Is Fluoroquinolone Exposure after Primary Tendon Repair Associated with Higher Rates of Reoperations? A Matched Cohort Study

Background

The association between tendon damage and fluoroquinolone (FQ) antibiotics has been well documented. However, there is limited data evaluating the impact of postoperative FQ use on outcomes of primary tendon repairs. The purpose of this study was to compare rates of reoperation for patients with FQ exposure after primary tendon repair versus controls.

Methods

A retrospective cohort study was conducted using the PearlDiver database. All patients who underwent primary repair of distal biceps ruptures, Achilles tendon ruptures, and rotator cuff tears were identified. For each tendon, patients who were prescribed FQs within 90 days postoperatively were propensity score matched at a 1:3 ratio with controls without postoperative FQ prescriptions across age, sex, and several comorbidities. Rates of reoperation were compared at two years postoperatively with multivariable logistic regression.

Results

A total of 124,322 patients who underwent primary tendon procedures were identified, including 3,982 (3.2%) patients with FQ prescriptions within 90 days postoperatively: 448 with distal biceps repair, 2,538 with rotator cuff repair, and 996 with Achilles tendon repair. These cohorts were matched with 1,344, 7,614, and 2,988 controls, respectively. Patients with postoperative FQ prescriptions exhibited significantly higher rates of revision surgery after primary repair of distal biceps ruptures (3.6% vs. 1.7%; OR 2.13; 95% CI, 1.09-4.04), rotator cuff tears (7.1% vs. 4.1%; OR 1.77; 95% CI, 1.48-2.15), and Achilles tendon ruptures (3.8% vs. 1.8%; OR 2.15; 95% CI, 1.40-3.27).

Conclusion

Patients with FQ prescriptions within 90 days after primary tendon repair demonstrated significantly higher rates of reoperations for distal biceps, rotator cuff, and Achilles tendon repair at two years postoperatively. To achieve optimal outcomes and avoid complications in patients following primary tendon repair procedures, physicians should consider prescribing alternative non-FQ antibiotics and counsel patients on the risk of reoperation associated with postoperative FQ use.

Microplastics in Freshwater Sediments Impact the Role of a Main Bioturbator in Ecosystem Functioning

While microplastic transport, fate, and effects have been a focus of studies globally, the consequences of their presence on ecosystem functioning have not received the same attention. With increasing evidence of the accumulation of microplastics at sediment-water interfaces there is a need to assess their impacts on ecosystem engineers, also known as bioturbators, which have direct and indirect effects on ecosystem health. This study investigated the impact of microplastics on the bioturbator Tubifex tubifex alongside any effects on the biogeochemical processes at the sediment-water interface. Bioturbators were exposed to four sediment microplastic concentrations: 0, 700, 7000, and 70000 particles kg^-1 sediment dry weight. Though no mortality was present, a significant response to oxidative stress was detected in tubificid worms after exposure to medium microplastic concentration (7000 particles kg^-1 sediment dry weight). This was accompanied by a reduction in worm bioturbation activities assessed by their ability to rework sediment and to stimulate exchange water fluxes at the sediment-water interface. Consequently, the contributions of tubificid worms on organic matter mineralization and nutrient fluxes were significantly reduced in the presence of microplastics. This study demonstrated that environmentally realistic microplastic concentrations had an impact on biogeochemical processes at the sediment-water interface by reducing the bioturbation activities of tubificid worms.

Global Human Threat: The Potential Synergism between Mercury Intoxication and COVID-19

The COVID-19 pandemic affected billions of people worldwide, and exposure to toxic metals has emerged as an important risk factor for COVID-19 severity. Mercury is currently ranked as the third toxic substance of global concern for human health, and its emissions to the atmosphere have increased globally. Both COVID-19 and mercury exposure present a high prevalence in similar regions: East and Southeast Asia, South America and Sub-Saharan Africa. Since both factors represent a multiorgan threat, a possible synergism could be exacerbating health injuries. Here, we discuss key aspects in mercury intoxication and SARS-CoV-2 infection, describing the similarities shared in clinical manifestations (especially neurological and cardiovascular outcomes), molecular mechanisms (with a hypothesis in the renin-angiotensin system) and genetic susceptibility (mainly by apolipoprotein E, paraoxonase 1 and glutathione family genes). Literature gaps on epidemiological data are also highlighted, considering the coincident prevalence. Furthermore, based on the most recent evidence, we justify and propose a case study of the vulnerable populations of the Brazilian Amazon. An understanding of the possible adverse synergism between these two factors is crucial and urgent for developing future strategies for reducing disparities between developed and underdeveloped/developing countries and the proper management of their vulnerable populations, particularly considering the long-term sequelae of COVID-19.

Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents

Today more than half of the world's population lives in urban areas. Children spend about 40 h a week in the school environment. Knowing the influence of school exposure to green/blue spaces could improve the children's health, creating healthier environments and preventing exposure to legal/illegal drugs. This systematic review summarized the main results of published studies on active or passive exposure to green or blue spaces in different domains of child neurodevelopment. In August 2022, five databases were searched and twenty-eight eligible studies were included in the analysis. Cognitive and/or academic performance was the most frequently studied (15/28). Most studies evaluate passive exposure to green/blue spaces (19/28) versus active exposure (9/28). Only three studies addressed the relationship between blue space and neurodevelopment. The main results point toward mixed evidence of a protective relationship between green/blue space exposure and neurodevelopment, especially in improving cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting "greener" capacities for school environmental health could improve children's neurodevelopment. There was great heterogeneity in methodologies and adjustment for confounding factors across studies. Future research should seek a standardized approach to delivering school environmental health interventions beneficial to children's development.

How Is the Spectrum of Sarcoma Surgery Assessed?

PURPOSE

To meet the challenges of the precision medicine era, quality assessment of shared sarcoma care becomes pivotal. The MDT approach is the most important parameter for a successful outcome. Of all MDT disciplines, surgery is the key step to rendering sarcoma patients disease free; therefore, defining its spectrum is critical. To the best of the authors' knowledge, a comprehensive interoperable digital platform to assess the scope of sarcoma surgery in its full complexity is lacking.

METHODS

An interoperable digital platform on sarcoma surgery has been created to assess the clinical exposure, tumor characteristics, and surgical settings and techniques applied for both resections and reconstructions of sarcomas.

RESULTS

The surgical exposure of an individual surgeon over time served as a pilot. Over the study period of 10 years, there were 723 sarcoma board/MDT meetings discussing 3130 patients. A total of 1094 patients underwent 1250 surgical interventions on mesenchymal tumors by one single sarcoma surgeon. These included 615 deep soft tissue tumors (197 benign, 102 intermediate, 281 malignant, 27 simulator, 7 metastasis, 1 blood); 116 superficial soft tissue tumors (45 benign, 12 intermediate, 40 malignant, 18 simulator, 1 blood); and 519 bone tumors (129 benign, 112 intermediate, 182 malignant, 18 simulator, 46 metastasis, 14 blood, and 18 sequelae of first treatment). Detailed types of resections and reconstructions were analyzed.

CONCLUSIONS

An interoperable digital data platform on sarcoma surgery with transparent real-time descriptive analytics is feasible and enables large-scale definition of the spectrum of sarcoma surgery to meet the challenges of sarcoma precision care in the future.

Gynaecology, general surgery and urology residents' perspective and exposure to endoscopy training and practice: a cross-sectional study of resident doctors in four residency training centres in Abuja, Nigeria from June to August, 2020

Introduction

the use of endoscopy in the surgical management of a wide range of ailments has revolutionised the practice of surgery. Endoscopy however has been underutilised in developing nations. Optimal training exposure during the residency training program is considered as very crucial to the improvement of endoscopy practice in this region. The objective of this study was to evaluate the perception and endoscopy training exposure of resident doctors in gynaecology, general surgery and urology in four residency training centres in Abuja.

Methods

this was an analytical cross-sectional study of endoscopy exposure of gynaecology, general surgery and urology resident doctors in four residency training centres in Abuja from June through August 2020. Using a structured questionnaire, information was obtained on demography, perception of endoscopy, exposure to and expectations for endoscopy training and practice. Data were analysed with SPSS version 25 (IBM Corp., Armonk, NY, USA).

Results

a total of 125 questionnaires were distributed with a 92% response rate. The mean age of the respondents was 36.17±4.62 years with a mean duration of training of 53.91±28.02 months. Eighteen (15.8%) were satisfied with endoscopy practice in their centre and only five respondents (4.4%) had attained competence in operative endoscopy. Twelve trainees (10.5%) reported that they had received formal training in endoscopy outside their workplace and 109 (95.6%) desired to have post-fellowship training. Competence was statistically significantly higher among the senior registrars compared to registrars (Fisher 51.81, P=< 0.001). Lack of funding was the most reported limiting factor to endoscopy training (66.7%) while most (85.1%) desired the incorporation of structured endoscopy training into the residency training curriculum.

