Pharmacokinetics and toxicity of bismuth compounds

Investigating the Impact of Bismuth Oxide Nanoparticles on Dazl Gene Expression and Spermatogenesis Indices in Male Mice

Bismuth (Bi) exposure has been linked to various health effects, but its direct impact on male fertility remains largely unexplored. This study investigated the effects of bismuth oxide nanoparticles (Bi₂O₃ NPs) on male reproductive function in Naval Medical Research Institute (NMRI) mice. The mice were randomly allocated to seven groups: one control receiving physiological saline and six treatment groups receiving Bi₂O₃ NPs (25, 50, 100, 200, 400, and 800 mg/kg body weight/day) for 35 days. Treatment was administered via oral gavage. Following treatment, we evaluated body weight, blood serum biochemistry, Dazl gene expression, sperm quality, testicular histology, and cell counts (spermatogenic, Leydig, and Sertoli cells). Compared with the control, Bi₂O₃ NPs exposure resulted in significant reductions in testosterone levels, total antioxidant capacity, superoxide dismutase activity, Dazl gene expression, sperm motility, count, viability, normal morphology, and DNA integrity, and the level of malondialdehyde (MDA) increased. Additionally, testicular tissue and seminiferous tubule volume decreased, whereas interstitial tissue volume increased. Notably, sperm production was impaired, as evidenced by reduced numbers of spermatogonia, spermatocytes, spermatids, Sertoli cells, and Leydig cells. Body weight and seminiferous tubule basement membrane parameters remained largely unaffected. These findings suggest that Bi₂O₃ NPs induce oxidative stress, leading to lipid peroxidation and ultimately compromising male fertility. Our study highlights the potential detrimental effects of Bi₂O₃ NPs exposure on male reproductive health and warrants further investigation into their impact on human fertility at relevant concentrations.

Non-lead flexible composite shields efficiency in decreasing dose in chest CT scan imaging

Lead-based radiation shielding used usually in radiology departments is being replaced by non-lead shields due to concerns over toxicity, high weight, and the impossibility of applying it in the imaging field. New studies refer to the use of nanomaterials and lightweight polymer-based composites as an alternative that can solve the problems caused by lead shields. The study aims to develop a flexible composite shield for CT scan imaging and examine its effectiveness in reducing radiation exposure. This study involved the construction of 1 mm thick composite shields used in chest CT scan imaging. The first type consisted of 10% bismuth oxide, the second type consisted of 10% tungsten, the third type consisted of 5% bismuth oxide and 5% tungsten, and 90% of the rest of the structure of all shields was silicone. This study examined the morphological test, tensile strength test, attenuation efficiency, and image quality assessment of these shields. The radiation transmission coefficient for 10% bismuth, 10% tungsten and 5% bismuth-5%tungsten shields was obtained as 0.86, 0.80, and 0.83, respectively. Also, the noise increasing percentage for mentioned shields were 6, 4, and 6%, respectively, compared to the case without a shield. The study found that the 10% tungsten-90% silicone shield is the most effective in reducing radiation exposure due to its K-edge and attenuation coefficients. According to the noise assessment, using these shields does not significantly affect the quality of images.

An investigation of high-Z material for bolus in electron beam therapy

Highlight. Electron beam treatment often requires bolus to augment surface dose to nearly 100%. There are no optimum bolus materials and hence a high-Z based clothlike material is investigated to reduce air column in treatment that provides optimum surface dose. This material is well suited as it can be used multiple times and can be sanitized. Characteristics of W-Si material is provided.Purpose /Objective(s). Electron beams are frequently used for superficial tumors. However, due to electron beam characteristics the surface dose is 75-95% of the prescribed dose depending on beam energy thus requiring placement of bolus to augment surface dose. Various types of boluses are commonly used in clinics, each having it's own unique limitation. Most bolus devices do not conform to the skin contour and create airgaps that are known to produce dose perturbations creating hot and cold spots. A cloth-like high-Z materials; Tungsten, (Z = 74) and Bismuth, (Z = 83) impregnated in silicone gel is investigated for electron bolus.Materials/Methods. Super soft silicone-gel based submillimeter thin tungsten and bismuth sheets were investigated for bolus for 6-12 MeV. Parallel plate ion chamber measurements were performed in a solid water phantom on a Varian machine. Depth dose characteristics were measured to optimize the thickness for surface dose to be 100% for selected electron therapy and validated with Monte Carlo simulations.Results. Silicone-gel tungsten and bismuth sheets produce significant electrons thus increasing surface dose. Based on measured depth dose, our data showed that tungsten sheets of 0.14 mm, 0.18 mm and 0.2 mm and Bismuth sheets of 0.42 mm, 0.18 mm and 0.2 mm provide 100% surface dose for 6, 9 and 12 MeV beams, respectively without any significant changes in depth dose except increasing surface dose.Conclusions. The new high-Z clothlike sheets are extremely soft but high tensile metallic bolus materials that can fit flawlessly on any skin contour. Only 0.2 mm thick sheets are needed for 100% surface dose without degradation of the depth dose characteristics. These materials are reusable and ideal for bolus in electron beam treatment. This investigation opens a new frontier in designing new bolus materials optimum for patient treatment.

A Counterion-Free Strategy for Chronic Metabolic Acidosis Based on an Orally Administered Gut-Restricted Inorganic Adsorbent

Chronic metabolic acidosis, arising as a complication of chronic kidney disease (CKD), not only reduces patients' quality of life but also aggravates renal impairment. The only available therapeutic modality, involving intravenous infusion of NaHCO3 , engenders undesirable sodium retention, thereby increasing hemodynamic load and seriously exacerbating the primary disease. This deleterious cascade extends to the development of cardiovascular diseases. Herein, an orally administered, gut-restricted inorganic adsorbent that can effectively alleviate chronic metabolic acidosis without causing any electrolytic derangement or superfluous cardiovascular strain is developed. The genesis of ABC-350 entails the engineering of bismuth subcarbonate via annealing, thereby yielding a partially β-Bi2 O3 -doped (BiO)2 CO3 biphasic crystalline structure framework enriched with atomic vacancies. ABC-350 can selectively remove chloride ions and protons from the gastrointestinal tract, mimicking the physiological response to gastric acid removal and resulting in increased serum bicarbonate. Owing to its gut-restricted nature, ABC-350 exhibits commendable biosafety, averting undue systemic exposure. In two rat models of metabolic acidosis, ABC-350 emerges not only as a potent mitigator of acidosis but also effects discernible amelioration concerning proximal tubular morphology, interstitial fibrosis, and the incendiary cascades incited by metabolic acidosis. ABC-350, as the translationally relevant material, provides a promising strategy for the treatment of metabolic acidosis.

