Catalytic hydrolysis of monochlorodifluoromethane over ZnO/ZrO2 catalysts at low temperatures

Monochlorodifluoromethane (HCFC-22) has been identified as a significant contributor to the depletion of the Earth's ozone layer, garnering considerable attention within the scientific community. Consequently, the investigation of Freon degradation has become a central focus of current research efforts. In this study, we opted to employ catalytic hydrolysis as it offers numerous advantages for the degradation of HCFC-22. Specifically, we prepared ZnO/ZrO2 catalysts with hexahedral rod-like structures through citric acid complexation. We examined the impact of various preparation conditions (such as the molar ratio of ZnO to ZrO2, calcination temperature, and calcination time) as well as catalytic hydrolysis conditions (including the amount of catalyst, total flow rate, and catalytic hydrolysis temperature) on the hydrolysis rate of HCFC-22. Characterization of the catalysts was performed using techniques such as XRD, SEM, EDS, TG-DTG, FTIR, N2 adsorption-desorption, CO2-TPD, and NH3-TPD. Our experimental findings revealed the optimal preparation conditions: a catalytic hydrolysis temperature of 100 °C, a molar ratio of ZnO to ZrO2 of 0.7, a water bath temperature of 90 °C, a roasting temperature of 400 °C, and a roasting time of 4 h. At a catalytic hydrolysis temperature of 100 °C, the hydrolysis rate of HCFC-22 reached 99.81%, with the main hydrolyzed products being HCl, HF, and CO2.

Synthesis of gem-Difluorinated 2,3-Dihydrobenzofurans Using Freon-22 via [4 + 1] Annulation of Difluorocarbene and Antitumor Activity Evaluation

As an inexpensive industrial chemical, chlorodifluoromethane (Freon-22), despite its relatively low reactivity, can serve as a practical CF2 source for the construction of gem-difluorinated ring structures. Here, we develop a protocol for the efficient assembly of valuable fluorinated 2,3-dihydrobenzofurans from the [4 + 1] annulation in good yields under basic conditions. The reliable practicability and scalability of the process have also been demonstrated by preparation at the multigram scale, late-stage modifications of pharmaceutical molecules, and potential antitumor potency.

Hydrodehalogenation of Trichlorofluoromethane over Biogenic Palladium Nanoparticles in Ambient Conditions

Among a number of persistent chlorofluorocarbons (CFCs, or freons), the emissions of trichlorofluoromethane (CFCl₃, CFC-11) have been increasing since 2002. Zero-valent-Pd (Pd⁰) catalysts are known to hydrodehalogenate CFCs; however, most studies rely on cost-inefficient and eco-unfriendly chemical synthesis of Pd⁰NPs and harsh reaction conditions. In this study, we synthesized Pd⁰ nanoparticles (Pd⁰NPs) using D. vulgaris biomass as the support and evaluated hydrodehalogenation of CFC-11 catalyzed by the biogenic Pd⁰NPs. The presence of D. vulgaris biomass stabilized and dispersed 3-6 nm Pd⁰NPs that were highly active. We documented, for the first time, Pd⁰-catalyzed simultaneous hydrodechlorination and hydrodefluorination of CFC-11 at ambient conditions (room temperature and 1 atm). More than 70% CFC-11 removal was achieved within 15 h with a catalytic activity of 1.5 L/g-Pd/h, dechlorination was 50%, defluorination was 41%, and selectivity to fully dehalogenated methane was >30%. The reaction pathway had a mixture of parallel and sequential hydrodehalogenation. In particular, hydrodefluorination was favored by higher H₂ availability and Pd⁰:CFC-11 ratio. This study offers a promising strategy for efficient and sustainable treatment of freon-contaminated water.

Levels and Seasonal Trends of C1-C4 Perfluoroalkyl Acids and the Discovery of Trifluoromethane Sulfonic Acid in Surface Snow in the Arctic

C1-C4 perfluoroalkyl acids (PFAAs) are highly persistent chemicals that have been found in the environment. To date, much uncertainty still exists about their sources and fate. The importance of the atmospheric degradation of volatile precursors to C1-C4 PFAAs were investigated by studying their distribution and seasonal variation in remote Arctic locations. C1-C4 PFAAs were measured in surface snow on the island of Spitsbergen in the Norwegian Arctic during January-August 2019. Trifluoroacetic acid (TFA), perfluoropropanoic acid (PFPrA), perfluorobutanoic acid (PFBA), and trifluoromethane sulfonic acid (TFMS) were detected in most samples, including samples collected at locations presumably receiving PFAA input solely from long-range processes. The flux of TFA, PFPrA, PFBA, and TFMS per precipitation event was in the ranges of 22-1800, 0.79-16, 0.19-170, and 1.5-57 ng/m2, respectively. A positive correlation between the flux of TFA, PFPrA, and PFBA with downward short-wave solar radiation was observed. No correlation was observed between the flux of TFMS and solar radiation. These findings suggest that atmospheric transport of volatile precursors and their subsequent degradation plays a major role in the global distribution of C2-C4 perfluoroalkyl carboxylic acids and their consequential deposition in Arctic environments. The discovery of TFMS in surface snow at these remote Arctic locations suggests that TFMS is globally distributed. However, the transport mechanism to the Arctic environment remains unknown.

Ultra-Short-Chain Perfluoroalkyl Acids Including Trifluoromethane Sulfonic Acid in Water Connected to Known and Suspected Point Sources in Sweden

Data presenting the environmental occurrence of ultra-short-chain perfluoroalkyl acids (PFAAs) are scarce and little is known about the potential sources. In this study, ultra-short-chain PFAAs were analyzed in water connected to potential point sources using supercritical fluid chromatography coupled with tandem mass spectrometry. Samples (n = 34) were collected in connection with firefighting training sites, landfills, and a hazardous waste management facility. Ultra-short-chain PFAAs were detected in all samples at concentrations up to 84 000 ng/L (∑C1-C3), representing up to 69% of the concentration of 29 per- and polyfluoroalkyl substances (PFASs). Trifluoroacetic acid (TFA), perfluoropropanoic acid (PFPrA), trifluoromethane sulfonic acid (TFMS), perfluoroethane sulfonic acid (PFEtS), and perfluoropropane sulfonic acid (PFPrS) were detected at concentrations up to 14 000, 53 000, 940, 1700, and 15 000 ng/L, respectively. Principal component analysis suggests that TFA is associated with landfills. PFPrS was associated with samples collected close to the source at all types of sites included in this study. These findings reveal the presence of high concentrations of ultra-short-chain PFAAs released into the environment from various sources and emphasize the large fraction of ultra-short-chain PFAAs to the total concentration of PFASs in water.

