[Analysis of Regional Differences in Cadmium Ecological Risk in Surface Waters of the Yangtze River Basin].

This study primarily focused on the regional disparities in both water quality criteria and ecological risks attributed to cadmium presence within the surface waters of the Yangtze River Basin. In the initial phase, the long-term water quality criteria for cadmium were recalibrated in accordance with the guidelines outlined in China's "Water Quality Criteria for Freshwater Aquatic Organisms-Cadmium," accounting for the prevalent hardness distribution within the Yangtze River Basin's surface water. Subsequently, a more refined revision was undertaken considering the specific characteristics of the species residing within the Yangtze River Basin. This undertaking led to a comprehensive interpretation of the regional variations in both the distribution of long-term water quality criteria values and the risk quotient distribution of cadmium throughout the Yangtze River Basin. The incorporation of hardness and species-specific attributes resulted in a revised range of long-term water quality criteria for cadmium across different urban locales within the Yangtze River Basin. Notably, the recalibrated values ranged from 0.08 µg·L-1 as the lowest threshold to 0.75 µg·L-1 as the upper limit, signifying a tenfold differentiation. Correspondingly, the urban average annual risk quotient associated with cadmium exposure demonstrated a variation from 0.035 to 1.12, marking a significant 32-fold discrepancy between the lowest and highest values. It is essential to highlight that regions of paramount importance, such as the confluence area connecting the upper and middle stretches of the Yangtze River Basin and the intricate Dongting Lake system, exhibited noteworthy ecological risks attributed to cadmium presence. Consequently, further in-depth investigations into these critical regions are imperative for a comprehensive understanding of the associated risks.

Possible use of 2D shear wave liver elastography in new-onset ascites evaluation.

BACKGROUND: No data on the use of 2D shear wave elastography exists regarding the evaluation of the new-onset ascites causality. AIMS: To determine whether 2D shear wave elastography can help in the non-invasive assessment of the new-onset ascites cause. To assess the applicability of liver stiffness measured by 2D shear wave elastography using Esaote MyLab Nine apparatus in patients with ascites. METHODS: In 52 consecutive patients with new-onset ascites (January 2020 to October 2021), liver stiffness using 2D shear wave elastography was prospectively measured. The reliable measurements were used for further analysis. Relevant clinical and laboratory data was collected. RESULTS: The calculated liver stiffness measurement cut-off value of 14.4 kPa held 94% accuracy, 100% sensitivity, and 83% specificity when determining ascites with serum ascites albumin gradient ≥11 g/L. Reliable 2D shear wave elastography success rate was 84%. CONCLUSIONS: 2D shear wave elastography may potentially be used to differentiate transudative from exudative ascites, especially in patients with portal hypertension and peritoneal carcinomatosis.

Profound regional disparities shaping the ecological risk in surface waters: A case study on cadmium across China.

The scientific advancement of water quality criteria (WQC) stands as one of the paramount challenges in ensuring the security of aquatic ecosystem. The region-dependent species distribution and water quality characteristics would impact the toxicity of pollutant, which would further affect the derivation of WQC across regions. Presently, however, numerous countries adhere to singular WQC values. The "One-size-fits-all" WQC value for a given pollutant may lead to either "over-protection" or "under-protection" of organisms in specific region. In this study, we used cadmium(Cd) pollution in surface waters of China as a case study to shed light on this issue. This study evaluated critical water quality parameters and species distribution characteristics to modify WQC for Cd across distinct regions, thus unveiling the geographical variations in ecological risk for Cd throughout China. Notably, regional disparities in ecological risk emerged a substantial correlation with water hardness, while species-related distinctions magnified these regional variations. After considering the aforementioned factors, the variation in long-term WQC among different areas reached 84-fold, while the divergence in risk quotient extended to 280-fold. This study delineated zones of both heightened and diminished ecological susceptibility of Cd, thereby establishing a foundation for regionally differentiated management strategies.

Hydrochemical characteristics and potential health risks of nitrate, fluoride, and uranium in Kota district, Rajasthan, India.