A Transformable Mucoadhesive Microgel Network for Noninvasive Multimodal Imaging And Radioprotection of a Large Area of the Gastrointestinal Tract

The lack of noninvasive imaging and modulation of a large area of the gastrointestinal (GI) tract constrain the diagnosis and treatment of many GI-related diseases. Recent advances use novel mucoadhesive materials to coat a part of the GI tract and then modulate its functions. High mucoadhesion is the key factor of the partial coating, but also the limitation for not spreading and covering the lower GI tract. Here, a bismuth-pectin organic-inorganic hybrid complex is screened and engineered into a transformable microgel network (Bi-GLUE) with high flowability and mucoadhesion, such that it can quickly transit through and coat a large area of the GI tract. In murine and porcine models, Bi-GLUE delivers contrast agents to achieve real-time, large-area GI-tract imaging under X-ray or magnetic resonance  modalities and to facilitate the non-invasive diagnosis of familial adenomatous polyposis. Moreover, Bi-GLUE, like an intracorporal radiation shield, decreases the radiotoxicity in a whole-abdomen irradiation rat model. This transformable microgel network offers a new direction that can modulate a large area of the GI tract and may have broad applications for GI-related conditions.

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Several heavy metals and other chemical elements are natural components of the Earth's crust and their properties and toxicity have been recognized for thousands of years. Moreover, their use in industries presents a major source of environmental and occupational pollution. Therefore, this ubiquity in daily life may result in several potential exposures coming from natural sources (e.g., through food and water contamination), industrial processes, and commercial products, among others. The toxicity of most chemical elements of the periodic table accrues from their highly reactive nature, resulting in the formation of complexes with intracellular compounds that impair cellular pathways, leading to dysfunction, necrosis, and apoptosis. Nervous, gastrointestinal, hematopoietic, renal, and dermatological systems are the main targets. This manuscript aims to collect the clinical and forensic signs related to poisoning from heavy metals, such as thallium, lead, copper, mercury, iron, cadmium, and bismuth, as well as other chemical elements such as arsenic, selenium, and fluorine. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could rapidly initiate treatment even before the toxicological results are available, which can make a huge difference in these patients' outcomes.

Effects of Bismuth Exposure on the Human Kidney-A Systematic Review

The effects of bismuth toxicity on the kidney-the main organ responsible for blood filtration-were systematically reviewed. This review was motivated by availability of several sources of bismuth in contact with humans including environmental, medications, dental materials, and cosmetics, potentially leading to kidney filtration of this chemical. No previous studies have systematically reviewed the literature considering this association. A total of 22 studies with a total of 46 individuals met the inclusion criteria, 19 being case reports with only one patient enrolled. The included studies publication dates ranged from 1961 to 2021 and the countries of publication were the United States of America, United Kingdom, Germany, Turkey, Switzerland, and Canada. Bismuth sources affecting the kidneys were uniquely reported as from medical purposes and mostly associated to overdoses with several symptoms, apparently with dose-dependent consequences. Patient history of renal impairment seemed to affect the outcome of the case. Several therapies were conducted following bismuth intoxication, and few studies performed renal biopsies describing its histological findings. It is crucial to reconsider the nephrotoxicity of bismuth compounds, mainly in patients with previous history of renal impairment.

Magnesium for Implants: A Review on the Effect of Alloying Elements on Biocompatibility and Properties

An attempt is made to cover the whole of the topic of biodegradable magnesium (Mg) alloys with a focus on the biocompatibility of the individual alloying elements, as well as shed light on the degradation characteristics, microstructure, and mechanical properties of most binary alloys. Some of the various work processes carried out by researchers to achieve the alloys and their surface modifications have been highlighted. Additionally, a brief look into the literature on magnesium composites as also been included towards the end, to provide a more complete picture of the topic. In most cases, the chronological order of events has not been particularly followed, and instead, this work is concentrated on compiling and presenting an update of the work carried out on the topic of biodegradable magnesium alloys from the recent literature available to us.

Understanding the Crystal Growth of Bismuth Chalcohalide Nanorods through a Self-Sacrificing Template Process: A Comprehensive Study

Bismuth-based semiconductors are promising candidates for applications in photocatalysis, photodetection, solar cells, etc. BiSI in particular is attracting attention. It has anisotropic optoelectronic properties and comprises relatively abundant elements. However, the synthesis of this ternary compound presents several challenges. Here, we delve into the underlying chemical processes that lead to the crystal growth of BiSI nanorods and optimize a solution-based synthesis. The mechanism of formation of BiSI nanocrystals is the self-sacrifice of Bi₂S₃ nanostructures, which also act as templates. The crystallographic similarities between the chalcogenide and the chalcohalide allow for the solid state transformation from one to the other. However, there is also a synergy with the I₃^- species formed in the reaction media needed to obtain BiSI. Our method makes use of a green solvent, avoids complicated media, and drastically reduces the reaction time compared to other methods. The obtained nanorods present a band gap of 1.6 eV, in accordance with the reported values. This work presents insight into the chemistry of bismuth-based semiconductors, while introducing an easy, green, and scalable synthesis of a promising material, which could also be applied to similar compounds and other chalcoiodides, such as SbSI. In addition, the optical properties of the BiSI nanorods show their potential in photovoltaic applications.