Conclusion

this study showed poor endoscopy training exposure, a high level of dissatisfaction with the state of endoscopy practice and high expectations of the trainees for improved training facilities and human capacity.

Persisting Cryptococcus yeast species Vishniacozyma victoriae and Cryptococcus neoformans elicit unique airway inflammation in mice following repeated exposure

Background

Allergic airway disease (AAD) is a growing concern in industrialized nations and can be influenced by fungal exposures. Basidiomycota yeast species such as Cryptococcus neoformans are known to exacerbate allergic airway disease; however, recent indoor assessments have identified other Basidiomycota yeasts, including Vishniacozyma victoriae (syn. Cryptococcus victoriae), to be prevalent and potentially associated with asthma. Until now, the murine pulmonary immune response to repeated V. victoriae exposure was previously unexplored.

Objective

This study aimed to compare the immunological impact of repeated pulmonary exposure to Cryptococcus yeasts.

Methods

Mice were repeatedly exposed to an immunogenic dose of C. neoformans or V. victoriae via oropharyngeal aspiration. Bronchoalveolar lavage fluid (BALF) and lungs were collected to examine airway remodeling, inflammation, mucous production, cellular influx, and cytokine responses at 1 day and 21 days post final exposure. The responses to C. neoformans and V. victoriae were analyzed and compared.

Results

Following repeated exposure, both C. neoformans and V. victoriae cells were still detectable in the lungs 21 days post final exposure. Repeated C. neoformans exposure initiated myeloid and lymphoid cellular infiltration into the lung that worsened over time, as well as an IL-4 and IL-5 response compared to PBS-exposed controls. In contrast, repeated V. victoriae exposure induced a strong CD4+ T cell-driven lymphoid response that started to resolve by 21 days post final exposure.

Discussion

C. neoformans remained in the lungs and exacerbated the pulmonary immune responses as expected following repeated exposure. The persistence of V. victoriae in the lung and strong lymphoid response following repeated exposure were unexpected given its lack of reported involvement in AAD. Given the abundance in indoor environments and industrial utilization of V. victoriae, these results highlight the importance to investigate the impact of frequently detected fungal organisms on the pulmonary response following inhalational exposure. Moreover, it is important to continue to address the knowledge gap involving Basidiomycota yeasts and their impact on AAD.

Methods and Strategies for Biomonitoring in Occupational Exposure to Plant Protection Products Containing Glyphosate

Glyphosate, and the ever growing reliance on its use in agriculture, has been a point of contention for many years. There have been debates regarding the risk and safety of using glyphosate-based herbicides as well as the effects of occupational, accidental, or systematic. Although there have been a number of studies conducted, the biomonitoring of glyphosate poses a series of challenges. Researchers attempting to determine the occupational exposure face questions regarding the most appropriate analytical techniques and sampling procedures. The present review aims to summarize and synthetize the analytical methodologies available and suitable for the purpose of glyphosate biomonitoring studies as well as discuss the advantages and disadvantages of each analytical technique, from the most modern to more well-established and older ones. The most relevant publications that have described analytical methods and published within the last 12 years were studied. Methods were compared, and the advantages and disadvantages of each methods were discussed. A total of 35 manuscripts describing analytical methods for glyphosate determination were summarized and discussed, with the most relevant one being compared. For methods that were not intended for biological samples, we discussed if they could be used for biomonitoring and approaches to adapt these methods for this purpose.

Study on the Use of Ozone Water as a Chemical Decontamination Agent for Antineoplastic Drugs in Clinical Settings

The exposure of healthcare workers to antineoplastic drugs in hospitals has been recognized to be harmful. To minimize the risk of exposure, the removal of these drugs from work environments, such as compounding facilities, has been recommended. In our previous paper, the degradation and inactivation efficacy of ozone water, which is being introduced into Japanese hospitals as a chemical decontamination agent, was reported for its effects on typical antineoplastic drugs (gemcitabine, irinotecan, paclitaxel). This article aims to further investigate the efficacy of ozone water for eight antineoplastic drugs to clarify its application limitations. A small amount (medicinal ingredient: typically ca. 1.5 μmol) of formulation containing 5-fluorouracil, pemetrexed, cisplatin, oxaliplatin, cyclophosphamide, ifosfamide, doxorubicin, or docetaxel was mixed with 50 mL of ozone water (~8 mg/L), and the resulting solutions were analyzed by high-performance liquid chromatography over time to observe the degradation. Consequently, the ozonation was overall effective for the degradation of the drugs, however this varied depending on the chemical structures of the drugs and additives in their formulations. In addition, after the parent drugs were completely degraded by the ozonation, the degradation mixtures were subjected to 1H nuclear magnetic resonance spectroscopy and evaluated for mutagenicity against Salmonella typhimurium strains and cytotoxicity against human cancer cells. The degradation mixtures of cisplatin and ifosfamide were mutagenic while those of the other drugs were non-mutagenic. Further, the ozonation resulted in clear decreases of cytotoxicity for 5-fluorouracil, oxaliplatin, and doxorubicin, but increases of cytotoxicity for pemetrexed, cisplatin, cyclophosphamide, and ifosfamide. These results suggest that the ozone water should be restrictedly used according to the situation of contamination in clinical settings because the ozonation enhances toxicity depending on the drug even if degradation is achieved.

Virus Emissions from Toilet Flushing: Comparing Urine-Diverting to Mix Flush Toilets

High levels of viruses can be found in human excrement from infected individuals, a fraction of which can be emitted from toilet flushing. Unlike the common mix flush toilet (MFT), the urine-diverting toilet (UDT) separates urine from the toilet water. Specific focus on urine-associated viruses is needed because the UDT can emit different levels of urine-associated and fecal-borne viruses and urine has different properties compared to feces that can affect emission levels (e.g., protein content). In this work, we quantified emission levels of surrogate bacteriophages for urine-associated and fecal-borne viruses, MS2 and T3, from flushing a UDT and an MFT, with and without protein in the water. Emission levels of viruses in the water of the UDT were lower than that of the MFT by up to 1.2-log10 and 1.3-log10 for T3 and MS2, respectively. If urine is completely diverted in the UDT, virus emissions can be reduced by up to 4-log10. Based on these results and typical levels in urine and feces, we estimate that up to 107 and 108 gene copies of human viruses per flush can be released from the UDT and MFT, respectively. Lower emissions observed with the UDT suggest reduced exposure to viruses from flushing the UDT.

Pleural Plaques and the Role of Exposure to Mineral Particles in the Asbestos Post-Exposure Survey

BACKGROUND

Previous studies have inconsistently reported associations between refractory ceramic fibers (RCFs) or mineral wool fibers (MWFs) and the presence of pleural plaques (PPs). All these studies were based on chest radiographs, known to be associated with a poor sensitivity for the diagnosis of PP.

RESEARCH QUESTION

Does the risk of PPs increase with cumulative exposure to RCFs, MWFs, and silica? If the risk does increase, do these dose-response relationships depend on the co-exposure to asbestos or, conversely, are the dose-response relationships for asbestos modified by co-exposure to RCFs, MWFs, and silica?

STUDY DESIGN AND METHODS

Volunteer workers were invited to participate in a CT scan screening program for asbestos-related diseases in France. Asbestos exposure was assessed by industrial hygienists, and exposure to RCFs, MWFs, and silica was determined by using job-exposure matrices. A cumulative exposure index (CEI) was then calculated for each subject and separately for each of the four mineral particle exposures. All available CT scans were submitted to randomized, double reading by a panel of radiologists.

RESULTS

In this cohort of 5,457 subjects, significant dose-response relationships were determined after adjustment for asbestos exposure between CEI to RCF or MWF and the risk of PPs (ORs of 1.29 [95% CI, 1.00-1.67] and 1.84 [95% CI, 1.49-2.27] for the highest CEI quartile, respectively). Significant interactions were found between asbestos on one hand and MWF or RCF on the other.

INTERPRETATION

This study suggests the existence of a significant association between exposure to RCFs and MWFs and the presence of PPs in a large population previously exposed to asbestos and screened by using CT scans.

Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial

We report on findings from the first randomized controlled pilot trial of virtual reality exposure therapy (VRET) developed specifically for reducing social anxiety associated with stuttering. People who stutter with heightened social anxiety were recruited from online adverts and randomly allocated to receive VRET (n = 13) or be put on a waitlist (n = 12). Treatment was delivered remotely using a smartphone-based VR headset. It consisted of three weekly sessions, each comprising both performative and interactive exposure exercises, and was guided by a virtual therapist. Multilevel model analyses failed to demonstrate the effectiveness of VRET at reducing social anxiety between pre- and post-treatment. We found similar results for fear of negative evaluation, negative thoughts associated with stuttering, and stuttering characteristics. However, VRET was associated with reduced social anxiety between post-treatment and one-month follow-up. These pilot findings suggest that our current VRET protocol may not be effective at reducing social anxiety amongst people who stutter, though might be capable of supporting longer-term change. Future VRET protocols targeting stuttering-related social anxiety should be explored with larger samples. The results from this pilot trial provide a solid basis for further design improvements and for future research to explore appropriate techniques for widening access to social anxiety treatments in stuttering.

