Modeling the impact of heat stress on the toxicokinetics of toluene and acetone

Many workers can be exposed simultaneously to heat and volatile chemicals. In a controlled human exposure study, it was observed that an increase in ambient temperature was associated with increased blood concentrations for acetone and toluene. Based on the expected changes in physiological parameters that occur with an increase in ambient temperature, we aimed to develop a PBPK model for acetone and toluene that could account for the impact of temperature on the kinetics of these solvents. Changes in temperature-dependent physiological parameters (i.e. blood flows, cardiac output, alveolar ventilation) based on recent measurements in volunteers were introduced in the PBPK models to simulate observed blood concentrations for different temperature exposure conditions. Because initial simulations did not adequately predict solvent kinetics at any temperature, the most sensitive parameter (alveolar ventilation; Qp) was, therefore, optimized on experimental acetone blood concentrations to obtain a relationship with temperature. The new temperature-dependent Qp relationship gave Qp values consistent with the literature and estimated a mean increase of 19% at 30 °C (wet bulb globe temperature) compared to 21 °C. The integration of a new temperature-dependent Qp relationship in the PBPK toluene model yielded adequate simulations of the experimental data for toluene in blood, exhaled air and urine. With further validation with other solvents, the temperature-dependant PBPK model could be a useful tool to better assess the risks of simultaneous exposure to volatile chemicals and heat stress and interpret biomonitoring data in workers as well as in the general population. TRN: NCT02659410, Registration date: January 15, 2016.

Determination of blood:air, urine:air and plasma:air partition coefficients of selected microbial volatile organic compounds

Partition coefficients (PCs) are essential parameters for understanding the toxicokinetics of chemicals in the human body since they are used in the description of different processes of absorption, distribution, and excretion in physiologically based pharmacokinetic (PBPK) models used in chemical exposure and risk assessment. The goal of this study was to determine urine:air, blood:air and plasma:air partition coefficients (PCs) of microbial volatile organic compounds (mVOCs) previously selected as having high potential as biomarkers of indoor mold exposure. To achieve this goal, the vial-equilibration technique was used, and quantification was performed using headspace gas chromatography tandem mass spectrometry (HS-GC-MS/MS) analysis. Matrix:air PCs of 19 different mVOCs have been successfully determined and their values ranged between 14 and 3586 for urine:air, 78 and 4721 for blood:air and 64 and 5604 for plasma:air PCs. Water:air PCs were also determined, and their values varied between 16 and 2210, showing a good correlation with urine:air PCs for 17 compounds of the selected mVOCs (R2 = 0.97, slope close to unity) indicating that water:air PCs below 103 may be a good surrogate for urine:air PCs. All studied mVOCs have high blood:air PCs (greater than 78) indicating strong pulmonary uptake. Due to their high blood:urine PCs, some mVOCs may be more easily measured in blood than in urine. This work is an important preliminary step toward the use of mVOCs as potential biomarkers of indoor mold exposure. The data obtained in this study will help to determine the most appropriate matrix to use in this biomonitoring approach and will eventually facilitate the development of PBPK models for these chemicals.

Full-scale multisampling and empirical modeling of DBPs in water and air of indoor pools

Disinfection by-products (DBPs) are formed in the water in swimming pools due to reactions between disinfectants (chlorine, bromine, ozone) and the organic matter introduced by bathers and supply water. High concentrations of DBPs are also reported in the air of indoor swimming pools. Based on a robust multisampling program, the levels and variations of DBPs in the air (trichloramine [TCAM] and trihalomethanes [THMs]) and water (THM) were assessed, as well as their precursors (total organic carbon, water temperature, pH, free, and total chlorine) and proxies (CO2 and relative humidity) in four indoor chlorinated swimming pools. High-frequency sampling was conducted during one high-attendance day for each pool. This study focused on parameters that are easy to measure in order to develop models for predicting levels of THMs and TCAM in the air. The results showed that the number of bathers had an important impact on the levels of THMs and TCAM, with a two-to-three-fold increase in air chloroform (up to 110 μg/m3) and a two-to-four-fold increase in TCAM (up to 0.52 mg/m3) shortly after pools opened. The results of this study for the first time showed that CO2 and relative humidity can serve as proxies for monitoring variations in airborne THMs and TCAM. Our results highlight the good predictive capacity of the developed models and their potential for use in day-to-day monitoring. This could help optimize and control DBPs formation in the air of indoor swimming pools and reduce contaminant exposure for both pool employees and users.

Quantification of the Conjugated Forms of Dichlorobisphenol A (3,3'-Cl 2 BPA) in Rat and Human Plasma Using HPLC-MS/MS

BACKGROUND

Bisphenol A (BPA) is a ubiquitous contaminant that has endocrine-disrupting effects. Chlorinated derivatives of BPA are formed during chlorination of drinking water and have higher endocrine-disrupting activity. Dichlorobisphenol A (Cl 2 BPA) is the most abundant chlorinated BPA derivative found in several human biological matrices. Recent in vitro experiments have shown that Cl 2 BPA is metabolized in sulpho- and glucuro-conjugated compounds. To date, no assay has been developed to quantify the sulfo- and glucuro-conjugates of 3,3'-Cl 2 BPA (3,3'-Cl 2 BPA-S and 3,3'-Cl 2 BPA-G, respectively).

METHODS

A high-performance liquid chromatography-tandem mass spectrometry assay for the determination of 3,3'-Cl 2 BPA conjugated forms in plasma samples was developed and validated according to the European Medicines Agency guidelines. Quantification was performed in the multiple reaction monitoring mode for all target analytes using a SCIEX 6500 + tandem mass spectrometer with an electrospray source operating in the negative ionization mode. Chromatographic separation was achieved using a C18 column maintained at 40°C and a binary mobile phase delivered in the gradient mode at a flow rate of 0.35 mL/min. Sample was prepared via simple precipitation using acetonitrile. The assay was validated and applied to rat and human plasma samples.

RESULTS

Linearity was demonstrated over the range of 0.006-25 ng/mL for 3,3'-Cl 2 BPA-G and 0.391-100 ng/mL for 3,3'-Cl 2 BPA-S. Intraday and interday bias values were in the 95%-109% range, and the imprecision <9%. Internal standard corrected matrix effects were also investigated. This method enabled quantification of the conjugated forms of 3,3'-Cl 2 BPA in plasma samples.

