Global producer responsibility for plastic pollution

Brand names can be used to hold plastic companies accountable for their items found polluting the environment. We used data from a 5-year (2018-2022) worldwide (84 countries) program to identify brands found on plastic items in the environment through 1576 audit events. We found that 50% of items were unbranded, calling for mandated producer reporting. The top five brands globally were The Coca-Cola Company (11%), PepsiCo (5%), Nestlé (3%), Danone (3%), and Altria (2%), accounting for 24% of the total branded count, and 56 companies accounted for more than 50%. There was a clear and strong log-log linear relationship production (%) = pollution (%) between companies' annual production of plastic and their branded plastic pollution, with food and beverage companies being disproportionately large polluters. Phasing out single-use and short-lived plastic products by the largest polluters would greatly reduce global plastic pollution.

Cleaning Up without Messing Up: Maximizing the Benefits of Plastic Clean-Up Technologies through New Regulatory Approaches

As the global plastics crisis grows, numerous technologies have been invented and implemented to recover plastic pollution from the environment. Although laudable, unregulated clean-up technologies may be inefficient and have unintended negative consequences on ecosystems, for example, through bycatch or removal of organic matter important for ecosystem functions. Despite these concerns, plastic clean-up technologies can play an important role in reducing litter in the environment. As the United Nations Environment Assembly is moving toward an international, legally binding treaty to address plastic pollution by 2024, the implementation of plastic clean-up technologies should be regulated to secure their net benefits and avoid unintended damages. Regulation can require environmental impact assessments and life cycle analysis to be conducted predeployment on a case-by-case basis to determine their effectiveness and impact and secure environmentally sound management. During operations catch-efficiency and bycatch of nonlitter items, as well as waste management of recovered litter, should be documented. Data collection for monitoring, research, and outreach to mitigate plastic pollution is recommended as added value of implementation of clean-up technologies.

Monitor compartments, mitigate sectors: A framework to deconstruct the complexity of plastic pollution

The rapid growth in science, media, policymaking, and corporate action aimed at "solving" plastic pollution has revealed an overwhelming complexity, which can lead to paralysis, inaction, or a reliance on downstream mitigations. Plastic use is diverse - varied polymers, product and packaging design, pathways to the environment, and impacts - therefore there is no silver bullet solution. Policies addressing plastic pollution as a single phenomenon respond to this complexity with greater reliance on downstream mitigations, like recycling and cleanup. Here, we present a framework of dividing plastic use in society into sectors, which can be used to disentangle the complexity of plastic pollution and direct attention to upstream design for the circular economy. Monitoring plastic pollution in environmental compartments will continue to provide feedback on mitigations, but with a sector framework, scientists, industry, and policymakers can begin to shape actions to curb the harmful impacts of plastic pollution at the source.

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world's oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and non-breeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging species.

A growing plastic smog, now estimated to be over 170 trillion plastic particles afloat in the world's oceans-Urgent solutions required

As global awareness, science, and policy interventions for plastic escalate, institutions around the world are seeking preventative strategies. Central to this is the need for precise global time series of plastic pollution with which we can assess whether implemented policies are effective, but at present we lack these data. To address this need, we used previously published and new data on floating ocean plastics (n = 11,777 stations) to create a global time-series that estimates the average counts and mass of small plastics in the ocean surface layer from 1979 to 2019. Today's global abundance is estimated at approximately 82-358 trillion plastic particles weighing 1.1-4.9 million tonnes. We observed no clear detectable trend until 1990, a fluctuating but stagnant trend from then until 2005, and a rapid increase until the present. This observed acceleration of plastic densities in the world's oceans, also reported for beaches around the globe, demands urgent international policy interventions.

Predicted growth in plastic waste exceeds efforts to mitigate plastic pollution

Plastic pollution is a planetary threat, affecting nearly every marine and freshwater ecosystem globally. In response, multilevel mitigation strategies are being adopted but with a lack of quantitative assessment of how such strategies reduce plastic emissions. We assessed the impact of three broad management strategies, plastic waste reduction, waste management, and environmental recovery, at different levels of effort to estimate plastic emissions to 2030 for 173 countries. We estimate that 19 to 23 million metric tons, or 11%, of plastic waste generated globally in 2016 entered aquatic ecosystems. Considering the ambitious commitments currently set by governments, annual emissions may reach up to 53 million metric tons per year by 2030. To reduce emissions to a level well below this prediction, extraordinary efforts to transform the global plastics economy are needed.

Predicted growth in plastic waste exceeds efforts to mitigate plastic pollution

Plastic pollution is a planetary threat, affecting nearly every marine and freshwater ecosystem globally. In response, multilevel mitigation strategies are being adopted but with a lack of quantitative assessment of how such strategies reduce plastic emissions. We assessed the impact of three broad management strategies, plastic waste reduction, waste management, and environmental recovery, at different levels of effort to estimate plastic emissions to 2030 for 173 countries. We estimate that 19 to 23 million metric tons, or 11%, of plastic waste generated globally in 2016 entered aquatic ecosystems. Considering the ambitious commitments currently set by governments, annual emissions may reach up to 53 million metric tons per year by 2030. To reduce emissions to a level well below this prediction, extraordinary efforts to transform the global plastics economy are needed.

