Target and Suspect Screening for Organic Additives in Six Classifications of Personal Care Products Using Liquid Chromatography-High-Resolution Mass Spectrometry.

Personal care products (PCPs) are integral components of daily human existence, including a large number of chemicals intentionally added for functional attributes (e.g., preservatives and fragrances) or unintentionally present, such as plasticizers. This investigation aimed to optimize the methodology for target and suspect screening via liquid chromatography-high-resolution mass spectrometry, focusing on nine prevalent organic additives (comprising bisphenols A, F, and S, methyl, ethyl, propyl, and butylparaben, 5-chloro-2-methyl-4-isothiazolin-3-one, and 4-hydroxybenzoic acid). A total of 50 high-selling PCPs were purchased from the local online market as samples. In detail, PCP samples were classified into body washes, shampoos, hair conditioners, facial cleansers, body lotions, and moisture creams. For calibration, the quality assurance and quality control results demonstrated a coefficient of determination (R2) surpassing 0.999, with detection and quantification limits ranging from 2.5 to 100.0 ng/g. For recovery experiments, replicate recoveries (n = 5) ranged from 61 to 134%. In purchased PCP samples, five of the nine target compounds were detected via a target screening. Methylparaben exhibited the highest concentration (7860 mg/kg) in a facial cleanser, which is known as an endocrine-disrupting chemical. A total of 248 suspects of organic additives were screened in PCPs, leading to a tentative identification of 9. Confirmation (confidence level 1) via reference standards was achieved for three suspects, while six were tentatively identified with a confidence level of 2. This two-step extraction methodology utilizing methyl tert-butyl ether and isopropyl alcohol enabled simultaneous analysis of diverse chemical groups with distinct properties.

Proposal for priority emerging pollutants in the Nakdong river, Korea: Application of EU watch list mechanisms.

The Nakdong River, the longest in Korea, has received numerous pollutants from heavily industrialized and densely populated areas while being used as a drinking water source. A number of research have reported occurrences of emerging pollutants (EPs) in the river. The results requested efficient monitoring and systematic management strategies such as EU watch list under Water Framework Directive. The aim of this study is to propose a watch list through preliminary monitoring of the river and risk-based prioritization approach. As candidates for monitoring target, 632 substances were selected based on literature and database searches. Among them, 175 substances were subjected to target screening method whereas 457 were evaluated via suspect screening. A risk-based prioritization was applied to substances quantified through target screening based on concentrations, and a scoring-based prioritization was applied to substances tentatively identified through suspect screening. Sampling campaigns (n = 12) were conducted from October 2020 to September 2021, at 8 sampling sites along the river. As a result, 130 target substances were quantified above the LOQ. Among the 21 substances whose priority score was assigned through risk-based prioritization, telmisartan and iprobenfos were identified with very high environmental risk while candesartan, TBEP, imidacloprid, azithromycin and clotrimazole were classified with high or intermediate risk. As result of the scoring system for 39 tentatively identified substances, 6 substances (benzophenone, caprolactam, metolachlor oxanilic acid, heptaethylene glycol, octaethylene glycol and pentaethylene glycol), which were then confirmed with reference standards, showed a potential environmental risk. Those substances prioritized through target and suspect screening followed by scoring systems can be a subset for the watch list and potential targets for nationwide water quality monitoring program in the future.

Target and non-target analyses of neutral per- and polyfluoroalkyl substances from fluorochemical industries using GC-MS/MS and GC-TOF: Insights on their environmental fate.

Novel and emerging per- and polyfluoroalkyl substances (PFAS) are a key issue of concern in global environmental studies. In this study, air, sediment, and wastewater samples were collected from areas in and/or surrounded by fluorochemical-related industrial facilities to characterize the contamination profiles of neutral and novel PFAS (n-PFAS) using a gas chromatograph-based target and non-target analyses. Fluorotelomer alcohols were predominant in the samples, accounting for 80 % of the n-PFAS, followed by fluorotelomer acrylates. Air samples collected proximate to the durable water repellent (DWR) facility had the highest concentration of n-PFAS, which was approximately two orders of magnitude higher than those found in others. Non-target analysis identified fluorotelomer iodides and fluorotelomer methacrylate in multiple matrices near DWR facilities, indicating significant contamination of n-PFAS. Levels of both C6- and C8-based PFAS reflected a shift in usage patterns from C8- to C6-based fluorochemicals. Matrix-dependent profiles of n-PFAS revealed that shorter-chain (e.g., C6) and longer-chain (>C8) PFAS were predominant in air and sediment, respectively, implying that air and sediment are mobile and secondary sources of PFAS. Untreated and treated industrial wastewater also contained n-PFAS and their transformation products. The findings shed light on our understanding of the multi-matrix distribution and transport of PFAS.