CONCLUSIONS

This is the first report on the development and validation of an analytical method for the quantification of 3,3'-Cl 2 BPA-G and 3,3'-Cl 2 BPA-S in the plasma matrix. This study is also the first report on the in vivo occurrence of these metabolites.

CETP inhibitor evacetrapib enters mouse brain tissue

High levels of plasma cholesterol, especially high levels of low-density lipoprotein cholesterol (LDL-C), have been associated with an increased risk of Alzheimer's disease. The cholesteryl ester transfer protein (CETP) in plasma distributes cholesteryl esters between lipoproteins and increases LDL-C in plasma. Epidemiologically, decreased CETP activity has been associated with sustained cognitive performance during aging, longevity, and a lower risk of Alzheimer's disease. Thus, pharmacological CETP inhibitors could be repurposed for the treatment of Alzheimer's disease as they are safe and effective at lowering CETP activity and LDL-C. Although CETP is mostly expressed by the liver and secreted into the bloodstream, it is also expressed by astrocytes in the brain. Therefore, it is important to determine whether CETP inhibitors can enter the brain. Here, we describe the pharmacokinetic parameters of the CETP inhibitor evacetrapib in the plasma, liver, and brain tissues of CETP transgenic mice. We show that evacetrapib crosses the blood-brain barrier and is detectable in brain tissue 0.5 h after a 40 mg/kg i.v. injection in a non-linear function. We conclude that evacetrapib may prove to be a good candidate to treat CETP-mediated cholesterol dysregulation in Alzheimer's disease.

Comparison of sampling collection strategies for assessing airborne trichloramine levels in indoor swimming pools

Since 1995, Hery's trichloramine sampling procedure has been widely used to determine trichloramine exposure in indoor swimming pools. This method consists of pumping air at a 1 L/min flow rate for 2 h through a Teflon prefilter and two quartz fiber filters. Modified Hery methods have been reported using different sampling pump flow rates and types of prefilters. It is possible that the prefilter type or sample collection pump flow rate influenced the results of these studies. This study is designed to evaluate the effects of different cassette assemblies and sampling flow rates on the levels of measured trichloramine. Laboratory tests were performed using a trichloramine production setup designed for this study. Workplace measurements were carried out at four indoor swimming pools. Different prefiltering strategies were used: no prefilter, glass prefilter or Teflon prefilter in the sampling cassette, and an original separable prefilter cassette is presented in this study. Laboratory tests indicated that at trichloramine concentrations higher than 1 mg/m³, the percentage of trichloramine captured on the first filter could be less than 75%, which demonstrated possible loss of the material during sampling. An investigation of the prefilter effect on the sampling strategy using different cassette assemblies revealed that using a separable cassette assembly prevented overestimations of trichloramine levels. Furthermore, there were no significant differences between trichloramine concentrations measured at flow rates (from 0.5 to 2 L/min) in swimming pools.

A new headspace solid-phase microextraction coupled with gas chromatography-tandem mass spectrometry method for the simultaneous quantification of 21 microbial volatile organic compounds in urine and blood

Mold growth can cause the development of several metabolites including microbial volatile organic compounds (mVOCs). These latter may be considered as potential biomarkers of fungal presence and have been detected in human biological matrices such as urine and blood. Exposure to molds and their metabolites (e.g., mVOCs, mycotoxins) in occupational settings, is responsible for several health effects. Thus, this exposure cannot be neglected and must be evaluated. Herein, a method has been developed to quantify 21 mVOCs in urine and human blood by headspace solid phase micro-extraction (HS-SPME) coupled with gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). The parameters influencing the extraction process, such as the type of fiber, the incubation and extraction time and temperature and the desorption time, have been optimized to ensure better mVOCs extraction. The developed method showed good linearity over the concentration range of the compounds (R² ˃ 0.995) for all the mVOCs in all the matrices. The low limits of detection (LOD) ranging from 0.7 to 417 ng/L in urine and from 1 to 507 ng/L in blood, make the developed methods sensitive and effective for biomonitoring of exposure at low levels. Recoveries, at low and high concentrations, were between 87% and 120% in urine and between 83% and 118% in blood. The repeatability and the intermediate precision in terms of coefficients of variation (CV%) was lower than 13% and 8.58% respectively for all compounds in all matrices. These values show satisfactory accuracy and precision of the developed method. Thus, this practical, simple, and sensitive method is well suited for the simultaneous quantification of target mVOCs.

Cardiopulmonary parameters and organ blood flows for workers expressed in terms of VO2 for use in physiologically based toxicokinetic modeling

