RSDL decontamination of human skin contaminated with the nerve agent VX

Dermal exposure to low volatile organophosphorus compounds (OPC) may lead to penetration through the skin and uptake in the blood circulation. Skin decontamination of toxic OPCs, such as pesticides and chemical warfare nerve agents, might therefore be crucial for mitigating the systemic toxicity following dermal exposure. Reactive skin decontamination lotion (RSDL) has been shown to reduce toxic effects in animals dermally exposed to the nerve agent VX. In the present study, an in vitro flow-through diffusion cell was utilized to evaluate the efficacy of RSDL for decontamination of VX exposed to human epidermis. In particular, the impact of timing in the initiation of decontamination and agent dilution in water was studied. The impact of the lipophilic properties of VX in the RSDL decontamination was additionally addressed by comparing chemical degradation in RSDL and decontamination efficacy between the VX and the hydrophilic OPC triethyl phosphonoacetate (TEPA). The epidermal membrane was exposed to 20, 75 or 90% OPC diluted in deionized water and the decontamination was initiated 5, 10, 30, 60 or 120min post-exposure. Early decontamination of VX with RSDL, initiated 5-10min after skin exposure, was very effective. Delayed decontamination initiated 30-60min post-exposure was less effective but still the amount of penetrated agent was significantly reduced, while further delayed start of decontamination to 120min resulted in very low efficacy. Comparing RSDL decontamination of VX with that of TEPA showed that the decontamination efficacy at high agent concentrations was higher for VX. The degradation mechanism of VX and TEPA during decontamination was dissected by ³¹P NMR spectroscopy of the OPCs following reactions with RSDL and its three nucleophile components. The degradation rate was clearly associated with the high pH of the specific solution investigated; i.e. increased pH resulted in a more rapid degradation. In addition, the solubility of the OPC in RSDL also influenced the degradation rate since the degradation of VX was significantly faster when the NMR analysis was performed in the organic solvent acetonitrile compared to water. In conclusion, we have applied the in vitro flow-through diffusion cell for evaluation of skin decontamination procedures of human epidermis exposed to OPCs. It was demonstrated that early decontamination is crucial for efficient mitigation of epidermal penetration of VX and that almost complete removal of the nerve agent from the skin surface is possible. Our data also indicate that the pH of RSDL together with the solubility of OPC in RSDL are of primary importance for the decontamination efficacy.

In vitro human skin penetration model for organophosphorus compounds with different physicochemical properties

A flow-through diffusion cell was validated for in vitro human epidermal penetration studies of organophosphorus compounds (OPCs) applied by infinite dosing. By testing OPCs with similar molecular weight but different physicochemical properties, it was shown that hydrophilic and lipophilic properties are major determinants for the penetration rate. Lipophilic OPCs displayed maximum cumulative penetration in the 20-75% agent concentration range whereas the hydrophilic OPCs displayed maximum cumulative penetration at 10 or 20% agent concentration. Low penetration was observed for all agents at 1% agent concentration or when applied as neat agents. The impact of the receptor solution composition was evaluated by comparing the penetration using receptor solutions of different ratios of ethanol and water. For diluted OPCs, a high concentration of ethanol in the receptor solution significantly increased the penetration compared to lower concentrations. When OPCs were applied as neat agents, the composition of the receptor solution only affected the penetration for one of four tested compounds. In conclusion, the flow-through diffusion cell was useful for examining the penetration of OPCs through the epidermal membrane. It was also demonstrated that the penetration rates of OPCs are strongly influenced by dilution in water and the receptor fluid composition.

Personal decontamination after exposure to stimulated liquid phase contaminants: functional assessment of a new unit

OBJECTIVE

To evaluate the efficacy of a decontamination station following exposure of volunteers to liquids with physical characteristics comparable to sarin and mustard gas.

DESIGN

Twenty-four volunteers participated in the experiment which was performed with all staff wearing personal protective equipment including respiratory protection. The clothes, skin, and hair of the volunteers were contaminated with the simulated liquid phase contaminants, ethyl lactate and methyl salicylate. Sulphur hexafluoride gas was used to confirm the ventilation efficacy. Decontamination followed guidelines using a two-stage procedure. In the first chamber, all volunteers received a 3-minute shower with water at 30 degrees C, and their clothes but not their respiratory masks were removed. In the second, they were twice washed thoroughly with soap and water. After decontamination, the volunteers entered a third chamber for first aid measures.