Efficacy and safety of mucous fistula refeeding in preterm infants: an exploratory randomized controlled trial.

BACKGROUND: This study aimed to evaluate whether mucous fistula refeeding (MFR) is safe and beneficial for the growth and intestinal adaptation of preterm infants with enterostomies. METHODS: This exploratory randomized controlled trial enrolled infants born before 35 weeks' gestation with enterostomy. If the stomal output was ≥ 40 mL/kg/day, infants were assigned to the high-output MFR group and received MFR. If the stoma output was < 40 mL/kg/day, infants were randomized to the normal-output MFR group or the control group. Growth, serum citrulline levels, and bowel diameter in loopograms were compared. The safety of MFR was evaluated. RESULTS: Twenty infants were included. The growth rate increased considerably, and the colon diameter was significantly larger after MFR. However, the citrulline levels did not significantly differ between the normal-output MFR and the control group. One case of bowel perforation occurred during the manual reduction for stoma prolapse. Although the association with MFR was unclear, two cases of culture-proven sepsis during MFR were noted. CONCLUSIONS: MFR benefits the growth and intestinal adaptation of preterm infants with enterostomy and can be safely implemented with a standardized protocol. However, infectious complications need to be investigated further. TRIAL REGISTRATION: clinicaltrials.gov NCT02812095, retrospectively registered on June 6, 2016.

Application of 3D printing technology for pre-operative evaluation, education and informed consent in pediatric retroperitoneal tumors.

To investigate usefulness of 3D printing for preoperative evaluations, student and resident education, and communication with parents or guardians of patients with pediatric retroperitoneal tumors. Ten patients planning retroperitoneal tumor resection between March and November 2019 were included. Preoperative computed tomography (CT) images were used for 3D reconstruction and printing. Surveyed items were understanding of preoperative lesions with 3 different modules (CT, 3D reconstruction, and 3D printing) by students, residents, and specialists; satisfaction of specialists; and comprehension by guardians after preoperative explanations with each module. The median age at operation was 4.2 years (range, 1.8-18.1), and 8 patients were diagnosed with neuroblastoma. The 3D printing was the most understandable module for all groups (for students, residents, and specialists, P = 0.002, 0.027, 0.013, respectively). No significant intraoperative adverse events or immediate postoperative complications occurred. All specialists stated that 3D printing enhanced their understanding of cases. Guardians answered that 3D printing were the easiest to comprehend among the 3 modules (P = 0.007). Use of 3D printing in treatment of pediatric patients with retroperitoneal tumors was useful for preoperative planning, education, and parental explaining with obtaining informed consents.

Optimization of the QuEChERS method for multi-residue analysis of pharmaceuticals and pesticides in aquaculture products.

The aim of study was to optimize an QuEChERS extraction procedure for simultaneous determination of organic pollutants in aquaculture products. The QuEChERS extracts were measured using LC-HRMS. The target contaminants include 32 pesticides and 20 pharmaceuticals which have not been regulated for the products in Korea. The method was validated according to CODEX guideline (CAC/GL 71-2009). LOD and LOQ for all analytes ranged from 0.1 to 2 µg/kg and from 0.5 to 5 µg/kg, respectively. Intra-day (n = 5) and inter-day (n = 9) accuracy and precision were evaluated with the guideline. The validated method was applied to aquaculture products (n = 303). As a result, 14 pesticides and 8 pharmaceuticals were quantified. Fluxapyroxad, a fungicide frequently detected in domestic surface waters, was found with relatively higher concentration in 17 out of 23 species. It proves that a hydrophobic inland contaminant can be accumulated in the aquaculture products.

Long-term degradation of toluene and phenol in soil: Identification of transformation products and pathways via HRMS-based suspect and non-target screening.

