Migration of bisphenol A from plastic baby bottles, baby bottle liners and reusable polycarbonate drinking bottles

Human exposure to bisphenol A (BPA) has recently received special attention. It has been shown that exposure to BPA may occur through the consumption of beverages or foods that have been in contact with polycarbonate (PC) plastic containers or epoxy resins in food packaging. A BPA migration study was conducted using a variety of plastic containers, including polycarbonate baby bottles, non-PC baby bottles, baby bottle liners, and reusable PC drinking bottles. Water was used to simulate migration into aqueous and acidic foods; 10% ethanol solution to simulate migration to low- and high-alcoholic foods; and 50% ethanol solution to simulate migration to fatty foods. By combining solid-phase extraction, BPA derivatization and analysis by GC-EI/MS/MS, a very low detection limit at the ng l(-1) level was obtained. Migration of BPA at 40 degrees C ranged from 0.11 microg l(-1) in water incubated for 8 h to 2.39 microg l(-1) in 50% ethanol incubated for 240 h. Residual BPA leaching from PC bottles increased with temperature and incubation time. In comparison with the migration observed from PC bottles, non-PC baby bottles and baby bottle liners showed only trace levels of BPA. Tests for leachable lead and cadmium were also conducted on glass baby bottles since these represent a potential alternative to plastic bottles. No detectable lead or cadmium was found to leach from the glass. This study indicated that non-PC plastic baby bottles, baby bottle liners and glass baby bottles might be good alternatives for polycarbonate bottles.

Occurrence of Lymphedema Continues To Increase Twelve to Thirty Months after Breast Cancer Treatment

Introduction:Breast cancer (BC) survivors are at lifetime risk for developing lymphedema (LE), the accumulation of protein-rich fluid in the interstitial spaces of the affected body part due to a blockage or malfunction in the lymph system. This is different than swelling which may occur immediately after surgery and may be present at the post-op visit, and the physical and psychological aspects of the condition greatly impact the daily lives of LE patients (Geller et al., 2003, Hull, 1998). Of those affected by breast cancer, up to 40% will develop LE, potentially comprising 1 to 5 million survivors. However, all breast cancer survivors are considered at risk for the condition (American Cancer Society, 2007).While numerous studies have reported LE incidence during the first 12 months following breast cancer treatment, little is known regarding long-term LE diagnosis. Very few studies have examined LE incidence past 1 year post-treatment, and many that have are retrospective or cross-sectional, not prospective, in nature. In fact, in one analysis of existing literature the study with the shortest follow-up (12 months) reported the lowest LE incidence (Ball et al., 1992) and the study with the longest follow-up (11 years) reported the highest incidence (Schunemann and Willich, 1997).Methods:Participants were enrolled following diagnosis of BC but before treatment and followed every 3 months for 12 months, then every 6 months until 2.5 years post-surgery. Limb volume changes (LVC) were measured using: (a) circumferences via tape measure at 4 cm intervals, (b) infra-red laser perometry, and (c) symptom experience (SS) via interview. Four diagnostic criteria for LE were used: (i) 2 cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) report of limb heaviness/swelling, 'now' or 'in the past year'. Standard survival analysis methods were applied to identify when the LE criteria were met.Results:At 30 months post-treatment, LE incidence using the four criteria ranged from 41%- 91% and had continued to increase over time, with 2 cm being the highest estimation method and SS the lowest.Conclusions:These preliminary findings provide additional evidence that BC survivors continue to be at risk for developing LE beyond the first year following treatment. LE identification, regardless of the criteria used, continued to increase past the initial 12 months post-treatment. From month 12 to month 30, LE identification increased by an additional 10-27%, depending on the criteria used. While identification of LE via symptom experience in the initial 12 months occurred in 31% of participants, only an additional 10% met the criteria at 30 months, by far the lowest incidence rate among all criteria. Overall, this analysis finds 2 cm criteria as the most liberal definition of LE (91%), while self-report of heaviness and swelling, along with 10% LVC, represent the most conservative definitions (41% and 45%, respectively).

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2070.