Mitigation strategies to reverse the rising trend of plastics in Polar Regions

Plastic marine pollution in the Arctic today illustrates the global distribution of plastic waste of all sizes traveling by wind and waves, entering food chains, and presenting challenges to management and mitigation. While currents move plastics from lower latitudes into the Arctic, significant waste is also generated by remote communities, as well as maritime activities, such as shipping, fishing and tourism, which are increasing their activities as seasonal sea ice diminishes. Mitigation strategies may include monitoring programs of plastic waste abundance and distribution, improved waste management in Arctic communities, Extended Producer Responsibility (EPR) to reverse the transport of waste plastics and packaging from remote communities, incentivized gear recovery of abandoned, lost and discarded fishing gear (ALDFG), gear tagging and tracking, and restricting tourism and employing "leave no trace" policies. Here we report how these mitigation strategies are employed in the Arctic to minimize plastic waste impacts, and move Arctic communities toward better materials management and circular economic practices. The evidence of harm from waste plastics exacerbated by the ubiquity of plastic marine pollution in all biomes, and the rapid reporting of ecological and social costs, together suggest that we know enough to act quickly to manage and mitigate plastics from all sources to the Arctic.

Spatial trends and drivers of marine debris accumulation on shorelines in South Eleuthera, The Bahamas using citizen science

This study measured spatial distribution of marine debris stranded on beaches in South Eleuthera, The Bahamas. Citizen science, fetch modeling, relative exposure index and predictive mapping were used to determine marine debris source and abundance. Citizen scientists quantified debris type and abundance on 16 beaches within three coastal exposures (The Atlantic Ocean, Great Bahama Bank and The Exuma Sound) in South Eleuthera. Marine debris, (~2.5 cm or larger) on each beach was monitored twice between March-May and September-November 2013 at the same locations using GPS. Approximately, 93% of all debris items were plastic with plastic fragments (≤2.5 cm) being the most common. There were spatial differences (p ≤ 0.0001) in plastic debris abundance between coastal exposures. Atlantic Ocean beaches had larger quantities of plastic debris by weight and by meter (m) of shoreline. Stranded plastic may be associated with Atlantic Ocean currents associated with leakage from the North Atlantic sub-tropical gyre.

Double trouble in the South Pacific subtropical gyre: Increased plastic ingestion by fish in the oceanic accumulation zone

Fish are an important food source for South Pacific (SP) island countries, yet there is little information on contamination of commercial marine fish species by plastic. The aim of our study was to perform a broad-scale assessment of plastic ingestion by fish common in the diet of SP inhabitants. We examined 932 specimens from 34 commercial fish species across four SP locations, and some of the prey they ingested, for the presence of marine plastics. Plastic was found in 33 species, with an average ingestion rate (IR) of 24.3 ± 1.4% and plastic load of 2.4 ± 0.2 particles per fish. Rapa Nui fish exhibited the greatest IR (50.0%), significantly greater than in other three locations. Rapa Nui is located within the SP subtropical gyre, where the concentration of marine plastics is high and food is limited. Plastic was also found in prey, which confirms the trophic transfer of microplastics.

Microplastic sampling with the AVANI trawl compared to two neuston trawls in the Bay of Bengal and South Pacific

Many typical neuston trawls can only be used during relatively calm sea states and slow tow speeds. During two expeditions to the Bay of Bengal and the eastern South Pacific we investigated whether the new, high-speed AVANI trawl (All-purpose Velocity Accelerated Net Instrument) collects similar amounts and types of microplastics as two established scientific trawl designs, the manta trawl and the DiSalvo neuston net. Using a 335 μm net, the AVANI trawl can collect microplastics from the sea surface at speeds up to 8 knots as it "skis" across the surface, whereas the manta and DiSalvo neuston trawls must be towed slowly in a less turbulent sea state and often represent shorter tow lengths. Generally, the AVANI trawl collected a greater numerical abundance and weight of plastic particles in most size classes and debris types than the manta trawl and DiSalvo neuston net, likely because these trawls only skim the surface layer while the AVANI trawl, moving vertically in a random fashion, collects a "deeper" sample, capturing the few plastics that float slightly lower in the water column. However, the samples did not differ enough that results were significantly affected, suggesting that studies done with these different trawls are comparable. The advantage of the AVANI trawl over traditional research trawls is that it allows for collection on vessels underway at high speeds and during long transits, allowing for a nearly continuous sampling effort over long distances. As local surface currents make sea surface abundance widely heterogeneous, widely spaced short-tow trawls, such as the manta and DiSalvo trawls, can catch or miss hotspots or meso-scale variability of microplastic accumulations, whereas the AVANI trawl, if utilized for back-to-back tows of intermediate distances (5-10 km), can bridge variable wind conditions and debris concentrations potentially reducing variance and provide a greater resolution of spatial distribution.