In this study, the long-term fate of toluene and phenol in the soil was investigated, and the transformation products (TPs) and pathways of these compounds were studied by a high resolution mass spectrometry (HRMS)-based suspect and non-target screening approach for the first time, and 9 and 12 transformation products were identified for toluene and phenol, respectively in the lab-exposed soil samples. Salicylaldehyde, 4-hydroxybenzaldehyde, and benzaldehyde were identified in toluene-contaminated field soil samples for the first time, and the main mechanisms involved in the biodegradation and detoxification of toluene and phenol in soil were oxidation, carboxylation, dehydroxylation, and ring fission amongst others. 2-oxoglutarate, TP165-A, TP165-B, TP172, and TP195 were identified as novel phenol transformation products, while salicylaldehyde, 2-oxoglutarate, TP165-A, and TP165-B were identified as novel toluene transformation products, providing new possible evidence for additional degradation pathways, which could give new insights into the fate of toluene and phenol during the natural attenuation process in the environment. Finally, salicylaldehyde, 4-OH-benzaldehyde, and 4-OH-benzoic acid which were detected at Level 1 identification confidence were suggested as indicator chemicals of toluene and phenol exposure in the contaminated field.

Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154 539 Patients.

Background With the widespread use of gadolinium-based contrast agents (GBCAs), the incidence of allergic-like hypersensitivity reactions (HSRs) to GBCAs is increasing. Research on the incidence and risk factors for HSRs to GBCAs is needed for their safe use. Purpose To determine the incidence of acute and delayed reactions to GBCAs and to discuss the risk factors and strategies for the prevention of HSRs to GBCAs. Materials and Methods All cases of HSRs to contrast media that occurred at the Seoul National University Hospital from July 1, 2012, to June 30, 2020, were assessed. Information including age, sex, GBCA type, onset, and severity of HSRs was retrospectively analyzed. Results Among the 331070 cases of GBCA exposure in 154539 patients, 1304 cases of HSRs (0.4%) were reported. Acute HSRs accounted for 1178 cases (0.4%), while 126 cases (0.04%) were delayed HSRs. While both premedication (odds ratio [OR] = 0.7, P = .041) and changing the type of GBCA (OR = 0.2, P < .001) showed preventative effects in patients with a history of acute HSRs, only premedication (OR = 0.2, P = .016) significantly reduced the incidence of HSRs in patients with a history of delayed reactions. The risk of an HSR to GBCA was higher in those with a history of an HSR to iodinated contrast media (OR = 4.6, P < .001). Conclusion The rate of hypersensitivity reactions (HSRs) to gadolinium-based contrast agents (GBCAs) was 0.4%. The absence of premedication, repeated exposures to the culprit GBCA, and a history of HSRs to iodinated contrast media and GBCAs were risk factors for HSRs to GBCAs. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kallmes and McDonald in this issue.

Factors associated with neurodevelopment in preterm infants with systematic inflammation.

BACKGROUND: Several studies have suggested that adverse neurodevelopment could be induced by systemic inflammation in preterm infants. We aimed to investigate whether preterm infants with systemic inflammation would have impaired neurodevelopment and which biomarkers and neurophysiologic studies during inflammation are associated with poor neurodevelopment. METHODS: This prospective cohort study enrolled infants born before 30 weeks of gestation or with birth weight < 1250 g. Infants were grouped according to the presence of systemic inflammation: Control (no inflammation, n = 49), I (systemic inflammation, n = 45). Blood and cerebrospinal fluid samples for markers of brain injury and inflammation were collected and amplitude-integrated electroencephalography (aEEG) was performed within 4 h of septic workup. We evaluated aEEG at 35 weeks postmenstrual age (PMA), head circumference at 36 weeks PMA, and brain MRI at discharge. The Bayley Scales of Infant and Toddler Development III (Bayley-III) was performed at a corrected age (CA) of 18 months. RESULTS: The I group had more white matter injuries (2 vs. 26.7%, Control vs. I, respectively) at the time of discharge, lower brain functional maturation (9.5 vs. 8), and smaller head size (z-score - 1.45 vs. -2.12) at near-term age and poorer neurodevelopment at a CA of 18 months than the control (p < 0.05). Among the I group, the proportion of immature neutrophils (I/T ratios) and IL-1 beta levels in the CSF were associated with aEEG measures at the day of symptom onset (D0). Seizure spike on aEEG at D0 was significantly correlated with motor and social-emotional domains of Bayley-III (p < 0.05). The I/T ratio and CRP and TNF-α levels of blood at D0, white matter injury on MRI at discharge, head circumference and seizure spikes on aEEG at near-term age were associated with Bayley-III scores at a CA of 18 months. CONCLUSIONS: Systemic inflammation induced by clinical infection and NEC are associated with neurodevelopmental impairment in preterm infants. The seizure spike on aEEG, elevated I/T ratio, CRP, and plasma TNF-alpha during inflammatory episodes are associated with poor neurodevelopment.