Breast Cancer Survivors Often Meet Multiple Criteria for Lymphedema

Introduction:Assessment and diagnosis of lymphedema (LE) has been problematic, in part due to the fact that various measurement approaches and criteria have been applied. This analysis examines four different criteria for diagnosing lymphedema among breast cancer survivors. Recent scientific literature reports that anywhere from 6 to 30 percent (Petrek and Heelan, 1998) or 6 to 62.5 percent (Passik, 1998) of the breast cancer population has LE. The discrepancies among the reported percentages stem from difficulties in measurement, diagnosis, and follow-up (Petrek and Heelan, 1998, Passik, 1998, Rockson, 1998, Meek, 1998, Armer and Stewart, 2005, Hayes et al., 2008). Traditionally, finding >2cm difference in limb girth between the affected and non-affected limbs warranted clinical diagnosis of LE (Callaway, 1988, Armer and Stewart, 2005). Measuring a 200 ml limb volume difference or a 10 percent limb volume change (LVC) from baseline and/or between limbs as well as self-reported signs and symptoms are also documented methods of LE diagnosis (Petlund, 1991, Armer and Stewart, 2005).Methods:Participants were enrolled post-breast cancer diagnosis but pre-surgery, and followed every 3 months for 12 months, then every 6 months until 2.5 years post-surgery. Limb volume changes (LVC) were measured using: (a) circumferences via tape measure at 4 cm intervals, (b) infra-red laser perometry, and (c) symptom experience (SS) via interview. Four diagnostic criteria for LE were used: (i) 2cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) self-report of limb heaviness/swelling.Results:In this cohort, 84% met at least one criterion to identify lymphedema by 2.5 years post-treatment (Figure 1). The most common single criterion met was 2-cm circumferential change (25%). When examining meeting multiple criteria, 13% of participants met the combination of 200mL LVC, 10% LVC, and 2cm change. In addition, 11% of participants met all four lymphedema criteria by 2.5 years post treatment.Conclusions:This analysis demonstrates breast cancer survivors who develop lymphedema often meet multiple criteria for the condition. We found 62% of those with lymphedema met two or more criteria used in this analysis, and 31% met three or more criteria. The most common criterion to identify lymphedema, either alone or associated with one or more criteria, was 2 cm circumference change (77%), while 10% LVC was least likely to be met (26%).

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2074.

A case of verocytotoxin-producing Escherichia coli O157 from a private barbecue in South East England

The following case report describes a cluster of Escherichia coli O157 cases in the United Kingdom related to undercooked beef at a barbecue, resulting in an intensive care admission in France with haemolytic uraemic syndrome and highlighting the need to cook beef properly.

Review of calls to NHS Direct related to attendance in the paediatric emergency department

OBJECTIVE

To examine the outcomes of calls to NHS Direct (NHS-D) in relation to attendance at the accident and emergency (A&E) department.

DESIGN

A prospective collection of data about consecutive calls to NHS-D North West Coast was matched with attendances at the A&E department over a period of 3 months.

SETTING

NHS-D Regional Trust and a large urban paediatric A&E department.

PATIENTS

Children and young adults aged <16 years living in local postal code areas.

MAIN OUTCOME MEASURES

To examine (1) whether advice given by NHS-D was followed and (2) the differences in disease severity and necessity of attendance of patients referred by NHS-D and those referred by general practitioners and self-presenters.

RESULTS

The relationship between the advice given and subsequent action is complex. Only 70% of calls advised to attend the A&E department did so. A further 1% (176) were advised not to attend the A&E department did in fact attend the department. Patients referred by NHS-D represented only 3.2% of department attendances. There was little difference in the triage categories of the presenting groups, but there were significantly less admissions (p<0.01) in the NHS-D group.

CONCLUSIONS

Delivering telephone advice about illness severity in children is difficult as visual clues are so important. More collaborative prospective studies are needed, including with primary care, to understand families' choices, and to refine and assess NHS-D's ability to discriminate those requiring further clinical assessment.