Zinc carnosine-based modified bismuth quadruple therapy vs standard triple therapy for Helicobacter pylori eradication: A randomized controlled study

BACKGROUND

Helicobacter pylori (H. pylori) infection is a worldwide problem with increasing burden on the health sector due to its increasing rate of resistance. The conventional triple therapy (TT) is becoming obsolete with a high failure rate of eradication, necessitating the need for better alternatives or regimens.

AIM

To investigate H. pylori eradication rate of TT vs modified bismuth quadruple therapy.

METHODS

Ninety-two patients with dyspepsia symptoms and positive ¹³C-urea breath test were randomly assigned to two groups. The first group (control group) was treated for 14 d using standard TT protocol: Esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). On the other hand, the second group was prescribed a 10-d course of modified bismuth quadruple therapy fortified with zinc carnosine: TT in addition to bismuth subcitrate (240 mg twice daily) and zinc carnosine (75 mg twice daily). A repeated ¹³C-urea breath test was done 4 wk after the completion of the eradication therapy.

RESULTS

Among the 92 subjects, 67.4% were males and 32.6% were females. There were no differences in demographic characteristics (age, body mass index, smoking history, previous antibiotics use and ethnicity) between the modified bismuth quadruple therapy group and TT group. The eradication rate was higher [93.5% (43/46)] in the modified bismuth quadruple therapy group compared to 69.6% (32/46) in the standard TT group (P = 0.003). Of the tested predictor variables, only nationality, smoking and therapy type were statistically significant. Besides dizziness, which was recorded in modified bismuth quadruple therapy group, there were no significant differences in side effects between the two groups.

CONCLUSION

Ten days of modified bismuth quadruple therapy fortified with zinc carnosine is superior to 14 d of conventional TT in eradicating H. pylori infection, with no additional significant adverse events.

Bioactive glasses incorporating less-common ions to improve biological and physical properties

Bioactive glasses (BGs) have been a focus of research for over five decades for several biomedical applications. Although their use in bone substitution and bone tissue regeneration has gained important attention, recent developments have also seen the expansion of BG applications to the field of soft tissue engineering. Hard and soft tissue repair therapies can benefit from the biological activity of metallic ions released from BGs. These metallic ions are incorporated in the BG network not only for their biological therapeutic effects but also in many cases for influencing the structure and processability of the glass and to impart extra functional properties. The "classical" elements in silicate BG compositions are silicon (Si), phosphorous (P), calcium (Ca), sodium (Na), and potassium (K). In addition, other well-recognized biologically active ions have been incorporated in BGs to provide osteogenic, angiogenic, anti-inflammatory, and antibacterial effects such as zinc (Zn), magnesium (Mg), silver (Ag), strontium (Sr), gallium (Ga), fluorine (F), iron (Fe), cobalt (Co), boron (B), lithium (Li), titanium (Ti), and copper (Cu). More recently, rare earth and other elements considered less common or, some of them, even "exotic" for biomedical applications, have found room as doping elements in BGs to enhance their biological and physical properties. For example, barium (Ba), bismuth (Bi), chlorine (Cl), chromium (Cr), dysprosium (Dy), europium (Eu), gadolinium (Gd), ytterbium (Yb), thulium (Tm), germanium (Ge), gold (Au), holmium (Ho), iodine (I), lanthanum (La), manganese (Mn), molybdenum (Mo), nickel (Ni), niobium (Nb), nitrogen (N), palladium (Pd), rubidium (Rb), samarium (Sm), selenium (Se), tantalum (Ta), tellurium (Te), terbium (Tb), erbium (Er), tin (Sn), tungsten (W), vanadium (V), yttrium (Y) as well as zirconium (Zr) have been included in BGs. These ions have been found to be particularly interesting for enhancing the biological performance of doped BGs in novel compositions for tissue repair (both hard and soft tissue) and for providing, in some cases, extra functionalities to the BG, for example fluorescence, luminescence, radiation shielding, anti-inflammatory, and antibacterial properties. This review summarizes the influence of incorporating such less-common elements in BGs with focus on tissue engineering applications, usually exploiting the bioactivity of the BG in combination with other functional properties imparted by the presence of the added elements.

Metallobiochemistry of ultratrace levels of bismuth in the rat I. Metabolic patterns of 205+206Bi3+ in the blood

BACKGROUND

The number of the applications of bismuth (Bi) is rapidly and remarkably increasing, enhancing the chance to increase the levels to which humans are normally daily exposed. The interest to Bi comes also from the potential of Bi-based nanoparticles (BiNPs) for industrial and biomedical purposes. Like other metal-based NPs used in nanomedicine, BiNPs may release ultratrace amounts of Bi ions when injected. The metabolic fate and toxicity of these ions still needs to be evaluated. At present, knowledge of Bi metabolism in laboratory animals refers almost solely to studies under unnatural "extreme" exposures, i.e. pharmacologically relevant high-doses (up to thousand mg kg^-1) in relation to its medical use, or infinitesimal-doses (pg kg^-1 as non-carrier-added Bi radioisotopes) for radiobiology protection, diagnostic and radiotherapeutic purposes. No specific study exists on the "metabolic patterns" in animal models exposed to levels of Bi, i.e. at "environmental dose exposure" that reflect the human daily exposure (μg kg^-1).

METHODOLOGY

Rats were intraperitoneally injected with 0.8 μg Bi kg^-1 bw as ^205+206Bi(NO)₃ alone or in combination with ⁵⁹Fe for radiolabelling of iron proteins. The use of ^205+206Bi radiotracers allowed the detection and measurement down to pg fg^-1 of the element in the blood biochemical compartments and protein fractions as isolated by differential centrifugation, size exclusion- and ion exchange chromatography, electrophoresis, solvent extraction, precipitation and dialysis.

