal-rich samples

Microplastics are small plastic particles, globally distributed throughout the oceans. To properly study them, all the methodologies for their sampling, extraction, and measurement should be standardized. For heterogeneous samples containing sediments, animal tissues and zooplankton, several procedures have been described. However, definitive methodologies for samples, rich in algae and plant material, have not yet been developed. The aim of this study was to find the best extraction protocol for vegetal-rich samples by comparing the efficacies of five previously described digestion methods, and a novel density separation method. A protocol using 96% ethanol for density separation was better than the five digestion methods tested, even better than using H₂O₂ digestion. As it was the most efficient, simple, safe and inexpensive method for isolating microplastics from vegetal rich samples, we recommend it as a standard separation method.