Comparison of ESIN and other minimally invasive techniques for anterior pelvic ring injury: a finite element analysis and case-control study.

OBJECT: A novel technique, percutaneous elastic stable intramedullary nail fixation (ESIN), proposed by our team for the treatment of anterior pelvic ring injury. Finite element analysis and retrospective case-control study were used to compare biomechanical properties and clinical outcomes between ESIN and other techniques. METHODS: Four groups of finite element models of pelvic anterior ring injury were simulated, including ESIN (model A), retrograde transpubic screw fixation (RTSF, model B), subcutaneous internal fixator (model C), and external fixator (model D), and a vertical downward load of 500 N was applied to the S1 vertebral endplate. Stress and displacement distributions of intact pelvis, displacement distributions of pubic fracture fragments, and stress distributions of fixation devices were analysed. Then 31 patients with anterior pelvic ring injury (15 in the ESIN group and 16 in the RTSF group) were reviewed. Clinical outcomes were evaluated at the final follow-up. Postoperative complications were also recorded. RESULTS: Under 500N loading, the intact stability of the pelvis was compared as follows: model B (20.58 mm, 121.82 MPa), model A (20.80 mm, 129.97 MPa), model C (22.02 mm, 141.70 MPa), and model D (22.57 mm, 147.06 MPa). The regional stability of superior pubic ramus was compared as follows: model B (9.48 mm), model A (10.16 mm), model C (10.52 mm), and model D (10.76 mm). All 31 patients received follow-up at least 12 months postsurgery (range 12-20 months). Age, sex, injury mechanism, fracture type, time between the injury and operation, American Society of Anesthesiologists score, intraoperative blood loss, hospital stay, follow-up period, time to union, and Majeed scores did not differ significantly between the two groups ( P >0.05). However, the differences in the duration of unilateral surgery, unilateral intraoperative fluoroscopy and one-time success rate were significant ( P <0.05). CONCLUSIONS: With sufficient biomechanical stability and minimally invasive advantage, the percutaneous technique using ESIN can be used to successfully treat anterior pelvic ring injuries. In addition, advantages over RTSF include a shorter duration of surgery, reduced requirement for intraoperative fluoroscopy, and a higher one-time success rate. ESIN therefore constitutes a good alternative to RTSF.

Non-invasive differential diagnosis of teratomas from other intracranial germ cell tumours using MRI-based fractal and radiomic analyses.

OBJECTIVES: The histologic subtype of intracranial germ cell tumours (IGCTs) is an important factor in deciding the treatment strategy, especially for teratomas. In this study, we aimed to non-invasively diagnose teratomas based on fractal and radiomic features. MATERIALS AND METHODS: This retrospective study included 330 IGCT patients, including a discovery set (n = 296) and an independent validation set (n = 34). Fractal and radiomic features were extracted from T1-weighted, T2-weighted, and post-contrast T1-weighted images. Five classifiers, including logistic regression, random forests, support vector machines, K-nearest neighbours, and XGBoost, were compared for our task. Based on the optimal classifier, we compared the performance of clinical, fractal, and radiomic models and the model combining these features in predicting teratomas. RESULTS: Among the diagnostic models, the fractal and radiomic models performed better than the clinical model. The final model that combined all the features showed the best performance, with an area under the curve, precision, sensitivity, and specificity of 0.946 [95% confidence interval (CI): 0.882-0.994], 95.65% (95% CI: 88.64-100%), 88.00% (95% CI: 77.78-96.36%), and 91.67% (95% CI: 78.26-100%), respectively, in the test set of the discovery set, and 0.944 (95% CI: 0.855-1.000), 85.71% (95% CI: 68.18-100%), 94.74% (95% CI: 83.33-100%), and 80.00% (95% CI: 58.33-100%), respectively, in the independent validation set. SHapley Additive exPlanations indicated that two fractal features, two radiomic features, and age were the top five features highly associated with the presence of teratomas. CONCLUSION: The predictive model including image and clinical features could help guide treatment strategies for IGCTs. CLINICAL RELEVANCE STATEMENT: Our machine learning model including image and clinical features can non-invasively predict teratoma components, which could help guide treatment strategies for intracranial germ cell tumours (IGCT). KEY POINTS: • Fractals and radiomics can quantitatively evaluate imaging characteristics of intracranial germ cell tumours. • Model combing imaging and clinical features had the best predictive performance. • The diagnostic model could guide treatment strategies for intracranial germ cell tumours.