RESULTS

24 h after the administration, the blood concentration of Bi was 0.18 ng mL^-1, with a repartition plasma/red blod cells (RBC) in a ratio of 2:1. Elution profiles of plasma from gel filtration on Sephadex G-150 showed four pools of Bi-binder proteins with different molecular sizes (> 300 kDa, 160 kDa, 70 kDa and < 6.5 kDa). In the 70 kDa fraction transferrin and albumin were identified as biomolecule carriers for Bi. In red blood cells, Bi was distributed between cytosol and membranes (ghosts) in a ratio of about 5:1. In the cytosol, low molecular components (LMWC) and the hemoglobin associated the Bi in a ratio of about 1.8:1. In the hemoglobin molecule, Bi was bound to the beta polypeptide chain of the globin. In the ghosts, Bi was detected at more than one site of the protein fraction, with no binding with lipids. Dialysis experiments and the consistently high recovery (80-90 %) of ²⁰⁶Bi from chromatography of ²⁰⁶Bi-containing biocomponents suggest that Bi was firmly complexed at physiological pH with a low degree of breaking during the applications of experimental protocols for the isolation of the ²⁰⁶Bi-biocomplexes. These latter were sensitive to acid buffer pH 5, and to the presence of complexing agents in the dialysis fluid.

CONCLUSIONS

On the basis of an environmental biochemical toxicology approach, we have undertaken a study on the metabolic patterns of Bi³⁺ ions in rats at tissue, subcellular and molecular level with the identification of cellular Bi-binding components. As a first part of the study the present work reports the results concerned with the metabolic fate of ultratrace levels of ^205+206Bi(NO)₃ in the blood.

Myoclonus From Intoxication by Bismuth Iodoform Paraffin Paste (BIPP) Nasopharyngeal Packing

Bismuth iodoform paraffin paste (BIPP) gauze is widely used as an antiseptic wound packing in otolaryngology, head, and neck surgery. Uncommonly, BIPP can cause intoxication. Our report highlights an elderly patient who developed encephalopathy and overt myoclonus after nasopharyngectomy secondary to intoxication by the components of the BIPP gauze. The patient’s impaired renal function, the amount of BIPP packing and the extensive nature of his wound likely predisposed him to BIPP toxicity. The myoclonus and delirium resolved promptly after removal of the BIPP packs. Clinicians should be aware of the clinical features of BIPP intoxication because of its common usage.

Eradication of Porphyromonas gingivalis Persisters Through Colloidal Bismuth Subcitrate Synergistically Combined With Metronidazole

Microbial persisters enable the development of certain intrinsic strategies for survival with extreme tolerance to multiple antimicrobials. Porphyromonas gingivalis is considered to be the "keystone" periodontopathogen. Indeed, periodontitis, as a highly common inflammatory disease, is the major cause of severe tooth loss and edentulism in adults globally, and yet it is crucially involved in various systemic comorbidities like diabetes. We have recently revealed P. gingivalis persisters-induced perturbation of immuno-inflammatory responses and effective suppression of this key pathogen by bismuth drugs. This study further explored novel approaches to eradicating P. gingivalis persisters through synergistic combination of colloidal bismuth subcitrate (CBS) with traditional antibiotics. P. gingivalis (ATCC 33277) cells in planktonic and biofilm states were cultured to stationary phase, and then treated with metronidazole (100 mg/L), amoxicillin (100 mg/L), CBS, (100 μM) and combinations of these medications, respectively. Persister survival rate was calculated by colony-forming unit. Cell viability and cytotoxicity of CBS were assessed in human gingival epithelial cells (HGECs). Notably, CBS combined with metronidazole enabled the effective eradication of P. gingivalis persisters in planktonic mode, and nearly eliminated their existence in biofilm mode. Importantly, CBS exhibited no effects on the viability of HGECs, along with minimal cytotoxicity (<5%) even at a high concentration (400 μM). This pioneering study shows that P. gingivalis persisters could be well eliminated via the synergistic combination of CBS with metronidazole. Our findings may contribute to developing novel approaches to tackling periodontitis and inflammatory systemic comorbidities.

On the Biocompatibility and Teat Retention of In Situ Gelling Intramammary Formulations: Cattle Mastitis Prevention and Treatment

Treatment and prevention of cattle mastitis remains a formidable challenge due to the anatomical and physiological constraints of the cow udder. In this study, we investigated polymeric excipients and solvents that can form, (when combined) novel, non-toxic and biocompatible in situ gelling formulations in the mammary gland of bovine cattle. We also report on a new approach to screen intramammary formulations using fresh excised cow teats. Fourteen hydrophilic polymers and six solvents were evaluated for in vitro cytotoxicity and biocompatibility towards cultured bovine mammary epithelial cells (MAC-T), microscopic and macroscopic examination upon contact with excised cow teats. No significant cytotoxicity (p > 0.05) was observed with polyethylene oxides, hydroxypropyl methylcellulose, carboxymethyl cellulose, sodium alginate and xanthan gum. Polycarbophil and carbopol polymers showed significantly higher cytotoxicity (p < 0.05). Concentration-dependent cytotoxicity was observed for glycerin, propylene glycol, polyethylene glycol 400, ethanol, N-methyl-2-pyrrolidone and 2-pyrrolidone, with the 2-pyrrolidone solvents showing higher cytotoxic effects (p < 0.05). In situ gelling formulations comprising hydroxypropyl methylcellulose or carboxymethyl cellulose and solvents in specific ratios were biocompatible at higher concentrations with MAC-T cells compared to alginates. All investigated formulations could undergo in situ sol-to-gel phase transformation, forming non-toxic gels with good biocompatibility in excised cow teats hence, showing potential for use as intramammary carriers for sustained drug delivery.

Enhanced Photovoltaic Performance of BiSCl Solar Cells Through Nanorod Array

BiSCl single-crystalline nanofibers were synthesized by a facile one-pot solvothermal approach for the first time. BiSCl possesses a double chain type structure and grows readily along the c-axis, resulting the fibrous morphology. UV/Vis absorption spectroscopy revealed that BiSCl nanofibers exhibit a strong light absorption in a wavelength range from UV to visible light, corresponding to a bandgap of 1.96 eV. Ultraviolet photoelectron spectroscopy and density functional theory calculations revealed that BiSCl is a direct n-type semiconductor with valence band maximum and conduction band minimum located at 6.04 and 4.08 eV below the vacuum level, respectively. To investigate the photovoltaic performance, the homogeneous thin film of BiSCl-nanorod array was fabricated on a TiO₂ porous film by a modified solvothermal process, where the nanorod array is oriented vertically to the surface of the TiO₂ porous film. A proper band alignment of BiSCl-based solar cells with an architecture of fluorine-doped tin oxide (FTO)/TiO₂ /BiSCl/(I₃ ^- /I^- )/Pt gave a PCE of 1.36 % and a relatively large short-circuit photocurrent density of 9.87 mA cm^-2 for the first time. The preliminary photovoltaic study result revealed a potential possibility of BiSCl-nanorod array as a light absorber for solar cells that can be fabricated by the low-cost solution process.