A Novel Apparatus for the Determination of Solubility in Pressurized Metered Dose Inhalers

The accurate solubility of salbutamol sulfate, budesonide, and formoterol fumarate dihydrate in hydrofluoroalkane propellant 134a at 25 degrees C for 24 h, are reported. The authors describe a novel reusable in-line pressurized solubility apparatus containing an integral filter holder and a continuous decrimpable valve for the determination of drug/excipients solubility in pressurized metered dose inhalers. The solubility was determined by high-performance liquid chromatography. Solubility of salbutamol sulfate was determined as being below the detection limits while budesonide and formoterol fumarate dihydrate solubility were 23.136 +/- 2.951 microg x g(-1) and 0.776 +/- 1.023 microg x g(-1), respectively (n = 3). This novel solubility apparatus offers an improved ease of use and potential higher analytical throughput.

Aspects of 6-[18F]fluoro-L-DOPA preparation. Deuterochloroform as a substitute solvent for Freon 11

AIM

Replacement of the ecologically harmful solvent Freon 11 (CFCl(3)) by chloroform for the module-assisted preparation of 6-[(18)F]fluoro-L-DOPA based on the electrophilic radiofluorodestannylation of the precursor N-formyl-3,4-di-tert-butoxycarbonyloxy-6-(trimethylstannyl)-L-phenylalanine ethyl ester.

MATERIALS, METHODS

The TRACERlab Fx FDOPA module (GE Medical Systems) was used for the preparation of 6-[(18)F]fluoro-L-DOPA. Cyclotron-produced [(18)F]F(2) gas (5 GBq) was passed through a cooled solution (5 degrees C) of the stannyl precursor (45 mg) in CDCl(3) (10 ml). After the [(18)F]fluorination step, HCl (2 ml, 6 mol/l) was added to the solution. Then the reaction mixture was heated at 80 degrees C for 5 min under vacuum to evaporate the chloroform. The hydrolysis to remove the protecting groups was completed by heating the closed reactor at 130 degrees C for 8 min. After cooling to 20 degrees C the reaction mixture was purified by HPLC with two polymer-based RP columns (PRP-1, 7 microm, 10 x 250 mm, Hamilton) using a solution of AcOH/AcONa (pH 4.7) as eluent. The 6-[(18)F]fluoro-L-DOPA fraction was collected and sterile filtrated.

RESULTS

Three types of stabilised chloroform were tested for the radiofluorination of the precursor. Only by use of deuterochloroform stabilised with silver no significant losses of radioactivity were observed. Thus, 6-[(18)F]fluoro-L-DOPA purified by HPLC was obtained in decay-corrected radiochemical yields of 25+/-3%, ready for human use.

CONCLUSION

CDCl(3) has proved to be a convenient solvent for the module-assisted preparation of 6-[(18)F]fluoro-L-DOPA. In this way the use of the polluting Freon 11 can be avoided.

RCM-Mediated Synthesis of Trifluoromethyl-Containing Nitrogen Heterocycles

A ring-closing metathesis mediated pathway to trifluoromethyl-containing piperidines is detailed. This involves the development of a synthetic route to a new (trifluoromethyl)allylating reagent via a Diels-Alder/retro-Diels-Alder strategy, its application in the synthesis of a series of trifluormethyl-substituted diolefin precursors for ring-closing metathesis, and eventually the successful cyclization of these precursor molecules into the corresponding functionalized piperidines.

Photoinduced Isomerization Kinetics of Diiodomethane in Supercritical Fluid Solution: Local Density Effects

The density dependence of diiodomethane photoinduced isomerization in supercritical (sc) CO2, CHF3, and C2H6 was investigated by transient absorption spectroscopy, covering a fluid density range from 0.7 to 2.5 (in reduced units). The solvent-caged photoproduct iso-diiodomethane is formed even at the lowest density, and its yield increases about 4-fold over the whole range. At the same time, isomer formation rate constants increase by roughly an order of magnitude and show little variation between CO2, C2H6, and CHF3. Furthermore, the formation rate constant decreases significantly with increasing excitation energy. We propose an isomer formation mechanism involving a rapidly established preequilibrium between a solvent-caged iodine atom-methyliodide radical pair and a loosely bound iodine-methyliodide radical complex, from which the reaction subsequently proceeds to the isomer. The latter step seems to be controlled by collisional stabilization of the initially hot radical moiety, as the formation rate constant increases linearly with sc solvent viscosity. The model predicts a quadratic dependence of relative isomer yield on fluid density. A corresponding correlation is found with the local fluid density, calculated via solute-solvent radial distribution functions obtained from molecular dynamics (MD) simulations.

Toxicological evaluation of propane expanded tobacco

A tiered testing strategy has been developed to evaluate the potential for tobacco processes, ingredients, and other technological developments to increase or decrease the biological activity resulting from burning tobacco. The strategy is based on comparative chemical and biological testing. Propane expanded tobacco is an example of a processed tobacco used in the modern manufacture of cigarettes. Test cigarettes containing propane expanded tobacco were compared to control cigarettes containing tobacco expanded with a traditional expansion agent (Freon-11). The toxicological evaluation included chemistry studies using mainstream cigarette smoke (determination of selected constituent yields), in vitro studies using cigarette smoke condensate (Ames study in Salmonella typhimurium and sister chromatid exchange study in Chinese hamster ovary cells) and in vivo studies (13-week inhalation study of mainstream cigarette smoke in Sprague-Dawley rats and 30-week dermal tumor promotion study of cigarette smoke condensate in SENCAR mice). Although statistically significant differences in several smoke constituents were observed, most constituents from cigarettes containing 100% propane expanded tobacco were within market survey ranges. Furthermore, biological tests indicated that the cigarettes containing propane or Freon-11 expanded tobacco were not significantly different.