Topological network properties of resting-state functional connectivity patterns are associated with metal mixture exposure in adolescents

Introduction

Adolescent exposure to neurotoxic metals adversely impacts cognitive, motor, and behavioral development. Few studies have addressed the underlying brain mechanisms of these metal-associated developmental outcomes. Furthermore, metal exposure occurs as a mixture, yet previous studies most often consider impacts of each metal individually. In this cross-sectional study, we investigated the relationship between exposure to neurotoxic metals and topological brain metrics in adolescents.

Methods

In 193 participants (53% females, ages: 15-25 years) enrolled in the Public Health Impact of Metals Exposure (PHIME) study, we measured concentrations of four metals (manganese, lead, copper, and chromium) in multiple biological media (blood, urine, hair, and saliva) and acquired resting-state functional magnetic resonance imaging scans. Using graph theory metrics, we computed global and local efficiency (global:GE; local:LE) in 111 brain areas (Harvard Oxford Atlas). We used weighted quantile sum (WQS) regression models to examine association between metal mixtures and each graph metric (GE or LE), adjusted for sex and age.

Results

We observed significant negative associations between the metal mixture and GE and LE [βGE = -0.076, 95% CI (-0.122, -0.031); βLE= -0.051, 95% CI (-0.095, -0.006)]. Lead and chromium measured in blood contributed most to this association for GE, while chromium measured in hair contributed the most for LE.

Discussion

Our results suggest that exposure to this metal mixture during adolescence reduces the efficiency of integrating information in brain networks at both local and global levels, informing potential neural mechanisms underlying the developmental toxicity of metals. Results further suggest these associations are due to combined joint effects to different metals, rather than to a single metal.

Socio-Economic Vulnerability to Climate Change in Rural Areas in the Context of Green Energy Development-A Study of the Great Masurian Lakes Mesoregion

Green energy production has become a common and recognized method of electricity generation. Giving up reliance on non-renewable energy sources is an important trend in the economies of many countries. The paper presents an analysis of the impact of indicators like increased green energy production on the level of vulnerability to climate change. The model of the Climate Change Vulnerability Index (VCC) recommended by the Intergovernmental Panel on Climate Change (considering three aspects: exposure, vulnerability, and adaptive capacity of the studied spatial unit/society) was applied. Sensitivity analysis, spatial heterogeneity, and temporal dynamics of indicators characterizing changes in electricity consumption, renewable energy production, greenhouse gas emissions, and variability of financial losses due to extreme weather events and their number were implemented. Several findings arose. First, the vulnerability to climate change (the level of the VCC index), does not decrease after the implementation of a single action, like the development of green energy production. The level of index of vulnerability to climate change (VCC1) from the reference year (2017) relative to VCC2 (2021) has changed slightly, despite the development of RES. The variation does not exceed a 1% reduction in the value of the VCC1 index. Second, the decrease in the level of the vulnerability requires global, coordinated action. The value of the VCC3 index, reflecting, including changes in green energy production (X15), electricity consumption/inhabitant (X38), and green-house gas emissions (X14), exhibited more favorably the impact of these indicators on vulnerability to climate change, compared to the VCC1 reference value. In eleven poviats, the VCC3 index decreased between 1 and 4%. In seven of these poviats, green energy production increased, resulting in an average 10% decrease in the X15 indicator, the X14 indicator representing green-house gas emissions decreased by an average of 7%, while the X38 indicator describing electricity consumption/per capita decreased by an average of 16%. Third, harmonized and inclusive action by the population holds the potential to be the clue to reducing vulnerability to climate change.

Assessment of information as regards the toxicity of deoxynivalenol for horses and poultry

In 2017, the EFSA Panel on Contaminants in the Food Chain (CONTAM) adopted a Scientific Opinion on the risks for animal health related to the presence of deoxynivalenol (DON) and its acetylated and modified forms in food and feed. No observed adverse effect levels (NOAELs) and lowest observed adverse effect levels (LOAELs) were derived for different animal species. For horses, an NOAEL of 36 mg DON/kg feed was established, the highest concentration tested and not showing adverse effects. For poultry, an NOAEL of 5 mg DON/kg feed for broiler chickens and laying hens, and an NOAEL of 7 mg DON/kg feed for ducks and turkeys was derived. The European Commission requested EFSA to review the information regarding the toxicity of DON for horses and poultry and to revise, if necessary, the established reference points (RPs). Adverse effect levels of 1.9 and 1.7 mg DON/kg feed for, respectively, broiler chickens and turkeys were derived from reassessment of existing studies and newly available literature, showing that DON causes effects on the intestines, in particular the jejunum, with a decreased villus height but also histological damage. An RP for adverse animal health effects of 0.6 mg/kg feed for broiler chickens and turkeys, respectively, was established. For horses, an adverse effect level of 5.6 mg DON/kg feed was established from studies showing reduced feed intake, with an RP for adverse animal health effects of 3.5 mg/kg feed. For ducks and laying hens, RPs remain unchanged. Based on mean and P95 (UB) exposure estimates performed in the previous Opinion, the risk of adverse health effects of feeds containing DON was considered a potential concern for broiler chickens and turkeys. For horses, the risk for adverse health effects from feed containing DON is low.

Potential exposure and risk assessment of agricultural workers to the insecticide chlorantraniliprole in rice paddies

BACKGROUND

Exposure of agricultural workers in rice paddies to the insecticide chlorantraniliprole and its subsequent potential health risks were investigated during two scenarios (mixing/loading and hand-held spraying). The exposure factors, such as the outer dosimeter, inner dosimeter, gauze, and nitrile gloves, were calculated using whole-body dosimetry to measure dermal exposure. The inhalation exposure was determined using a fiberglass filter which is set with an Institute of Occupational Medicine (IOM) sampler. A recovery test was performed to evaluate the accuracy of the analytical method.

RESULTS

The exposure amounts of various matrices were calculated from extraction volume and concentration of the target compound. The dermal exposure to chlorantraniliprole was 0.6 mg [0.001% of the total active ingredient (a.i.)] for mixing and loading, and 28.6 mg (0.066% of the total a.i.) for application. The inhalation exposure to chlorantraniliprole was 7.2 μg (1.3%, 1.2 × 10^-5 % of the total applied a.i.) for mixing and loading, and 1.9 μg (0.006%, 4.4 × 10^-6 % of the total applied a.i.) for application. The most exposed part of the body was the hand (90.4%) during mixing and loading, whereas the primary sites during application were the thighs (32.8%) and shins (22.6%). For mixing and loading, the amount of actual dermal exposure was 5.5 μg day^-1 and that of actual inhalation exposure was 21.9 μg day^-1 . By contrast, in the application, the amounts of actual dermal and actual inhalation exposures were 34 178.7 and 5.9 μg day^-1 , respectively.

CONCLUSIONS

The risk assessment results demonstrated that the risk of chlorantraniliprole exposure in rice paddies was low during application than during mixing and loading. © 2022 Society of Chemical Industry.

Entrance Skin Dose (ESD) and Bucky Table Induced Backscattered Dose (BTI-BSD) in Abdominal Radiography With nanoDot Optically Stimulated Luminescence Dosimeter (OSLD)

In radiography, inconsistencies in patients' measured entrance skin dose (ESD) exist. There is no published research on the bucky table induced backscattered radiation dose (BTI-BSD). Thus, we aimed to ascertain ESD, calculate the BTI-BSD in abdominal radiography with a nanoDot OSLD, and compare the ESD results with the published data. A Kyoto Kagaku PBU-50 phantom (Kyoto, Japan) in an antero-posterior supine position was exposed, selecting a protocol used for abdominal radiography. The central ray of x-ray beam was pointed at the surface of abdomen at the navel, where a nanoDot dosimeter was placed to measure ESD. For the BTI-BSD, exit dose (ED) was determined by placing a second dosimeter on the exact opposite side (backside) of the phantom from the dosimeter used to determine (ESD) with and without bucky table at identical exposure parameters. The BTI-BSD was calculated as the difference between ED with and without bucky table. The ESD, ED, and BTI-BSD were measured in milligray (mGy). ESD mean values with and without bucky table were 1.97 mGy and 1.84 mGy, whereas ED values were 0.062 mGy and 0.052 mGy, respectively. Results show 2-26% lower ESD values with nanoDot OSLD. The BTI-BSD mean value was found to be approximately 0.01 mGy. A local dose reference level (LDRL) can be established using ESD data to safeguard patients from unnecessary radiation. In addition, to minimize the risk of BTI-BSD in patients in radiography, the search for the use or fabrication of a new, lower atomic number material for the bucky table is suggested.