Diffusion MRI is valuable in brainstem glioma genotyping with quantitative measurements of white matter tracts.

OBJECTIVES: To investigate the value of diffusion MRI (dMRI) in H3K27M genotyping of brainstem glioma (BSG). METHODS: A primary cohort of BSG patients with dMRI data (b = 0, 1000 and 2000 s/mm2) and H3K27M mutation information were included. A total of 13 diffusion tensor and kurtosis imaging (DTI; DKI) metrics were calculated, then 17 whole-tumor histogram features and 29 along-tract white matter (WM) microstructural measurements were extracted from each metric and assessed within genotypes. After feature selection through univariate analysis and the least absolute shrinkage and selection operator method, multivariate logistic regression was used to build dMRI-derived genotyping models based on retained tumor and WM features separately and jointly. Model performances were tested using ROC curves and compared by the DeLong approach. A nomogram incorporating the best-performing dMRI model and clinical variables was generated by multivariate logistic regression and validated in an independent cohort of 27 BSG patients. RESULTS: At total of 117 patients (80 H3K27M-mutant) were included in the primary cohort. In total, 29 tumor histogram features and 41 WM tract measurements were selected for subsequent genotyping model construction. Incorporating WM tract measurements significantly improved diagnostic performances (p < 0.05). The model incorporating tumor and WM features from both DKI and DTI metrics showed the best performance (AUC = 0.9311). The nomogram combining this dMRI model and clinical variables achieved AUCs of 0.9321 and 0.8951 in the primary and validation cohort respectively. CONCLUSIONS: dMRI is valuable in BSG genotyping. Tumor diffusion histogram features are useful in genotyping, and WM tract measurements are more valuable in improving genotyping performance. CLINICAL RELEVANCE STATEMENT: This study found that diffusion MRI is valuable in predicting H3K27M mutation in brainstem gliomas, which is helpful to realize the noninvasive detection of brainstem glioma genotypes and improve the diagnosis of brainstem glioma. KEY POINTS: • Diffusion MRI has significant value in brainstem glioma H3K27M genotyping, and models with satisfactory performances were built. • Whole-tumor diffusion histogram features are useful in H3K27M genotyping, and quantitative measurements of white matter tracts are valuable as they have the potential to improve model performance. • The model combining the most discriminative diffusion MRI model and clinical variables can help make clinical decision.

A Segmentation Framework With Unsupervised Learning-Based Label Mapper for the Ventricular Target of Intracranial Germ Cell Tumor.

Intracranial germ cell tumors are rare tumors that mainly affect children and adolescents. Radiotherapy is the cornerstone of interdisciplinary treatment methods. Radiation of the whole ventricle system and the local tumor can reduce the complications in the late stage of radiotherapy while ensuring the curative effect. However, manually delineating the ventricular system is labor-intensive and time-consuming for physicians. The diverse ventricle shape and the hydrocephalus-induced ventricle dilation increase the difficulty of automatic segmentation algorithms. Therefore, this study proposed a fully automatic segmentation framework. Firstly, we designed a novel unsupervised learning-based label mapper, which is used to handle the ventricle shape variations and obtain the preliminary segmentation result. Then, to boost the segmentation performance of the framework, we improved the region growth algorithm and combined the fully connected conditional random field to optimize the preliminary results from both regional and voxel scales. In the case of only one set of annotated data is required, the average time cost is 153.01 s, and the average target segmentation accuracy can reach 84.69%. Furthermore, we verified the algorithm in practical clinical applications. The results demonstrate that our proposed method is beneficial for physicians to delineate radiotherapy targets, which is feasible and clinically practical, and may fill the gap of automatic delineation methods for the ventricular target of intracranial germ celltumors.

Diffusion MRI-based connectomics features improve the noninvasive prediction of H3K27M mutation in brainstem gliomas.