Effect of whitening gels on the surface roughness of restorative materials in situ

Peroxide gels are effective in changing tooth colour but their effect on restorative materials has been poorly studied. The purpose of this investigation was to assess the impact of a commercially available whitening gel containing hydrogen peroxide and a sodium percarbonate formulation on the surface of restorative materials. A total of 12 subjects participated in a double-blinded crossover study. Each wore an intra-oral appliance containing five bovine enamel blocks restored with amalgam, posterior composite, microfilled composite, glass ionomer cement and porcelain. Appliances were worn continuously for 14 days and whitening products were applied twice daily. After 14 days the appliances were removed and values for roughness (R(a)) were obtained using atomic force microscopy. Mean values of R(a) were assessed between baseline and 14 days, and although minor variations were seen, there were no statistically significant differences detected for any material or any whitening product.

Experimental charge-density study on the nickel(II) coordination complex [Ni(H3 L)][NO3][PF6] [H3 L = N,N′,N′′-tris(2-hydroxy-3-methylbutyl)-1,4,7-triazacyclononane]: a reappraisal

The experimental charge density in the title complex has been re-examined. The original work, reported some 8 years ago [Smith et al. (1997). J. Am. Chem. Soc. 119, 5028–5034], was undertaken using a very early version of the XD software, which contained serious programming errors. A re-refinement, using the original data and a recent version of the XD software, shows that many of the unusual aspects of this earlier study are artefacts due to these programming errors. The topological properties of the newly obtained experimental density compare well with those calculated from a theoretical DFT (density-functional theory) UHF-SCF (unrestricted Hartree Fock–self-consistent field) density. This report corrects several erroneous conclusions regarding the charge density in the title complex – in particular, the highly unusual diffuse Laplacian distribution about the Ni atom, and the trifurcated bond path from the Ni atom to the alcohol oxygen donor atoms are no longer observed. An examination of a range of topological properties of the metal–ligand bonds leads to the conclusion that the Ni—N and Ni—O bonds have an intermediate character, with a significant shared interaction, but with a substantial ionic component. This new study also reveals a previously unrecognized intramolecular H...H interaction in the macrocyclic ligand.

Actin-dependent motility of melanosomes from fish retinal pigment epithelial (RPE) cells investigated using in vitro motility assays

Melanosomes (pigment granules) within retinal pigment epithelial (RPE) cells of fish and amphibians undergo massive migrations in response to light conditions to control light flux to the retina. Previous research has shown that melanosome motility within apical projections of dissociated fish RPE cells requires an intact actin cytoskeleton, but the mechanisms and motors involved in melanosome transport in RPE have not been identified. Two in vitro motility assays, the Nitella assay and the sliding filament assay, were used to characterize actin-dependent motor activity of RPE melanosomes. Melanosomes applied to dissected filets of the Characean alga, Nitella, moved along actin cables at a mean rate of 2 microm/min, similar to the rate of melanosome motility in dissociated, cultured RPE cells. Path lengths of motile melanosomes ranged from 9 to 37 microm. Melanosome motility in the sliding filament assay was much more variable, ranging from 0.4-33 microm/min; 70% of velocities ranged from 1-15 microm/min. Latex beads coated with skeletal muscle myosin II and added to Nitella filets moved in the same direction as RPE melanosomes, indicating that the motility is barbed-end directed. Immunoblotting using antibodies against myosin VIIa and rab27a revealed that both proteins are enriched on melanosome membranes, suggesting that they could play a role in melanosome transport within apical projections of fish RPE.

Validation of the Alder Hey Triage Pain Score

AIMS

To describe the validation and reliability of a new pain tool (the Alder Hey Triage Pain Score, AHTPS) for children at triage in the accident and emergency (A&E) setting.

METHODS

A new behavioural observational pain tool was developed because of dissatisfaction with available tools and a lack of confidence in self-assessment scores at triage. The study was conducted in a large paediatric A&E department; 575 children (aged 0-16 years) were included. Inter-rater reliability and various aspects of validity were assessed. In addition this tool was compared to the Wong-Baker self-assessment tool. The children were concurrently scored by a research nurse and triage nurses to assess inter-rater reliability. Construct validity was assessed by comparing the research nurse's triage score with the research nurse reassessment score after intervention and/or analgesia. Known group construct validity was assessed by comparing the research nurse's score at triage with the level of pain of the condition as judged by the discharge diagnosis. Predictive validity was assessed by comparing the research nurse's AHTPS with the level of analgesia needed by each patient. The AHTPS was also compared to a self-assessment score.