A Whole-Body Physiologically Based Pharmacokinetic Model for Alpha Particle Emitting Bismuth in Rats

Introduction/Aim: α particle emitting bismuth (²¹²Bi) as decay product of ²¹²Pb-labeled pharmaceuticals has been effective in targeted α particle therapy (TAT). Estimating the contribution of ²¹²Bi released from its chelator to the absorbed doses in nontarget tissues is challenging in TAT. Physiologically based pharmacokinetic (PBPK) modeling can help overcome this limitation. Therefore, a whole-body ²¹²Bi-PBPK model was developed to describe the pharmacokinetics (PKs) of ²¹²Bi in rats. Materials and Methods: The rat ²¹²Bi-PBPK model was implemented using the modeling software SAAM II with data and parameter values from the literature. Besides other mechanisms, ²¹²Bi interactions with red blood cells, high molecular weight plasma protein, and intracellular biological thiols are described. Important PK parameters were fitted to time-activity data. Absorbed dose coefficients (ADCs) were calculated for injecting 0.774 fmol of ²¹²Bi. Results: ²¹²Bi uptake rates of liver, bone, small intestine, bone marrow, skin, and muscle were (0.86 ± 0.13), (3.85 ± 0.63), (0.27 ± 0.05), (1.44 ± 0.29), (0.04 ± 0.01), and (0.007 ± 0.007) per min with corresponding ADCs of 0.09, 0.03, 0.03, 0.07, 0.01, and 0.003 mGy/kBq, respectively. An ADC of 0.70 mGy/kBq was determined for kidneys. Conclusion: Kidneys are the dose-limiting organs in ²¹²Bi-based TAT. The ²¹²Bi-PBPK model is an effective tool to investigate the ²¹²Bi biodistribution in murine models. Integrating the ²¹²Bi-PBPK model into other murine and human PBPK models of α particle generators can help study the efficacy and safety of TAT.

Comparative study of allicin-containing quadruple therapy vs. bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection: a prospective randomized study

BACKGROUND

Bismuth has antimicrobial activity and can improve the efficacy of triple Helicobacter pylori (H. pylori) therapy. Allicin added to conventional therapy for H. pylori infection also improves H. pylori eradication rates. Thus, this study aims to evaluate and compare the efficacy, safety and tolerability of allicin-containing quadruple therapy and bismuth-containing quadruple therapy and to investigate the factors that affect the eradication rates.

METHODS

Two hundred twenty H. pylori-infected patients were included and randomly (1:1) assigned to 14-day quadruple therapy: ilaprazole (5 mg bid), doxycycline (100 mg bid), and furazolidone (100 mg bid) with an allicin soft capsule (40 mg of DATS tid) (IDFA) or colloidal bismuth tartrate (220 mg of elemental bismuth bid) (IDFB). Eradication was confirmed by urea breath tests. Symptom improvement, adverse events, and adherence were assessed by a questionnaire.

RESULTS

In the intention-to-treat and per-protocol analysis, the eradication rates for IDFA and IDFB groups were 87.5% (70/80) vs. 86.3% (69/80, P = 0.815) and 91.9% (68/74) vs. 91.8% (67/73, P = 0.980) as first-line therapies; 83.3% (25/30) vs. 83.3% (25/30, P = 1) and 89.3% (25/28) vs. 88.9% (24/27, P = 1) as second-line therapies. Symptom improvement rates were 96.1% and 97.0% for IDFA and IDFB (P = 1). The adverse event rates were 10.9% in IDFA and 14.5% in IDFB groups (P = 0.418). Nausea occurred frequently in IDFB than IDFA (1.8% vs. 8.2%, P = 0.030). Smoking and sharing utensils significantly affected the efficacy.

CONCLUSION

Allicin-containing quadruple therapy might be regarded as a promising alternative to bismuth-containing quadruple therapy in H. pylori eradication.

Tungsten carbide and LMPA electron cutouts: comparison and validation using Monte Carlo modelling and measurement of dose

Electron applicator cutouts for radiation therapy electron beam shaping are typically cast from Low Melting Point Alloys (LMPA), such as cerrobend. In this work, we describe the Monte Carlo modelling of novel 3D printed cutouts based on tungsten carbide powder and the resulting dose profiles subject to Elekta Agility electron beams. Cerrobend cutouts were also modelled using the Monte Carlo code EGSnrc. Cerrobend and tungsten carbide cutouts were found to have the same dose profiles within model variance. Computed profiles and percentage depth dose (PDDs) curves of the Elekta Agility accelerator model using standard cutouts in water were found to agree with water tank measurements using gamma criteria of 2%/2mm. The Monte Carlo computed dose profiles of the tungsten carbide cutouts in a polystyrene phantom were also found to agree with liquid-filled ionization chamber array measurements using gamma criteria of 2%/2mm. We conclude that the tungsten carbide cutouts are clinically equivalent to LMPA cutouts.

A Short Review on Biomedical Applications of Nanostructured Bismuth Oxide and Related Nanomaterials

In this review, we reported the main achievements reached by using bismuth oxides and related materials for biological applications. We overviewed the complex chemical behavior of bismuth during the transformation of its compounds to oxide and bismuth oxide phase transitions. Afterward, we summarized the more relevant studies regrouped into three categories based on the use of bismuth species: (i) active drugs, (ii) diagnostic and (iii) theragnostic. We hope to provide a complete overview of the great potential of bismuth oxides in biological environments.