Minute ventilation rates (VE), alveolar ventilation rates (VA), cardiac outputs (Q), liver blood flow (LBF) and kidneys blood flows (KBF) for physiologically based toxicokinetic modeling and occupational health risk assessment in active workers have apparently not been determined. Minute energy expenditure rates (E) and oxygen consumption rates (VO₂) in workers during exertions and their aggregate daytime activities are obtained by using open-circuit wearable devices for indirect calorimetry measurements and the doubly labeled water method respectively. Hundreds of E (in kcal/min) and VO₂ (in L of O₂/min) were previously reported for workers. The oxygen uptake factors of 0.2059 ± 0.0019 and 0.2057 ± 0.0018 L of O₂/kcal during postprandial and fasting phases respectively enabled conversion of E into VO₂. Equations determined in this study based upon more than 25 000 published measurements enable the calculation of 15 parameters in the same worker only by using the VO₂ reflecting workload. These parameters, notably VE, VA, VE/VO₂ VA/Q, Q, LBF and KBF were found to be interrelated. Altering one of these changes the order of magnitude of the others. Q, LBF and KBF decrease when supine adults at rest switch to an upright position. This effect of gravity diminished when VO₂ increased. The fall in LBF and KBF during exertion might enhance muscle blood flow as reported previously. Taken together these equations and data may improve the accuracy of physiologically based toxicokinetic modeling as well as occupational health assessment studies in active workers exposed to xenobiotics.List of main abbreviations: AVOD: arterioveinous oxygen content difference.BMI: body mass index (in kg/m²).BSA: body surface area (in m²).BTPS: body temperature and saturated with water vapor.Bw: body weight (in kg).E: minute energy expenditure rate (in kcal/min).F_GE: organ blood flow factor for the gravitational effect on blood circulation.H: oxygen uptake factor, volume of oxygen (at STPD) consumed to produce 1 kcal of energy expended.KBF: kidneys blood flow (in ml/min).LBF: liver blood flow (in ml/min).P_BF: liver or kidneys blood flows expressed in terms of percentages (in %) of Q_{sup C} values: namely P_BF = (LBF or KBF/Q_{sup C}) x 100.Q: cardiac output (in L/min or ml/min).Q_{sup C:} cardiac output for the cohort of males or females in supination (in ml/min).STPD: standard temperature and pressure, dry air.sup: values measured when adults are in the supine position.up: values measured when adults are in the upright position.VDphys: physiological dead space at BTPS (in L).VT: tidal volume at BTPS (in L).VA: alveolar ventilation rate at BTPS (in L/min).VA/Q: ventilation-perfusion ratio (unitless).VE: minute ventilation rate at BTPS (in L/min).VO₂: oxygen consumption rate (i.e. the oxygen uptake) at STPD (in L/min).VQ: ventilatory equivalent for VO₂ (VE at BTPS /VO₂ at STPD).

Temporal and spatial variations in the levels of prominent airborne disinfection by-products at four indoor swimming pools

Exposure to airborne disinfection by-products, especially trichloramine and trichloromethane, may cause various adverse health effects for the workers and users of indoor swimming pools. This study aims to evaluate the spatial and temporal variations in trichloramine and trichloromethane concentrations within and between swimming pools. Workplace measurements were carried out at four indoor swimming pools in Quebec (Canada) during the cold season. To fully represent daily operating conditions, sampling started 2 hr before the swimming pool opened and continued until 2 hr after closing. To quantify trichloramine and trichloromethane concentrations, 304 air samples have been collected. Temperature, humidity, and CO₂ were measured-simultaneously every 2 hr. The results showed that both trichloramine and trichloromethane concentrations varied significantly in time. The observed daily variations in trichloramine and trichloromethane concentrations suggest that the common practice of collecting a single 2-hr air sample does not represent daily pool trichloramine and trichloromethane contamination levels and, consequently, does not represent the true exposure and health risks for workers that are present for a full 8-hr shift. This study recommends a new 8-hr sampling strategy or a full-shift strategy using a cassette with three impregnated filters as a valid and cost-effective solution for comparing time-weighted average (TWA) concentrations to permissible trichloramine exposure limits.

Volatile organic compounds (VOCs) in indoor air and tap water samples in residences of pregnant women living in an area of unconventional natural gas operations: Findings from the EXPERIVA study

BACKGROUND

Northeastern British Columbia (Canada) is an area of unconventional natural gas (UNG) exploitation by hydraulic fracturing, which can release several contaminants, including volatile organic compounds (VOCs). To evaluate gestational exposure to contaminants in this region, we undertook the Exposures in the Peace River Valley (EXPERIVA) study.

OBJECTIVES

We aimed to: 1) measure VOCs in residential indoor air and tap water from EXPERIVA participants; 2) compare concentrations with those in the general population and explore differences related to sociodemographic and housing characteristics; and 3) determine associations between VOC concentrations and density/proximity to UNG wells.

METHODS

Eighty-five pregnant women participated. Passive air samplers were analyzed for 47 VOCs, and tap water samples were analyzed for 44 VOCs. VOC concentrations were compared with those from the Canadian Health Measure Survey (CHMS). We assessed the association between different metrics of well density/proximity and indoor air and tap water VOC concentrations using multiple linear regression.

RESULTS

40 VOCs were detected in >50% of air samples, whereas only 4 VOCs were detected in >50% of water samples. We observed indoor air concentrations >95th percentile of CHMS in 10-60% of samples for several compounds (acetone, 2-methyl-2-propanol, chloroform, 1,4-dioxane, hexanal, m/p-xylene, o-xylene, styrene, decamethylcyclopentasiloxane, dodecane and decanal). Indoor air levels of chloroform and tap water levels of total trihalomethanes were higher in Indigenous participants compared to non-Indigenous participants. Indoor air levels of chloroform and acetone, and tap water levels of total trihalomethanes were positively associated with UNG wells density/proximity metrics. Indoor air BTEX (benzene, toluene, ethylbenzene, xylenes) levels were positively correlated with some well density/proximity metrics.

CONCLUSION

Our results suggest higher exposure to certain VOCs in pregnant women living in an area of intense unconventional natural gas exploitation compared with the general Canadian population, and that well density/proximity is associated with increased exposure to certain VOCs.

Kinetic time courses of inhaled silver nanoparticles in rats

Silver nanoparticles (Ag NPs) are priority substances closely monitored by health and safety agencies. Despite their extensive use, some aspects of their toxicokinetics remain to be documented, in particular following inhalation, the predominant route of exposure in the workplace. A same experimental protocol and exposure conditions were reproduced two times (experiments E1 and E2) to document the kinetic time courses of inhaled Ag NPs. Rats were exposed nose-only to 20 nm Ag NPs during 6 h at a target concentration of 15 mg/m³ (E1: 218,341 ± 85,512 particles/cm³; E2, 154,099 ± 5728 particles/cm³). The generated aerosol showed a uniform size distribution of nanoparticle agglomerates with a geometric mean diameter ± SD of 79.1 ± 1.88 nm in E1 and 92.47 ± 2.19 nm in E2. The time courses of elemental silver in the lungs, blood, tissues and excreta were determined over 14 days following the onset of inhalation. Excretion profiles revealed that feces were the dominant excretion route and represented on average (± SD) 5.1 ± 3.4% (E1) and 3.3 ± 2.5% (E2) of the total inhaled exposure dose. The pulmonary kinetic profile was similar in E1 and E2; the highest percentages of the inhaled dose were observed between the end of the 6-h inhalation up to 6-h following the end of exposure, and reached 1.9 ± 1.2% in E1 and 2.5 ± 1.6% in E2. Ag elements found in the GIT followed the trend observed in lungs, with a peak observed at the end of the 6-h inhalation exposure and representing 6.4 ± 4.9% of inhaled dose, confirming a certain ingestion of Ag NPs from the upper respiratory tract. Analysis of the temporal profile of Ag elements in the liver showed two distinct patterns: (i) progressive increase in values with peak at the end of the 6-h inhalation period followed by a progressive decrease; (ii) second increase in values starting at 72 h post-exposure with maximum levels at 168-h followed by a progressive decrease. The temporal profiles of Ag elements in lymphatic nodes, olfactory bulbs, kidneys and spleen also followed a pattern similar to that of the liver. However, concentrations in blood and extrapulmonary organs were much lower than lung concentrations. Overall, results show that only a small percentage of the inhaled dose reached the lungs-most of the dose likely remained in the upper respiratory tract. The kinetic time courses in the gastrointestinal tract and liver showed that part of the inhaled Ag NPs was ingested; lung, blood and extrapulmonary organ profiles also suggest that a small fraction of inhaled Ag NPs progressively reached the systemic circulation by a direct translocation from the respiratory tract.