RESULTS

The air concentration of sulphur hexafluoride was reduced by 1:10,000 between the first and the third chambers. Ethyl lactate and methyl salicylate were measured in low concentrations in the third chamber. The capacity was 16 volunteers per hour with two-thirds on stretchers. After self-decontamination of the staff, the concentration of ethyl lactate increased significantly in the third chamber, consistent with residual ethyl lactate adsorbed by their underwear. This observation revealed a deficiency in the guidelines for self-decontamination.

CONCLUSION

The capacity of the decontamination unit was found to be 16 volunteers per hour. The ventilation system and guidelines of the decontamination unit were demonstrated to be effective under the conditions examined. The self-decontamination of the staff was not optimal.

Emission factors for gases and particle-bound substances produced by firing lead-free small-caliber ammunition

Lead-free ammunition is becoming increasingly popular because of the environmental and human health issues associated with the use of leaded ammunition. However, there is a lack of data on the emissions produced by firing such ammunition. We report emission factors for toxic gases and particle-bound compounds produced by firing lead-free ammunition in a test chamber. Carbon monoxide, ammonia, and hydrogen cyanide levels within the chamber were analysed by Fourier transform infrared spectroscopy, while total suspended particles and respirable particles were determined gravimetrically. The metal content of the particulate emissions was determined and the associated organic compounds were characterized in detail using a method based on thermal desorption coupled to gas chromatography and mass spectrometry. The particulate matter (∼30 mg/round) consisted primarily of metals such as Cu, Zn, and Fe along with soot arising from incomplete combustion. Nitrogen-containing heterocyclic aromatic compounds such as carbazole, quinolone, and phenazine were responsible for some of the 25 most significant chromatographic peaks, together with PAHs, diphenylamine, and phthalates. Emission factors were determined for PAHs and oxygenated PAHs; the latter were less abundant in the gun smoke particles than in domestic dust and diesel combustion smoke. This may be due to the oxygen-deficient conditions that occur when the gun is fired. By using an electrical low pressure impactor, it was demonstrated that more than 90% of the particles produced immediately after firing the weapon had diameters of less than 30 nm, and so most of the gun smoke particles belonged to the nanoparticle regime.

Comparing acute toxicity of gunshot particles, from firing conventional and lead-free ammunition, in pulmonary epithelial cell cultures

Numerous studies demonstrated that the use of lead (Pb)-containing ammunition is associated with mainly chronic health problems and also is a burden on the environment and wildlife. Recently, a number of reports showed evidence of undesirable acute health effects related to the use of newly developed Pb-free small-caliber ammunition. In this study, particles from leaded and Pb-free ammunition were collected in liquid collection medium, in a highly controlled chamber, while firing a pistol (9 mm) or a rifle (7.62 × 51 mm). The emitted particles were typically smaller than 4 μm, with the great majority in even smaller size ranges, as shown by gravimetrical analysis and a multistage impactor. Chemical analysis revealed significant differences in content and concentration of several metals in the particles. After administration of the liquids to alveolar and bronchial in vitro cell systems, particles were taken up by the cells; the Pb-free particles displayed higher cytotoxicity (EC50 = 2 μg/cm(2)) than particles from Pb ammunition. High correlation factors (>0.9) were found between cell death and content of copper and zinc. Particles from both Pb-containing and Pb-free ammunition were able to induce oxidative stress and the proinflammatory marker interleukin (IL)-8 in both in vitro systems. These results support previous findings that indicate an association between gunshot emissions and metal fume fever. This study demonstrates the usefulness of combining chemical data with biological in vitro responses in assessing acute toxicological effects from emissions from firing both Pb and Pb-free ammunition.