[Digital X-ray Machine Carestream DRX-NOVA Fault Maintenance]

OBJECTIVE

To analyze the malfunction and maintenance process of Carestream digital X-ray machine DRX-NOVA for reference.

METHODS

The fault of Carestream digital X-ray machine DRX-NOVA in 2011-2021 was summarized, the fault types were classified, and the maintenance process was summarized.

RESULTS

Fault types can be divided into three categories, each of which has its own characteristics and specific solutions.

CONCLUSIONS

It is necessary to master the principle of equipment to repair all kinds of equipment failures. Repair the machine should be careful, comprehensive consideration of the cause of the failure. To correctly understand and analyze the operation of the machine under normal conditions, we can accurately analyze the cause of failure, so that we can really solve the problem.

Exposure to Respirable Particulate Matter and Its Association with Respiratory Outcomes in Beauty Salon Personnel

We aimed to assess exposure to respirable particulate matter (PM) of beauty salon personnel, identify its determinants and ascertain the associated respiratory effects. We collected 122 full-day respirable PM samples from 12 beauty salons (floor area ranging from 24 to 550 m³, staff from 4 to 8) in Almaty, Kazakhstan, taking 10 samples from each place using a portable SidePak AM520 monitor. We also assessed lifestyle (smoking, etc.), respiratory symptoms and health-related quality of life (HRQL) of the personnel using questionnaires. Out of 11,831 5-min data points, daily median respirable PM concentrations were highly variable and ranged from 0.013 to 0.666 mg/m³ with 8.5-times difference in the median concentrations between the venue with the highest median (0.29 mg/m³) and the least median (0.034 mg/m³). In a multivariate linear regression modelling, ambient PM_2.5 concentration was the strongest predictor of daily median respirable PM concentration (beta 2.12; 95% CI 1.89; 2.39), and R² of the model was 0.63. We also found a positive association of the median respirable PM with respiratory symptoms and seasonal allergy, but not with HRQL. Short-term respirable PM levels in the beauty salons may be very high, but the median concentrations are mainly determined by the ambient air pollution.

An Overview of Physiologically-Based Pharmacokinetic Models for Forensic Science

A physiologically-based pharmacokinetic (PBPK) model represents the structural components of the body with physiologically relevant compartments connected via blood flow rates described by mathematical equations to determine drug disposition. PBPK models are used in the pharmaceutical sector for drug development, precision medicine, and the chemical industry to predict safe levels of exposure during the registration of chemical substances. However, one area of application where PBPK models have been scarcely used is forensic science. In this review, we give an overview of PBPK models successfully developed for several illicit drugs and environmental chemicals that could be applied for forensic interpretation, highlighting the gaps, uncertainties, and limitations.

Climate change awareness and risk perceptions in the coastal marine ecosystem of Palawan, Philippines

Understanding coastal communities' awareness and risk perceptions of climate change impact is essential in developing effective risk communication tools and mitigation strategies to reduce the vulnerability of these communities. In this study, we examined coastal communities' climate change awareness and risk perceptions of climate change impact on the coastal marine ecosystem, sea level rise impact on the mangrove ecosystem and as a factor affecting coral reefs and seagrass beds. The data were gathered by conducting face-to-face surveys with 291 respondents from the coastal areas of Taytay, Aborlan and Puerto Princesa in Palawan, Philippines. Results showed that most participants (82%) perceived that climate change is happening and a large majority (75%) perceived it as a risk to the coastal marine ecosystem. Local temperature rise and excessive rainfall were found to be significant predictors of climate change awareness. Sea level rise was perceived by most participants (60%) to cause coastal erosion and to affect the mangrove ecosystem. On coral reefs and seagrass ecosystems, anthropogenic drivers and climate change were perceived to have a high impact, while marine livelihoods had a low impact. In addition, we found that climate change risk perceptions were influenced by direct experiences of extreme weather events (i.e., temperature rise and excessive rainfall) and climate-related livelihood damages (i.e., declining income). Climate change risk perceptions were also found to vary with household income, education, age group and geographical location. The results suggest that addressing poverty and effectively communicating climate change risks can improve climate change awareness and risk perceptions.

Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study

BACKGROUND

Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs).

OBJECTIVE

We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale.

METHODS

Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM_2.5 and PM₁. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure-reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed.

RESULTS

A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7% (1520/22,570). Our findings showed that PM₁ and PM_2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM₁ during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM_2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM₁ and PM_2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95% CI 1.007-1.042; HR 1.007, 95% CI 1.000-1.015, respectively, per 10 μg/m³ increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs.

CONCLUSIONS

Exposure to PM₁ and PM_2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs.

Long-Term Indoor-Outdoor PM2.5 Measurements Using PurpleAir Sensors: An Improved Method of Calculating Indoor-Generated and Outdoor-Infiltrated Contributions to Potential Indoor Exposure

Low-cost monitors make it possible now for the first time to collect long-term (months to years) measurements of potential indoor exposure to fine particles. Indoor exposure is due to two sources: particles infiltrating from outdoors and those generated by indoor activities. Calculating the relative contribution of each source requires identifying an infiltration factor. We develop a method of identifying periods when the infiltration factor is not constant and searching for periods when it is relatively constant. From an initial regression of indoor on outdoor particle concentrations, a Forbidden Zone can be defined with an upper boundary below which no observations should appear. If many observations appear in the Forbidden Zone, they falsify the assumption of a single constant infiltration factor. This is a useful quality assurance feature, since investigators may then search for subsets of the data in which few observations appear in the Forbidden Zone. The usefulness of this approach is illustrated using examples drawn from the PurpleAir network of optical particle monitors. An improved algorithm is applied with reduced bias, improved precision, and a lower limit of detection than either of the two proprietary algorithms offered by the manufacturer of the sensors used in PurpleAir monitors.

Effect of Antibiotic Exposure on Staphylococcus epidermidis Responsible for Catheter-Related Bacteremia

Coagulase-negative staphylococci (CoNS) and especially Staphylococcus epidermidis are responsible for health care infections, notably in the presence of foreign material (e.g., venous or central-line catheters). Catheter-related bacteremia (CRB) increases health care costs and mortality. The aim of our study was to evaluate the impact of 15 days of antibiotic exposure (ceftobiprole, daptomycin, linezolid and vancomycin) at sub-inhibitory concentration on the resistance, fitness and genome evolution of 36 clinical strains of S. epidermidis responsible for CRB. Resistance was evaluated by antibiogram, the ability to adapt metabolism by the Biofilm Ring test^® and the in vivo nematode virulence model. The impact of antibiotic exposure was determined by whole-genome sequencing (WGS) and biofilm formation experiments. We observed that S. epidermidis strains presented a wide variety of virulence potential and biofilm formation. After antibiotic exposure, S. epidermidis strains adapted their fitness with an increase in biofilm formation. Antibiotic exposure also affected genes involved in resistance and was responsible for cross-resistance between vancomycin, daptomycin and ceftobiprole. Our data confirmed that antibiotic exposure modified bacterial pathogenicity and the emergence of resistant bacteria.

Exposure and Health Risk Assessment of Per- and Polyfluoroalkyl Substances in Crayfish from the Middle and Lower Reaches of the Yangtze River

Per- and polyfluoroalkyl substances (PFASs) are a novel class of emerging persistent organic pollutants (POPs) owing to their environmental persistence and bioaccumulation. Red swamp crayfish is a major source of exposure to PFASs, while the dietary intake of PFASs from crayfish is still unclear. We investigated the concentrations of PFASs in 130 batches of crayfish and 100 environmental samples from Middle and Lower Reaches of the Yangtze River Delta. Seven Perfluoroalkyl carboxylic acids (PFCAs), 3 Perfluoroalkyl sulfonates (PFSAs), and 6:2 Cl-PFESA were analyzed by ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Meanwhile, PFASs exposure levels were examined concretely in four tissues of crayfish and different circulation links. The average daily intake (ADI) risk model was used to evaluate the human health risk of consuming crayfish and suggested that the risk of PFASs exposure is at a low level.