Impact of heat on biological concentrations of toluene and acetone resulting from exposure by inhalation: A pilot study

Climatic conditions raise new concerns about the potential impact of heat on the absorption and kinetics of certain chemicals. The impact of 3 temperatures (21, 25 and 30 °C WBGT) on the toxicokinetics of toluene and acetone was therefore evaluated in five human subjects during controlled exposures in an inhalation chamber. Biological samples were collected and analyzed by GC-MS/MS. Increases between 4 and 85 % were observed for solvents concentrations in blood (30 vs 21 °C) while decreases in urine samples for acetone and o-cresol were measured at the end of the exposure period (4 h). Mean blood concentrations at 4 h are well correlated with temperature. Results suggest an increased absorption and/or a decreased elimination of volatile chemicals in the presence of heat. Higher increases of blood chemical concentrations were observed in heavier individuals. Further studies should include physiologically based toxicokinetic models to help in better understanding the mechanisms involved and their respective contribution.

An overview of the literature on emerging pollutants: Chlorinated derivatives of Bisphenol A (ClxBPA)

CONTEXT

Bisphenol A (BPA) is a ubiquitous contaminant with endocrine-disrupting effects in mammals. During chlorination treatment of drinking water, aqueous BPA can react with chlorine to form chlorinated derivatives of BPA (mono, di, tri and tetra-chlorinated derivatives) or Cl_xBPA.

OBJECTIVE

The aim of this study is to summarize and present the state of knowledge on human toxicological risk assessment of Cl_xBPA.

MATERIALS AND METHODS

A search on Cl_xBPA in the PubMed database was performed based on studies published between 2002 and 2021. Forty-nine studies on chlorinated derivatives of BPA were found. Available information on their sources and levels of exposure, their effects, their possible mechanisms of action and their toxicokinetics data was extracted and presented.

RESULTS

Cl_xBPA have been essentially detected in environmental aqueous media. There is evidence in toxicological and epidemiological studies that Cl_xBPA also have endocrine-disrupting capabilities. These emerging pollutants have been found in human urine, serum, breast milk, adipose and placental tissue and can constitute a risk to human health. However, in vitro and in vivo toxicokinetic data on Cl_xBPA are scarce and do not allow characterization of the disposition kinetics of these compounds.

CONCLUSION

More research to assess their health risks, specifically in vulnerable populations, is needed. Some water chlorination processes are particularly hazardous, and it is important to evaluate their chlorination by-products from a public health perspective.

[Professional profiles and representations of staff members in Burundi health centers: Socio-professional groups with compartmentalizes knowledge]

BACKGROUND

The professional identities, profiles and representations of Burundian health workers remain insufficiently explored. Our twofold objective is to identify the different socio-professional profiles of first-line caregivers and to explore their respective representations of health workers and work.

METHODS

The first study describes the overall population of the 1047 staff members employed in 2014-2015 in 62 health centers. The second is a cross-sectional survey conducted in April 2014. Using IRAMUTEQ© software, we conducted textology analysis of the structure and contents of 911 respondents' representations via 3 free associations with regard to 6 questions on the "good worker" and the "what renders one capable of doing good work".

RESULTS

At the normative level, among all categories of staff, a relational role is a foundation of professional identity, while technical or administrative functions remain marginal. At the positional level, responses differed according to initial qualification level but not as a function of their role with patients or their professional experience. Three socio-professional categories emerged. The most qualified category (one-quarter of the population) consists primarily of male caregivers, with a high turnover rate (4 years) associated with prospects for further training and career development. These persons present the most professionalized representations of the worker and work. The second quarter has an average level of qualification and turnover (10 years), and is mainly composed of female caregivers with limited professional perspectives. This group's representations are less technical and more patient-centered. Finally, the remaining half consists of relatively low-skilled staff members in charge of technical and logistical support, who are likely to spend their entire career in the same center (>20 years). Largely disregarded by the health care system and its funders, they have few opportunities for training or advancement and despite their long experience, maintain profane representations of workers and work.

CONCLUSION

Our results shed light on the predicament of unskilled staff members whose expectations are rarely taken into consideration, even though they represent a significant proportion of the workforce, perform tasks essential to quality of care, and serve as bearers of the memory of their hospital center. These results also highlight the compartmentalization of practices and knowledge between categories of workers and underscore the failure of continuous training strategies targeting the unskilled.

Cardiopulmonary values and organ blood flows before and during heat stress: data in nine subjects at rest in the upright position

Physiological changes associated with thermoregulation can influence the kinetics of chemicals in the human body, such as alveolar ventilation (VA) and redistribution of blood flow to organs. In this study, the influence of heat stress on various physiological parameters was evaluated in nine male volunteers during sessions of exposure to wet blub globe temperatures (WBGT) of 21, 25 and 30°C for four hours. Skin and core temperatures and more than twenty cardiopulmonary parameters were measured. Liver, kidneys, brain, skin and muscles blood flows were also determined based on published measurements. Results show that most subjects (8 out of 9) have been affected by the inhalation of hot and dry air at the WBGT of 30°C. High respiratory rates, superficial tidal volumes and low VA values were notably observed. The skin blood flow has increased by 2.16-fold, whereas the renal blood flow and liver blood flow have decreased by about by 11 and 18% respectively. A complete set of key cardiopulmonary parameters in healthy male adults before and during heat stress was generated for use in PBPK modeling. A toxicokinetic studies are ongoing to evaluate the impact of heat stress on the absorption, biotransformation and excretion rates of volatile xenobiotics.