This study examines the uranium, fluoride, and nitrate dispositions in groundwater as well as potential health risks in Kota district, Rajasthan, India. Total 198 groundwater samples were collected in both dry and wet periods and analyzed for physicochemical parameters along with U, F-, and NO3- using standard methods. Results indicate that the electrical conductivity, total dissolved solids, total hardness, alkalinity, Ca2+, Mg2+, HCO3-, Cl-, NO3-, and F- exceed the WHO standard limits of drinking water in both periods. Uranium concentration is at the broader of drinking water permissible limit (30 µg/L) and found about 1.05 times more. Nitrate and fluoride concentrations ranged from 9.8 to 412.0 mg/L and 0.1 to 4.0 mg/L for the dry season, while in the wet period, they varied from 10.0 to 954.0 mg/L and 0.1 to 3.5 mg/L, respectively. Correlation studies show a significantly strong positive correlation between uranium and total alkalinity and carbonate. Natural background levels (NBLs) were explored to assess the source of groundwater pollution. It shows that the second inflection points of NBLs estimated for NO3-, F-, and U are about 168 mg/L, 1.2 mg/L, and 7.3 µg/L, respectively, during the experimental period. The USEPA technique was used to evaluate the non-carcinogenic health risks associated with consuming the NO3- and F--contaminated groundwater. The health risks in Kota district show that children are more at risk than adults. The risk assessment of uranium reveals that the excess cancer risk (ECR) and hazard quotient (HQ) are found to be below the standard limits, but a high concentration of uranium (31.6 µg/L) is observed at Amarpura village of Digod block. This study will provide a baseline of uranium, fluoride, and nitrate dispositions in groundwater for simulating mass transport model and safe use of drinking water.

The Application of Reference Dose Prediction Model to Human Health Water Quality Criteria and Risk Assessment.

Oral reference dose (RfD) is a key parameter for deriving the human health ambient water quality criteria (AWQC) for non-carcinogenic substances. In this study, a non-experimental approach was used to calculate the RfD values, which explore the potential correlation between toxicity and physicochemical characteristics and the chemical structure of pesticides. The molecular descriptors of contaminants were calculated using T.E.S.T software from EPA, and a prediction model was developed using a stepwise multiple linear regression (MLR) approaches. Approximately 95% and 85% of the data points differ by less than 10-fold and 5-fold between predicted values and true values, respectively, which improves the efficiency of RfD calculation. The model prediction values have certain reference values in the absence of experimental data, which is beneficial to the advancement of contaminant health risk assessment. In addition, using the prediction model constructed in this manuscript, the RfD values of two pesticide substances in the list of priority pollutants are calculated to derive human health water quality criteria. Furthermore, an initial assessment of the health risk was performed by the quotient value method based on the human health water quality criteria calculated by the prediction model.

Validation and Application of Predictive Models for Inadequate Bowel Preparation in Colonoscopies in a Tertiary Hospital Population.

Background: Bowel preparation is a major quality criterion for colonoscopies. Models developed to identify patients with inadequate preparation have not been validated in external cohorts. We aim to validate these models and determine their applicability. Methods: Colonoscopies between April and November 2019 were retrospectively included. Boston Bowel Preparation Scale ≥2 per segment was considered adequate. Insufficient data, incomplete colonoscopies, and total colectomies were excluded. Two models were tested: model 1 (tricyclic antidepressants, opioids, diabetes, constipation, abdominal surgery, previous inadequate preparation, inpatient status, and American Society of Anesthesiology [ASA] score ≥3); model 2 (co-morbidities, tricyclic antidepressants, constipation, and abdominal surgery). Results: We included 514 patients (63% males; age 61.7 ± 15.6 years), 441 with adequate preparation. The main indications were inflammatory bowel disease (26.1%) and endoscopic treatment (24.9%). Previous surgery (36.2%) and ASA score ≥3 (23.7%) were the most common comorbidities. An ASA score ≥3 was the only identified predictor for inadequate preparation in this study (p < 0.001, OR 3.28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of model 1 were 60.3, 64.2, 21.8, and 90.7%, respectively. Model 2 had a sensitivity, specificity, PPV, and NPV of 57.5, 67.4, 22.6, and 90.5%, respectively. The AUC for the ROC curves was 0.62 for model 1, 0.62 for model 2, and 0.65 for the ASA score. Conclusions: Although both models accurately predict adequate bowel preparation, they are still unreliable in predicting inadequate preparation and, as such, new models, or further optimization of current ones, are needed. Utilizing the ASA score might be an appropriate approximation of the risk for inadequate bowel preparation in tertiary hospital populations.