Toxicological evaluation of dry ice expanded tobacco

A tiered testing strategy has been developed to evaluate the potential of tobacco processes, ingredients, or technological developments to change the biological activity resulting from burning tobacco. The strategy is based on comparative chemical and biological testing. Dry ice expanded tobacco (DIET) is an example of a common tobacco expansion process currently used in the manufacture of cigarettes to increase tobacco filling capacity. As part of the toxicological evaluation of DIET, test cigarettes containing DIET were compared with control cigarettes containing tobacco expanded with a traditional expansion agent (Freon-11, also known as trichlorofluoromethane). Testing included mainstream cigarette smoke chemistry studies, genotoxicity studies (Ames and sister chromatid exchange, SCE), a 13-week inhalation study in Sprague-Dawley rats, and a 30-week dermal tumor promotion study in SENCAR mice. Cigarettes containing DIET or Freon-11 expanded tobacco were similar in biological activity.

Synthesis and studies of 3'-C-trifluoromethyl nucleoside analogues bearing adenine or cytosine as the base

3'-Deoxy-3'-C-CF3, 2',3'-dideoxy-3'-C-CF3 and 2',3'-unsaturated-3'-C-CF3 nucleoside derivatives of adenosine and cytidine have been synthesized. All these derivatives were prepared by glycosylation of adenine and uracil with a suitable peracylated 3-trifluoromethyl sugar precursor. The resulting protected nucleosides were subject to appropriate chemical modifications to afford the target nucleoside derivatives. Additionally, the chemical stability in acidic and neutral media of the 2',3'-dideoxy-3'-C-CF3 and 2',3'-unsaturated-3'-C-CF3 nucleoside derivatives of adenosine was compared to that of their parent nucleosides 2',3'-dideoxyadenosine (ddA) and 2',3'-dideoxy-2',3'-didehydroadenosine (d(4)A). Our results confirm that addition of a trifluoromethyl group at C-3' on such nucleoside derivatives appears to confer increased chemical stability toward acid-catalyzed cleavage of the glycosidic bond comparatively to their parent counterparts. When evaluated for their antiviral activity in cell culture experiments, two compounds, namely, 2',3'-dideoxy-3'-C-CF3-adenosine and 2',3'-dideoxy-2',3'-didehydro-3'-C-CF3-cytidine exhibited moderate anti-HBV activity with EC50 values of 10 and 5 microM, respectively.

High-energy neutron dosimetry with superheated drop detectors

A systematic analysis of the response of dichlorodifluoromethane superheated drop detectors was performed in the 46-133 MeV energy range. Experiments with quasi-monoenergetic neutron beams were performed at the Université Catholique de Leuvain-la-Neuve, Belgium and the Svedberg Laboratory, Sweden, while tests in a broad field were performed at CERN. To determine the response of the detectors to the high-energy beams, the spectra of incident neutrons were folded over functions modelled after the cross sections for the production of heavy ions from the detector elements. The cross sections for fluorine and chlorine were produced in this work by means of the Monte Carlo high-energy transport code HADRON based on the cascade exciton model of nuclear interactions. The new response data permit the interpretation of measurements at high-energy accelerators and on high-altitude commercial flights, where a 30-50% under-response had been consistently recorded with respect to neutron dose equivalent. The introduction of a 1 cm lead shell around the detectors effectively compensates most of the response defect.

Reversed-phase separation of basic tricyclic antidepressants using buffered and fluoroform-enhanced fluidity liquid mobile phases

In an effort to expand the range of applications of enhanced-fluidity liquid chromatography (EFLC) to strongly polar and basic analytes, fluoroform (CHF3) was investigated as a fluidity-enhancing agent. Fluoroform was chosen due to its high polarity, low viscosity and chemical inertness toward water and basic analytes. A group of representative basic compounds, tricyclic antidepressants, covering a wide range of polarity was chosen as model compounds. Their retention behavior on a C18 stationary phase in methanol/phosphate buffer and methanol/phosphate buffer/CHF3 mobile phases was characterized. The chromatographic performance with mobile phase conditions of different pH, with and without CHF3 addition and with addition of triethylamine was studied. The advantages of using CHF3 enhanced and buffered mobile phases were shown in the much improved chromatographic performance, such as shortened analysis time, increased efficiency, lower pressure drop and improved selectivity. Furthermore, this study demonstrated for the first time, that a commercial instrument could be readily utilized for EFLC separations which greatly expands the application range of the EFLC technique and chromatographic instrumentation.

Characterisation of the aggregation behaviour in a salmeterol and fluticasone propionate inhalation aerosol system

The nature of the drug-drug aggregation phenomena between salmeterol xinafoate and fluticasone propionate used in a metered-dose inhaler system has been examined. Interactions between the drugs in the solvents 1,1,2-trichlorotrifloroethane (CFC-113) and 1,1,1,2-tetrafluoroethane (HFA-134a) have been characterised using a focused beam reflectance measurement probe by measuring the average floc size of the drug particles individually and in combination as a function of stirrer rate. The floc composition in the CFC-113 system, where the drug particles cream, was determined by high-performance liquid chromatography analysis. The aggregation behaviour of the individual drugs was shown to depend on the physical and chemical properties of both the drug substance and the media. Larger flocs were observed for salmeterol xinafoate compared with fluticasone propionate, while both drugs formed larger aggregates in HFA-134a compared with in CFC-113. The floc composition studies demonstrated that, in the combined formulation in CFC-113, salmeterol xinafoate and fluticasone propionate aggregate together to form hetero-flocs. The interaction between the two drugs was such that they did not separate on creaming, despite having different densities. The average floc size of the combined drug suspension was also found to depend on the dispersion medium.

Delivery of fenoterol via Respimat, a novel 'soft mist' inhaler. a randomised, double-blind (within device), placebo-controlled, cross-over, dose-ranging study in asthmatic patients

BACKGROUND

The phase-out of chlorofluorocarbons (CFCs) for metered dose inhalers (MDIs) has prompted the development of alternative propellants and the design of propellant-free devices for inhalation therapy.

OBJECTIVE

This study was carried out to determine the dose of fenoterol inhaled from Respimat (RMT), a new propellant-free soft mist inhaler, which is equivalent in terms of efficacy and safety to 1 puff of either 100 or 200 microg fenoterol inhaled from a conventional CFC-MDI (Berotec).

METHODS

Sixty-two asthmatic patients (35 male, 27 female) with a mean baseline FEV(1) of 1.7 liters, corresponding to 55% of the predicted normal value, were randomized at two study centers to 4 of a total of 8 possible treatments: placebo; 12.5, 25, 50, 100, or 200 microg fenoterol via RMT, and 100 or 200 microg fenoterol delivered via the MDI.