A New Guidance for the Prediction of Hepatic Clearance in the Early Drug Discovery and Development from the in Vitro-to-in Vivo Extrapolation Method and an Approach for Exploring Whether an Albumin-Mediated Hepatic Uptake Phenomenon Could be Present Under in Vivo Conditions

The in vitro-to-in vivo extrapolation (IVIVE) methods for predicting the hepatic clearance (CL) of drugs based on microsomal or hepatocyte data have certainly advanced; however, there is still place for improving the extrapolations from in vitro assays containing no plasma proteins. Accordingly, there is a discussion on whether the free drug hypothesis or an albumin (ALB)-mediated hepatic uptake phenomenon is the best scaling method. Therefore, the objectives of this study were to guide the prediction of CL and to diagnose which scaling method between the free drug hypothesis and ALB-mediated uptake could be more accurate; this, irrespective of the mechanism(s) governing CL if the drugs can get to the hepatocyte membrane. The analysis of several datasets demonstrated that almost all values of CL in vivo fall within the two calculated values of CL use as boundaries from: 1) the free drug hypothesis, and 2) ALB-mediated uptake. The average value from these two CL boundaries predicted the CL in vivo with an incredible accuracy. Validating these boundaries in preclinical species prior going to human as well as considering the fractional binding in plasma increased the accuracy. Overall, this study is another step towards guiding the CL prediction in drug discovery and development.

A novel solution of using mixed reality in bowel and oral and maxillofacial surgical telepresence: 3D mean value cloning algorithm

BACKGROUND AND AIM

Most of the mixed reality models used in the surgical telepresence are suffering from the discrepancies in the boundary area and spatial-temporal inconsistency due to the illumination variation in the video frames. The aim behind this work is to propose a new solution that helps produce the composite video by merging the augmented video of the surgery site and virtual hand of the remote expertise surgeon. The purpose of the proposed solution is to decrease the processing time and enhance the accuracy of merged video by decreasing the overlay and visualization error and removing occlusion and artefacts.

METHODOLOGY

The proposed system enhanced mean-value cloning algorithm that helps to maintain the spatial-temporal consistency of the final composite video. The enhanced algorithm includes the three-dimensional mean-value coordinates and improvised mean-value interpolant in the image cloning process, which helps to reduce the sawtooth, smudging and discolouration artefacts around the blending region.

RESULTS

The accuracy in terms of overlay error of the proposed solution is improved from 1.01 to 0.80 mm, whereas the accuracy in terms of visualization error is improved from 98.8% to 99.4%. The processing time is reduced to 0.173 s from 0.211 s. The processing time and the accuracy of the proposed solution are enhanced as compared to the state-of-art solution.

CONCLUSION

Our solution helps make the object of interest consistent with the light intensity of the target image by adding the space distance that helps maintain the spatial consistency in the final merged video.

Estimation of toluene exposure in air from BMA (S-benzylmercapturic acid) urinary measures using a reverse dosimetry approach based on physiologically pharmacokinetic modeling

This study aimed to use a reverse dosimetry PBPK modeling approach to estimate toluene atmospheric exposure from urinary measurements of S-benzylmercapturic acid (BMA) in a small group of individuals and to evaluate the uncertainty associated to urinary spot-sampling compared to 24-h collected urine samples. Each exposure assessment technique was developed namely to estimate toluene air exposure from BMA measurements in 24-h urine samples (24-h-BMA) and from distributions of daily urinary BMA spot measurements (DUBSM). Model physiological parameters were described based upon age, weight, size and sex. Monte Carlo simulations with the PBPK model allowed converting DUBSM distribution (and 24-h-BMA) into toluene air levels. For the approach relying on DUBSM distribution, the ratio between the 95% probability of predicted toluene concentration and its 50% probability in each individual varied between 1.2 and 1.4, while that based on 24-h-BMA varied between 1.0 and 1.1. This suggests more variability in estimated exposure from spot measurements. Thus, estimating toluene exposure based on DUBSM distribution generated about 20% more uncertainty. Toluene levels estimated (0.0078-0.0138 ppm) are well below Health Canada's maximum chronic air guidelines. PBPK modeling and reverse dosimetry may be combined to interpret urinary metabolites data of VOCs and assess related uncertainties.

Repeat induced abortion and adverse childhood experiences in Aquitaine, France: a cross-sectional survey

OBJECTIVE

The aim of the study was to analyse the relationship between adverse childhood experiences (ACEs) and repeat induced abortion, with regard to the potential effects of social deprivation and intimate partner violence.

METHODS

An observational cross-sectional survey was conducted across each of the 25 abortion centres in Aquitaine, France, from 15 June to 15 September 2009. The sample comprised 806 women >18 years who had requested an induced abortion. Data were collected through a self-reported anonymous questionnaire on ACEs and experience of previous abortion. The main outcome measure was the percentage of repeat induced abortions.

RESULTS

Among the participants, 473 (58.7%) were having their first induced abortion and 333 (41.3%) had already had a previous induced abortion. The abortion rank (first, second, third or more) was inversely related to the proportion of women with no ACE exposure (28%, 20% and 9%, respectively) and positively related to the proportion of women with a high ACE exposure (17%, 27% and 32%, respectively). Compared with women with no ACE exposure who were having a first induced abortion, in those with high ACE exposure, the odds of a third or more request for abortion was high: adjusted odds ratio 7.73 (95% confidence interval 3.56, 16.77).

CONCLUSION

We found a strong graded link between the extent of ACE exposure and the occurrence of repeat induced abortion.