PURPOSE: To establish an individualized predictive model to identify patients with brainstem gliomas (BSGs) at high risk of H3K27M mutation, with the inclusion of brain structural connectivity analysis based on diffusion MRI (dMRI). MATERIALS AND METHODS: A primary cohort of 133 patients with BSGs (80 H3K27M-mutant) were retrospectively included. All patients underwent preoperative conventional MRI and dMRI. Tumor radiomics features were extracted from conventional MRI, while two kinds of global connectomics features were extracted from dMRI. A machine learning-based individualized H3K27M mutation prediction model combining radiomics and connectomics features was generated with a nested cross validation strategy. Relief algorithm and SVM method were used in each outer LOOCV loop to select the most robust and discriminative features. Additionally, two predictive signatures were established using the LASSO method, and simplified logistic models were built using multivariable logistic regression analysis. An independent cohort of 27 patients was used to validate the best model. RESULTS: 35 tumor-related radiomics features, 51 topological properties of brain structural connectivity networks, and 11 microstructural measures along white matter tracts were selected to construct a machine learning-based H3K27M mutation prediction model, which achieved an AUC of 0.9136 in the independent validation set. Radiomics- and connectomics-based signatures were generated and simplified combined logistic model was built, upon which derived nomograph achieved an AUC of 0.8827 in the validation cohort. CONCLUSION: dMRI is valuable in predicting H3K27M mutation in BSGs, and connectomics analysis is a promising approach. Combining multiple MRI sequences and clinical features, the established models have good performance.

There's something in the air: A review of sources, prevalence and behaviour of microplastics in the atmosphere.

Literature regarding microplastics in the atmosphere has advanced in recent years. However, studies have been undertaken in isolation with minimal collaboration and exploration of the relationships between air, deposition and dust. This review collates concentrations (particle count and mass-based), shape, size and polymetric characteristics for microplastics in ambient air (m3), deposition (m2/day), dust (microplastics/g) and snow (microplastics/L) from 124 peer-reviewed articles to provide a holistic overview and analysis of our current knowledge. In summary, ambient air featured concentrations between <1 to >1000 microplastics/m3 (outdoor) and <1 microplastic/m3 to 1583 ± 1181 (mean) microplastics/m3 (indoor), consisting of polyethylene terephthalate, polyethylene, polypropylene. No difference (p > 0.05) was observed between indoor and outdoor concentrations or the minimum size of microplastics (p > 0.5). Maximum microplastic sizes were larger indoors (p < 0.05). Deposition concentrations ranged between 0.5 and 1357 microplastics/m2/day (outdoor) and 475 to 19,600 microplastics/m2/day (indoor), including polyethylene, polystyrene, polypropylene, polyethylene terephthalate. Concentrations varied between indoor and outdoor deposition (p < 0.05), being more abundant indoors, potentially closer to sources/sinks. No difference was observed between the minimum or maximum reported microplastic sizes within indoor and outdoor deposition (p > 0.05). Road dust concentrations varied between 2 ± 2 and 477 microplastics/g (mean), consisting of polyvinyl chloride, polyethylene, polypropylene. Mean outdoor dust concentrations ranged from <1 microplastic/g (remote desert) to between 18 and 225 microplastics/g, comprised of polyethylene terephthalate, polyamide, polypropylene. Snow concentrations varied between 0.1 and 30,000 microplastics/L, containing polyethylene, polyamide, polypropylene. Concentrations within indoor dust varied between 10 and 67,000 microplastics/g, including polyethylene terephthalate, polyethylene, polypropylene. No difference was observed between indoor and outdoor concentrations (microplastics/g) or maximum size (p > 0.05). The minimum size of microplastics were smaller within outdoor dust (p > 0.05). Although comparability is hindered by differing sampling methods, analytical techniques, polymers investigated, spectral libraries and inconsistent terminology, this review provides a synopsis of knowledge to date regarding atmospheric microplastics.

Exposure to PAHs during Firefighting Activities: A Review on Skin Levels, In Vitro/In Vivo Bioavailability, and Health Risks.