Fluorescence Sensors for Bismuth (III) Ion from Pyreno[4,5-d]imidazole Derivatives

Three pyreno[4,5-d]imidazole derivatives are synthesized and evaluated as fluorescent sensors for bismuth (III) ion. The target compounds are prepared in 55-86% yields from a condensation reaction between pyrene-4,5-dione and aromatic aldehydes. The compound bearing a phenolic group can selectively detect bismuth (III) ion via fluorescence enhancement with a detection limit of 1.20 μm in CH₃ CN-DMSO mixture and 3.40 μm in 10% pH5 aqueous in CH₃ CN-DMSO mixture. The sensing mechanism involving a formation of coordination complex is investigated by UV-VIS and fluorescence titrations, ¹ H-NMR and the decomplexation of the bismuth complex by sulfide ion. The application of this sensor for quantitative analysis of spiked bismuth (III) ion in real water samples from two different sources is demonstrated.

Effect of bismuth subnitrate on in vitro growth of major mastitis pathogens

The mode of action of bismuth subnitrate in teat sealant formulations as a preventative for intramammary infections during the dry period is unknown. Although previous studies proposed an action mechanism-creating a physical barrier in the teat canal to prevent bacterial invasion-it has not been proven experimentally. We hypothesized that bismuth subnitrate has an inhibitory effect on bacterial growth, in addition to its barrier effect. The objective of this study was to assess the effect of bismuth subnitrate on bacterial growth of major mastitis-causing agents. A strain of Streptococcus uberis (SR115), 2 strains of Staphylococcus aureus (SA3971/59 and SA1), and a strain of Escherichia coli (P17.14291) were tested in vitro for their ability to grow in the presence or absence of bismuth subnitrate. Disk diffusion testing, impedance measurement, and evaluation of bacterial growth in shaking conditions were the methods used to test this hypothesis. A reduction of growth in the presence of bismuth subnitrate occurred for all the strains tested. However, we observed strain and species variations in the extent of growth inhibition. These results suggest that an inhibitory effect on bacterial growth by bismuth subnitrate could partially explain the efficacy of bismuth-based formulations for preventing intramammary infections over the dry period. Further research is required to test the effect of teat sealant formulations on bacterial growth.

Bismuth chalcohalide-based nanocomposite for application in ionising radiation detectors

Bismuth sulpho iodide (BiSI) belongs to the family of chalcohalides, which present several attractive electro-optic properties. In particular, BiSI is a semiconductor which could be used in X and gamma ray detection due to a band gap of 1.6 eV, density of 6.4 g cm^-3, and absorption coefficient for 60 keV radiation of 5.6 cm² g^-1. This work presents a facile synthesis under solvothermal conditions of a nanocomposite consisting of BiSI nanorods and amorphous carbon structures. Furthermore, it studies its ionising radiation detection properties at room temperature, when prototype detectors were built from pellets. The construction conditions of pellets were also studied, varying the applied pressure and heat treatment to the nanocomposite. Dark current density and response to different exposure rates of a ²⁴¹Am source were measured for the prototype detectors built. It was found that heat treatment of pellets considerably improves detectors performance. Dark current density was one order of magnitude lower than for the pellets without heat treatment, and its response to the ²⁴¹Am source, linear, with a signal to noise ratio of 7 for 20 V. Finally, the resistivity for the heat treated detector was in the order of 10¹¹ Ω cm, comparable to other materials studied for this application.

Derivation of biomonitoring equivalents (BE values) for bismuth

Bismuth (Bi) is a natural element present in the environmental media. Bismuth has been used medicinally for centuries, specifically for the treatment of gastrointestinal (GI) disorders. Although bismuth toxicity is rare in humans, an outbreak of bismuth-induced neurotoxicity was reported in France and Australia in the mid-1970s. The primary source of bismuth exposure in the general population is via food. US FDA (2019) estimated recommended daily intake (RDI) for bismuth as 848 mg bismuth/day (12.1 mg Bi/kg-d assuming a body weight of 70 kg) for GI tract disorders. Exposures to bismuth can be quantified by measuring concentrations in blood and urine. Biomonitoring equivalents (BEs) were derived based on US FDA's RDI as a tool for interpretation of population-level biomonitoring data. A regression between steady state plasma concentrations and oral intakes was used to derive plasma BEs. A whole blood: plasma partitioning coefficient of 0.6 was used to convert plasma BE into whole blood BE. A mass balance equation with a urinary excretion fraction of 0.0003 was used to derive urinary BE. The BE values associated with US FDA's RDI for plasma, whole blood and urine were 8.0, 4.8 and 0.18 μg/L, respectively. These BE values together with bismuth biomonitoring data may be used in screening and prioritization of health risk assessment of bismuth in the general population.

Bismuth Concentrations in Patients Treated in Real-Life Practice with a Bismuth Subcitrate-Metronidazole-Tetracycline Preparation: The SAPHARY Study

INTRODUCTION

A fixed-dose association of bismuth subcitrate, metronidazole and tetracycline (BMT) (Pylera^®, Allergan, NJ, USA) was made available in France in 2013 for the eradication of Helicobacter pylori. Due to a historical issue of bismuth encephalopathy, the French Health Authorities requested a study of blood and plasma bismuth concentrations with BMT in daily practice.

AIMS

The aim of the study was to measure eventual bismuth accumulation and neurological toxicity in patients prescribed BMT.

METHODS

Patients initiating BMT for H. pylori between March 2014 and December 2015 were included. A blood sample was taken before first BMT intake and 24 h after the last intake, for assay of bismuth. A concentration > 50 μg/L was considered abnormal. Neurological complaints were assessed at inclusion, at the end of the 10-day treatment course, and 28 days later.

RESULTS

202 patients were included, of whom 190 took at least one dose of BMT, and 167 provided both required blood samples. Mean blood bismuth concentrations after the BMT course were 16.9 μg/L (95% confidence interval 15.6-18.3). Concentrations were > 50 μg/L (56.0 μg/L and 50.9 μg/L) in two elderly patients, one of whom presented mild, transient memory impairment during treatment. Non-serious neurological symptoms occurred in 20% of all patients and treatment failure was documented in 5% of patients.