A Novel Solution of Using Mixed Reality in Bowel and Oral and Maxillofacial Surgical Telepresence: 3D Mean Value Cloning algorithm

BACKGROUND AND AIM

Most of the Mixed Reality models used in the surgical telepresence are suffering from the discrepancies in the boundary area and spatial-temporal inconsistency due to the illumination variation in the video frames. The aim behind this work is to propose a new solution that helps produce the composite video by merging the augmented video of the surgery site and virtual hand of the remote expertise surgeon. The purpose of the proposed solution is to decrease the processing time and enhance the accuracy of merged video by decreasing the overlay and visualization error and removing occlusion and artefacts.

METHODOLOGY

The proposed system enhanced the mean value cloning algorithm that helps to maintain the spatial-temporal consistency of the final composite video. The enhanced algorithm includes the 3D mean value coordinates and improvised mean value interpolant in the image cloning process, which helps to reduce the sawtooth, smudging and discoloration artefacts around the blending region RESULTS: As compared to the state of art solution, the accuracy in terms of overlay error of the proposed solution is improved from 1.01mm to 0.80mm whereas the accuracy in terms of visualization error is improved from 98.8% to 99.4%. The processing time is reduced to 0.173 seconds from 0.211 seconds CONCLUSION: Our solution helps make the object of interest consistent with the light intensity of the target image by adding the space distance that helps maintain the spatial consistency in the final merged video. This article is protected by copyright. All rights reserved.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Impact of pesticide coexposure: an experimental study with binary mixtures of lambda-cyhalothrin (LCT) and captan and its impact on the toxicokinetics of LCT biomarkers of exposure

This study aimed at gaining more insights into the impact of pesticide coexposure on the toxicokinetics of biomarkers of exposure. This was done by conducting an in vivo experimental case-study with binary mixtures of lambda-cyhalothrin (LCT) and captan and by assessing its impact on the kinetic profiles of LCT biomarkers of exposure. Groups of male Sprague-Dawley rats were exposed orally by gavage to LCT alone (2.5 or 12.5 mg/kg bw) or to a binary mixture of LCT and captan (2.5/2.5 or 2.5/12.5 or 12.5/12.5 mg/kg bw). In order to establish the temporal profiles of the main metabolites of LCT, serial blood samples were taken, and excreta (urine and feces) were collected at predetermined intervals up to 48 h post-dosing. Major LCT metabolites were quantified in these matrices: 3-(2-chloro-3,3,3-trifluoroprop-1-enyl)-2,2-dimethyl-cyclopropane carboxylic (CFMP), 3-phenoxybenzoic acid (3-PBA), 4-hydroxy-3-phenoxybenzoic acid (4-OH3PBA). There was no clear effect of coexposure at the low LCT dose on the kinetics of CFMP and 3-PBA metabolites, based on the combined assessment of temporal profiles of these metabolites in plasma, urine and feces; however, plasma levels of 3-PBA were diminished in the coexposed high-dose groups. A significant effect of coexposure on the urinary excretion of 4-OH3PBA was also observed while fecal excretion was not affected. The temporal profiles of metabolites in plasma and in excreta were further influenced by the LCT dose. In addition, the study revealed kinetic differences between metabolites with a faster elimination of 3-PBA and 4-OH3BPA compared to CFMP. These results suggest that the pyrethroid metabolites CFMP and 3-PBA, mostly measured in biomonitoring studies, remain useful as biomarkers of exposure in mixtures, when pesticide exposure levels are below the reference values. However, the trend of coexposure effect observed in the benzyl metabolite pathway (in particular 4-OH3BPA) prompts further investigation.

Incidence of colon cancer in younger population and lower incidence in Asians and females in central balley of California: Health disparity and epigenetic study model

e19028

Background: California acts as a boiling pot for immigration and the perfect ecosystem to study epigenetic changes from dietary and environmental factors in various ethnicities. It has a significant immigrant population, with approximately a quarter of the 40 million residents being foreign-born. The impact of migration on colon cancer incidences over time has not yet been characterized on a broad-scale level in the Northern Central Valley. This provides a unique opportunity to study the influence of migration, socio-economic gradient, environmental, and racial identity on the incidence of cancer in a subset of California’s San Joaquin County Population. Colon cancer affects around 100,000 annually, with white and African Americans being more often affected than Asians or Hispanics. Methods: This study is a retrospective, single-institution study that compared the socio-demographic variables and clinical characteristics of the patients who had a history of colon cancer in an academic central valley institution. We reviewed all the patient charts with a diagnosis of colon cancer from 2014-2019 and compared the age, demographics, socioeconomic status, comorbidities, pathology, treatment, and outcomes in the population. Appropriate statistics have been used for analyzing the data. Results: A retrospective chart review of all patients diagnosed with colon cancer from our Hospital from 2014-2019 which revealed that 23.9% of patients were younger than 50 years at diagnosis, and mean age of diagnosis is 56.6 years, compared to the national average where younger population constituted at 11% and mean age for men and women are 68 years and 72 years respectively. 36.5% were 50-60 years old, and 39.2% were > 60 years old. Women constituted 31% in our group compared to compared to 35.6% nationally. Asians are 23% of the central California population, but only 11.4% of patients in our group of colon cancer patients were Asian/pacific islanders, with 6.4% being average weight. 36.7% of patients have obesity. 67.4% were > 25 BMI, of which 12.8% were younger Hispanics with BMI 25-30. Adenocarcinoma is seen in 91.4% of patients. Conclusions: The younger population with male predominance is seen. Asians see a surge in colon cancer incidence, but the incidence rate is still lower. Epigenetic, western lifestyle, and environmental are responsible factors. Younger overweight Hispanics are increasing in number as well. We will present further subgroup analysis at presentation.

Encephalopathy and seizure activity in a COVID-19 well controlled HIV patient

A 41-year-old male with a history of well controlled HIV presented with confusion and was found to have COVID-19. Lumbar puncture was negative. He had worsening encephalopathy with tonic-clonic seizure requiring intubation. He was treated with hydroxychloroquine and azithromycin with improvement in mental status back to baseline after 6 days.