Occupational exposure as a firefighter is a complex activity that continuously exposes subjects to several health hazards including fire emissions during firefighting. Firefighters are exposed to polycyclic aromatic hydrocarbons (PAHs), known as toxic, mutagenic, and carcinogenic compounds, by inhalation, dermal contact, and ingestion. In this work, a literature overview of firefighters' dermal exposure to PAHs after firefighting and data retrieved from skin in vitro/in vivo studies related to their dermal absorption, bioavailability, and associated toxicological and carcinogenic effects are reviewed. The evidence demonstrates the contamination of firefighters' skin with PAHs, mainly on the neck (2.23-62.50 ng/cm2), wrists (0.37-8.30 ng/cm2), face (2.50-4.82 ng/cm2), and hands (1.59-4.69 ng/cm2). Concentrations of possible/probable carcinogens (0.82-33.69 ng/cm2), including benzopyrene isomers, were found on firefighters' skin. PAHs penetrate the skin tissues, even at low concentrations, by absorption and/or diffusion, and are locally metabolized and distributed by the blood route to other tissues/organs. Lighter PAHs presented increased dermal permeabilities and absorption rates than heavier compounds. Topical PAHs activate the aryl hydrocarbon receptor and promote the enzymatic generation of reactive intermediates that may cause protein and/or DNA adducts. Future research should include in vitro/in vivo assays to perform a more realistic health risk assessment and to explore the contribution of dermal exposure to PAHs total internal dose.

Phthalate esters in face masks and associated inhalation exposure risk.

This study assessed the composition of single-use face mask materials, quantified the concentration of phthalate esters in masks and evaluated associated inhalation exposure risk. All the mask samples, including 12 surgical and four N95/P1/P2 masks, were identified to be made of polypropylene, with polyethylene terephthalate present in the N95/P1/P2 masks. Di-methyl phthalate, di-n-butyl phthalate, di-ethyl phthalate, di-isobutyl phthalate and di(2-ethylhexyl) phthalate were frequently detected and their concentration summed up 55 ± 35 ~ 1700 ± 140 ng per surgical mask and 2300 ± 150 ~ 5200 ± 800 ng per N95/P1/P2 mask. Our simulation experiment suggested a mean loss of 13 - 71% of phthalate mass depending on compounds, during 5-hour wearing of these masks. This resulted in an estimated daily intake of individual compounds no higher than 20 ng/kg/day for adults and 120 ng/kg/day for toddlers, which were at least 80 times lower compared to relevant tolerable daily intake values. Two interventional trials were conducted where a volunteer wore a mask for four hours and urine samples were collected before and after the mask wearing. No obvious increase was observed for the urinary concentration of any phthalate metabolite, indicating minimal contribution to overall exposure to phthalate esters.

Plastics contamination of store-bought rice.

This study investigated mass concentrations of selected plastics in store-bought rice, the staple of more than half the world's population. Polyethylene, polyethylene terephthalate, poly-(methyl methacrylate), polypropylene, polystyrene and polyvinyl chloride were quantified using pressurized liquid extraction coupled to double-shot pyrolysis gas chromatography/mass spectrometry. Polyethylene, polypropylene and polyethylene terephthalate were quantifiable in the rice samples with polyethylene the most frequently detected (95%). There was no statistical difference between total plastic concentration in paper and plastic packaged rice. Shaking the rice in its packaging had no significant difference on the concentration of plastics. Washing the rice with water significantly reduced plastic contamination. Instant (pre-cooked) rice contained fourfold higher levels of plastics, suggesting that industrial processing potentially increases contamination. A preliminary estimate of the intake of plastic through rice consumption for Australians established 3.7 mg per serve (100 g) if not washed and 2.8 mg if washed. Annual consumption was estimated around 1 g/person.

1,8-cineole ameliorates ischaemic brain damage via TRPC6/CREB pathways in rats.