RESULTS

Fifty-nine patients completed the study as planned. Results of the therapeutic equivalence test for the primary endpoint, average FEV(1) (AUC(0-6))/6 and for the secondary endpoint, peak FEV(1), showed that the 12.5- and 25-microg fenoterol doses administered via RMT were equivalent to the 100 microg fenoterol dose from the MDI. The 50-, 100- and 200-microg fenoterol doses delivered by RMT did not meet the criterion for therapeutic equivalence with the 100-microg dose from the MDI, and if tested for a difference would have been significantly different in favor of RMT. All 5 RMT fenoterol doses were therapeutically equivalent to the MDI 200-microg fenoterol dose. Headache, reported by 4 patients on test days and 2 patients between test days in those randomized to RMT, was the most common adverse event, but the active treatments were generally well tolerated with no dose-dependent increases in incidence or severity of adverse events observed.

CONCLUSIONS

The results from the study suggest that safe and efficacious bronchodilation can be obtained from single-dose fenoterol administered via RMT. Use of lower absolute doses to obtain a clinically significant improvement in pulmonary function may be possible because of the increased lung deposition achievable with the novel soft mist inhaler.

Pseudo-dental pain and sensitivity to percussion

Two case reports examine a little-known cause of dental pain and sensitivity to percussion. Contrary to the traditional assumption that pain and sensitivity to percussion almost always are diagnostic of pulpal inflammation and/or necrosis, these symptoms actually may be referred to the sensitive tooth from trigger points in the masticatory muscles. Therefore, myofascial pain syndrome must be ruled out in patients who have dental pain and display sensitivity to percussion.

A comparative analysis of freon substitutes in the purification of reovirus and calicivirus

Freon 113 (Freon) is an essential component used in some viral purification methods to separate virus from infected cell debris. With its environmental and toxic hazards, Freon's availability is limited and more tightly regulated. Several organic solvent substitutes were selected to identify a suitable Freon replacement for the purification of both cultivable reovirus and fastidious calicivirus. Reovirus was extracted from tissue cultured cells with each solvent tested and purified in cesium chloride gradients by standard techniques. Purified virions were analyzed for conservation of physical and biological properties by morphological examination and infectivity studies. The purification of calicivirus nucleic acid from stool samples using selected solvents was also examined. Solvent-extracted calicivirus RNA was reverse transcribed and quantified by polymerase chain reaction amplification of a standard diagnostic 117 bp amplicon. These studies indicated that Vertrel XF (a newly developed environmentally friendly Freon substitute) and a 7:3 mixture of isopentane/1-chlorobutane are suitable replacements. Considerations of flammability and ease of use suggest that Vertrel XF is the preferred choice as a Freon substitute for the purification of these non-enveloped viruses.

Post-inhalation bronchoconstriction by beclomethasone dipropionate: a comparison of two different CFC propellant formulations in asthmatics

OBJECTIVE

To assess the change in bronchial response to cumulative doses from two beclomethasone dipropionate metered-dose inhalers (MDI), each using chlorofluorocarbon (CFC) propellants, in asthma patients previously showing falls in forced expiratory volume in 1 s (FEV1) shortly after exposure to beclomethasone MDI.

METHODOLOGY

A total of 18 patients were randomized to a single-blind, three-period cross-over treatment regimen, whereby each was administered increasing doses of control mixture (containing surfactant and CFC propellants) or beclomethasone, formulated as either Becloforte or Respocort (250-1000 microg per dose; cumulative dose 2000 microg). Bronchial response was measured by comparison of FEV1 values pre- and post-inhalation.

RESULTS

Respocort formulation produced the least post-dose mean maximum reduction in FEV1 (0.36 +/- 0.17 L; 14.3 +/- 7.2% of baseline FEV1), while the reduction caused by the control was similar (0.40 +/- 0.18 L; 16.2 +/- 9.9% of baseline FEV1). Becloforte produced a significantly greater maximum reduction in FEV1 than Respocort (0.55 +/- 0.32 L, P = 0.003; 22.0 +/- 15.3% of baseline FEV1, P = 0.005). No serious adverse events were reported, but four patients experienced falls in FEV1 of greater than 15% (three on Becloforte, one using the control).

CONCLUSION

The incidence of falls in FEV1 following use of beclomethasone MDI was low and generally not serious even in a selected population. The Becloforte preparation produced significantly more post-dose bronchoconstriction than the Respocort formulation, perhaps because of differences in the composition of the surfactant and/or CFC propellant mixtures used to formulate each of the aerosols.

Transition to CFC-free metered dose inhalers--into the new millennium

Metered dose inhalers (MDIs) are the most popular vehicle for drug delivery into the lungs and some 500 million are manufactured each year. All MDIs marketed prior to 1995 contained chlorofluorocarbons (CFC) as a propellant. These are implicated in the depletion of stratospheric ozone and, except for specific exemptions, their production has been banned since 1996 under the terms of the Montreal Protocol. Hydrofluoroalkanes have been identified as suitable alternatives for MDI propellants but their physico-chemical properties differ significantly from CFCs and an extensive redevelopment and testing programme has been required to demonstrate the safety, quality and efficacy of HFA containing MDIs. Hydrofluoroalkanes contribute to global warming but the benefit to human health through continued MDI availability currently outweighs the environmental concern. Several HFA-MDIs have reached the market and the transition to replace existing CFC-MDIs is now underway.

Oral frostbite injury from intentional abuse of a fluorinated hydrocarbon

BACKGROUND

A serious but rarely reported complication of halogenated hydrocarbon inhalation abuse is severe mucosal frostbite.

CASE REPORT

A 16-year-old male attempted to "get high" by inhaling airbrush propellant which contained 1,1-difluoroethane (CAS #75-376). The patient lost consciousness and upon awakening his lips and tongue were frozen. He suffered first- and second-degree burns of the larynx with vocal cord involvement and first-degree burns of the trachea, main stem bronchi, and esophagus. The oral cavity had second- and third-degree burns which required debridement.

CONCLUSION

This case demonstrates the unusual but severe damage that can occur with the abuse of fluorinated hydrocarbons.