Field evaluation and calibration of a small axial passive air sampler for gaseous and particle bound polycyclic aromatic hydrocarbons (PAHs) and oxygenated PAHs

Polycyclic aromatic hydrocarbons (PAHs) and their oxygenated analogues (OPAHs) are ubiquitous air pollutants known to cause adverse health effects. PAH air levels are commonly monitored by active sampling but passive sampling has become popular because of its lower cost and simplicity, which facilitate long-term sampling and increased spatial coverage. However, passive samplers are less suitable for short-term sampling and are in general less accurate than active samplers because they require reliable sampling rate (Rs) measurements for individual analytes under diverse environmental conditions. In this study a small passive sampler designed to sample both particle-bound and gaseous compounds was evaluated and calibrated for PAHs and OPAHs in a traffic environment by co-deployment with active samplers for two weeks. Despite the relatively low average air concentrations of PM10 (20 μg/m(3)), PM2.5 (5 μg/m(3)), total PAHs (4.2 ng/m(3)), and OPAHs (2.3 ng/m(3)) at the site, detectable quantities (on average 24 times above blank values) of the full range of PAHs and OPAHs were captured, with low variability (average RSD of 16%). This was accomplished by using a Tenax(®) TA-modified glass fiber substrate that is compatible with highly sensitive thermal desorption GC-MS analysis, which made it possible to achieve detection limits per sample in the pg range. Experiments with inverted samplers revealed that the relative contribution of gravitational settling to the sampling of particles carrying PAHs and OPAHs was around 3.5 times larger than other deposition mechanisms. Average Rs values for individual OPAHs and PAHs were 0.046 ± 0.03 m(3)/day and 0.12 ± 0.07 m(3)/day, respectively, with no appreciable difference between the values for particle-associated and gaseous compounds. Furthermore, the Rs values were competitive with other currently used passive samplers if normalized for substrate area. Overall, the new sampler's performance, simplicity and ability to generate relatively time-resolved data make it a promising candidate for diverse SVOC monitoring studies.

Reduced rate of postoperative infections in emergency cesarean section after two doses of cefuroxim perioperatively. A placebo-controlled study

The rate of postoperative infections after cesarean section was studied in a prospective double-blind randomized study to compare cefuroxim with a placebo. Intravenous bolus injections were given at the beginning of, and 12h after the operation. Eighty patients received cefuroxim and 80 received placebo. Endometritis or wound infection, or both, was diagnosed in 2/80 (2.5%) patients receiving cefuroxim and in 23/80 (29%) patients receiving placebo. No side effects were demonstrated or reported by the patients. Thus, two bolus injections of 1.5 g of cefuroxim given perioperatively significantly reduced postoperative infectious morbidity after emergency cesarean section.

N-acetyl cysteine protects against chlorine-induced tissue damage in an ex vivo model

High-level concentrations of chlorine (Cl₂) can cause life-threatening lung injuries and the objective in this study was to understand the pathogenesis of short-term sequelae of Cl₂-induced lung injury and to evaluate whether pre-treatment with the antioxidant N-acetyl cysteine (NAC) could counteract these injuries using Cl₂-exposed precision-cut lung slices (PCLS). The lungs of Sprague-Dawley rats were filled with agarose solution and cut into 250 μm-thick slices that were exposed to Cl₂ (20-600 ppm) and incubated for 30 min. The tissue slices were pre-treated with NAC (5-25 mM) before exposure to Cl₂. Toxicological responses were analyzed after 5 h by measurement of LDH, WST-1 and inflammatory mediators (IL-1β, IL-6 and CINC-1) in medium or lung tissue homogenate. Exposure to Cl₂ induced a concentration-dependent cytotoxicity (LDH/WST-1) and IL-1β release in medium. Similar cytokine response was detected in tissue homogenate. Contraction of larger airways was measured using electric-field-stimulation method, 200 ppm and control slices had similar contraction level (39 ± 5%) but in the 400 ppm Cl₂ group, the evoked contraction was smaller (7 ± 3%) possibly due to tissue damage. NAC-treatment improved cell viability and reduced tissue damage and the contraction was similar to control levels (50 ± 11%) in the NAC treated Cl₂-exposed slices. In conclusion, Cl₂ induced a concentration-dependent lung tissue damage that was effectively prevented with pre-treatment with NAC. There is a great need to improve the medical treatment of acute lung injury and this PCLS method offers a way to identify and to test new concepts of treatment of Cl₂-induced lung injuries.