A recent review and a taxonomy for hard and soft tissue visualization-based mixed reality

BACKGROUND

Mixed reality (MR) visualization is gaining popularity in image-guided surgery (IGS) systems, especially for hard and soft tissue surgeries. However, a few MR systems are implemented in real time. Some factors are limiting MR technology and creating a difficulty in setting up and evaluating the MR system in real environments. Some of these factors include: the end users are not considered, the limitations in the operating room, and the medical images are not fully unified into the operating interventions.

METHODOLOGY

The purpose of this article is to use Data, Visualization processing, and View (DVV) taxonomy to evaluate the current MR systems. DVV includes all the components required to be considered and validated for the MR used in hard and soft tissue surgeries. This taxonomy helps the developers and end users like researchers and surgeons to enhance MR system for the surgical field.

RESULTS

We evaluated, validated, and verified the taxonomy based on system comparison, completeness, and acceptance criteria. Around 24 state-of-the-art solutions that are picked relate to MR visualization, which is then used to demonstrate and validate this taxonomy. The results showed that most of the findings are evaluated and others are validated.

CONCLUSION

The DVV taxonomy acts as a great resource for MR visualization in IGS. State-of-the-art solutions are classified, evaluated, validated, and verified to elaborate the process of MR visualization during surgery. The DVV taxonomy provides the benefits to the end users and future improvements in MR.

A novel mixed reality in breast and constructive jaw surgical tele-presence

BACKGROUND AND AIM

Surgical telepresence has been implemented using Mixed reality (MR) but, MR is theory based and only used for investigating research. The Aim of this paper is to propose and implement a new solution by merging augmented video (generating in local site) and virtual expertise surgeon hand (remote site). This system is to improve the visualization of surgical area, overlay accuracy in the merged video without having any discoloured patterns on hand, smudging artefacts on surgeon hand boundary and occluded areas of surgical area.

METHODOLOGY

The Proposed system consists of an Enhanced Multi-Layer Mean Value Cloning (EMLMV) algorithm that improves the overlay accuracy, visualization accuracy and the processing time. This proposed algorithm includes trimap and alpha matting as a pre-processing stage of merging process, which helps to remove the smudging and discoloured artefacts surrounded by remote surgeon hand.

RESULTS

Results showing that the proposed system improved the accuracy by reducing the overlay error of merging image from 1.3 mm (Millimeter) to 0.9 mm. Furthermore, it improves the visibility of surgeon hand in the final merged image from 98.4% (visibility of pixels) to 99.1% (visibility of pixels). Similarly, the processing time in our proposed solution is reduced, which is computed as 10 s to produce 50 frames, whilst, the state of art solution computes 11 s for the same number of frames.

CONCLUSION

The proposed system focuses on the merging of augmented reality video (local site), and the virtual reality video (remote site) with the accurate visualization. we consider discoloured areas, smudging artefacts and occlusion as the main aspects to improve the accuracy of merged video in terms of overlay error and visualization error. So, the proposed system would produce the merged video with the removal of artefacts around the expert surgeon hand.

A novel optimized initial cluster center and enhanced objective function: Medical diagnosis through classification

Medical diagnosis through classification is often critical as the medical datasets are multilabel in nature, that is, a patient may have more than one health condition: high blood pressure, obesity, and diabetes. The aim of this article is to improve the accuracy and performance of multilabel classification using multilabel feature selection and improved overlapping clustering method. The proposed system consists of Optimized Initial Cluster Centers and Enhanced Objective Function technique to reduce the number of iterations in the clustering process thereby improving the clustering performance and to improve the clustering accuracy which will result in improving the accuracy and performance of multilabel classification. Ratios of clustering distance to class distance and execution time are used as the evaluation metric for accuracy and total execution time is used as the evaluation metric for performance. Based on the different combination with the number of labels, attributes, instances, and number of clusters, different values of accuracy and performance are obtained. The results on all 10 datasets show that the proposed technique is superior to the current technique. Furthermore, on average, the proposed technique has improved the classification accuracy by 5%-7%. Furthermore, the performance of new technique is improved by decreasing the processing time by 0.5-1 s on average. The proposed system targets on improving the accuracy and performance of the multilabel classification for medical diagnosis, which consists of multilabel feature selection and enhanced overlapping clustering technique. This study provides an acceptable range of accuracy with improved processing time, which assists the doctors in medical diagnosis (high blood pressure, obesity, and diabetes) of patients.

Electron-phonon dynamics in 2D carbon based-hybrids XC (X = Si, Ge, Sn)

The effect of the presence of electron-phonon (e-ph) coupling in the SiC, GeC and SnC hybrids is studied in the framework of the ab initio perturbation theory. The electronic bang gap thermal dependence reveals a normal monotonic decrease in the SiC and GeC semiconductors, whereas SnC exhibits an anomalous behavior. The electron line widths were evaluated and the contributions of acoustic and optical phonon modes to the imaginary part of the self-energy were determined. It has been found that the e-ph scattering rates are globally controlled by the out-of-plane acoustic transverse mode ZA in SiC while both ZA and ZO are overriding in GeC. In SnC, the out-of-plane transverse optical mode ZO is the most dominant. The relaxation lifetime of the photo-excited electrons shows that the thermalization of the hot carrier occurs at 90 fs, 100 fs and 120 fs in SiC, GeC and SnC, respectively. The present study properly describes the subpicosecond time scale after sunlight illumination using an approach that requires no empirical data. The results make the investigated structures suitable for providing low cost and high-performance optical communication and monitoring applications using 2D materials.