Cardioprotective effects of the MR contrast agent MnDPDP and its metabolite MnPLED upon reperfusion of the ischemic porcine myocardium

Purpose: To evaluate whether manganese dipyridoxyl diphosphate (MnDPDP) or its metabolite manganese dipyridoxyl ethyldiamine (MnPLED) reduces post-ischemic myocardial injury.

Material and Methods: Left anterior descending artery (LAD) in anesthetized pigs was occluded (30 min) followed by reperfusion (120 min) during hemodynamic monitoring and infarct assessment. Three μmol/kg MnDPDP, 1 μmol/kg MnPLED (or a mixture of both) or saline was injected i.v. 10 min before reperfusion followed by infusion of either 3 μmol/kg/h MnDPDP, 1 μmol/kg/h MnPLED (or a mixture of both) or saline. The plasma concentrations of MnDPDP, MnPLED and other metabolites (e.g., ZnDPDP and ZnPLED) were analyzed.

Results: Femoral blood flow was reduced by 60% during early reperfusion in controls, whereas only 23 and 31% reductions were seen in animals treated with MnDPDP and MnPLED. During that time, +LV/dP and -LV/dP (maximum rate of left ventricular isovolumic contraction and relaxation, respectively), systolic pressure and diastolic pressure fell significantly less in animals treated with MnDPDP or MnPLED. Three out of 5 control animals experienced ventricular fibrillation (VF) during reperfusion, whereas VF was not seen in any of the pigs treated with MnPLED or/and MnDPDP. The infarct sizes in saline- and MnPLED-treated animals were 39±6 and 16±5%, respectively, of the occluded areas. MnDPDP did not reduce the infarct size. A mixture of MnDPDP and MnPLED significantly reduced infarct size (10±4%). When reperfusion started and throughout reperfusion, almost all injected MnDPDP was present as Zn-metabolites.

Conclusion: MnPLED seems to reduce reperfusion-induced cardiac dysfunction and infarct size in pigs. MnDPDP does not reduce infarct size in the pig, probably because of the rapid exchange of Mn2+ for Zn2+ taking place in the pig.

Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy

Aims

Cardiac resynchronization therapy (CRT) in heart failure is limited by many non-responders. This study explores whether degree of wasted left ventricular (LV) work identifies CRT responders.

Methods and results

Twenty-one patients who received CRT according to guidelines were studied before and after 8 ± 3 months. By definition, segments that shorten in systole perform positive work, whereas segments that lengthen do negative work. Work was calculated from non-invasive LV pressure and strain by speckle tracking echocardiography. For each myocardial segment and for the entire LV, wasted work was calculated as negative work in percentage of positive work. LV wall motion score index (WMSI) was assessed by echocardiography. Response to CRT was defined as ≥15% reduction in end-systolic volume (ESV). Responder rate to CRT was 71%. In responders, wasted work for septum was 117 ± 102%, indicating more negative than positive work, and decreased to 14 ± 12% with CRT (P < 0.01). In the LV free wall, wasted work was 19 ± 16% and showed no significant change. Global LV wasted work decreased from 39 ± 21 to 17 ± 7% with CRT (P < 0.01). In non-responders, there were no significant changes. In multiple linear regression analysis, septal wasted work and WMSI were the only significant predictors of ESV reduction (β = 0.14, P = 0.01; β = 1.25, P = 0.03). Septal wasted work together with WMSI showed an area under the curve of 0.86 (95% confidence interval 0.71–1.0) for CRT response prediction.

Conclusion

Wasted work in the septum together with WMSI was a strong predictor of response to CRT. This novel principle should be studied in future larger studies.

Plastic Pollution in the World's Oceans: More than 5 Trillion Plastic Pieces Weighing over 250,000 Tons Afloat at Sea

Plastic pollution is ubiquitous throughout the marine environment, yet estimates of the global abundance and weight of floating plastics have lacked data, particularly from the Southern Hemisphere and remote regions. Here we report an estimate of the total number of plastic particles and their weight floating in the world's oceans from 24 expeditions (2007–2013) across all five sub-tropical gyres, costal Australia, Bay of Bengal and the Mediterranean Sea conducting surface net tows (N = 680) and visual survey transects of large plastic debris (N = 891). Using an oceanographic model of floating debris dispersal calibrated by our data, and correcting for wind-driven vertical mixing, we estimate a minimum of 5.25 trillion particles weighing 268,940 tons. When comparing between four size classes, two microplastic <4.75 mm and meso- and macroplastic >4.75 mm, a tremendous loss of microplastics is observed from the sea surface compared to expected rates of fragmentation, suggesting there are mechanisms at play that remove <4.75 mm plastic particles from the ocean surface.

High-levels of microplastic pollution in a large, remote, mountain lake

Despite the large and growing literature on microplastics in the ocean, little information exists on microplastics in freshwater systems. This study is the first to evaluate the abundance, distribution, and composition of pelagic microplastic pollution in a large, remote, mountain lake. We quantified pelagic microplastics and shoreline anthropogenic debris in Lake Hovsgol, Mongolia. With an average microplastic density of 20,264 particles km(-2), Lake Hovsgol is more heavily polluted with microplastics than the more developed Lakes Huron and Superior in the Laurentian Great Lakes. Fragments and films were the most abundant microplastic types; no plastic microbeads and few pellets were observed. Household plastics dominated the shoreline debris and were comprised largely of plastic bottles, fishing gear, and bags. Microplastic density decreased with distance from the southwestern shore, the most populated and accessible section of the park, and was distributed by the prevailing winds. These results demonstrate that without proper waste management, low-density populations can heavily pollute freshwater systems with consumer plastics.