Adolescent inhalant abuse: environments of use

A questionnaire survey of 285 consecutively recruited adolescents who were adjudicated to juvenile correctional facilities in Virginia was conducted using the Inhalant Use Questionnaire (1). White youths (36.1%) and youths from other ethnic backgrounds (44.4%) are significantly more likely to report past inhalant use than black youths (1.4%). The median age reported for first-time use of inhalants is 13 years. Youths were divided between those who experimented with inhalants (27%) and those who were heavy users (27%). Huffing was preferred by 60% of youths. Of the youths, 52% reported using inhalants with friends present, whereas 34% used inhalants when they were alone. Sites where youths reported inhalant use include at a friend's home (68%), at home (54%), on the street (40%), at parties (28%), on school grounds (26%), and at school (18%). There are no gender differences in age of onset of inhalant use, lifetime frequency of inhalant use, frequency of inhalant use in the past year, or preferred method of using inhalants. The five substances most frequently used as inhalants include gasoline (by 57.4%), Freon (40.45%), butane lighter fluid (38.3%), glue (29.8%), and nitrous oxide (23.4%). There were no gender differences for use of other products.

A controlled trial of chlorofluorocarbon-free triamcinolone acetonide inhalation aerosol in the treatment of adult patients with persistent asthma. Azmacort HFA Study Group

STUDY OBJECTIVE

To compare the dose response, efficacy, and safety of inhaled triamcinolone acetonide (TAA) with a hydrofluoroalkane (HFA) propellant (75 microg/puff), TAA with a chlorofluorocarbon propellant (dichlorodifluoromethane [P-12]; 75 microg/puff), and placebo in adult patients with persistent asthma.

DESIGN

Multicenter, randomized, double-blind, placebo-controlled, parallel-group study of 514 adult patients with persistent asthma.

INTERVENTIONS AND MEASUREMENTS

Patients received 8 weeks of treatment with 150, 300, or 600 microg/d of TAA HFA, the same doses of TAA P-12, or placebo following a 5- to 21-day baseline period. Efficacy was assessed by spirometry, and by daily recordings of albuterol use, peak expiratory flow (PEF), asthma symptom ratings, and nighttime awakenings throughout the study.

RESULTS

Linear trend analysis showed that both formulations of TAA at all doses produced statistically significant improvements compared with placebo in spirometry, asthma symptom scores, albuterol use, and PEF. Significant improvement was seen as early as 24 h for morning PEF and as early as 1 week for FEV(1) (TAA HFA, 600 microg/d; TAA P-12, 300 and 600 microg/d) and albuterol use (all doses of both formulations). The P-12 and HFA formulations had comparable efficacy. A dose response showing greater improvement with higher doses was evident for the majority of parameters for both formulations. The incidences of adverse events were similar across all treatment groups with no dose-related trends.

CONCLUSION

HFA and P-12 formulations of TAA inhalation aerosol were therapeutically equivalent and showed comparable safety and dose-related efficacy in the treatment of patients with persistent asthma.

Effect of the type carrier used on the results of dichlorodifluoromethane application to teeth

Thermal testing, especially cold, is an important part of diagnosing pulpal vitality. It was the purpose of this study to determine (i) if a difference exists in temperature when Endo ice is used with four different applicators, and (ii) if there is one applicator device that provides the greatest thermal change for a tooth. Endo ice was used with the following applicators: a #2 standard size large cotton pellet, a #4 standard size small cotton pellet, a wood stick cotton tip applicator, and a cotton roll. The temperature of a mandibular incisor pulp chamber was measured in degree C 10 s after the application of the dichlorodifluoromethane (DDM) to the midfacial surface of the crown. Also, the DDM was applied to each applicator either by direct spray or by submergence in DDM liquid. This study found that the greatest temperature change was recorded by Endo Ice (DDM) sprayed directly onto a large cotton pellet. There was no significant difference between directly spraying or submerging the applicator in DDM liquid.

Neural tube defects and drinking water disinfection by-products

We conducted a population-based case control study of neural tube defects and drinking water contaminants, specifically, disinfection by-products. We used public monitoring records concurrent with the first month of gestation to assess exposure. The prevalence odds ratios (PORs) for the highest tertile of total trihalomethanes compared with the lowest was 1.6 (95% confidence interval [CI] = 0.9-2.70). Surface water source was also associated with neural tube defects (POR = 1.5; 95% CI = 0.9-2.5). Sensitivity analyses restricted to isolated neural tube defect cases and mothers with known residence at conception yielded stronger associations [total trihalomethanes, POR = 2.1 (95% CI = 1.1-4.0); surface water, POR = 1.7 (95% CI = 0.9-3.2)]. Other major groups of disinfection by-products (haloacetic acids and haloacetonitriles) showed little relation to these defects.

Frigen II improves the reliability of measurement of interleukin-1 related substances in amniotic fluid

BACKGROUND

To investigate the role of interleukin-1 related substances in amniotic fluid in normal term labor without intrauterine infection.

METHODS

Amniotic fluid samples were collected from forty-one patients with various backgrounds. A novel pre-assay treatment using Frigen II was introduced to improve the recovery rates of cytokines, i.e., interleukin-1alpha, interleukin-1beta and interleukin-1 receptor antagonist, prior to ELISA assay. Urine samples from newborn infants were also tested.

RESULTS

The concentrations of interleukin-1alpha, interleukin-1beta and interleukin-1ra were significantly higher in samples from normal vaginal delivery. The higher levels of interleukin-1alpha were also observed in samples from preterm labor without infection. Preterm infants produced more of interleukin-1 receptor antagonist in urine compared with term infants.

CONCLUSIONS

This study provides evidence of the possible involvement of interleukin-1 related substances in labor without signs of infection. The data from newborn urine suggests that amniotic interleukin-1ra originates from the fetus. However, amniotic fluid interleukin-1alpha and interleukin-1beta may be derived from maternal tissue, such as decidua.

Influence of temperature on the emitted dose of an oral metered dose inhaler

The performance of metered dose inhalers is critical for the efficient delivery of drugs to the intended site of deposition in the respiratory tract. The temperature at which metered dose inhaler products are used by patients may influence the physicochemical characteristics of the emitted dose. Product performance characteristics of a metered dose inhaler containing beclomethasone dipropionate and oleic acid in a blend of chlorofluorocarbon propellants, Freon-11 and Freon-12, were determined by cascade impaction analysis and dose delivery through the valve after the metering chamber was loaded and actuated at 4 degrees C, 23 degrees C, and 40 degrees C. The dose delivered from the valve was not affected by the temperature at which the metering chamber was loaded and actuated. The mass median aerodynamic particle size of the emitted aerosol decreased and the percentage respirable fraction increased as the temperature was increased. The geometric standard deviation of the particle size distribution was not significantly affected by the temperature at which the metering chamber was loaded and actuated. The temperature at which a metered dose inhaler is used by a patient may influence the amount of drug that is potentially respirable; therefore, the dose expected to be delivered and the corresponding therapeutic effect may also be affected.