OBJECTIVES: A previous in vitro study reported that the monoterpene oxide 1,8-cineole (cineole) attenuates neuronal caused by oxygen-glucose deprivation/reoxygenation in culture. However, to date, there is no in vivo evidence showing neuroprotective effects of cineole against stroke. This study aimed to investigate whether cineole attenuates cerebral ischaemic damage in rats. METHODS: A rat model of middle cerebral artery occlusion (MCAO) followed by 24 h reperfusion was applied. Male rats were treated with oral cineole (100 mg/kg) for 7 consecutive days, then subjected to MCAO surgery. Infarct volume, neurologic deficits, apoptosis and expression levels of all-spectrin breakdown products of 145 kDa (SBDP145), transient receptor potential canonical (subtype) 6 (TRPC6) and phosphorylated CREB (p-CREB) were measured in ischaemic brain tissues. KEY FINDINGS: Cineole treatment significantly reduced infarct volume, neurological dysfunction, neuronal apoptosis, SBDP145 formation and TRPC6 degradation and enhanced p-CREB expression in MCAO rats compared with vehicle treatment. These neuroprotective effects were markedly suppressed by pharmacological inhibition of MEK or CaMKIV signalling. CONCLUSIONS: Our study provides in vivo evidence demonstrating that cineole pretreatment attenuates ischaemic stroke-induced brain damage, mainly through blocking calpain-induced TRPC6 degradation and activating CREB via MEK/CREB and CaMKIV/CREB signalling pathways.

Quantification of selected microplastics in Australian urban road dust.

Microplastics (1 - 5000 µm) are pervasive in every compartment of our environment. However, little is understood regarding the concentration and size distribution of microplastics in road dust, and how they change in relation to human activity. Within road dust, microplastics move through the environment via atmospheric transportation and stormwater run-off into waterways. Human exposure pathways to road dust include dermal contact, inhalation and ingestion. In this study, road dust along an urban to rural transect within South-East Queensland, Australia was analysed using Accelerated Solvent Extraction followed by pyrolysis Gas Chromatography-Mass Spectrometry (Pyr-GC/MS). Polypropylene, polystyrene, polyethylene terephthalate, polyvinyl chloride, poly (methyl methacrylate) and polyethylene were quantified. Microplastic concentrations ranged from ~0.5 mg/g (rural site) to 6 mg/g (Brisbane city), consisting primarily of polyvinyl chloride (29%) and polyethylene terephthalate (29%). Size fractionation (< 250 µm, 250-500 µm, 500-1000 µm, 1000-2000 µm and 2000-5000 µm) established that the < 250 µm size fraction contained the majority of microplastics by mass (mg/g). Microplastic concentrations in road dust demonstrated a significant relationship with the volume of vehicles (r2 = 0.63), suggesting traffic, as a proxy for human movement, is associated with increased microplastic concentrations in the built environment.

Amphiregulin inhibits TNF-α-induced alveolar epithelial cell death through EGFR signaling pathway.

BACKGROUND: We previously observed that amphiregulin (Areg), a ligand of epithelial growth factor receptor (EGFR), was highly expressed in lipopolysaccharide (LPS)-induced acute lung injury (ALI) lung tissues mainly by the classically activated (M1) alveolar macrophages (AMs). Areg also plays a protective role in LPS-induced injury in lung tissues and alveolar epithelial cells (AECs). However, whether Areg is co-expressed with tumor necrosis factor (TNF)-α in ALI lung tissues, and can directly inhibit TNF-α-induced AEC injury remains unclear. METHODS: We first detected the kinetic expressions of Areg and TNF-α in LPS-stimulated lung tissues and M1 AMs and then identified the role of exogenous recombinant Areg (rmAreg) in the injured lung tissues. The effect of Areg on TNF-α-induced apoptosis in MLE-12 cells, a kind of AECs, was examined by terminal deoxynucleotidyl transferase dUTP nick end labeling staining. The activation of the EGFR-AKT pathway and caspase-3, -8, and -9 were detected by Western blotting. The EGFR knockdown by small interfering RNA was used to assess the role of EGFR in Areg functions. RESULTS: Areg production occurred in close parallel with TNF-α expression in M1 AMs and ALI lung tissues, and rmAreg attenuated LPS-induced ALI in mice. TNF-α stimulation induced significant apoptosis in MLE-12 cells, but this apoptosis was inhibited under rmAreg treatment. Moreover, rmAreg enhanced the activation of EGFR and AKT, and reduced the expressions of cleaved caspase-3, -8, and -9 in ALI lung tissues and TNF-α-challenged MLE-12 cells. However, the EGFR knockdown significantly inhibited the Areg-induced improvement in apoptosis, enhancement of EGFR and AKT activation, and reduction of cleaved caspase-3, -8, and -9 expressions. CONCLUSIONS: Areg and TNF-α were synchronously produced by ALI lung tissues and M1 AMs, and Areg directly inhibited the TNF-induced apoptosis and transduction of caspase death signals in AECs via the EGFR pathway.