Polybrominated diphenyl ethers (PBDEs) in fish tissue may be an indicator of plastic contamination in marine habitats

The accumulation of plastic debris in pelagic habitats of the subtropical gyres is a global phenomenon of growing concern, particularly with regard to wildlife. When animals ingest plastic debris that is associated with chemical contaminants, they are at risk of bioaccumulating hazardous pollutants. We examined the relationship between the bioaccumulation of hazardous chemicals in myctophid fish associated with plastic debris and plastic contamination in remote and previously unmonitored pelagic habitats in the South Atlantic Ocean. Using a published model, we defined three sampling zones where accumulated densities of plastic debris were predicted to differ. Contrary to model predictions, we found variable levels of plastic debris density across all stations within the sampling zones. Mesopelagic lanternfishes, sampled from each station and analyzed for bisphenol A (BPA), alkylphenols, alkylphenol ethoxylates, polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), exhibited variability in contaminant levels, but this variability was not related to plastic debris density for most of the targeted compounds with the exception of PBDEs. We found that myctophid sampled at stations with greater plastic densities did have significantly larger concentrations of BDE#s 183 -209 in their tissues suggesting that higher brominated congeners of PBDEs, added to plastics as flame-retardants, are indicative of plastic contamination in the marine environment. Our results provide data on a previously unsampled pelagic gyre and highlight the challenges associated with characterizing plastic debris accumulation and associated risks to wildlife.

Microplastic pollution in the surface waters of the Laurentian Great Lakes

Neuston samples were collected at 21 stations during an ~700 nautical mile (~1300 km) expedition in July 2012 in the Laurentian Great Lakes of the United States using a 333 μm mesh manta trawl and analyzed for plastic debris. Although the average abundance was approximately 43,000 microplastic particles/km², station 20, downstream from two major cities, contained over 466,000 particles/km², greater than all other stations combined. SEM analysis determined nearly 20% of particles less than 1 mm, which were initially identified as microplastic by visual observation, were aluminum silicate from coal ash. Many microplastic particles were multi-colored spheres, which were compared to, and are suspected to be, microbeads from consumer products containing microplastic particles of similar size, shape, texture and composition. The presence of microplastics and coal ash in these surface samples, which were most abundant where lake currents converge, are likely from nearby urban effluent and coal burning power plants.

The plastic-associated microorganisms of the North Pacific Gyre

Microorganisms likely mediate processes affecting the fate and impacts of marine plastic pollution, including degradation, chemical adsorption, and colonization or ingestion by macroorganisms. We investigated the relationship between plastic-associated microorganism communities and factors such as location, temperature, salinity, plankton abundance, plastic concentration, item size, surface roughness, and polymer type. Small plastic items from the surface of the North Pacific Gyre in 2011 were examined using scanning electron microscopy. Bacillus bacteria (mean 1664 ± 247 individuals mm(-2)) and pennate diatoms (1097 ± 154 mm(-2)) were most abundant, with coccoid bacteria, centric diatoms, dinoflagellates, coccolithophores, and radiolarians present. Bacterial abundance was patchy, but increased on foamed polystyrene. Diatom abundance increased on items with rough surfaces and at sites with high plastic concentrations. Morphotype richness increased slightly on larger fragments, and a biogeographic transition occurred between pennate diatom groups. Better characterizing this community will aid in understanding how it interacts with plastic pollution.

A pilot study quantifying the shape of tidal breathing waveforms using centroids in health and COPD

During resting tidal breathing the shape of the expiratory airflow waveform differs with age and respiratory disease. While most studies quantifying these changes report time or volume specific metrics, few have concentrated on waveform shape or area parameters. The aim of this study was to derive and compare the centroid co-ordinates (the geometric centre) of inspiratory and expiratory flow-time and flow-volume waveforms collected from participants with or without COPD. The study does not aim to test the diagnostic potential of these metrics as an age matched control group would be required. Twenty-four participants with COPD and thirteen healthy participants who underwent spirometry had their resting tidal breathing recorded. The flow-time data was analysed using a Monte Carlo simulation to derive the inspiratory and expiratory flow-time and flow-volume centroid for each breath. A comparison of airflow waveforms show that in COPD, the breathing rate is faster (17 ± 4 vs 14 ± 3 min(-1)) and the time to reach peak expiratory flow shorter (0.6 ± 0.2 and 1.0 ± 0.4 s). The expiratory flow-time and flow-volume centroid is left-shifted with the increasing asymmetry of the expired airflow pattern induced by airway obstruction. This study shows that the degree of skew in expiratory airflow waveforms can be quantified using centroids.