Identification, quantification, and prioritization of new emerging pollutants in domestic and industrial effluents, Korea: Application of LC-HRMS based suspect and non-target screening.

The present study was designed to identify recently (or rarely) recognized or unreported substances (RRS or URS) contained in the effluents from water treatment plants in two industrialized urban areas, Gumi and Daegu, in Korea. In addition to 30 initial targets, 72 substances were identified through suspect and non-target screening (SNTS). Among them were 4 RRSs and 22 URSs, respectively. The quantitative analyses were applied to 35 pharmaceuticals, 15 pesticides, 13 poly-/perfluorinated alkyl substances (PFASs), 2 organophosphate flame retardants (OPFRs), 2 corrosion inhibitors, and 3 metabolites. The highest average concentration was observed for benzotriazole, followed by those for niflumic acid, and metformin. Effluents from Gumi mainly contained benzotriazole and metformin whereas niflumic acid and tramadol were the major components in effluents from Daegu. According to a scoring system based on risk relevant parameters, higher priorities were given to telmisartan, PFOA, and cimetidine. Yet, priorities for some substances were area specific (e.g., benzotriazole from Gumi, PFASs from Daegu), reflecting differences in industry profiles and populations. Many of the RRSs and URSs were recognized as potential hazards. The new identifications and evaluations should be taken into consideration for constant monitoring and management, as do the previously recognized contaminants.

Replacing the internal standard to estimate micropollutants using deep and machine learning.

Similar to the worldwide proliferation of urbanization, micropollutants have been involved in aquatic and ecological environmental systems. These pollutants have the propensity to wreak havoc on human health and the ecological system; hence, it is important to persistently monitor micropollutants in the environment. Micropollutants are commonly quantified via target analysis using high resolution mass spectrometry and the stable isotope labeled (SIL) standard. However, the cost-intensiveness of this standard presents a major obstacle in measuring micropollutants. This study resolved this problem by developing data-driven models, including deep learning (DL) and machine learning (ML), to estimate the concentration of micropollutants without resorting to the SIL standard. Our study hypothesized that natural organic matter (NOM) could replace internal standards if there was a specific mass spectrum (MS) subset, including NOM information, which correlated with an SIL standard peak. Therefore, we analyzed the MS to find the specific MS subsets for replacing the SIL standard peak. Thirty-five alternative MS subsets were determined for applying DL and ML as input data. Thereafter, we trained four different DL models, namely, ResNet101, GoogLeNet, VGG16, and Inception v3, as well as three different ML models, i.e., random forest (RF), support vector machine (SVM), and artificial neural network (ANN). A total of 680 MS data were used for the model training to estimate five different micropollutants, namely Sulpiride, Metformin, and Benzotriazole. Among the DL models, ResNet 101 exhibited the highest model performance, showing that the average validation R2 and MSE were 0.84 and 0.26 ng/L, respectively, while RF was the best in the ML models, manifesting R2 and MSE values of 0.69 and 0.58 ng/L. The trained models showed accurate training and validation results for the estimation of the five micropollutant concentrations. Therefore, this study demonstrates that the suggested analysis has a potential for alternative micropollutant measurement that has rapid and economic vantages.

Identification of transformation products to characterize the ability of a natural wetland to degrade synthetic organic pollutants.