Tube-type passive sampling of cyclic volatile methyl siloxanes (cVMSs) and benzene series simultaneously in indoor air: uptake rate determination and field application.

Cyclic volatile methyl siloxanes (cVMSs) and benzene series compounds have attracted increasing attention because they are associated with various adverse health effects. In this study, we developed and validated a novel passive air sampling method (PAS), using Tenax-TA as the sorbent, to measure the concentrations of cVMSs (D4, D5, and D6) and benzene series compounds simultaneously in indoor air. The uptake rates (R), which were calibrated side-by-side by an active air sampling method (Tenax-TA-AAS), ranged from 0.10 to 0.56 mL min-1 depending on chemicals, and the R of the TD tube with Tenax-TA was controlled by the sampler material-side and not the air-side. The passive sampling efficiency (PSE) of styrene and m,p-xylene was close to 1. Based on Pearson correlation analysis, a negative correlation was found between the molecular weight of compounds and their uptake rates. Furthermore, the calibrated Tenax-TA-PAS method was used to quantify cVMSs and benzene series compounds in a living room and an office environment in the urban area of Dalian, China. The concentrations of toluene were the highest in both the living room (10.4 µg m-3) and office (7.02 µg m-3) among the target compounds.

Exposure to metals and semivolatile organic compounds in Australian fire stations.

Firefighting is an occupation with exposure to a wide range of chemicals by means of inhalation, ingestion or dermal contact. Although advancements in personal protective clothing and equipment have reduced the risks for acute exposure during fire suppression operations, chronic exposure may still be present at elevated levels in fire stations. The aim of this study was to assess chemicals in air and on surfaces in fire stations, compare this with other indoor environments, and use this data to estimate firefighter exposure within the fire station. Fifteen Australian fire stations were selected for chemical exposure assessment by means of 135 active air monitors, 60 passive air monitors, and 918 wipe samples. These samples were collected from the interior and exterior of fire stations, from personal protective clothing and equipment, and from within the cabins of vehicles. Chemicals analysed included polycyclic aromatic hydrocarbons, volatile organic compounds, metals, and diesel particulate matter. Specific chemicals were detected from within each class of chemicals, with metals being most frequently detected. Statistical analysis by means of Pearson's Correlations and threshold tests were used to consider the source of exposure, and a collective addition risk quotient calculation was used to determine firefighter exposure. The presence of metals in fire stations was compared with findings from global indoor dust measurements. Concentrations across firefighter ensemble, inside vehicle cabins, and within fire stations for chromium (39.5-493 µg/m2), lead (46.7-619 µg/m2), copper (594-3440 µg/m2), zinc (11100-20900 µg/m2), nickel (28.6-2469 µg/m2) and manganese (73.0-997 µg/m2) were in most instances orders of magnitude higher when compared with concentrations measured in homes and offices. Our study suggests that the elevated concentrations are associated with the transfer of chemicals from fire suppression operations. Due to this elevated concentration of chemicals, firefighters may face increased exposure, and in turn increased risk of adverse health effects. Data suggest that exposure may be mitigated by means of increased laundering frequency and increased decontamination at the scene of the fire.

Polycyclic aromatic hydrocarbons, polychlorinated biphenyls and legacy and current pesticides in indoor environment in Australia - occurrence, sources and exposure risks.