Distribution, chemical speciation, and mobility of lead and antimony originating from small arms ammunition in a coarse-grained unsaturated surface sand

This study quantified the heavy metal contamination caused by firing 500 high-velocity 7.62-mm jacketed Swedish military rounds. Contamination of solid and aqueous phases was studied, with Pb and Sb being the two contaminants of primary interest. The distribution of the Pb and Sb were measured in terms of depth of penetration in sand and grain size distribution of the bullet particles. The Pb- and Sb-contaminated sand was then used as a source material in two bench-scale unsaturated lysimeters to measure the transport of Pb and Sb through two coarse-grained sands, which were taken from the berms on two Swedish military small arms ranges. The lysimeters were subjected to an infiltration cycle that reproduced spring snowmelt, which is the most significant infiltration event of the year in northern climates. The levels of mobile Pb and Sb were monitored in the effluent from the lysimeters. Extended X-ray absorption fine-structure spectroscopy analysis was performed on the contaminated sands to determine Pb speciation before and after leaching. Ninety-three percent of the mass of bullets was found in the top 30 cm of sand. Lead oxide was the predominant species of Pb before and after leaching. Transport of Pb was small, with aqueous concentrations remaining stable at <2 microg L(-1). Antimony was far more mobile, with solute breakthrough occurring between 5 and 14 d and concentrations rising to over 125 microg L(-1) within 1 month.

Structure of a Natural Microbial Community in a Nitroaromatic Contaminated Groundwater Is Altered during Biodegradation of Extrinsic, but Not Intrinsic Substrates

A BSTRACTThis study demonstrates microbial community changes over time in a nitroaromatic-contaminated groundwater upon amendment with hydrocarbons previously unknown to the microbial community (extrinsic) and hydrocarbons previously known to the microbial community (intrinsic). Sealed flasks, shaken and incubated at 25 degrees C, containing contaminated groundwater and salts were amended twice with extrinsic hydrocarbons including phenol, benzoic acid, and naphthalene, and intrinsic hydrocarbons including 2,4-dinitrotoluene (2,4-DNT) and para-nitrotoluene ( p-NT). Microbial growth, biodegradation, and community structure changes measured by random amplified polymorphic DNA (RAPD) and quantitative PCR (qPCR) targeting catechol-2,3-dioxygenase (C23O) genes were monitored over time. All amended substrates were biodegraded after both substrate amendments except for 2,4-DNT, which was only partially degraded after the second amendment. Unique microbial communities were developed in flasks amended with phenol, benzoic acid, and naphthalene. However, in the flasks amended with intrinsic hydrocarbons the microbial community remained similar to the unamended control flasks. The relative amount of C23O genes detected by qPCR correlated with the biodegradation of phenol and naphthalene but not with 2,4-DNT. The results showed that a selection for microorganisms capable of catabolizing extrinsic hydrocarbons naturally and initially present in the nitroaromatic-contaminated groundwater occurred. However, growth-linked biodegradation of added intrinsic hydrocarbons was not selective.

Phenotypic biomonitoring using multivariate flow cytometric analysis of multi-stained microorganisms

A new method for monitoring phenotypic profiles of pure cultures and complex microbial communities was evaluated. The approach was to stain microorganisms with a battery of fluorescent dyes prior to flow cytometry analysis (FCM) and to analyse the data using multivariate methods, including principal component analysis and partial least squares. The FCM method was quantitatively evaluated using different mixtures of pure cultures as well as microbial communities. The results showed that the method could quantitatively and reproducibly resolve both populations and communities of microorganisms with 5% abundance in a diverse microbial background. The feasibility of monitoring complex microbial communities over time during the biodegradation of naphthalene using the FCM method was demonstrated. The biodegradation of naphthalene occurred to differing extents in microcosms representing three different types of aromatic-contaminated groundwater and a sample of bio-basin water. The FCM method distinguished each of these four microbial communities. The phenotypic profiles were compared with genotypic profiles generated by random-amplified polymorphic DNA analysis. The genotypic profiles of the microbial communities described only the microbial composition, and not their functional change, whereas the phenotypic profiles seemed to contain information on both the composition and the functional change of the microorganisms. Furthermore, event analysis of the FCM data showed that microbial communities with initially differing compositions could converge towards a similar composition if they had a capacity for high levels of degradation, whereas microbial communities with similar initial compositions could diverge if they differed in biodegrading ability.

Effect of a strict preoperative hygienic routine on the rate of infections following cesarean section

The frequency of postoperative infections after cesarean section was studied during two periods. In the first period no strict preoperative hygienic routines were applied; 321 patients were delivered by cesarean section during this period. In the next period strict hygienic routines were introduced; this period included 337 patients. The infection rate was significantly reduced during the second period from 20% to 16%. This reduction was found among the elective operations, and among parturients who had been treated in the hospital for more than 24 h prior to delivery. The frequency of endometritis decreased significantly from the first to the second period, whereas no difference was found concerning wound infections. Significantly fewer patients contracted septicemia during the second period. Since all septicemia cases occurred in endometritis patients the results might indicate that not only the number of patients contracting infection but also the severity of the infections was reduced. No reduction of infections was found after emergency operations. Antibiotic prophylaxis might therefore be of value in this group of patients.