Plastic pollution in the South Pacific subtropical gyre

Plastic marine pollution in the open ocean of the southern hemisphere is largely undocumented. Here, we report the result of a (4489 km) 2424 nautical mile transect through the South Pacific subtropical gyre, carried out in March-April 2011. Neuston samples were collected at 48 sites, averaging 50 nautical miles apart, using a manta trawl lined with a 333 μm mesh. The transect bisected a predicted accumulation zone associated with the convergence of surface currents, driven by local winds. The results show an increase in surface abundance of plastic pollution as we neared the center and decrease as we moved away, verifying the presence of a garbage patch. The average abundance and mass was 26,898 particles km(-2) and 70.96 g km(-2), respectively. 88.8% of the plastic pollution was found in the middle third of the samples with the highest value of 396,342 particles km(-2) occurring near the center of the predicted accumulation zone.

Plastic pollution in the South Pacific subtropical gyre

Plastic marine pollution in the open ocean of the southern hemisphere is largely undocumented. Here, we report the result of a (4489 km) 2424 nautical mile transect through the South Pacific subtropical gyre, carried out in March-April 2011. Neuston samples were collected at 48 sites, averaging 50 nautical miles apart, using a manta trawl lined with a 333 μm mesh. The transect bisected a predicted accumulation zone associated with the convergence of surface currents, driven by local winds. The results show an increase in surface abundance of plastic pollution as we neared the center and decrease as we moved away, verifying the presence of a garbage patch. The average abundance and mass was 26,898 particles km(-2) and 70.96 g km(-2), respectively. 88.8% of the plastic pollution was found in the middle third of the samples with the highest value of 396,342 particles km(-2) occurring near the center of the predicted accumulation zone.

Estimation of tidal ventilation in preterm and term newborn infants using electromagnetic inductance plethysmography

Tidal volume (VT) measurements in newborn infants remain largely a research tool. Tidal ventilation and breathing pattern were measured using a new device, FloRight, which uses electromagnetic inductive plethysmography,and compared simultaneously with pneumotachography in 43 infants either receiving no respiratory support or continuous positive airway pressure (CPAP).Twenty-three infants were receiving CPAP (gestational age 28 ± 2 weeks, mean ± SD) and 20 were breathing spontaneously (gestational age 34 ± 4 weeks). The two methods were in reasonable agreement, with VT (r2 = 0.69) ranging from 5 to 23 ml (4–11 ml kg−1) with a mean difference of 0.4 ml and limit of agreement of −4.7 to + 5.5 ml. For respiratory rate, minute ventilation,peak flow and breathing pattern indices, the mean difference between the two methods ranged between 0.7% and 5.8%. The facemask increased the respiratory rate (P < 0.001) in both groups with the change in VT being more pronounced in the infants receiving no respiratory support. Thus, FloRight provides an easy to use technique to measure term and preterm infants in the clinical environment without altering the infant's breathing pattern.

Prevalence of raised Yersinia enterocolitica antibody titre in unselected, adult populations in Denmark during 12 years

Yersinia enterocolitica biotype 4, serotype 0:3 is by far the most common human pathogenic Yersinia enterocolitica subtype in Scandinavia. It is extraordinarily immunologically specific, and an elevated antibody titre greater than or equal 80-160 is known to indicate acute infection. This titre was measured in five population surveys conducted in 1967-78, including 3278 examined adult men and women. The prevalence of titre elevation greater than or equal to was 1.0% in 1967. In 1978 it was significantly higher, 7.7%, and also the individual course of the titre in a ten-year longitudinal survey showed a significant increase in this prevalence, indicating an increasing incidence of infection. Significant sex and age differences were seen, women and younger subjects being more frequently affected than men and older subjects. The prevalence of elevated titre showed a seasonal variation with a maximum in the spring and autumn.

An ecological assessment of bisphenol-A: Evidence from comparative biology

This review assesses the effects of environmental concentrations of bisphenol-A (BPA) on wildlife. Water concentrations of BPA vary tremendously due to proximity to point and non-point sources, but reported concentrations in stream/river water samples are less than 21 microg/L, and concentrations in landfill leacheate are less than 17.2mg/L. Extensive evidence indicates that BPA induces feminization during gonadal ontogeny of fishes, reptiles, and birds, but in all cases the amount of BPA necessary to cause such ontogenetic disruption exceeds concentrations in the environment. Extensive evidence also exists that adult exposure to environmental concentrations of BPA is detrimental to spermatogenetic endpoints and stimulates vitellogenin synthesis in model species of fish. Most of the reported effects of BPA on vertebrate wildlife species can be attributed to BPA acting as an estrogen receptor agonist, but mechanisms of disruption in invertebrates are less certain. A comparison of measured BPA environmental concentrations with chronic values suggests that no significant margin of safety exists for the protection of aquatic communities against the toxicity of BPA. Further studies should examine the most vulnerable vertebrate and invertebrate species.

Cardiac fibrinolytic capacity is markedly increased after brief periods of local myocardial ischemia, but declines following successive periods in anesthetized pigs

BACKGROUND

Fibrinolysis in blood is mainly reflected by the activities of tissue plasminogen activator (tPA) and of plasminogen activator inhibitor-1 (PAI-1). The effect of myocardial ischemia on their activities in the coronary circulation is, however, not established.