Cardiac sensitization testing of the halon replacement candidates trifluoroiodomethane (CF3I) and 1,1,2,2,3,3,3-heptafluoro-1-iodopropane (C3F7I)

Trifluoroiodomethane (CF3I) and 1,1,2,2,3,3,3-heptafluoro-1-iodopropane (C3F7I) have been considered as replacement candidates for halon fire suppressants due to their excellent fire extinguishant capabilities and low ozone depletion potential compared to halon fire extinguishants in use currently. As part of the process to develop environmental and health effects criteria for halon substitutes, a cardiac sensitization test was conducted in beagle dogs. Cardiac sensitization to adrenaline is a phenomenon associated with the inhalation of a number of unsubstituted and halogenated hydrocarbons. Adrenaline was administered by intravenous injection before and during inhalation of the test substance. CF3I was administered to dogs at concentrations in air of 0.1, 0.2, 0.4 or 1% v/v. At each of 0.4 and 1.0% CF3I, the first dog exposed developed fatal ventricular fibrillation, and no further dogs were exposed at these concentrations. There was no cardiac sensitization at 0.1 or 0.2% CF3I. For the C3F7I experiment, dogs were exposed to concentrations in air of 0.1, 0.2 or 0.4% v/v. At each of 0.1 and 0.4% C3F7I, one dog responded with multifocal ventricular ectopic beats. Thus, CF3I and C3F7I are potent cardiac sensitizers in the adrenaline-challenged dog model.

A position-sensitive superheated emulsion chamber for three-dimensional photon dosimetry

A position-sensitive detector chamber is introduced for the three-dimensional (3D) dosimetry of photon-emitting brachytherapy sources. The detector is based on an extremely fine suspension of monochloropentafluoroethane droplets emulsified in a gel. The droplets are highly superheated at room temperature and their evaporation can be triggered by photon interactions, leading to the formation of microscopic bubbles. Thus, when photon-emitting brachytherapy sources are inserted into the detector, bubble distributions form around them, enabling visualization of the radiation field. The tissue-equivalent emulsifier gel is highly viscous and keeps the bubbles immobilized at the location of their formation. Bubbles can then be imaged by nuclear magnetic resonance or optical scanning techniques. After the imaging, the detector can be pressurized in order to recondense the bubbles to the liquid phase. In a few minutes, the device is annealed and ready to be used again for repeated measurements improving the counting statistics. The photon sensitivity of the monochloropentafluoroethane droplets was determined with highly filtered, quasi-monochromatic x-ray beams and radionuclide gamma sources. The air-kerma response presents a broad maximum at low energies, due to the relatively high effective atomic number of the halocarbon molecule. A prototype chamber was built and successfully tested: bubble distributions deriving from the insertion of a 125I source were imaged by means of a slice-selective 3D gradient-echo technique. These experiments confirm the potential and viability of this new approach to 3D photon dosimetry.

[Bronchodilator aerosol propellant interferes with an photoacoustic spectrophotometer respiratory gas analyzer]

A patient with bronchial asthma was scheduled for an operation under nitrous oxide-isoflurane anesthesia. We monitored isoflurane concentrations continuously using an anesthetic gas analyzer (BK 1304). Upon puffing procaterol hydrochloride aerosol for 4 times, the analyzer showed a rapid increase in end-tidal isoflurane concentration. The BK 1304 uses infrared photoacoustic spectrophotometry and it is susceptible to interferences caused by Freon propellants in bronchodilator aerosols. We should take care in monitoring inhalational anesthetics when using aerosols containing Freon propellants.

Virion concentration method for the detection of human enteric viruses in extracts of hard-shelled clams

A method to extract and concentrate intact human enteric viruses from oyster extracts for detection using reverse transcription-polymerase chain reaction (RT-PCR) was applied to hard-shelled clams (mercenaria mercenaria). Fifty-gram clam samples were processed by an adsorption-elution-precipitation method and then seeded with 10(1) to 10(5) PFU to poliovirus 1 (PV1) and/or hepatitis A virus (HAV). Seeded viruses in extracts were purified by fluorocarbon (Freon) extraction and concentrated by polyethylene glycol (PEG) precipitation and elution. Efficiency of virion recovery from PEG precipitates was dependent upon PEG concentration and elution buffer volume, with optimized variable yielding recoveries as high as 99% for PV1 and 45% for HAV, as evaluated by cell culture infectivity assay. To further concentrate viruses, remove inhibitors, and reduce sample volumes, the protein-precipitating agent Pro-Cipitate was used in an adsorption-elution-precipitation scheme. The final concentrate was of low volume (< 1 ml) and directly compatible with viral genomic amplification using RT-PCR. When extracts from 50-g clam samples were seeded and processed by the combined concentration and purification scheme, direct RT-PCR detection of viral genomic RNA was possible at initial inoculum levels of 10(3) PFU for PV1 and HAV. Corresponding virus recoveries based on cell culture infectivity were 7 to 50% and 0.3 to 8% for pV1 and HAV, respectively, when extracts of clams were artificially contaminated with the Norwalk virus, direct detection of virion RNA using RT-PCR and subsequent oligoprobe hybridization was possible at levels as low as 450 RT-PCR amplifiable units of the Norwalk virus per extract of 50-g clam sample.

Raised concentration of serum bile acids following occupational exposure to halogenated solvents, 1,1,2-trichloro-1,2,2-trifluoroethane and trichloroethylene

OBJECTIVES

The objectives of this study were threefold. First, to examine the hepatic effects of occupational exposure to 1,1,2-trichloro-1,2,2-trifluoroethane (FC 113) using conventional and newer tests (serum bile acids) of hepatobiliary function. Second, to assess the effects of altered work practices that included a reduced exposure to a different halogenated solvent (trichloroethylene) on the same parameters of liver function; and finally, to gather further data to support or refute the contention that serum bile acid (SBA) levels could provide a sensitive biological marker of exposure to these solvents.

DESIGN

Two groups of workers (control and exposed) in an Australian steel industry participated in the study. The exposed group (n = 5-6) comprised individuals who had either exposure to FC 113 (68.2 +/- 12.6 ppm) or trichloroethylene (8.9 +/- 3.1 ppm) during the application of these solvents in a cleaning procedure, whereas the control group (n = 7-11) was composed of non-solvent-exposed office workers in the same company. The initial investigation involved exposure to FC 113 while a follow-up study was undertaken after changes in work practices were made including replacement of FC 113 with trichloroethylene (TRI).