Paired indoor air and floor dust samples were collected from residential houses and offices (n = 28) in two Australian cities in 2015. For the air samples, a modified passive air sampler (PAS) was used to collect semi-volatile organic compounds (SVOCs) in gaseous phase and airborne particles simultaneously. Sampling rates (R) of the PAS for gaseous SVOCs ranged from 0.69 to 3.4 m3 sampler-1 day-1. Out of the 33 analytes, 22, 14 and 17 compounds were detected (above the method detection limit) in over 50% of air, airborne particles and floor dust samples respectively. The highest median level in air, airborne particles and floor dust was observed for phenanthrene (2.0 ng m-3), permethrin (8800 ng g-1) and permethrin (5100 ng g-1) respectively. Among polychlorinated biphenyl (PCB) congeners, with few exceptions, the largest contribution was from 3,3'-dichlorobiphenyl (PCB11) for both indoor air and floor dust samples. In these houses and offices, the indoor level of polycyclic aromatic hydrocarbons (PAHs) was mainly influenced by ambient (outdoor) air. Primary sources of PCBs were from within indoor environments and generally older houses have higher concentrations in air. Among pesticides, hexachlorobenzene in indoor environments appeared to be due to transfer from outdoor sources whereas chlordanes and pyrethroids were associated with past and current household application respectively. Compared to data from other countries/regions, concentrations of chlordanes, chlorpyrifos and pyrethroids in indoor air and dust samples from Australia were among the highest whereas PCB and PAH levels were among the lowest. The sum of estimated daily intakes (EDIs) via inhalation and dust contact and ingestion were calculated. The highest median value of EDI was observed for permethrin at 2.8 (for adults) and 74 ng kg-1 day-1 (for toddlers), which are <0.15% of the U.S. EPA reference dose.

Chlorinated paraffins in indoor dust from Australia: Levels, congener patterns and preliminary assessment of human exposure.

Chlorinated paraffins (CPs) are a group of polychlorinated n-alkanes with high production volumes. Until now, there are only limited data on the levels of CPs in the environment, especially in the indoor environment. In this study, dust samples were collected from 44 indoor environments, including 27 private houses, 10 offices, and 7 vehicles. Short-, medium-, and long-chain CPs were detected in all dust samples. The median concentration of ∑CPs (C10-C21) was 57, 160 and 290 µg/g, in houses, offices, and vehicles, respectively. Medium-chain CPs were the dominant group, on average accounting for 86% of ∑CPs. Cl6 and Cl8 groups had the highest contributions to ∑CPs across all the different microenvironments, while C13 and C14 were the predominant groups of SCCPs and MCCPs. Median exposure to ∑CPs via indoor dust were estimated at 80 ng/kg/day and 620 µg/kg/day for Australian adults and toddlers respectively. The daily intake of CPs via dust, in the worse scenario, was still 2-3 orders of magnitudes lower than the reference doses based on neoplastic effects.

Concentrations of organophosphate flame retardants and plasticizers in urine from young children in Queensland, Australia and associations with environmental and behavioural factors.

In recent years, the production and usage volumes of organophosphate flame retardants (OPFRs) has increased substantially. Certain OPFRs are suspected reproductive toxins, carcinogenic, and neurotoxic. Insufficient information is available on human exposure pathways to these chemicals, particularly in Australia. We aim to assess the association between OPFR concentrations in the urine of children to environmental and behavioural risk factors. Concentrations of eight OPFRs and eleven metabolites were measured in the urine of 51 children, aged 3-29 months, in Southeast Queensland, Australia and compared to their behavioural and environmental risk factor data obtained by an online questionnaire. Of the 11 OPFR metabolites analysed, 55% were frequently detected in the majority (> 80%) of samples. The most frequently detected metabolite was bis(1,3-dichloroisopropyl) phosphate (BDCIPP) (detected in 100% of samples), followed by 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP) (96%), diphenyl phosphate (DPHP) (94%) and bis(1-chloroisopropyl) phosphate (BCIPP) (86%). In multivariable modelling, age was positively associated with concentrations of bis(2-butoxyethyl) phosphate (BBOEP) and negatively associated with concentrations of BCIPP and BCIPHIPP. Other non-age related factors, including vacuuming frequency, hand-washing frequency and presence and number of some electrical appliances in the home were also associated with concentrations of OPFR metabolites.

Urinary metabolites of organophosphate esters: Concentrations and age trends in Australian children.