OBJECTIVES

With an improved experimental model, we therefore examined the effect of a brief period of myocardial ischemia on their activities. Furthermore, the consequences of repeated periods of ischemia, mimicking the situations in patients with unstable angina, were investigated.

METHODS

In six anesthetized pigs, we occluded the distal left anterior descending coronary artery (LAD) four times for 10 min with 40 min intervals and determined the activities of tPA and PAI-1 in arterial and coronary venous blood. By simultaneously recording LAD flow, we could estimate cardiac release of these factors at baseline conditions and during reperfusion.

RESULTS

Neither net cardiac release of PAI-1 nor alterations in plasma PAI-1 levels were demonstrated during the experiment. However, a significant net release of tPA activity of 10.4 +/- 3.2 IU mL(-1) (P < 0.005) was recorded during baseline conditions. During reperfusion following the first period of ischemia, the cardiac release of tPA activity increased to a peak of 103 +/- 30-fold baseline release, but declined progressively after repeated periods of ischemia. After the fourth period, tPA release did not exceed an estimated baseline accumulation during ischemia and early reperfusion.

CONCLUSIONS

In this porcine model, a substantial local increase in fibrinolytic capacity was observed after brief periods of ischemia, but declined subsequently by repeated periods of ischemia.

Oxygen delivery and return of spontaneous circulation with ventilation:compression ratio 2:30 versus chest compressions only CPR in pigs

The need for rescue breathing during the initial management of sudden cardiac arrest is currently being debated and reevaluated. The present study was designed to compare cerebral oxygen delivery during basic life support (BLS) by chest compressions only with chest compressions plus ventilation in pigs with an obstructed airway mimicked by a valve hindering passive inhalation. Resuscitability was then studied during the subsequent advanced life support (ALS) period. After 3 min of untreated ventricular fibrillation (VF) BLS was started. The animals were randomised into two groups. One group received chest compressions only. The other group received ventilations and chest compressions with a ratio of 2:30. A gas mixture of 17% oxygen and 4% carbon dioxide was used for ventilation during BLS. After 10 min of BLS, ALS was provided. All six pigs ventilated during BLS attained a return of spontaneous circulation (ROSC) within the first 2 min of advanced cardiopulmonary resuscitation (CPR) compared with only one of six compressions-only pigs. While all except one compressions-only animal achieved ROSC before the experiment was terminated, the median time to ROSC was shorter in the ventilated group. With a ventilation:compression ratio of 2:30 the arterial oxygen content stayed at 2/3 of normal, but with compressions-only, the arterial blood was virtually desaturated with no arterio-venous oxygen difference within 1.5-2 min. Haemodynamic data did not differ between the groups. In this model of very ideal BLS, ventilation improved arterial oxygenation and the median time to ROSC was shorter. We believe that in cardiac arrest with an obstructed airway, pulmonary ventilation should still be strongly recommended.

Increased spillover of norepinephrine to the portal vein during CO-pneumoperitoneum in pigs

BACKGROUND

Elevated intra abdominal pressure (IAP) during CO2-insufflation has been associated with increased catecholamine concentrations in plasma. We have previously indicated that this may be due to a regional increased spillover from the abdominal region. In this experimental study we investigated catecholamine spillover from the drainage area of the portal vein during CO2-pneumoperitoneum.

METHODS

Eight pigs under general anesthesia were investigated before and after CO2-pneumoperitoneum with an IAP of 15 mmHg. Regional spillover of catecholamines was determined by measuring plasma catecholamine concentrations and flow simultaneously. Plasma concentrations of catecholamines were measured from the portal and femoral veins, the pulmonary and carotid arteries. Flow data were collected with laser-Doppler transit time flow probes around the portal and femoral veins. Cardiac output was measured by the thermo-dilution technique. Estimated spillover was calculated by the veno-arterial difference multiplied by flow.

RESULTS

We found a significant increase in estimated spillover of norepinephrine from the drainage area of the portal vein from 10 (-1.2, 78) ng x min(-1) to 27 (1.8, 475) ng x min(-1)[median (range)] (P = 0.05), but no change in estimated spillover of norepinephrine from the drainage area of the femoral vein. Plasma concentrations of norepinephrine increased in central venous and arterial blood. There was no significant change in epinephrine concentrations in arterial blood.

CONCLUSION

Estimated norepinephrine spillover from the drainage area of the portal vein increased during CO2-pneumoperitoneum in pigs. This may indicate that the increased norepinephrine concentrations found in arterial plasma reflects a local activation of sympathetic nerves in the region of the portal drainage area.