Natural wetlands have been recognized as a natural reactor for degradation and elimination of environmental pollutants. The Upo Wetland, the largest inland wetland in Korea, is mainly surrounded by agricultural lands and it is susceptible to contamination from excess nutrient loads and synthetic organic contaminants (SOCs) (e.g., pesticides). The aim of this study was to identify major SOCs in the wetland and evaluate their degradation. We used high resolution mass spectrometry (HRMS) with a two-step analysis approach (i.e., 1st analysis for target measurement along with suspect and non-target screening (SNTS) and 2nd analysis for complimentary suspect screening) to identify and quantify the transformation products (TPs) of the identified parent SOCs. Quantitative analysis of 30 targets, mainly including pesticides, showed that fungicides were the major SOCs detected in the wetland, accounting for about 50% of the composition ratio of the total SOCs quantified. Orysastrobin occurred at the highest mean concentration (>700 ng/L), followed by two other fungicides, carbendazim and tricyclazole. The first analysis (SNTS) tentatively identified 39 TPs (30 by suspect, 9 by non-target screening) of 14 parent pesticides. Additionally, the second analysis (complimentary suspect screening) identified 9 more TPs. Among the 48 total TPs identified, 7 were confirmed with reference standards. The identification of the remaining TPs had a high confidence level (e.g., level 2 or 3). Regarding transport though the wetland, most TPs showed greater peak area ratios (i.e., the relative portion of chromatographic area of the TPs to the parent compound) at the outlet point of the wetland compared to the inlet point. The risk quotient, which was calculated using the concentrations of parent compounds, decreased toward the outlet, demonstrating the degradation capacity of the wetland. The estimates for biodegradability, hydrophobicity, and toxicity by an in-silico quantitative structure-activity relationship (QSAR) model indicated a lower half-life, lower logDOW, and greater effect concentration for most TPs compared to the parent compounds. Based on these results, we conclude that natural wetlands play a role as an eco-friendly reactor for degrading SOCs to form numerous TPs that are lower risk than the parent compounds.

Characterizing biotransformation products and pathways of the flame retardant triphenyl phosphate in Daphnia magna using non-target screening.

Triphenyl phosphate (TPHP), one of the organophosphate flame retardants, has been widely used in manufacturing, thereby causing a gradual increase in TPHP concentrations in aquatic environments. However, the information on the biotransformation mechanism of TPHP in invertebrates is lacking. The study identified the biotransformation products of TPHP in Daphnia magna, which showed particularly high toxicity in aquatic organisms, and determined the rates of depuration. Daphnia magna, a standard species for toxicity studies, was exposed to triphenyl phosphate and transferred to the pure medium. The biotransformation products of TPHP and its depuration rates were determined by liquid chromatography-high resolution mass spectrometry. Nine biotransformation products (five in the positive mode and four in the negative mode) of triphenyl phosphate were identified in D. magna. Based on the depuration ratio, the major biotransformation mechanism is estimated to be cysteine conjugation and sulfation. Certain biotransformation products (diphenyl phosphate, hydroxylated triphenyl phosphate, and thiol triphenyl phosphate) might induce toxicity in biota. The results could be used to predict main biotransformation processes and toxic products of organophosphate flame retardants in aquatic invertebrates.

Ny-Ålesund-oriented organic pollutants in sewage effluent and receiving seawater in the Arctic region of Kongsfjorden.

Ny-Ålesund, one of four permanent settlements on Spitsbergen in Svalbard, is a research town that includes scientific institutes from many countries. Because of daily-used chemicals (e.g., pharmaceutical and personal care products (PPCPs)) used by residents in the area, generated sewage is considered as a point source in the Kongsfjorden. The aim of the present study was to identify and quantify organic pollutants in the effluent and along the shoreline and offshore via target, suspect, and non-target screening using liquid chromatography-high-resolution mass spectrometry. We tentatively identified 30 compounds using the suspect and non-target screening methods in effluent samples from our first visit to the settlement in 2016. Among these, 3 were false positive, 24 were confirmed, and the 3 remaining compounds were not confirmed because of a lack of reference standards. Of the confirmed, 21 were quantifiable and considered target compounds for the 2nd year study. The quantified compounds in the effluent samples in 2017 totaled 17, including PPCPs, pesticides, perfluorinated compounds, and their metabolites. Some of the compounds, such as caffeine, paraxanthine/theophylline, acetaminophen, cetirizine, diethyl toluamide (DEET), and icaridin, were also detected in the receiving seawater. The concentration range was from 4 to 280,000 ng/L in the effluent and 2-98 ng/L in the seawater. Other 24 compounds were tentatively identified in the second-year effluent samples. Five were further confirmed using reference standards. Prioritization was performed on the 47 substances screened in Ny-Ålesund using the exposure and toxicity index. As the result, the top seven substances of concern present were perfluorooctanesulfonic acid (PFOS), triphenyl phosphate (TPHP), irbesartan, DEET, acetaminophen, caffeine, and paraxanthine/theophylline. As the effluent was identified as a source of the concerned organic pollutants, an emission reduction strategy should take place for protection of Arctic Fjorden environment.