CONCLUSIONS

In this study measuring blood bismuth concentrations in real-life practice, in < 1% of patients the BMT course resulted in blood bismuth concentrations > 50 μg/L. No serious neurological adverse events were observed.

STUDY REGISTRATION

EU-PAS register EUPAS3142 at www.encepp.eu ; ENCePP study seal.

Zero-dimensional hybrid iodobismuthate derivatives: from structure study to photovoltaic application

The quest for lead-free light-absorbing perovskite materials has long been the target of researchers to make the ‘star’ material friendly to the commercial market.

203/212Pb Theranostic Radiopharmaceuticals for Image-guided Radionuclide Therapy for Cancer

Receptor-targeted image-guided Radionuclide Therapy (TRT) is increasingly recognized as a promising approach to cancer treatment. In particular, the potential for clinical translation of receptor-targeted alpha-particle therapy is receiving considerable attention as an approach that can improve outcomes for cancer patients. Higher Linear-energy Transfer (LET) of alpha-particles (compared to beta particles) for this purpose results in an increased incidence of double-strand DNA breaks and improved-localized cancer-cell damage. Recent clinical studies provide compelling evidence that alpha-TRT has the potential to deliver a significantly more potent anti-cancer effect compared with beta-TRT. Generator-produced 212Pb (which decays to alpha emitters 212Bi and 212Po) is a particularly promising radionuclide for receptor-targeted alpha-particle therapy. A second attractive feature that distinguishes 212Pb alpha-TRT from other available radionuclides is the possibility to employ elementallymatched isotope 203Pb as an imaging surrogate in place of the therapeutic radionuclide. As direct non-invasive measurement of alpha-particle emissions cannot be conducted using current medical scanner technology, the imaging surrogate allows for a pharmacologically-inactive determination of the pharmacokinetics and biodistribution of TRT candidate ligands in advance of treatment. Thus, elementally-matched 203Pb labeled radiopharmaceuticals can be used to identify patients who may benefit from 212Pb alpha-TRT and apply appropriate dosimetry and treatment planning in advance of the therapy. In this review, we provide a brief history on the use of these isotopes for cancer therapy; describe the decay and chemical characteristics of 203/212Pb for their use in cancer theranostics and methodologies applied for production and purification of these isotopes for radiopharmaceutical production. In addition, a medical physics and dosimetry perspective is provided that highlights the potential of 212Pb for alpha-TRT and the expected safety for 203Pb surrogate imaging. Recent and current preclinical and clinical studies are presented. The sum of the findings herein and observations presented provide evidence that the 203Pb/212Pb theranostic pair has a promising future for use in radiopharmaceutical theranostic therapies for cancer.

Labeling Stem Cells with a New Hybrid Bismuth/Carbon Nanotube Contrast Agent for X-Ray Imaging

The poor retention and survival of cells after transplantation to solid tissue represent a major obstacle for the effectiveness of stem cell-based therapies. The ability to track stem cells in vivo can lead to a better understanding of the biodistribution of transplanted cells, in addition to improving the analysis of stem cell therapies' outcomes. Here, we described the use of a carbon nanotube-based contrast agent (CA) for X-ray computed tomography (CT) imaging as an intracellular CA to label bone marrow-derived mesenchymal stem cells (MSCs). Porcine MSCs were labeled without observed cytotoxicity. The CA consists of a hybrid material containing ultra-short single-walled carbon nanotubes (20-80 nm in length, US-tubes) and Bi(III) oxo-salicylate clusters which contain four Bi³⁺ ions per cluster (Bi₄C). The CA is thus abbreviated as Bi₄C@US-tubes.

Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease

Bismuth subsalicylate (BSS) is the active ingredient in over-the-counter antacid and antidiarrheal medications. Coagulopathy in the setting of acetylsalicylic acid toxicity is well documented but not in setting of bismuth subsalicylate overuse. We present a case report of coagulopathy from BSS poisoning in a patient with underlying cirrhosis. The patient's high prothrombin time suggests inhibition of vitamin K-dependent coagulation factors. The patient had decreased factor V activity, which is responsible for converting prothrombin to thrombin. Patients with cirrhosis often have hypoprothrombinemia which may be exacerbated by salicylate-induced coagulopathy. Given the widespread use of BSS products, physicians should recognize coagulopathy as a possible manifestation of toxicity especially in patients with underlying liver disease.

[((R)-C8H12N)4][Bi2Br10] and [((S)-C8H12N)4][Bi2Br10]: Chiral Hybrid Bismuth Bromides Templated by Chiral Organic Cations

Single crystals of organically templated chiral bromobismuthates(III), [((R/S)-C₈H₁₂N)₄][Bi₂Br₁₀], have been grown for the first time via a slow evaporation method. Each of the chiral molecular compound consists of (R) or (S)-1-phenylethylammonium ([C₈H₁₂N]⁺) cations and [Bi₂Br₁₀]^4- anions. Both the title compounds reveal thermal and moisture stabilities up to ca. 220 °C and over 1 month, respectively. The newly prepared Bi³⁺-based organic-inorganic hybrid materials show optical band gap of ca. 2.88 eV. The noncentrosymmetric [((R)-C₈H₁₂N)₄][Bi₂Br₁₀] and [((S)-C₈H₁₂N)₄][Bi₂Br₁₀] exhibit second harmonic generation efficiency of ca. 20 times that of α-SiO₂ and are type I nonphase matchable. Uniformly deposited thin films of [((R)-C₈H₁₂N)₄][Bi₂Br₁₀] and [((S)-C₈H₁₂N)₄][Bi₂Br₁₀] have been also successfully obtained by a simple spin-coating method. The circular dichroism spectra for both reported thin films are symmetrical, attributable to the corresponding Cotton effect. The selectively deposited chiral thin films are expected to be used as a useful platform for various surface reactions and interface engineering.