Breast Cancer and Exposure to Organochlorines in the CECILE Study: Associations with Plasma Levels Measured at the Time of Diagnosis and Estimated during Adolescence

Exposure to environmental chemicals with hormonal effects, such as organochlorine compounds (OCs), during developmental periods of breast cells may have an impact on the incidence of breast cancer later in life. However, the assessment of exposure to these chemicals that occurred in early life at the time of breast cancer development in adult women is a difficult challenge in epidemiological studies. Plasma levels of the OCs p,p'-dichlorodiphenyl dichloroethene (DDE) and polychlorinated biphenyl congener 153 (PCB153) were measured in 695 cases and 1055 controls of a population-based case-control study conducted in France (CECILE study). Based on these values, we used a physiologically-based pharmacokinetic (PBPK) model to estimate PCB153 levels at age 11⁻20 years when the women were adolescents. Overall, there was no clear association between breast cancer risk and measured levels of DDE and PCB153 at the time of diagnosis, but there was a trend of decreasing odds ratios of breast cancer with increasing DDE and PCB153 levels in women aged 50 years and over. The PBPK model revealed that PCB153 concentrations estimated during adolescence were highest in the youngest women born after 1960 who reached adolescence at a time when environmental contamination was maximum, and very low in the oldest women who attained adolescence before the contamination peak. Negative associations between breast cancer and PCB153 estimates during adolescence were also found. The negative associations between DDE and PCB153 levels measured at the time of diagnosis or estimated during adolescence in our study were unexplained. Further investigations are needed to clarify whether this finding is real or related to study artifacts. However, this study suggests that using PBPK models in epidemiological studies to back-estimate OC exposures during early life stages may be useful to address critical questions on cancer development.

Time series analysis of ambient air-temperature during the period 1970-2016 over Sydney, Australia

Providing evidence of potential changes in the climate has become increasingly important as it is the first step towards adopting mitigation and adaptation measures and planning for urban resilience. In this study a statistical analysis of the ambient air temperature time series over Sydney, Australia during 1970-2016 has been carried out with the aim to investigate potential changes towards higher temperatures. The dataset has been statistically analyzed using different techniques, concluding that the investigation should be performed on a monthly basis. A persistence analysis was conducted using different statistical approaches to investigate the dependence between consecutive monthly and daily ambient air temperature values. A trend analysis of the ambient air temperature and degree days time series has been conducted using linear regression to estimate the linear trend (slope) and its statistical significance (using a Student-t-test) and the Kendall-Mann test to identify the time at which the tendency starts to occur as well as the time after which it becomes statistically significant.

Reverse dosimetry modeling of toluene exposure concentrations based on biomonitoring levels from the Canadian health measures survey

Biomonitoring might provide useful estimates of population exposure to environmental chemicals. However, data uncertainties stemming from interindividual variability are common in large population biomonitoring surveys. Physiologically based pharmacokinetic (PBPK) models might be used to account for age- and gender-related variability in internal dose. The objective of this study was to reconstruct air concentrations consistent with blood toluene measures reported in the third Canadian Health Measures Survey using reverse dosimetry PBPK modeling techniques. Population distributions of model's physiological parameters were described based upon age, weight, and size for four subpopulations (12-19, 20-39, 40-59, and 60-79 years old). Monte Carlo simulations applied to PBPK modeling allowed converting the distributions of venous blood measures of toluene obtained from CHMS into related air levels. Based upon blood levels observed at the 50^th, 90^th and 95^th percentiles, corresponding air toluene concentrations were estimated for teenagers aged 12-19 years as being, respectively, 0.009, 0.04 and 0.06 ppm. Similarly, values were computed for adults aged 20-39 years (0.007, 0.036, and 0.06 ppm), 40-59 years (0.007, 0.036 and 0.06 ppm) and 60-79 years (0.006, 0.022 and 0.04 ppm). These estimations are well below Health Canada's maximum recommended chronic air guidelines for toluene. In conclusion, PBPK modeling and reverse dosimetry may be combined to help interpret biomonitoring data for chemical exposure in large population surveys and estimate the associated toxicological health risk.

Biallelic mutations in EXOC3L2 cause a novel syndrome that affects the brain, kidney and blood

BACKGROUND

Dandy-Walker malformation features agenesis/hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle and enlargement of posterior fossa. Although Dandy-Walker malformation is relatively common and several genes were linked to the syndrome, the genetic cause in the majority of cases is unknown.

OBJECTIVE

To identify the mutated gene responsible for Dandy-Walker malformation, kidney disease and bone marrow failure in four patients from two unrelated families.

METHODS

Medical assessment, sonographic, MRI and pathological studies were used to define phenotype. Chromosomal microarray analysis and whole-exome sequence were performed to unravel the genotype.

RESULTS

We report four subjects from two unrelated families with homozygous mutations in the Exocyst Complex Component 3-Like-2 gene (EXOC3L2).EXOC3L2 functions in trafficking of post-Golgi vesicles to the plasma membrane. In the first family a missense mutation in a highly conserved amino acid, p.Leu41Gln, was found in three fetuses; all had severe forms of Dandy-Walker malformation that was detectable by prenatal ultrasonography and confirmed by autopsy. In the second family, the affected child carried a nonsense mutation, p.Arg72*, and no detected protein. He had peritrigonal and cerebellar white matter abnormalities with enlargement of the ventricular trigones, developmental delay, pituitary hypoplasia, severe renal dysplasia and bone marrow failure.

CONCLUSION

We propose that biallelic EXOC3L2 mutations lead to a novel syndrome that affects hindbrain development, kidney and possibly the bone marrow.

Healthcare itinerary of women undergoing an abortion according to their vulnerability

CONTEXT

Precariousness is increasing among all populations and especially among women. The access to healthcare is increasingly unequal upon the population and particularly in access to contraception methods or abortion according to their vulnerability level.

OBJECTIVE

Our main object is to describe the socio-demographic specifications, the different steps involved in the healthcare itinerary to contraception and abortion, according to the level of social vulnerability for a woman population sample requesting an abortion. The secondary objects are to detect the existence of a difficult healthcare itinerary and to describe the exposure to risky situations or behaviors according to their vulnerability level.

METHOD

It is an observational cross-sectional survey to women having recourse to induced abortion in centers providing them, during 3 month in 2014, in the Aquitaine area. The validated tool to evaluate this situation in a psycho-social approach is the "EPICES score".

RESULTS

Our sample identifies 49% of women in a precariousness situation. These women are younger and more often less employed. They benefit less often from a regular gynecology follow-up, do not use contraception as often and resort to abortion more often. They relate more often risky behavior for the health, conflict with the partner and psychological, physical violence.

CONCLUSION

Special attention should be brought to all women in request of an abortion, for half of them are in a precarious situation and this physical might be a rare occasion of access to healthcare. Violence screening should be systematic and the choice of a long term birth control method should be encouraged.