Combining Contamination Indices and Multivariate Statistical Analysis for Metal Pollution Evaluation during the Last Century in Lacustrine Sediments of Lacu Sărat Lake, Romania

Integrated study of both water and sediment in lakes provides important information regarding the human impact on the environment. The current work is focused on the correlation between age, source, composition, and degree of human intervention over the last 178 years and health impact of sediments from Lacu Sărat Lake (Romania), one of the most important balneo-climateric resorts in the country. The novelty relies on the fact that this is the first time the temporal patterns of metal contamination and the human health effects associated with the metal exposure from sediment core samples have been assessed. The sediment contamination status was determined by evaluating several indices, such as the enrichment factor, geo-accumulation index, metal pollution index, and potential ecological risk index, etc. Results showed a significant accumulation of Cd, Cr, As and Ni and a major contribution of Pb, Zn, Cd, Hg, Cr as well as Cu to the potential acute toxicity. The sediment quality guidelines emphasized a risk concerning the life and proper development of benthic organisms in Lacu Sărat Lake. Moreover, the incidental ingestion lifetime carcinogenic risk values for As and Cr suggest a potential risk of developing cancer. A strong human impact was observed especially between 1950 and 1990, which can be attributed to the rapid economic growth and intensive industrial development strategies pursued by the communist political regime in Romania.

Intrauterine and Neonatal Exposure to Opioids: Toxicological, Clinical, and Medico-Legal Issues

Opioids have a rapid transplacental passage (i.e., less than 60 min); furthermore, symptoms characterize the maternal and fetal withdrawal syndrome. Opioid withdrawal significantly impacts the fetus, inducing worse outcomes and a risk of mortality. Moreover, neonatal abstinence syndrome (NAS) follows the delivery, lasts up to 10 weeks, and requires intensive management. Therefore, the prevention and adequate management of NAS are relevant public health issues. This review aims to summarize the most updated evidence in the literature regarding toxicological, clinical, and forensic issues of intrauterine exposure to opioids to provide a multidisciplinary, evidence-based approach for managing such issues. Further research is required to standardize testing and to better understand the distribution of opioid derivatives in each specimen type, as well as the clinically relevant cutoff concentrations in quantitative testing results. A multidisciplinary approach is required, with obstetricians, pediatricians, nurses, forensic doctors and toxicologists, social workers, addiction specialists, and politicians all working together to implement social welfare and social services for the baby when needed. The healthcare system should encourage multidisciplinary activity in this field and direct suspected maternal and neonatal opioid intoxication cases to local referral centers.

Noise exposure assessment of non-coal mining workers in four provinces of China

Objective

This study aimed to understand the noise exposure of non-coal mines in China to take appropriate controls to protect workers' health.

Methods

An assessment of non-coal miners' noise exposures was conducted in four provinces in China. Individual noise exposure levels were measured, and the survey on the hearing protector device (HPD) equipment was administered.

Results

423 noise dosimeter measurements were obtained, including drilling, blasting, ore drawing, transportation, winching, crushing, screening and ball milling, and auxiliary (air pressure, pump, and maintenance). A total of 31.9% of the individual noise levels (L_EX,8h) exceeded 85 dB(A), and the median dosages of non-coal miners with high noise exposure were: excavation workers-89.1 dB(A), mill operators-88.7 dB(A), and crusher operators-87.0 dB(A). The noise dose of underground mine workers is higher than that of surface mine workers (P < 0.001). A total of 53.7% of non-coal mining enterprises are not equipped with HPD for workers, mainly small and micro enterprises.

Conclusions

High levels of hazardous noise exposure are typical in non-coal mines. Noise exposure data can help to develop more feasible noise controls.

Maternal smoking during pregnancy negatively affects brain volumes proportional to intracranial volume in adolescents born very preterm

Background

Maternal smoking during pregnancy has been shown to associate with smaller frontal lobe and cerebellar volumes in brain magnetic resonance imaging (MRI) at term age in very preterm infants. The aim of this study was to examine the effect of maternal smoking during pregnancy on volumetric brain MRI findings at 13 years. We hypothesized that adverse effects of smoking during pregnancy on brain volumes are still seen during adolescence.

Methods

Included adolescents were born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1,500 g) between April 2004 and December 2006 at the Turku University Hospital, Finland. Information on maternal smoking status (yes or no) during pregnancy was collected from medical records and maternal questionnaires before discharge. Adolescents underwent volumetric brain MRI at 13 years of age. Image post-processing was performed with FreeSurfer. Regional volumes, cortical thickness, surface area, and curvature were computed from 33 cortical regions of interest (ROIs). Additionally, volumes were calculated for 18 subcortical regions, as well as for white matter, gray matter, and intracranial volume. We normalized quantified absolute volumes for head size by dividing volumes with corresponding intracranial volumes. false discovery rate (FDR) correction for multiple comparisons across regions was used.

Results

A total of 9/44 (21%) adolescents had been exposed to maternal smoking during pregnancy. No statistically significant differences in absolute volumes were observed between the groups (p > 0.05). Regarding volumes proportional to intracranial volume, the adolescents in the exposed group exhibited smaller gray matter volumes in the inferotemporal (FDR corrected p = 0.022) and parahippocampal (p = 0.018) regions compared to the unexposed group. The surface area in the exposed group was also smaller in the parahippocampal (p = 0.046) and postcentral (p = 0.046) regions compared to the unexposed group. No statistically significant differences after correction for multiple comparisons were found for either curvature or cortical thickness between the groups.

Conclusion

Maternal smoking exposure during pregnancy may have long-term effects on brain volumes up to 13 years in adolescents born very preterm. Our findings emphasize the importance of smoking-free pregnancy.

Re-evaluation of Patient-Sourced Radiation Doses in PET/CT

New generation PET/CT devices provide quality images using low radiopharmaceutical activities. Dose monitoring is carried out for nuclear medicine personnel, other health personnel, and companions by determining the radiation dose emitted from low-activity patients to the environment. In particular, it is necessary to revise the working conditions of the personnel according to the radiation dose exposed.

AIM

It was aimed to reevaluate the radiation dose rate transmitted to the environment from patients injected with 18F-FDG.

MATERIAL AND METHODS

A total of 31 patients (14F, 17M) who underwent 18F-FDG PET/CT imaging were included. The mean 18F-FDG activity of 7.26 ± 1.29 mCi was used for injection. After injection, radiation dose rates (mR/h) were measured at distances of 25, 50, 100, 150, and 200cm for 3 different periods from the level of the head, thorax, abdomen, and pelvis by using a GM counter. Additionally, biological samples such as urine and sweat were taken during 3 different periods. The activity amounts (µCi) in the samples were measured with a well-type counter.

RESULTS

Strong correlations were calculated between normalized dose rates obtained by all regions and time. Considering the nuclear medicine staff handling time with a PET/CT patient, the average dose received by staff was calculated between a range of 0.002-0.004 mSv/pt. The radiation dose exposed to the porter and nurse was calculated as 0.049 mSv/pt for the 2nd hour and 0.001-0.007 mSv/pt for the 4th hour, respectively. The companion was exposed to a dose between 0.073-0.147 mSv and 0.024-0.048 mSv for public transport and private car transportation after 4-6 hours of injection (for 30-60 min of travel duration), respectively. For inpatients, the received dose for porters, serving 20min from a distance of 30cm for the 2nd and 4th hours after the PET/CT scan, was 0.049 mSv/pt and 0.048 mSv/pt, respectively. And for nurses serving from a 50cm distance between 1-5 minutes, these values were found to be 0.001-0.007mSv/pt, 0.001-0.007mSv/pt, and 0.001-0.006mSv/pt, respectively.

CONCLUSION

The radiation dose of nuclear medicine staff, porters, nurses, and companions are found to be below the recommended dose limit by the ICRP. According to our results, there is no need for any restrictions for patients, companions, or healthcare personnel in PET/CT units.

Occurrence of Furfural and Its Derivatives in Coffee Products in China and Estimation of Dietary Intake

This is the first report on the content of furfural and its derivatives in coffee products in China. The concentrations of furfural and its derivatives in 449 sampled, commercially available coffee products in China were analyzed through a GC-MS technique, and the associated health risks were estimated. As a result, 5-hydroxymethyl furfural (5-HMF) was identified as the predominant derivative compound, with the highest concentration of 6035.0 mg/kg and detection frequency of 98.7%. The mean dietary exposures of 5-HMF, 5-MF(5-methylfurfural), and 2-F(2-furfural) in coffee products among Chinese consumers were 55.65, 3.00, and 3.23 μg/kg bw/day, respectively. The ranges of mean dietary intake of furfural and its derivatives based on age groups were all lower than the acceptable daily intake (ADI) and the toxicological concern threshold (TTC). Risk evaluation results indicate that coffee product intake did not pose potential risks to consumers. Notably, the analysis revealed that children aged 3-6 years had the highest mean exposure due to their low body weight.