Quality of CPR with three different ventilation:compression ratios

Current adult basic cardiopulmonary resuscitation (CPR) guidelines recommend a 2:15 ventilation:compression ratio, while the optimal ratio is unknown. This study was designed to compare arterial and mixed venous blood gas changes and cerebral circulation and oxygen delivery with ventilation:compression ratios of 2:15, 2:50 and 5:50 in a model of basic CPR. Ventricular fibrillation (VF) was induced in 12 anaesthetised pigs, and satisfactory recordings were obtained from 9 of them. A non-intervention interval of 3 min was followed by CPR with pauses in compressions for ventilation with 17% oxygen and 4% carbon dioxide in a randomised, cross-over design with each method being used for 5 min. Pulmonary gas exchange was clearly superior with a ventilation:compression ratio of 2:15. While the arterial oxygen saturation stayed above 80% throughout CPR for 2:15, it dropped below 40% during part of the ventilation:compression cycle for both the other two ratios. On the other hand, the ratio 2:50 produced 30% more chest compressions per minute than either of the two other methods. This resulted in a mean carotid flow that was significantly higher with the ratio of 2:50 than with 5:50 while 2:15 was not significantly different from either. The mean cerebrocortical microcirculation was approximately 37% of pre-VF levels during compression cycles alone with no significant differences between the methods. The oxygen delivery to the brain was higher for the ratio of 2:15 than for either 5:50 or 2:50. In parallel the central venous oxygenation, which gives some indication of tissue oxygenation, was higher for the ratio of 2:15 than for both 5:50 and 2:50. As the compressions were done with a mechanical device with only 2-3 s pauses per ventilation, the data cannot be extrapolated to laypersons who have great variations in quality of CPR. However, it might seem reasonable to suggest that basic CPR by professionals should continue with ratio of 2:15 at present if it can be shown that similar brief pauses for ventilation can be achieved in clinical practice.

Circulatory responses to a meal in patients with a newly transplanted heart

It is well established that consumption of a meal releases a gradually developing and quite marked increase in blood flow to the gastrointestinal organs and a similar and simultaneous increase in cardiac output (CO). It is not known through which mechanism the pumping of the heart adjusts so accurately to the gastrointestinal flow increase. We have approached this problem by serving a standardized, mixed meal to five patients with recently transplanted and thus denervated hearts and to five sex- and age-matched controls. Pre- and postprandial levels of CO and blood flow in the superior mesenteric artery (SMA) were recorded with Doppler ultrasound technique. The patients with transplanted hearts had significantly higher preprandial levels of heart rate (HR) and CO than the controls. With a timing similar to that seen in the controls did all five patients develop considerable and synchronous postprandial increases in superior mesenteric arterial flow and in CO. Increases in superior mesenteric arterial flow were significantly greater than the controls. Also, COs, high even before meals were given, increased further and to the same relative extent as in the control persons. The marked postprandial increase in CO, probably secondary to the increase in intestinal blood flow, could hardly come about through any sort of nervous reflex to the recently transplanted and denervated hearts. It appears more likely that a humoral connection of some sort exists between the two circulatory events.

Muscle contractile properties during intermittent nontetanic stimulation in rat skeletal muscle

To examine changes in contractile properties and mechanisms of fatigue during submaximal nontetanic skeletal muscle activity, in situ perfused soleus (60-min protocol) and extensor digitorum longus (EDL; 10-min protocol) muscles of the rat were electrically stimulated intermittently at low frequency. The partly fused trains of contractions showed a two-phase change in appearance. During the first phase, relaxation slowed, one-half relaxation time increased, and maximal relaxation first derivative of force (dF/dt) decreased. Developed force during the trains was reduced and was closely related to the rate of relaxation in this first phase. During the second phase, relaxation became faster again, one-half relaxation time decreased, and force returned to resting levels between contractions in a train. In contrast, developed force remained reduced, so that peak force of the contractions was 51% (soleus) and 30% (EDL) of control. In the soleus muscle, the changes in contractile properties were not related to ATP, creatine phosphate, or lactate content. The changes in contractile properties fit best with a mechanism of fatigue involving changes in Ca(2+) handling by the sarcoplasmic reticulum.

Reducing CPR artefacts in ventricular fibrillation in vitro

CPR creates artefacts on the ECG, and a pause in CPR is therefore mandatory during rhythm analysis. This hands-off interval is harmful to the already marginally circulated tissues during CPR, and if the artefacts could be removed by filtering, the rhythm could be analyzed during ongoing CPR. Fixed coefficient filters used in animals cannot solve this problem in humans, due to overlapping frequency spectra for artefacts and VF signals. In the present study, we established a method for mixing CPR-artefacts (noise) from a pig with human VF (signal) at various signal-to-noise ratios (SNR) from -10 dB to +10 dB. We then developed a new methodology for removing CPR artefacts by applying a digital adaptive filter, and compared the results with this filter to that of a fixed coefficient filter. The results with the adaptive filter clearly outperformed the fixed coefficient filter for all SNR levels. At an original SNR of 0 dB, the restored SNRs were 9.0+/-0.7 dB versus 0.9+/-0.7 dB respectively (P<0.0001).

Mental disorders in medical inpatients and the association to severity of illness, self-rated physical disability, and health perception

In a study of 294 consecutive medical inpatients, the authors assessed a subsample of 157 patients for psychiatric diagnoses using an extensive semistructured interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients rated their health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A life-threatening condition increased odds for having a psychiatric diagnosis by 3.1 times (95% Confidence Interval (CI): 1.03-9.1), while a chronic medical disease had no such impact (OR=1.1; 95% CI: 0.5-2.3). In women, mental disorders were strongly associated with self-rated disability (OR=6.7; 95% CI: 1.6-27.8) and self-rated health (OR=9.4; 95% CI: 2.7-32.4). This association was absent in men (OR(disability)=0.7; 95% CI: 0.2-2.7; OR(health)=1.6; 95% CI: 0.6-4.7). Analyses included adjustment for age and gender.