METHODS

Standard liver function tests and individual serum bile acids (ISBA) were measured before and after exposure to solvents and simultaneously in the control subjects by enzymatic methods and high performance liquid chromatography (HPLC), respectively.

RESULTS

Statistical analysis of the data showed a significant increase in the concentration of total serum bile acids (TSBA), some of the subgroups of SBA, and a few of the ISBA in workers after a period of exposure to FC 113. After TRI replaced FC 113 together with other changes in work practices to give substantial reduction in exposure to solvent, a repeat study also found elevated SBA after the cleaning procedure but to a lesser extent. No other indications of adverse liver effects, as measured by conventional parameters of hepatobiliary function, were detected.

CONCLUSION

Exposure to FC 113 was clearly associated with a significant rise in SBA levels, which are sensitive indicators of liver function. This finding is consistent with, and provides further support for, our previous investigations on chlorinated aliphatic hydrocarbon solvents which showed that SBA levels are a sensitive biological marker of exposure to these solvents. Changes in work practices including replacement of FC 113 resulted in a reduced effect on SBA, consistent with lower exposures.

Cryogen spray cooling during Nd:YAG laser treatment of hemangiomas. A preliminary animal model study

BACKGROUND

Successful laser treatment of hemangiomas requires selective photothermal destruction of dilated cutaneous vessels without damaging the overlying epidermis. Delivering a short cryogen spurt, on the order of milliseconds, has been shown to result in localized cooling of the superficial skin structures during laser irradiation.

OBJECTIVE

The purpose of this study was to examine the effectiveness of cryogen spray cooling (CSC) in protecting superficial tissue structures during continuous Nd:YAG laser irradiation of an in vivo model hemangioma.

METHODS

The highly vascularized chicken comb was selected as the animal model for hemangiomas. The Nd:YAG laser irradiation ranged from 2.6 to 35.1 J/mm2. A feedback system utilizing infrared radiometry monitored the comb surface temperature and controlled delivery time of the cryogen spurt. When comb surface temperature during laser irradiation reached 36-42 degrees C, a 30-100 msec cryogen spurt was delivered. Animals were euthanized 1 hour to 21 days following each experiment. Gross and histologic analyses were performed.

RESULTS

Nd:YAG laser irradiation resulted in deep (up to 6.1 mm) tissue photocoagulation, while CSC preserved the overlying epidermis and papillary dermis.

CONCLUSION

The results demonstrate that CSC is effective in protecting the epidermis and papillary dermis, while achieving deep tissue photocoagulation during Nd:YAG laser irradiation. Further pilot studies in humans appear warranted.

Effect of dynamic cooling on 585-nm pulsed dye laser treatment of port-wine stain birthmarks

BACKGROUND AND OBJECTIVE

The objective of this study was to determine the effectiveness of a dynamic cooling device (DCD), spraying the skin with a brief spurt of cryogen prior to the laser pulse, in reducing transient pain associated with 585-nm pulsed dye laser (PDL) treatment of port-wine stains (PWS), and reducing epidermal damage (hypo/hyperpigmentation) caused by this laser during PWS treatment.

MATERIALS AND METHODS

Matched treatment sites were compared with and without the use of the cryogen spray in 47 patients at two investigational sites. Pain ratings, clearance of the PWS, and pigmentation changes were assessed. The results were analyzed by skin type and patient age.

RESULTS

A statistically significant reduction in pain ratings was found in all patient groups using the DCD without changing the efficacy of PWS clearance. Pain reduction was most remarkable in patients with darker skin types. Dynamic cooling prevented the occurrence of epidermal damage or pigmentation change in most cases.

CONCLUSIONS

This study suggests that dynamic cooling can dramatically diminish pain during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage in most patients suggests that precooling with the DCD may allow the use of higher laser fluences to expedite clearance without inducing epidermal change. Dynamic cooling has potential use with other lasers and different lesions where discomfort and epidermal effects limit therapy.

The response of anesthetic agent monitors to trifluoromethane warns of the presence of carbon monoxide from anesthetic breakdown

OBJECTIVE

Trifluoromethane and CO are produced simultaneously during the breakdown of isoflurane and desflurane by dry CO2 absorbents. Trifluoromethane interferes with anesthetic agent monitoring, and the interference can be used as a marker to indicate anesthetic breakdown with CO production. This study tests representative types of gas monitors to determine their ability to provide a clinically useful warning of CO production in circle breathing systems.

METHODS

Isoflurane and desflurane were reacted with dry Baralyme at 45 degrees C. Standardized samples of breakdown products were created from mixtures of reacted and unreacted gases to simulate the partial degrees of reaction which might result during clinical episodes of anesthetic breakdown using 1% or 2% isoflurane and 6% or 12% desflurane. These mixtures were measured by the monitors tested, and the indication of the wrong agent or a mixture of agents due to the presence of trifluoromethane was recorded and related to the CO concentration in the gas mixtures.

RESULTS

When presented with trifluoromethane from anesthetic breakdown, monochromatic infrared monitors displayed inappropriately large amounts of isoflurane or desflurane. Agent identifying infrared and Raman scattering monitors varied in their sensitivity to trifluoromethane. Mass spectrometers measuring enflurane at mass to charge = 69 were most sensitive to trifluoromethane.

CONCLUSION

Monochromatic infrared monitors were unable to indicate anesthetic breakdown via interference by trifluoromethane, but did indicate falsely elevated anesthetic concentrations. Agent identifying infrared and Raman monitors provided warning of desflurane breakdown via the interference of trifluoromethane by displaying the wrong agent or mixed agents, but may not be sensitive enough to warn of isoflurane breakdown Some mass spectrometers provided the most sensitive warnings to anesthetic breakdown via trifluoromethane, but additional data processing by some patients monitor units reduced their overall effectiveness.

An overview of the risk assessment of hazardous materials and the role of toxicology

The chemical risk assessment process and the need for health-based approaches to identify and characterize potential hazardous substances will be discussed. The risk assessment process can be applied to both workplace and environmental settings. Toxicology will be defined and related to the risk assessment process. A brief overview of toxicity screens and tests will be presented in order to help make toxicity data more meaningful. Toxicity data for Halon 1301 replacements and trichloroethylene (TCE) will be presented as examples. The paper will conclude with a description of tri-service toxicology; what it is and what this laboratory provides to the Department of Defense (DOD), industry, and academia.