Occurrence and Concentration of Chemical Additives in Consumer Products in Korea.

As the variety of chemicals used in consumer products (CPs) has increased, concerns about human health risk have grown accordingly. Even though restrictive guidelines and regulations have taken place to minimize the risks, human exposure to these chemicals and their eco-compatibility has remained a matter of greater scientific concern over the years. A major challenge in understanding the reality of the exposure is the lack of available information on the increasing number of ingredients and additives in the products. Even when ingredients of CPs formulations are identified on the product containers, the concentrations of the chemicals are rarely known to consumers. In the present study, an integrated target/suspect/non-target screening procedure using liquid chromatography-high resolution mass spectrometry (LC-HRMS) with stepwise identification workflow was used for the identification of known, suspect, and unknown chemicals in CPs including cosmetics, personal care products, and washing agents. The target screening was applied to identify and quantify isothiazolinones and phthalates. Among analyzed CPs, isothiazolinones and phthalates were found in 47% and in 24% of the samples, respectively. The highest concentrations were 518 mg/kg for benzisothiazolone, 7.1 mg/kg for methylisothiazolinone, 2.0 mg/kg for diethyl phthalate, and 21 mg/kg for dimethyl phthalate. Suspect and non-target analyses yielded six tentatively identified chemicals across the products including benzophenone, ricinine, iodocarb (IPBC), galaxolidone, triethanolamine, and 2-(2H-Benzotriazol-2-yl)-4, 6-bis (1-methyl-1-phenylethyl) phenol. Our results revealed that selected CPs consistently contain chemicals from multiple classes. Excessive use of these chemicals in daily life can increase the risk for human health and the environment.

Acute Adverse Reactions to Nonionic Iodinated Contrast Media: A Meta-Analysis.

OBJECTIVES: We aimed to meta-analytically compare the incidence of acute adverse reactions (AARs) to nonionic iodinated contrast media (ICM) according to the type of ICM in patients who underwent radiologic examinations with administration of ICM via intravascular route. MATERIALS AND METHODS: A systematic literature search identified studies evaluating the incidence of AARs to 7 nonionic ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, ioversol, and iodixanol) with extractable outcomes. These outcomes were pooled using a random-effects model, and the effect of ICM type on the incidence of overall and severe AARs was evaluated using meta-regression analysis. RESULTS: Thirty studies with 1,360,488 exposures to ICM were included. The pooled incidences of overall and severe AARs to nonionic ICM were 1.03% (95% confidence interval [CI], 0.81%-1.30%; I = 0.99) and 0.0141% (95% CI, 0.0108%-0.0183%; I = 0.56), respectively. Iomeprol had the highest overall AAR incidence (1.74%; 95% CI, 0.79%-3.76%; I = 0.99), followed by iohexol (1.21%; 95% CI, 0.67%-2.17%; I = 0.99), iopamidol (1.10%; 95% CI, 0.60%-2.03%; I = 0.99), ioversol (0.88%; 95% CI, 0.43%-1.83%; I = 0.96), iodixanol (0.85%; 95% CI, 0.36%-1.95%; I = 0.99), iopromide (0.82%; 95% CI, 0.43%-1.55%; I = 0.99), and iobitridol (0.77%; 95% CI, 0.36%-1.62%; I = 0.99). Multivariable meta-regression analysis revealed that study design (P = 0.0014) and premedication (P = 0.0230) were statistically significant determinants affecting the incidence of overall AARs. Iodinated contrast media type did not affect the incidence of overall and severe AARs (P = 0.1453 and 0.4265, each). CONCLUSIONS: The varying pooled incidences of overall and severe AARs to specific types of nonionic ICM do not remain as significant after adjusting confounders. Our results may support nonrestriction of certain types of nonionic ICM in the context of AAR avoidance.

Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation.