Allergic Contact Dermatitis in Refractory Brick Production Worker: A Case Report

In this study, we investigated a 42-year-old man working in a refractory brick (RB) production line who had allergic contact dermatitis (ACD) due to skin exposure to chromium (Cr). He had visited a dermatologist several times over a five-month period and although he had been medically treated, the symptoms reappeared after he returned to work and resumed exposure. Finally, with the announcement of the definite diagnosis of ACD through a patch test, it was decided to exclude him from exposure, and after 20 days, the symptoms went through the recovery process. No new recurring episodes were reported during the six-month follow-up period.

Assessing Radiation Dosage in Pediatric Head and Neck Computed Tomography Examinations During COVID-19 in a Tertiary Hospital in Saudi Arabia, Jeddah

This study aimed to assess the practice of imaging and optimization of the radiation dose in pediatric head and neck computed tomography (CT) examinations during the coronavirus disease of 2019 (COVID-19) period. This study is based on a retrospective analysis of pediatric head CT records, conducted in the Radiology Department of the King Abdulaziz University Hospital in Jeddah, Saudi Arabia. We examined the data of all pediatric patients between 0 and 14 years of age who underwent head CT scans between March and September in both 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). In total, we analyzed 1005 scans; 531 (52.8%) were performed before and 474 (47.2%) during COVID-19. The dose parameters were similar; however, the exposure time was significantly lower during COVID-19 (5432 ms vs. 5811 before; p < 0.001). In contrast, the mean total CTDI_vol and dose-length product (DLP) were slightly higher during COVID-19 than those before (23.34 mGy vs. 22.04 mGy (p-value=0.565) and 577.36 mGy*cm vs. 518.93 mGy*cm (p-value=0.193) respectively). These changes could be attributed to the desire to limit the contact between technicians and patients. The limitation of contact with the patient allows the technicians to be independent during the scan, possibly accounting for this slight decrease.

Maternal risk factors for posterior urethral valves

Introduction

Posterior urethral valves (PUV) is a congenital disorder causing an obstruction of the lower urinary tract that affects approximately 1 in 4,000 male live births. PUV is considered a multifactorial disorder, meaning that both genetic and environmental factors are involved in its development. We investigated maternal risk factors for PUV.

Methods

We included 407 PUV patients and 814 controls matched on year of birth from the AGORA data- and biobank and three participating hospitals. Information on potential risk factors (family history of congenital anomalies of the kidney and urinary tract (CAKUT), season of conception, gravidity, subfertility, and conception using assisted reproductive techniques (ART), plus maternal age, body mass index, diabetes, hypertension, smoking, and use of alcohol and folic acid) was derived from maternal questionnaires. After multiple imputation, adjusted odds ratios (aORs) were estimated using conditional logistic regression corrected for minimally sufficient sets of confounders determined using directed acyclic graphs.

Results

A positive family history and low maternal age (<25 years) were associated with PUV development [aORs: 3.3 and 1.7 with 95% confidence intervals (95% CI) 1.4-7.7 and 1.0-2.8, respectively], whereas higher maternal age (>35 years) was associated with a lower risk (aOR: 0.7 95% CI: 0.4-1.0). Maternal preexisting hypertension seemed to increase PUV risk (aOR: 2.1 95% CI: 0.9-5.1), while gestational hypertension seemed to decrease this risk (aOR: 0.6 95% CI: 0.3-1.0). Concerning use of ART, the aORs for the different techniques were all above one, but with very wide 95% CIs including one. None of the other factors studied were associated with PUV development.

Conclusion

Our study showed that family history of CAKUT, low maternal age, and potentially preexisting hypertension were associated with PUV development, whereas higher maternal age and gestational hypertension seemed to be associated with a lower risk. Maternal age and hypertension as well as the possible role of ART in the development of PUV require further research.

Low- and no-calorie sweetener intakes from beverages - an up-to-date assessment in four regions: Brazil, Canada, Mexico and the United States

The current assessment estimated exposure to four low- and no-calorie sweeteners (LNCS) (aspartame, acesulfame potassium (AceK), steviol glycosides and sucralose) from beverages in Brazil, Canada, Mexico and the United States, using up-to-date nationally representative consumption data and industry reported-use level information. Two modelling scenarios were applied - the probabilistic model was guided by reported use level data, with estimated intake for an individual leveraging market-weighted average use level of a particular LNCS in any given LNCS-sweetened beverage type, while the distributional (brand-loyal) model assumed consumer behaviour-led patterns, namely that an individual will be brand loyal to a pre-determined beverage type. Consumer-only and general population intake estimates were derived for the overall population and individual age categories, and compared to the respective acceptable daily intake (ADI) as established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) for each LNCS. The mean, 90th percentile and 95th percentile intake estimates were substantially lower than the ADI in both modelling scenarios, regardless of the population group or market. In the probabilistic model, the highest consumer-only intake was observed for AceK in Brazilian adolescents (95th percentile, 12.4% of the ADI), while the highest 95th percentile intakes in the distributional model were observed for sucralose in Canadian adults at 20.9% of the ADI. This study provides the latest insights into current intakes of LNCS from water-based non-alcoholic LNCS-sweetened beverages in these regions, aligning well with those published elsewhere.

Treatment of disgust in specific emotional disorders

Although conditioning approaches have highlighted potential characteristics of disgust in anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), these findings have yet to be translated into evidence-based treatments. Examination of the literature suggests various indicators of disgust that predict treatment outcome in these disorders. However, mechanisms remain unclear because studies examining disgust during the course of treatment are limited. Increasingly, the field has moved toward experimental investigation of strategies that reduce disgust. While cognitive reappraisal and imagery techniques appear promising, such techniques have yet to be examined as anxiety disorder treatments in large-scale randomized clinical trials. The literature also points to novel approaches to treating disgust, ranging from an inhibitory-informed approach to exposure therapy to transcranial direct current stimulation. However, the development of novel treatment approaches will require more rigorous experimental psychopathology approaches that can further elucidate processes that contribute to the etiology and/or maintenance of disorders of disgust.

A systematic review of the health effects of lead exposure from electronic waste in children

Introduction

Electronic waste (e-waste) is an emerging human and environmental problem. Lead (Pb) is one of the most dangerous chemicals for human health, and it is the most prevalent heavy metal pollutant in e-waste. Despite the rapid growth of e-waste globally and the health effects of Pb, there is little information regarding the effects of Pb exposure from e-waste on children. Therefore, the aim of this review was to provide concise information on the health effects of Pb exposure from e-waste on children.

Methods

A comprehensive search of databases was undertaken using PubMed/MEDLINE, Cochrane Library, Science Direct, HINARI, African Journal Online (AJOL), and additional sources were searched up to November 25, 2022. Eligibility criteria were determined using Population, Exposure, Comparator, and Outcome (PECO). The guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used during the article selection process. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (Registration ID: CRD42022377028). The Joanna Briggs Institute (JBI) quality appraisal checklist was used to assess the quality of the included studies.

Results

From a total of 1,150 identified studies, 20 full-text studies were included in the systematic review. All most included studies were conducted in China recycling area for e-waste. The included studies were conducted with an exposed group versus a reference group. The majority of the included studies found that blood Pb levels were ≥5 μg/dl and that Pb exposures from e-waste were affecting children's health, such as a decrease in serum cortisol levels, inhibition of hemoglobin synthesis, impact on neurobehavioral development, affect physical development, etc.

Conclusion

Lead exposure had a significant impact on children's health as a result of informal e-waste recycling. Therefore, formalizing the informal sector and raising public health awareness are important steps toward reducing Pb exposure from e-waste. Moreover, the concerned stakeholders, like national and international organizations, should work together to effectively manage e-waste.

Assessment of biological hazards in a laboratory in Boa Vista, Roraima

Introduction

Safety in health care should be a priority of all health professionals. The occurrence of occupational accidents is many times attributed to a failure in following established standards, and identifying and correcting the risks to which professionals are exposed is important.

Objectives

The aim of this study was to assess the level of understanding on the biological hazards to which workers of a clinical analysis laboratory are exposed.

Methods

We applied a questionnaire for assessing knowledge on biological hazards, comprising an assessment of the understanding of biosafety and biological hazards, an investigation of the occurrence, types, and causes of accidents with biological material, and the employment of preventive measures. Data were tabulated in spreadsheets. All qualitative variables were tested with the chi-square test.

Results

We verified that 100% of the workers reported having some knowledge on biosafety; 25% of them reported they had suffered an occupational accident; and 81% of the workers reported having received training on biosafety measures. As to the level of exposure of workers and the community to biological agents, we noticed a very low level of exposure in one of the laboratory sectors.

Conclusions

Considering our results, we concluded that professionals at a clinical analysis laboratory are prone to occupational hazards, facing a low risk of exposure despite carrying out hazardous activities with potential exposure, which requires caution and exposure prevention measures.