RESULTS

A high level of inter-rater reliability, kappa statistic 0.84 (95% CI 0.80 to 0.88), was shown. Construct validity was well demonstrated; known group construct validity and predictive validity were also demonstrated to a varying degree.

CONCLUSIONS

Results support the use of this observational pain scoring tool in the triage of children in A&E.

Outcomes of the peer-taught 12-week family-to-family education program for severe mental illness

OBJECTIVE

Family-to-Family Education Program (FFEP) is a 12-week course for family members of adults with serious mental illness (SMI). This study evaluates the effectiveness of FFEP for several family member outcomes.

METHOD

The FFEP enrollees on a > or =3-month waiting list were eligible; 95 consenting family members agreed to four interviews (waitlist, pre-FFEP, post-FFEP, and 6 months post-FFEP) regarding subjective and objective burden, empowerment, and depression. Mixed effects ANOVA models tested hypotheses of decreased burden and increased empowerment after FFEP.

RESULTS

The FFEP was associated with reduced subjective burden (P < 0.01) and increased empowerment (P < 0.01) without changes in objective burden. Knowledge about SMI, understanding the mental health system, and self-care also improved. There was no significant decay at 6-month followup.

CONCLUSION

This study provides evidence that FFEP is helpful to relatives of persons with SMI by reducing subjective burden and worry, and increasing empowerment, knowledge about SMI, understanding the mental health system, and self-care.

Outcome following haematopoietic cell transplantation in patients with myelodysplasia and del (5q) karyotypes

The deletion (5q) karyotype [del (5q)] in patients with myelodysplastic syndrome (MDS) is considered a good risk feature, while the impact of del (5q) combined with other karyotypic abnormalities [del (5q)+] is less well defined. We analysed the outcome of haematopoietic cell transplants (HCT) in patients with MDS with del (5q) or del (5q)+. Fifty-seven patients, aged 6-72 years, with MDS and del (5q) abnormalities received HCT from related (n = 32) or unrelated (n = 25) donors. By French-American-British (FAB) criteria, 27 patients had refractory anaemia (RA), 10 RA with excess blasts (RAEB), eight RAEB in transformation (RAEB-T) and 12 acute myeloid leukaemia evolving from MDS (tAML). Non-relapse mortality at 1-year post-transplantation was 30% for del (5q) and 38% for del (5q)+ patients. Relapse occurred in one of 20 del (5q) patients and 15 of 37 del (5q)+ patients (P = 0.001). After adjusting for del (5q) status, blast count (<5%) was the only factor significantly associated with relapse-free survival. Patients with del (5q), either as a '5q- syndrome' or with MDS in general, had better outcomes than did patients with del (5q)+. The indication for transplantation in patients with del (5q) was generally severe cytopenias, compared with disease progression to a more advanced FAB stage in patients with del (5q)+. Conceivably, outcome for patients with del (5q)+ would be improved with transplantation earlier in the disease course.

239,240Pu and inorganic substances in aerosols from the vicinity of a waste isolation pilot plant: the importance of resuspension

Aerosol samples were collected and analyzed to characterize the spatial and temporal variations in the concentrations of plutonium and selected inorganic substances in the atmosphere around the Waste Isolation Pilot Plant (WIPP). High-volume aerosol sampling was conducted at three sites: (1) On Site, (2) Near Field, and (3) Cactus Flats. 239,240Pu was determined by alpha spectrometry following chemical separations; mass loadings were determined gravimetrically. A separate set of low-volume aerosol samples was analyzed for major ions using ion chromatography and for trace elements by inductively-coupled plasma emission spectrometry and mass spectrometry. The average 239,240Pu activity concentrations in total suspended particle (TSP) samples (12 to 16 nBq m(-3)) were consistent with those previously reported, but they varied strongly with season, with the highest values generally in spring. Further, the 239,240Pu activity concentrations were comparable among the three sites, and therefore there was no evidence for elevated 239,240Pu activities due to WIPP operations. The fraction of the 239,240Pu activity concentrations in the PM10, samples (particles less than 10 microm diameter) relative to TSP was lower than the corresponding PM10/TSP ratios of either high-volume mass or several inorganics (sulfate, aluminum or lead), indicating that 239,240Pu tends to be on large particles. Aerosol mass loadings (microg m(-3)) and 239,240Pu activity concentrations were correlated for all sets of samples, but at On Site, the TSP samples showed higher mass to 239,240Pu ratios than the other sites. Thus activities or processes occurring at or near the WIPP site evidently produced aerosols that contributed to the mass loadings but contained less 239,244Pu than ambient aerosols. About 63% of the variability in 239,240Pu activity concentrations was explained by wind travel, sampling location, length of the sampling interval, and aerosol mass. 239,240Pu activity concentrations also were correlated with aluminum (an indicator of mineral dust), further implicating the resuspension of soils as an important determinant of 239,240Pu in aerosols. The 239,240Pu/Al ratios for the aerosols were higher than in soils, and this could be explained by the preferential binding of 239,240Pu to small soil particles that have large surface area to mass ratios and also have higher aluminum contents than larger particles.