Kinetics and tissue distribution of bismuth, tin and lead after implantation of miniature shotgun alloy pellets in rats

INTRODUCTION

Shotgun pellets containing bismuth (Bi) as substitute for lead (Pb) are increasingly being used due to environmental concerns. Information on toxicokinetics of Bi is lacking for the assessment of humans accidentally shot by Bi-containing shotgun alloy pellets.

METHODS

Male Wistar rats were exposed to miniature alloy pellets containing Bi, tin (Sn) and minor amounts of Pb by implantation in muscle tissues of the hind legs.

RESULTS

The concentrations of Bi in whole blood and urine increased up to 53 weeks after implantation. The highest concentrations of Sn in whole blood were observed three weeks after implantation, then declining to background levels 53 weeks after implantation. Lead in whole blood increased up to 13 weeks of exposure, and declined for the remaining observation period. Bismuth and Sn accumulated mainly in kidney, but also in liver, testicle and brain. Analytical field emission scanning electron microscopy of post-implant pellets showed depletion of Pb towards the pellet surface. Oxygen and chlorine accumulated in Sn rich lamellas in areas next to the pellet surface. The distribution of Bi remained visually unaffected as compared to pre-implant pellets.

CONCLUSION

The concentration of Bi increased during the whole observation period in blood, urine, kidney, brain, testicle and liver. The decline in the concentrations of Pb and Sn in blood and urine after reaching the peak concentration may be related to alterations in the chemical composition and element distribution of the implanted alloy pellets.

Exposure and nephrotoxicity concern of bismuth with the occurrence of autophagy

Metal nanoparticles or metal-based compounds have drawn attention in various fields ranging from industry to medicine because of their unique physicochemical properties. Bismuth (Bi) compounds and nanomaterials have been commonly used in alloys, electronic industry, batteries, and as flame retardants as well as for anti- Helicobacter pylori therapy, while the nanomaterial form has great potential for computed tomography imaging and thermotherapy, both of which will be introduced in this review. Although Bi was used for several decades, there is a lack of detailed information concerning their toxicity and mechanisms on human health. We described the toxicity of Bi on the kidney that seemed to be relatively known by researchers, while the mechanisms remain unclear. Recently, our group has found that Bi compounds, including bismuth nitrate (BN) and Bi nanomaterials, can induce autophagy in kidney cells. We also extended our findings by selecting five Bi compounds, and the results showed that BN, bismuth oxychloride, bismuth citrate, colloidal bismuth subcitrate, and Bi nanomaterials all induced slight cytotoxicity accompanied with autophagy. Although the role of autophagy in Bi-induced cytotoxicity and kidney injury is under investigation by us, autophagy may help with the exploration of the mechanisms of nephrotoxicity by Bi.

Efficacy and Safety of Wei Bi Mei, a Chinese Herb Compound, as an Alternative to Bismuth for Eradication of Helicobacter pylori

Bismuth-containing quadruple therapy has been recommended as the first line of treatment in areas of high clarithromycin or metronidazole resistance. However, safety concerns of bismuth agents have long been raised. We first assessed the efficacy and safety of Wei Bi Mei granules, which are bismuth compounds consisting of three synthetic drugs and five medicinal herbs, compared to bismuth aluminate and colloidal bismuth subcitrate (CBS) in H. pylori-infected mouse model. We then used atomic fluorescence spectroscopy and autometallography to measure the accumulation of three bismuth agents in the brain, heart, liver, and kidneys in adult Sprague-Dawley rats. We also evaluated the safety of bismuth agents by conducting clinical biochemistry tests in blood samples of experimental animals. Wei Bi Mei granules exhibited the highest efficacy of anti-H. pylori activity and yielded the lowest bismuth accumulation when compared to CBS and bismuth aluminate. Our findings show that Wei Bi Mei granules are a safe Chinese medicinal herb with potent anti-H. pylori activity and can be considered as an alternative to current bismuth compounds. Thus, Wei Bi Mei granules merit further evaluation, particularly with regard to efficacy and safety when they are combined with other H. pylori eradication medications in the clinical setting.

Lead-Free Hybrid Perovskite Absorbers for Viable Application: Can We Eat the Cake and Have It too?

Many years since the booming of research on perovskite solar cells (PSCs), the hybrid perovskite materials developed for photovoltaic application form three main categories since 2009: (i) high-performance unstable lead-containing perovskites, (ii) low-performance lead-free perovskites, and (iii) moderate performance and stable lead-containing perovskites. The search for alternative materials to replace lead leads to the second group of perovskite materials. To date, a number of these compounds have been synthesized and applied in photovoltaic devices. Here, lead-free hybrid light absorbers used in PV devices are focused and their recent developments in related solar cell applications are reviewed comprehensively. In the first part, group 14 metals (Sn and Ge)-based perovskites are introduced with more emphasis on the optimization of Sn-based PSCs. Then concerns on halide hybrids of group 15 metals (Bi and Sb) are raised, which are mainly perovskite derivatives. At the same time, transition metal Cu-based perovskites are also referred. In the end, an outlook is given on the design strategy of lead-free halide hybrid absorbers for photovoltaic applications. It is believed that this timely review can represent our unique view of the field and shed some light on the direction of development of such promising materials.

Beyond methylammonium lead iodide: prospects for the emergent field of ns2 containing solar absorbers

The field of photovoltaics is undergoing a surge of interest following the recent discovery of the lead hybrid perovskites as a remarkably efficient class of solar absorber. Of these, methylammonium lead iodide (MAPI) has garnered significant attention due to its record breaking efficiencies, however, there are growing concerns surrounding its long-term stability. Many of the excellent properties seen in hybrid perovskites are thought to derive from the 6s² electronic configuration of lead, a configuration seen in a range of post-transition metal compounds. In this review we look beyond MAPI to other ns² solar absorbers, with the aim of identifying those materials likely to achieve high efficiencies. The ideal properties essential to produce highly efficient solar cells are discussed and used as a framework to assess the broad range of compounds this field encompasses. Bringing together the lessons learned from this wide-ranging collection of materials will be essential as attention turns toward producing the next generation of solar absorbers.