Influence of User Profile Attributes on e-Cigarette-Related Searches on YouTube: Machine Learning Clustering and Classification

Background

The proliferation of e-cigarette content on YouTube is concerning because of its possible effect on youth use behaviors. YouTube has a personalized search and recommendation algorithm that derives attributes from a user's profile, such as age and sex. However, little is known about whether e-cigarette content is shown differently based on user characteristics.

Objective

The aim of this study was to understand the influence of age and sex attributes of user profiles on e-cigarette-related YouTube search results.

Methods

We created 16 fictitious YouTube profiles with ages of 16 and 24 years, sex (female and male), and ethnicity/race to search for 18 e-cigarette-related search terms. We used unsupervised (k-means clustering and classification) and supervised (graph convolutional network) machine learning and network analysis to characterize the variation in the search results of each profile. We further examined whether user attributes may play a role in e-cigarette-related content exposure by using networks and degree centrality.

Results

We analyzed 4201 nonduplicate videos. Our k-means clustering suggested that the videos could be clustered into 3 categories. The graph convolutional network achieved high accuracy (0.72). Videos were classified based on content into 4 categories: product review (49.3%), health information (15.1%), instruction (26.9%), and other (8.5%). Underage users were exposed mostly to instructional videos (37.5%), with some indication that more female 16-year-old profiles were exposed to this content, while young adult age groups (24 years) were exposed mostly to product review videos (39.2%).

Conclusions

Our results indicate that demographic attributes factor into YouTube's algorithmic systems in the context of e-cigarette-related queries on YouTube. Specifically, differences in the age and sex attributes of user profiles do result in variance in both the videos presented in YouTube search results as well as in the types of these videos. We find that underage profiles were exposed to e-cigarette content despite YouTube's age-restriction policy that ostensibly prohibits certain e-cigarette content. Greater enforcement of policies to restrict youth access to e-cigarette content is needed.

An explorative study on respiratory health among operators working in polymer additive manufacturing

Additive manufacturing (AM), or 3D printing, is a growing industry involving a wide range of different techniques and materials. The potential toxicological effects of emissions produced in the process, involving both ultrafine particles and volatile organic compounds (VOCs), are unclear, and there are concerns regarding possible health implications among AM operators. The objective of this study was to screen the presence of respiratory health effects among people working with liquid, powdered, or filament plastic materials in AM.

Methods

In total, 18 subjects working with different additive manufacturing techniques and production of filament with polymer feedstock and 20 controls participated in the study. Study subjects filled out a questionnaire and underwent blood and urine sampling, spirometry, impulse oscillometry (IOS), exhaled NO test (FeNO), and collection of particles in exhaled air (PEx), and the exposure was assessed. Analysis of exhaled particles included lung surfactant components such as surfactant protein A (SP-A) and phosphatidylcholines. SP-A and albumin were determined using ELISA. Using reversed-phase liquid chromatography and targeted mass spectrometry, the relative abundance of 15 species of phosphatidylcholine (PC) was determined in exhaled particles. The results were evaluated by univariate and multivariate statistical analyses (principal component analysis).

Results

Exposure and emission measurements in AM settings revealed a large variation in particle and VOC concentrations as well as the composition of VOCs, depending on the AM technique and feedstock. Levels of FeNO, IOS, and spirometry parameters were within clinical reference values for all AM operators. There was a difference in the relative abundance of saturated, notably dipalmitoylphosphatidylcholine (PC16:0_16:0), and unsaturated lung surfactant lipids in exhaled particles between controls and AM operators.

Conclusion

There were no statistically significant differences between AM operators and controls for the different health examinations, which may be due to the low number of participants. However, the observed difference in the PC lipid profile in exhaled particles indicates a possible impact of the exposure and could be used as possible early biomarkers of adverse effects in the airways.

U.S. Blue Water Navy Veterans of the Vietnam War: Comparisons from the Vietnam Era Health Retrospective Observational Study (VE-HEROeS)

Background

US Vietnam War Blue Water Navy veterans (BWN) conducted military operations on Vietnam's offshore waters and likely experienced various war-related exposures. The overall health of the BWN has never been systematically studied.

Purpose

Describe and compare BWN's health with other servicemembers and non-veterans of the Vietnam era.

Materials and methods

Survey of 45 067 randomly selected US Vietnam War theatre and non-theatre veterans and 6885 non-veterans.

Results

For 22 646 male respondents, self-reported health was contrasted by veteran status defined as BWN (n=985), theatre veterans (n=6717), non-theatre veterans (n=10 698) and non-veterans (n=4246). Exposure was service in the Vietnam War theatre. Collected were demographics, military service characteristics, lifestyle factors and health conditions. Adjusted odds ratios (aOR) were calculated using multivariable logistic regression. Controlling for cigarette smoking and other covariates, respiratory cancer risk was highest in BWN vs other veterans (theatre: aOR 1.65; 95% CI 1.09, 2.50; non-theatre: aOR 1.77; 1.13, 2.77) and to non-veterans (aOR 1.78; 1.15, 2.74). Other findings showed BWN's health risks between theatre and non-theatre veterans.

Conclusion

There was a higher risk for respiratory cancers in BWN. Other risks were less than theatre veterans but greater than non-theatre or non-veterans, indicating a potential role of military exposures in BWN's health.

Exposure, perceived risk, and psychological distress among general population during the COVID-19 lockdown in Wuhan, China

Introduction

The COVID-19 pandemic that has been going on since the end of 2019 impacts people on both the physical and psychological levels. However, the psychological status, especially its underlying psychosocial mechanisms among the general population in Wuhan, the earliest epicenter and hardest-hit city in China during the pandemic, has not been well investigated. This study aimed to examine the relationships between exposures, perceived risk, and psychological distress among the general population in Wuhan during the COVID-19 lockdown.

Methods

Data were from a cross-sectional online survey conducted from 20 February to 4 March 2020. Final analyses included 4,234 Wuhan respondents. A 5-item Hopkins Symptom Checklist was adopted to assess respondents' psychological distress.

Results

It was found that nervousness, fear, and worry were the most common symptoms among Wuhan residents during the lockdown. Exposure within a close physical distance, exposure within the social network, and perceived risk are significantly positively related to respondents' psychological distress. Moreover, perceived risk mediated the effects of exposures on respondents' psychological condition.

Discussion

These findings conduce to identify the populations at higher risk of suffering psychological disturbance during the pandemic and are expected to inform the policymakers and mental health professionals to monitor and improve the perception of risk among the target population by appropriate interventions.

Annual banned-substance review-Analytical approaches in human sports drug testing 2021/2022

Also in 2021/2022, considerable efforts were invested into advancing human sports drug testing programs, recognizing and taking into account existing as well as emerging challenges in anti-doping, especially with regard to substances and methods of doping specified in the World Anti-Doping Agency's 2022 Prohibited List. In this edition of the annual banned-substance review, literature on recent developments published between October 2021 and September 2022 is summarized and discussed. Focus is put particularly on enhanced analytical approaches and complementary testing options in human doping controls, appreciating the exigence and mission in anti-doping and, equally, the contemporary "new normal" considering, for example, the athlete's exposome versus analytical sensitivity and applicable anti-doping regulations for result interpretation and management.

Facing Uncertainty: A Comparison of Hierarchical and Variable Exposure Interventions for Contamination Fear

Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N=73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d=.78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.

Time-dependent effects of cellulose and gelatin-based hemostats on cellular processes of wound healing

INTRODUCTION

Oxidized regenerated cellulose-based (ORC - TABOTAMP), oxidized non-regenerated cellulose-based (ONRC - RESORBA CELL), and gelatin-based (GELA - GELITA TUFT-IT) hemostats are commonly used in surgery. However, their impact on the wound healing process remains largely unexplored. We here assess time-dependent effects of exposure to these hemostats on fibroblast-related wound healing processes.

MATERIAL AND METHODS

Hemostats were applied to fibroblast cell cultures for 5-10 (short-), 30 and 60 min (intermediate-) and 24 h (long-term). Representative images of the hemostat degradation process were obtained, and the pH value was measured. Cell viability, apoptosis and migration were analyzed after the above exposure times at 3, 6 and 24 h follow-up. Protein levels for tumor necrosis factor α (TNF-α) and transforming-growth factor β (TGF-β) were assessed.

RESULTS

ORC and ONRC reduced pH values during degradation, while GELA proved to be pH-neutral. Hemostat structural integrity was prolonged for GELA (vs. ORC and ONRC). TGF-β and TNF-α levels were reduced for ORC and ONRC (vs. GELA and control) (p < 0.05). Further, exposure of ORC and ONRC for longer than 5-10 min reduced cell viability vs. GELA and control at 3 h post-exposure (p < 0.05). Similarly, cell migration was impaired with ORC and ONRC exposure longer than 60 min at 24 h follow-up (p < 0.05).