Characterization of toxicological effects of complex nano-sized metal particles using in vitro human cell and whole blood model systems

Metal oxide fumes form at high temperatures, for instance, during welding or firing ammunition. Inhalation exposure to high levels of airborne metal oxide particles can cause metal fume fever, cardiovascular effects, and lung damage in humans, but the associated underlying pathological mechanisms are still not fully understood. Using human alveolar epithelial cells, vascular endothelial cells, and whole blood model systems, we aimed to elucidate the short-term effects of well-characterized metal particles emitted while firing pistol ammunition. Human lung epithelial cells exposed to gunshot smoke particles (0.1-50 μg/ml) produced reactive oxygen species (ROS) and pro-inflammatory cytokines (interleukin 8 (IL-8), granulocyte-macrophage colony-stimulating factor (GM-CSF)) that activate and recruit immune cells. Particles comprising high copper (Cu) and zinc (Zn) content activated human endothelial cells via a non-ROS-mediated mechanism that triggered immune activation (IL-8, GM-CSF), leukocyte adhesion to the endothelium (soluble intercellular adhesion molecule 1 (sICAM-1)), and secretion of regulators of the acute-phase protein synthesis (interleukin 6 (IL-6)). In human whole blood, metal oxides in gunshot smoke demonstrated intrinsic properties that activated platelets (release of soluble cluster of differentiation 40 ligand (sCD40L), platelet-derived growth factor B-chain homodimer(PDGF-BB), and vascular endothelial growth factor A (VEGF-A)) and blood coagulation and induced concomitant release of pro-inflammatory cytokines from blood leukocytes that further orchestrate thrombogenesis. The model systems applied provide useful tools for health risk assessment of particle exposures, but more studies are needed to further elucidate the mechanisms of metal fume fever and to evaluate the potential risk of long-term cardiovascular diseases.

Development of air sampling strategies for monitoring common air pollutants in a mission area at Camp Victoria in Kosovo--stationary vs. personal monitoring

It can be problematic to collect representative samples in the occupational environment of deployed soldiers using personal samplers. In this study, several air sampling strategies were examined to identify the most efficient method for collecting air samples that were representative of the soldiers' exposure profiles at the Swedish KFOR Camp Victoria outside Pristina, Kosovo. Stationary monitoring was performed during two 5-day sampling campaigns, one in summer and one in winter. The acquired data were related to measurements obtained by personal monitoring of three and four subgroups, respectively. Patrolling soldiers, mechanics, and indoor workers were selected to represent groups with different exposure profiles, and the particles, metals associated with particles, nitrogen dioxide, sulfur dioxide, polycyclic aromatic hydrocarbons, aldehydes, and volatile organic compounds that they were exposed to were measured. Generally, low concentrations of the analytes were found in both sampling periods, but the variability was greater in the winter campaign. Samples collected by stationary samplers captured most of the variation in the personnel's exposure, according to principal component analysis (PCA). However, the results also indicate that personal exposure to most potential pollutants would be underestimated if a single outdoor station was used to monitor them. Nevertheless, combined data from stations located outdoors and in relevant microenvironments (workshop, office, and guard station) provided substantially better representation. Thus, it may be possible to obtain monitoring data without using personal samplers in these inherently problematic situations.

Risk factors in cesarean section infection

Factors associated with risk of postoperative infection after cesarean section were studied in 321 patients not given antibiotic prophylaxis. Infections occurred in 56 (25%) of the 228 patients who were delivered by emergency cesarean section and in eight (9%) of the 93 patients who underwent elective surgery (P less than .01). These frequencies corresponded well with the infection rates reported after administration of antibiotics in other studies. Risk factors were: duration of operation more than one hour; blood loss more than 800 ml; presence of Staphylococcus aureus in the nares; signs of intrauterine infection before surgery; and failure of progress in labor. The results indicated that obstetric interventions had been performed more frequently in patients at risk of infection, rather than being the real cause of the infections. The importance of strict preoperative hygienic routine is discussed.