Electrophysiological evidence of reinnervation of the transplanted human heart

Beat-by-beat heart rate (HR) changes during exercise were studied in two young and fit heart-transplanted humans at different time intervals following transplantation. Upon the start of the exercise, a slow gradual increase in HR was seen during the early experiments after the transplantation, whereas an immediate rapid increase in HR was observed during the later experiments. From standard ECGs obtained 32 months after transplantation, two P waves at somewhat different rates could be identified in both subjects, probably arising from donor and recipient sinoatrial nodes, respectively. The two P wave rate changes during and following exercise were very similar. We conclude that these changes in the HR pattern and ECG must be due to reinnervation of the donor hearts, most likely by parasympathetic cardiac fibers.

Development of oxygen sensitivity in infants of smoking and non-smoking mothers

AIMS

To assess the effect of prenatal cigarette smoke exposure on the postnatal resetting of oxygen sensitivity in term infants.

METHODS

15 healthy term infants of smoking mothers (median 10 cigarettes/day) and 16 controls were studied during quiet sleep 1, 3, and 10 days and 10 weeks postnatally. Strain-gauge respiratory trace was continuously recorded. Repeated 15-s challenges with 100% O2 and 15% O2 were presented in randomised order through a face mask. A median of six hyperoxic and six hypoxic challenges per recording were obtained. Breath-by-breath ventilation in a time-window from 20 s before onset of stimulus to 60 s after was extracted. For each infant at each age, the normalised coherently averaged response to hyperoxia and hypoxia was calculated. Mean ventilation at end of the 15-s stimulus was analysed with ANOVA, as were parameters describing a function fitted to each averaged response.

RESULTS

During air breathing, smoke-exposed infants had higher respiratory rates and lower tidal volumes than controls. Nicotine concentration in infant hair, measured by gas chromatography, was positively correlated with maternal level of smoking. A long-term development in oxygen sensitivity was demonstrated in both groups. However, neither the time-course nor the magnitude of O2 responses was affected by maternal smoking. Overall, hyperoxia reduced ventilation by 6.3% at day 1, 13.2% at day 3, 29.6% at day 10, and 40.0% at week 10. Transient hypoxia increased ventilation by 3.5%, 3.2%, 6.4%, and 8.8%, respectively, at the four ages studied.

Involvement of the human splanchnic circulation in pressor response induced by handgrip contraction

We have analysed the adjustment of blood flow and vascular conductance in the abundantly supplied splanchnic circulation to a generally released pressor reaction. Pressor responses were induced by 2-min periods of standardized, sustained handgrip in seven healthy students. The effects of handgrip tests were followed both in the fasting state and after the consumption of a substantial, mixed meal. In the first of the two sessions, changes in superior mesenteric artery blood flow were recorded and concomitant changes in local vascular conductance derived. In the other session, pressor released cardiac output changes were recorded and changes in total peripheral vascular conductance derived. Both types of flow changes were recorded using ultrasound Doppler technique. Typically, blood flow in the superior mesenteric artery increased two- to threefold after a meal. Handgrip contractions induced an initial rapid increase in heart rate, cardiac output and total peripheral conductance, followed by a gradual decline in total peripheral conductance and stroke volume and a gradual increase in heart rate and mean arterial pressure for the rest of the period. At the end of 2-min pressor periods, total peripheral conductance was only about 10% below the pre-handgrip level, whereas vascular conductance locally in the area of the superior mesenteric artery decreased by some 30%. Thus, it appears that the splanchnic vascular bed contributes markedly to the compound pressor response. Handgrips caused significantly less reduction in local vascular conductance in the post-prandial than in the pre-prandial state, indicating that blood flow to the digesting gastrointestinal tract retains a relatively high priority also in a pressor situation.

A method of assessing ventilatory responses to chemoreceptor stimulation in infants

Various methods of assessing infant chemoreceptor responses have been reported in the literature. However, equipment dead space, trigeminal stimulation and inherent respiratory variability may have affected the results. A method is presented which attempts to reduce the effect of these factors and thereby isolate the chemoreceptor response. Inspiratory gas was delivered into a lightweight face mask with a pliable rim, minimal dead space and a connected pneumotachograph. Ventilatory data were computed breath by breath. Computer-controlled electromagnetic valves allowed instantaneous switching between air and different gas mixtures, repeated in a randomized sequence. In 18 healthy term neonates, the mask increased ventilation by 12% (95% confidence interval 6-18%), measured by calibrated strain-gauge bands. The effect on respiratory frequency and tidal volume differed significantly between sleep states. Neonates were challenged with short-lasting hyperoxia, mild hypoxia, rebreathing and mild hypercapnia. Coherent averaging of several ventilatory responses from each sleep state reduced the variability while maintaining a high time-resolution.