There is growing concern around the use of organophosphate esters (OPEs) due to their suspected reproductive toxicity, carcinogenicity, and neurotoxicity. OPEs are used as flame retardants and plasticizers, and due to their extensive application in consumer products, are found globally in the indoor environment. Early life exposure to OPEs is an important risk factor for children's health, but poorly understood. To study age and sex trends of OPE exposures in infants and young children, we collected, pooled, and analysed urine samples from children aged 0-5years from Queensland, Australia for 9 parent OPEs and 11 metabolites. Individual urine samples (n=400) were stratified by age and sex, and combined into 20 pools. Three individual breast milk samples were also analysed to provide a preliminary estimate on the contribution of breast milk to the intake of OPEs. Bis(1-chloroisopropyl) phosphate (BCIPP), 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP), bis(1,3-dichloroisopropyl) phosphate (BDCIPP), dibutyl phosphate (DBP), diphenyl phosphate (DPHP), bis(2-butoxyethyl) phosphate (BBOEP), bis(2-butoxyethyl) 3-hydroxyl-2-butoxyethyl phosphate (3OH-TBOEP), and bis(2-butoxyethyl) hydroxyethyl phosphate (BBOEHEP) were detected in all urine samples, followed by bis(methylphenyl) phosphate (80%), and bis(2-ethylhexyl) phosphate (BEHP, 20%), and bis(2-chloroethyl) phosphate (BCEP, 15%). Concentrations of tris(2-chloroethyl) phosphate (TCEP), BCEP, tris(2-ethylhexyl) phosphate (TEHP), and DBP decreased with age, while bis(methylphenyl) phosphate (BMPP) increased with age. Significantly higher concentrations of DPHP (p=0.039), and significantly lower concentrations of TEHP (p=0.006) were found in female samples compared to males. The estimated daily intakes (EDIs) via breastfeeding, were 4.6, 26 and 76ng/kg/day for TCEP, TBP and TEHP, respectively, and were higher than that via air and dust, suggesting higher exposure through consumption of breast milk.

Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials.

BACKGROUND: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. OBJECTIVES: To evaluate the use of oral oxycodone for acute postoperative pain management. STUDY DESIGN: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. METHODS: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were "oral strong opioids," "postsurgical," "postoperative," "post-surgical," and "post-operative." Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. RESULTS: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. LIMITATIONS: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. CONCLUSION: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics.Key words: Postoperative, pain, analgesia, oral oxycodone, opioid.

Serum angiopoietin-2 and ß-hCG as predictors of prolonged uterine bleeding after medical abortion in the first trimester.

OBJECTIVE: The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We evaluate serum Angiopoietin-2 (Ang-2) and ß human chorionic gonadotropin (ß-hCG) in women who had undergone a medical abortion as markers of prolonged uterine bleeding (PUB). METHODS: Prospective trial involving 2843 women attending an gynecology outpatient clinic who following a medical abortion with mifepristone and misoprostol, the study cohort was divided into women with duration of uterine bleeding >14 days (PUB) and women with duration of uterine bleeding ≤14 days (normal uterine bleeding, NUB). Serum determinations of Ang-2 levels by ELISA and ß-hCG levels by electrochemiluminiscence immunoassay. Receiver Operating Characteristics (ROC) analyses were calculated and plotted for the diagnostic accuracy of serum ß-hCG and Ang-2 concentration to discriminate PUB and NUB. RESULTS: Baseline characteristics for both groups were similar, Only duration of bleeding showed a significant difference between the PUB group and NUB group. Ang-2 serum levels moderately correlated with serum ß-hCG levels with statistically significant correlation coefficients of 0.536. Serum ß-hCG and Ang-2 levels on day 7 and on day 14 after medical abortion were signifcantly higher in PUB group than in NUB group. Plotted as ROC curves, ß-hCG area under curve (AUC) was 0.65 (95% CI, 0.53-0.76) on day 7, rising to AUC = 0.83 (95% CI, 0.75-0.92) on day 14. Using Ang-2 on day 7 and day 14 as predictive parameter resulted in an analogous AUC (AUC = 0.61 on day 7, AUC = 0.78 on day 14). CONCLUSIONS: Both parameters are clinically useful as a diagnostic test in predicting PUB after medical abortion, and can be helpful in uncertain clinical situations, but should be considered as supplementary to a general clinical evaluation.