A randomized clinical trial of the desensitizing efficacy of three dentifrices

The effect on dentinal hypersensitivity from the use of a new dentifrice containing 5.0% potassium nitrate and 0.454% stannous fluoride in a silica base (Colgate Sensitive Maximum Strength Toothpaste, Colgate-Palmolive Co.) over an 8-week period was compared to a commercially available dentifrice containing 5.0% potassium nitrate and 0.243% sodium fluoride in a silica base (positive control [Sensodyne Fresh Mint Toothpaste, Block Drug Company, Inc.]) and to a commercially available nondesensitizing dentifrice containing 0.243% sodium fluoride in a silica base (negative control [Colgate Winterfresh Gel, Colgate-Palmolive Co.]). A total of 120 participants were stratified into 3 balanced groups according to baseline mean air blast (thermal) and tactile (Yeaple Probe) sensitivity scores, gender, and age. Participants brushed their teeth twice daily (morning and evening) for 1 minute. Dentinal hypersensitivity examinations were conducted at baseline, 4 weeks, and 8 weeks by the same dental examiner. After 4- and 8-weeks' use of their assigned products, participants in the new dentifrice group demonstrated statistically significant improvements (p < 0.05) in tactile and air blast sensitivity, as compared to those using the positive and negative control dentifrices.

The comparative anticaries efficacy of a dentifrice containing 0.3% triclosan and 2.0% copolymer in a 0.243% sodium fluoride/silica base and a dentifrice containing 0.243% sodium fluoride/silica base: a two-year coronal caries clinical trial on adults in Israel

The purpose of this two-year clinical study was to provide a comparison of the anticaries efficacy associated with two commercially available, American Dental Association-accepted dentifrices: Colgate Total Toothpaste, which contains 0.3% triclosan and 2% copolymer in a 0.243% sodium fluoride/silica base; and Crest Cavity Fighting Toothpaste with Fluoristat, which contains 0.243% sodium fluoride in a silica base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. The study employed a double-blind parallel-group design, and involved adults living in communities throughout Israel. Qualifying subjects were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. Two calibrated examiners performed all of the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to ensure compliance with the study. Post-baseline examinations were performed after one year of product use, and again after two years of product use. Three-thousand, three-hundred and ninety-two (3,392) subjects completed this two-year study. For these subjects, the mean caries scores (DFS, decayed or filled surfaces) at baseline were 21.96 for the Colgate Total Toothpaste group, and 21.49 for the Crest Cavity Fighting Toothpaste with Fluoristat group. For caries increment after one year, the respective means were 1.37 for the Colgate Total Toothpaste group, and 1.56 for the Crest Cavity Fighting Toothpaste with Fluoristat group. After two years, the mean caries increments were 1.46 for the Colgate Total Toothpaste group, and 1.75 for the Crest Cavity Fighting Toothpaste with Fluoristat group. No statically significant difference was indicated between the treatment groups at baseline. However, for both the one-year and two-year increments, there was a statistically significant difference between treatment groups. Relative to the Crest Cavity Fighting Toothpaste with Fluoristat group, the Colgate Total Toothpaste group presented a 12.2% reduction in caries increment scores at one year, and a 16.6% reduction in caries increment scores at two years. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that Colgate Total Toothpaste provides a superior level of coronal anticaries efficacy compared to Crest Cavity Fighting Toothpaste with Fluoristat.