CONCLUSIONS

Short-term exposure to ORC and ONRC impairs relevant wound healing-related processes in fibroblasts, and alters protein levels of key mediating cytokines. GELA does not show similar effects. We conclude that GELA may be preferred over ORC and ONRC over short-, intermediate- and long-term exposures. Future validation of the clinical relevance is warranted.

Particle Size Modulates Silver Nanoparticle Toxicity during Embryogenesis of Urchins Arbacia lixula and Paracentrotus lividus

Silver nanoparticles represent a threat to biota and have been shown to cause harm through a number of mechanisms, using a wide range of bioassay endpoints. While nanoparticle concentration has been primarily considered, comparison of studies that have used differently sized nanoparticles indicate that nanoparticle diameter may be an important factor that impacts negative outcomes. In considering this, the aim of the present study was to determine if different sizes of silver nanoparticles (AgNPs; 10, 20, 40, 60 and 100 nm) give rise to similar effects during embryogenesis of Mediterranean sea urchins Arbacia lixula and Paracentrotus lividus, or if nanoparticle size is a parameter that can modulate embryotoxicity and spermiotoxicity in these species. Fertilised embryos were exposed to a range of AgNP concentrations (1−1000 µg L−1) and after 48 h larvae were scored. Embryos exposed to 1 and 10 µg L−1 AgNPs (for all tested sizes) showed no negative effect in both sea urchins. The smaller AgNPs (size 10 and 20 nm) caused a decrease in the percentage of normally developed A. lixula larvae at concentrations ≥50 µg L−1 (EC50: 49 and 75 μg L−1, respectively) and at ≥100 µg L−1 (EC50: 67 and 91 μg L−1, respectively) for P. lividus. AgNPs of 40 nm diameter was less harmful in both species ((EC50: 322 and 486 μg L−1, for P. lividus and A. lixula, respectively)). The largest AgNPs (60 and 100 nm) showed a dose-dependent response, with little effect at lower concentrations, while more than 50% of larvae were developmentally delayed at the highest tested concentrations of 500 and 1000 µg L−1 (EC50(100 nm); 662 and 529 μg L−1, for P. lividus and A. lixula, respectively. While AgNPs showed no effect on the fertilisation success of treated sperm, an increase in offspring developmental defects and arrested development was observed in A. lixula larvae for 10 nm AgNPs at concentrations ≥50 μg L−1, and for 20 and 40 nm AgNPs at concentrations >100 μg L−1. Overall, toxicity was mostly ascribed to more rapid oxidative dissolution of smaller nanoparticles, although, in cases, Ag+ ion concentrations alone could not explain high toxicity, indicating a nanoparticle-size effect.

The effects of long-term prenatal exposure to 900, 1800, and 2100 MHz electromagnetic field radiation on myocardial tissue of rats

It is well-known that wireless communication technologies facilitate human life. However, the harmful effects of electromagnetic field (EMF) radiation on the human body should not be ignored. In the present study, we evaluated the effects of long-term, prenatal exposure to EMF radiation on the myocardium of rats at varying durations. Overall, 18 pregnant Sprague-Dawley rats were assigned into six groups (n = 3 in each group). In all groups other than the control group, three pregnant rats were exposed to EMF radiation (900, 1800 and 2100 MHz) for 6, 12 and 24 h over 20 days. After delivery, the newborn male pups were identified and six newborn male pups from each group were randomly selected. Then, histopathological and biochemical analysis of myocardial samples were performed. When 24-h/day prenatal exposures to 900, 1800, 2100 MHz EMF radiation were evaluated, myocardial damage was greater in the 2100 MHz EMF-24h group than the other groups. In addition, when malondialdehyde (MDA) and glutathione (GSH) levels associated with reactive oxidative species (ROS) were evaluated, the MDA level was higher in the 2100 MHz EMF-24h group compared with the other groups. The GSH level was also lower in the 2100 MHz EMF-24h group. When the 6, 12 and 24 h/day prenatal exposures to 1800 MHz EMF radiation were evaluated, myocardial damage was greater in 1800 MHz EMF-24h group than the remaining groups (p < 0.0001). Also, MDA level was greater in the 1800 MHz EMF-24h group compared with the other groups while the GSH level was lower in this group. It was shown that myocardial tissue was affected more by long-term exposure to EMF radiation at high frequencies. The data raise concerns that the harmful effects of non-ionizing radiation exposure on cardiac tissue will increase with 5G technology.

Citrinin Exposure in Germany: Urine Biomarker Analysis in Children and Adults

Citrinin (CIT), a mycotoxin known to exert nephrotoxicity, is a contaminant in food and feed. Since CIT contamination is not regularly analyzed, data on its occurrence and especially levels in food commodities are insufficient for conducting a conventional exposure assessment. Yet, human biomonitoring, i.e., an analysis of CIT and its metabolite dihydrocitrinone (DH-CIT) in urine samples allows to estimate exposure. This study investigated CIT exposure in young (2-14 years) and adult (24-61 years) residents of three federal states in Germany. A total of 179 urine samples from children and 142 from adults were collected and analyzed by a targeted LC-MS/MS based method for presence of CIT and DH-CIT. At least one of the biomarkers was detected and quantified in all urines, which indicated a widespread dietary exposure to the mycotoxin in Germany. Interestingly, the biomarker concentrations of CITtotal (sum of CIT and DH-CIT) were higher in children's urine (range 0.05-7.62 ng/mL; median of 0.54 ng/mL) than in urines from adults (range 0.04-3.5 ng/mL; median 0.3 ng/mL). The biomarker levels (CITtotal) of individual urines served to calculate the probable daily CIT intake, for comparison to a value of 0.2 µg/kg bw/day defined as 'level of no concern for nephrotoxicity' by the European Food Safety Authority. The median exposure of German adults was 0.013 µg/kg b.w., with only one urine donor exceeding this provisional tolerable daily intake (pTDI) for CIT. The median exposure of children was 0.05 µg/kg bw per day (i.e., 25% of the pTDI); however, CIT exposure in 12 individuals (6.3% of our study group) exceeded the limit value, with a maximum intake of 0.46 µg/kg b.w. per day. In conclusion, these results show evidence for non-negligible exposure to CIT in some individuals in Germany, mainly in children. Therefore, further biomonitoring studies and investigations aimed to identify the major sources of CIT exposure in food commodities are required.

Neurobehavioral Alterations from Noise Exposure in Animals: A Systematic Review

Ecosystems are increasingly involved and influenced by human activities, which are ever-increasing. These activities are mainly due to vehicular, air and sea transportation, thus causing possible repercussions on the fauna that exists there. The aim of this systematic review is to investigate the possible consequences that these activities may have in the field of animal neurobehavior, with special emphasis on the species involved, the most common environment concerned, the noise source and the disturbance that is caused. This research includes articles published in the major databases (PubMed, Cochrane Library, Scopus, Embase, Web of Sciences); the online search yielded 1901 references. After selection, 49 articles (14 reviews and 35 original articles) were finally scrutinized. The main problems that were reported were in relation to movement, reproduction, offspring care and foraging. In live experiments carried out, the repercussions on the marine environment mainly concerned altered swimming, shallower descents, less foraging and an escape reaction for fear of cetaceans and fish. In birds, alterations in foraging, vocalizations and nests were noted; laboratory studies, on the other hand, carried out on small mammals, highlighted spatio-temporal cognitive alterations and memory loss. In conclusion, it appears that greater attention to all ecosystems should be given as soon as possible so as to try to achieve a balance between human activity and the well-being of terrestrial fauna.

Sun protection and occupation: Current developments and perspectives for prevention of occupational skin cancer

A substantial proportion of all reported occupational illnesses are constituted by skin cancer, making this disease a serious public health issue. Solar ultra-violet radiation (UVR) exposure is the most significant external factor in the development of skin cancer, for which the broad occupational category of outdoor workers has already been identified as high-risk group. Sun protection by deploying adequate technical, organizational, and person-related measures has to be understood as a functional aspect of workplace safety. To prevent skin cancers brought on by-typically cumulative-solar UVR exposure, outdoor workers must considerably lower their occupationally acquired solar UVR doses. Estimating cumulative sun exposure in outdoor workers requires consideration of the level of solar UVR exposure, the tasks to be done in the sun, and the employees' solar UVR preventive measures. Recent studies have highlighted the necessity for measures to enhance outdoor workers' sun protection behavior. In the coming decades, occupational dermatology is expected to pay increasing attention to sun protection at work. Also, the field of dermato-oncology will likely be concerned with sky-rocketing incidences of occupational skin cancers. The complete range of available alternatives should be utilized in terms of preventive actions, which seems pivotal to handle the present and future challenges in a purposeful manner. This will almost definitely only be possible if politicians' support is effectively combined with communal and individual preventive actions in order to spur long-term transformation.