Nanosafety research--are we on the right track?

The number of studies that have been published on the topic of nanosafety speaks for itself. We have seen an almost exponential rise over the past 15 years or so in the number of articles on nanotoxicology. Although only a couple of hundred papers had appeared on the topic of "Nanomaterials: environmental and health effects" before 2000, this number has exploded to over 10 000 since 2001. Most of these studies, however, do not offer any kind of clear statement on the safety of nanomaterials. On the contrary, most of them are either self-contradictory or arrive at completely erroneous conclusions. Three years ago in this Journal we underscored the deficiencies in the way these studies were designed and pointed out the sources of error in the methods used. Now, on the basis of a comprehensive review of the literature and with the help of selected toxicological end points, we attempt to indicate where the significant weaknesses of these studies lie and what we must improve in the future.

Dispersion method for safety research on manufactured nanomaterials

Nanomaterials tend to agglomerate in aqueous media, resulting in inaccurate safety assessment of the biological response to these substances. The present study searched for suitable dispersion methods for the preparation of nanomaterial suspensions. Titanium dioxide (TiO2) and zinc oxide (ZnO) nanoparticles were dispersed in a biocompatible dispersion medium by direct probe-type sonicator and indirect cup-type sonicator. Size characterization was completed using dynamic light scattering and transmission electron microscopy. A series of dispersion time and output power, as well as two different particle concentrations were tested. Microscopic contamination of metal titanium that broke away from the tip of the probe into the suspension was found. Size of agglomerated nanoparticles decreased with increase in sonication time or output power. Particle concentration did not show obvious effect on size distribution of TiO2 nanoparticles, while significant reduction of secondary diameter of ZnO was observed at higher concentration. A practicable protocol was then adopted and sizes of well-dispersed nanoparticles increased by less than 10% at 7 d after sonication. Multi-walled carbon nanotubes were also well dispersed by the same protocol. The cup-type sonicator might be a useful alternative to the traditional bath-type sonicator or probe-type sonicator based on its effective energy delivery and assurance of suspension purity.

Poly traditional Chinese medicine formulation prepared with skin moisturizing properties

Many traditional Chinese medicine compositions can moisturize the skin and utilize in cosmetics. Using a combination of Chinese Medicine Materials and guided by Traditional Chinese Medicine principles, this study selected Echinacea purpurea to protect the skin barrier, Dendrobium nobile to clear heat and promote fluid production, Sophora flavescens to clear heat for diminished inflammation, and Aloe vera combined Lycium barbarum to nourish yin, to together form a "poly TCM moisturizing formulation." These poly plant extracts were investigated and optimized for the stability, safety, and moisturizing ability. The combination moisturizing effect was determined by measuring the expression of FLG mRNA, CLDN-1 mRNA, and AQP3 protein. Toxicological analysis included a red blood cell hemolysis test and a 3T3 phototoxicity test. It has been observed that by using polysaccharide yield as the evaluation criterion showed optimal extraction at a material-to-liquid ratio of 1:100, an extraction temperature of 100°C, and an extraction time of 3 hours. Moisturizing effect experiments showed that the expression of FLG mRNA, CLDN-1 mRNA, and AQP3 protein was significantly increased. Toxicological tests showed that the composition was safe and caused no irritating effects. Based on these results, this poly traditional Chinese medicine moisturizing formulation is safe within moisturizing effects and can be used as a moisturizing raw material in cosmetics.

Current States and Future Trends in Safety Research of Construction Personnel: A Quantitative Analysis Based on Social Network Approach

The construction industry is recognized as a high-risk industry given that safety accidents and personnel injuries frequently occur. This study provided a systematic and quantitative review of existing research achievements by conducting social network approach to identify current states and future trends for the occupational safety of construction personnel. A total of 250 peer-reviewed articles were collected to examine the research on safety issues of workers in construction industry. Social network approach was applied to analyze the interrelationship among authors, keywords, and citations of these articles using VOS viewer and CitNetExplorer. A knowledge structure map was drawn using main path analysis (MPA) towards the collected papers, which was implemented by Pajek. In line with the findings of social network analysis, five research groups, and six keyword themes were identified in accordance with the times of cooperation of researchers and correlation among keywords of the papers. Core papers were identified by using main path analysis for each research domain to represent the key process and backbone for the corresponding area. Based on the finding of the research, significant implications and insights in terms of current research status and further research trends were provided for the scholars, thus helping generate a targeted development plan for occupational safety in construction industry.

To establish a body of evidence on safety for postmarketing Chinese medicine: A new research paradigm

The issue of safety evaluation on postmarketing Chinese medicines has become a hot topic in mainland China recently. Researchers and decision-makers can obtain a variety of evidence resources about safety in order to evaluate the safety profile for postmarketing Chinese medicines. A registry study on ten Chinese medicine injections for postmarketing surveillance has come to the end. From such a study observing more than 300,000 patients for more than 4 years, a theoretical research question emerges, that is, how to identify and evaluate safety evidence systematically. We put forward a brand new research paradigm on the theory level, which is to establish a body of evidence on safety evaluation for postmarketing Chinese medicine. Therefore, multiple information sources were explored and extracted from preclinical experiments for toxicity, postmarketing clinical trials for effificacy and safety evaluation, registry study for surveillance, retrospective data analysis from hospital information system and spontaneous response system, and case reports and systematic review from literature. Greater efforts for this idea and cooperation with experts in this fifield both in China and abroad are urgently needed.

The impact of "To Err Is Human" on patient safety in anesthesiology. A bibliometric analysis of 20 years of research

Background

Patient safety gained public notoriety following the 1999 report of the Institute of Medicine: To Err is Human - Building a Safer Health System which summarized a culminated decades' worth of research that had so far been largely ignored. The aim of this study was to analyze the report's impact on patient safety research in anesthesiology.

Methods

A bibliometric analysis was performed on all anesthesiologic publications from 2000 to 2019 that referenced To Err Is Human. In bibliometric literature, references are understood to represent an author's conscious decision to express a relationship between his own manuscript and the cited document.

Results

The anesthesiologic data base contained 1.036 publications. The journal with the most references to the IOM report is Anesthesia & Analgesia. By analyzing author keywords and patterns of collaboration, changes in the patient safety debate and its core themes in anesthesiology over time could be visualized. The generic notion of "error," while initially a central topic in the scientific discourse, was subsequently replaced by terms representing a more granular, team-oriented, and educational approach. Patient safety research in anesthesia, while profiting from a certain intellectual and conceptual head start, showed a discursive shift toward more managerial, quality-management related topics as observed in the health care system as a whole.

Conclusions

Over the last 20 years, the research context expanded from the initial focus set forth by the IOM report, which ultimately led to an underrepresentation of research on critical incident reporting and systemic approaches to safety. Important collaborations with safety researchers from outside of health care dating back to the 1990's were gradually reduced, while previous research within anesthesiology was aligned with a broader, more managerial patient safety agenda.