Objective: To evaluate the current status of managing adverse reactions to iodinated contrast media (ICM) for computed tomography in referral hospitals in South Korea compared with hospitals in other countries. Materials and Methods: This survey investigation involved 59 Korean and 15 overseas hospitals using guideline-based questionnaires consisting of 24 items in 7 main categories related to managing adverse reactions to ICM. Results: Informed written consent with risk factor evaluation was appropriately performed in most of the Korean hospitals. There was considerable variability in assessing renal function across the hospitals; serum creatinine level was used as a reference in 76.4% of Korean hospitals. The Korean hospitals preferred a more stringent approach to determining normal renal function (p = 0.01), withholding metformin (p = 0.01), and fasting before ICM exposure (p < 0.001) compared with overseas hospitals. All the Korean hospitals had an emergency protocol and in-hospital system for adverse reactions to ICM. The Korean (87.7%) and overseas hospitals (100%) were similarly equipped with epinephrine (p = 0.332), but only 38.6% of Korean hospitals were equipped with a bronchodilator (p = 0.004). For patients with a previous hypersensitivity reaction to ICM, 62.3% of Korean hospitals pre-medicated with anti-histamine and corticosteroid according to the severity of the previous reaction, and changed the culprit ICM in 52.8%, while skin test was performed in 17%. Conclusion: In general, Korean referral hospitals were well-prepared regarding informed consent, protocol, and an in-hospital system for managing adverse reactions to ICM. Nevertheless, there was considerable variability in details and management, thus requiring standardization by reflecting current guidelines.

Immediate Mild Reactions to CT with Iodinated Contrast Media: Strategy of Contrast Media Readministration without Corticosteroids.

Purpose To evaluate premedication protocols involving administration of antihistamine and multidose corticosteroid that have been widely used in prevention of recurrent hypersensitivity reactions (HSRs) to iodinated contrast media (ICM); an evidence-based optimal preventive strategy customized for patients with mild cases has not yet been established. Materials and Methods The outcomes of patients with mild HSR who subsequently underwent contrast material-enhanced computed tomography (CT) between January 2012 and December 2015 were analyzed. For premedication, 4 mg of chlorpheniramine was intravenously administered 30 minutes prior to reexposure to ICM. Logistic regression with generalized estimating equations was used to determine the relationship between premedication and recurrence rate. Results A total of 1178 patients with mild immediate HSR were reexposed to ICM 3533 times. Among these patients, 1056 patients experienced allergylike reactions and 122 patients developed gastrointestinal reactions. With reexposure to the culprit agent without premedication, the recurrence rate was 31.1% (85 of 273 examinations). The recurrence rate decreased to 12% (105 of 872 examinations; P < .001) by only changing the culprit agent and to 7.6% (148 of 1947 examinations; P < .001) by using the combination of changing the ICM and antihistamine premedication. Changing the ICM plus antihistamine premedication was also helpful in reducing the recurrence of gastrointestinal symptoms from 16.1% to 1.8% (P = .020). However, despite changing of the ICM, some combinations of ICM did not show a prophylactic effect. Conclusion A combination of changing the culprit agent and antihistamine premedication resulted in the best preventive outcome for patients with mild immediate HSR. The optimal choice of substitute ICM could be individualized according to the culprit agent.

Prioritization of highly exposable pharmaceuticals via a suspect/non-target screening approach: A case study for Yeongsan River, Korea.

Pharmaceuticals and personal care products (PPCPs) in the Yeongsan River, Korea were prioritized via suspect and non-target analysis using LC-HRMS (QExactive plus Orbitrap) followed by semi-quantitative analysis to confirm the priority of PPCPs. A scoring and ranking system for prioritization was suggested based on occurrence frequency and chromatographic peak area or concentration. Through suspect and non-target screening, more than 50 PPCPs were tentatively identified and ranked by the scoring system. Among them, 28 substances were finally confirmed using reference standards. For estimating concentration, 26 confirmed PPCPs and 12 additional substances not included in the first ranking were semi-quantitatively analyzed. We found that carbamazepine, metformin, paraxanthine, naproxen, and fluconazole occurred 100% of the time above the limit of quantification in 14 samples, whereas carbamazepine, metformin, paraxanthine, caffeine, and cimetidine showed maximum concentrations above 1000 ng/L. Thus, in the final prioritization list, carbamazepine, metformin, and paraxanthine shared first place, followed by caffeine, cimetidine, lidocaine, naproxen, cetirizine, climbazole, fexofenadine, tramadol, and fluconazole, with scores of 100 or above. We suggest that these 12 PPCPs are the most highly exposable substances, and thus must be considered in future water monitoring in the Yeongsan River.