Nd:YAG laser irradiation in conjunction with cryogen spray cooling induces deep and spatially selective photocoagulation in animal models

Successful laser treatment of haemangiomas requires selective photocoagulation of subsurface targeted blood vessels without thermal damage to the overlying epidermis. We present an in vivo experimental procedure, using a chicken comb animal model, and an infrared feedback system to deliver repetitive cryogen spurts (of the order of milliseconds) during continuous Nd:YAG laser irradiation. Gross and histologic observations show deep-tissue photocoagulation is achieved, while superficial structures are protected from thermal injury due to cryogen spray cooling. Experimental observation of epidermis protection in chicken comb animal models suggests selective photocoagulation of subsurface targeted blood vessels for successful treatment of haemangiomas can be achieved by repetitive applications of a cryogen spurt during continuous Nd:YAG laser irradiation.

The influence of sleeping position on functional residual capacity and effective pulmonary blood flow in healthy neonates

Variation in body position has been shown to affect respiratory function in adults and neonates with and without respiratory illness. At present it remains unclear why respiratory function should be affected by different body positions. We hypothesized that the effect of body weight on the relatively compliant chest wall of the newborn infant in the prone position would cause a reduction in functional residual capacity (FRC) and a compensatory improvement in ventilation/perfusion matching as measured by effective pulmonary blood flow. To evaluate this, a paired crossover study was performed on 12 normal newborn infants. The inert gas (argon) rebreathing method adapted for neonates was used to measure FRC. Simultaneously effective pulmonary blood flow (Qpeff) was determined using Freon 22 and a mass spectrometer with computerized analysis. The babies were studied in three different positions in random order: prone, supine and right lateral decubitus. The means (95% confidence intervals) of the three groups of FRC were 23.8 (19.2 to 28.4), 23.8 (20.2 to 27.5), and 24.3 (19.5 to 29.2) ml/kg, respectively (P = 0.59) and for Qpeff were 104 (91 to 116), 108 (95 to 122), 109 (97 to 122) ml/ kg-min, respectively (P = 0.11). Thus no significant differences were demonstrated. In nine of the babies, a repeat supine measurement was taken at the end of the study to assess repeatability of the method. In these nine babies alone the results were 22.7 (19.1 to 26.3) and 22.1 (18.6 to 25.6) ml/kg for FRC, and 102 (89 to 116) and 98 (90 to 107) ml/kg-min for Qpeff. The coefficients of repeatability were 4.7 ml/kg for FRC (21%) and 30 ml/kg-min for Qpeff (30%).

Systemic concentrations of salbutamol and HFA-134a after inhalation of salbutamol sulfate in a chlorofluorocarbon-free system

The objective of this study was to determine if salbutamol was absorbed from a new salbutamol sulfate chlorofluorocarbon (CFC)-free metered-dose inhaler (MDI). Measurement of HFA-134a, the CFC-free propellant, was included to provide proof of delivery of this MDI. Eight healthy men received two inhalations (90 micrograms salbutamol base equivalents per inhalation ex adapter) from the CFC-free inhaler (MDI A) in period 1 and from a reference CFC inhaler (MDI V) in period 2. Eight postdose samples were collected for the determination of salbutamol serum levels over a 4-h period. Salbutamol levels were not quantifiable in most samples. Four subjects given MDI A and two given MDI V had a few transient salbutamol levels, which occurred in the first hour after dosing, within a narrow range of 1-2 ng/ml and close to the lower limit of detection (1 ng/ml). No pharmacokinetic analyses were possible. Blood samples were also collected after MDI A for propellant quantitation. HFA-134a levels were seen in all subjects, verifying absorption. We conclude that the transient salbutamol serum levels can be attributed to the two-inhalation dose and not to either propellant system.

Improved MR images of arterial specimens by submersion in trichlorotrifluoroethane

MR images of ex vivo arterial specimens immersed in 1,1,2-trichloro-1,2,2-trifluoroethane (R-113) have improved signal-to-noise ratio and contrast-to-noise ratio. R-113 has no hydrogen atoms, so it yields no proton signal; hence, the contrast between the specimen and its background is maximized. SNR is maximized because (i) R-113 is nonconductive so that coil loading and inductive noise are minimized, and (ii) the volume susceptibility of R-113 closely matches that of water and tissue so that T2* effects are minimized. Short-term submersion of porcine aortas in R-113 was found to have no significant effect on the artery's hydration level, relaxation time, tensile strength, and structure or quantity of elastin, collagen, or smooth muscle cells.

Dynamic epidermal cooling during pulsed laser treatment of port-wine stain. A new methodology with preliminary clinical evaluation

BACKGROUND AND DESIGN

The clinical objective in the treatment of a patient with port-wine stain (PWS) undergoing laser therapy is to maximize thermal damage to the PWS, while at the same time minimizing nonspecific injury to the normal overlying epidermis. With dynamic cooling, the epidermis can be cooled selectively. When a cryogen spurt is applied to the skin surface for an appropriately short period of time (on the order of tens of milliseconds), the cooling remains localized in the epidermis, while leaving the temperature of the deeper PWS vessels unchanged.

RESULTS

Comparative measurements obtained by a fast infrared imaging detector demonstrated that the surface temperature prior to laser exposure could be reduced by as much as 40 degrees C using the dynamic cooling technique. No skin surface textural changes were noted on PWS test sites cooled with a 20- to 80-millisecond cryogen spurt after flashlamp-pumped pulsed dye laser (FLPPDL) exposure (lambda = 585 nm; tau p = 450 microseconds) at the maximum light dosage possible (10 J/cm2). In contrast, epidermal necrosis occurred on the uncooled sites after such exposure. Six months after laser exposure, clinically significant blanching on the cooled sites indicates laser photothermolysis of PWS blood vessels did occur.

CONCLUSIONS

Our preliminary experiments demonstrate the feasibility of selectively cooling the normal overlying epidermis without affecting the temperature of the deeper PWS vessels. Furthermore, protection of the epidermis from thermal injury, produced by melanin light absorption at clinically relevant wavelengths, can be achieved effectively. An additional advantage of dynamic epidermal cooling is reduction of patient discomfort associated with FLPPDL therapy. Further studies are under way to determine an optimum strategy for applying this dynamic cooling technique during pulsed laser treatment of patients with PWS and others with selected dermatoses (dermal melanocytic lesions and tattoos).