Introdução: A preparação intestinal é um dos principais critérios de qualidade na colonoscopia. Modelos desenvolvidos para identificar doentes com preparação inadequada nunca foram validados em coortes externas. Pretendemos validar esses modelos e determinar sua aplicabilidade clínica. Métodos: Colonoscopias entre abril-novembro/2019 foram incluídas retrospectivamente. A Escala de Preparação Intestinal de Boston ≥2 por segmento foi considerada adequada. Dados insuficientes, colonoscopias incompletas e colectomias totais foram excluídos. Dois modelos foram testados: modelo 1 (antidepressivos tricíclicos, opióides, diabetes, obstipação, cirurgia abdominal, preparação prévia inadequada, internamento e American Society of Anesthesiology [ASA] ≥3); modelo 2 (comorbilidades, antidepressivos tricíclicos, obstipação e cirurgia abdominal). Resultados: Foram incluídos 514 doentes (63% homens; idade 61.7 ± 15.6), 441 com preparação adequada. As principais indicações foram doença inflamatória intestinal (26.1%) e tratamento endoscópico (24.9%). Cirurgias anteriores (36.2%) e ASA ≥3 (23.7%) foram as comorbilidades mais comuns. Um score ASA ≥3 foi o único fator de risco identificado para preparação inadequada (p < 0.001, OR 3.28). A sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) do modelo 1 foi de 60.3, 64.2, 21.8 e 90.7%. O modelo 2 apresentou sensibilidade, especificidade, VPP e VPN de 57.5, 67.4, 22.6 e 90.55%. A AUC para a curva ROC foi de 0.62 para o modelo 1, 0.62 para o modelo 2 e 0.65 para o score ASA. Conclusões: Embora ambos os modelos sejam eficazes a prever preparação intestinal adequada, não se verifica o mesmo para a preparação inadequada e como tal, novos modelos ou otimização dos atuais são ainda necessários. Utilizar o score ASA pode ser uma aproximação adequada do risco de preparação intestinal inadequada em populações de hospitais terciários.

Pesticides bioassays using neotropical aquatic species: Trends during the last twenty years and future challenges in Argentina.

The presence of pesticides in aquatic ecosystems is one of the most relevant stressors which biota usually face. Laboratory tests using model organisms for pesticides toxicity assessment are employed worldwide. The use of these species has been encouraged in the scientific community due to their advantageous features and their acceptation by regulatory and standardization organizations. However, non-model species as well as those belonging particular ecosystems could contribute in the laboratory-field toxicity extrapolation. In this context, this work aims on exploring the state of the ecotoxicological studies of pesticides in neotropical aquatic species, focusing on bioassays performed in Argentina over the last 20 years as a case of study. Furthermore, we analyzed the possible advantages and disadvantages of these studies, possible differential sensitivities among native and model species, and future challenges to be faced. The analysis of more than 150 publications allowed identify the chemical identity of tested compounds, organisms used for the bioassays, characteristics of the experimental designs, and the toxicity endpoints. Particularly, the studied cases showed that the tested chemicals are related to those most used in the agricultural activity in Argentina, the predilection for particular species in some taxonomic groups (e.g. amphibians), and the wide election of biochemical biomarkers in the studies. Regarding the sensitivity comparison between native and non-native species, the amount of data available indicates that there is not a clear difference beyond some particular cases. However, deeper understanding of toxic effects of pesticides on non-model species could help in a more comprehensive ecological risk assessment in different ecosystems.

Validation of Nickel Bioavailability Models for Algae, Invertebrates, and Fish in Chinese Surface Waters.

Nickel (Ni) is used primarily in the production of alloys like stainless steel and is increasingly being used in the production of batteries for the electric vehicle market. Exposure of Ni to ecosystems is of concern because Ni can be toxic to aquatic organisms. The influence of water chemistry constituents (e.g., hardness, pH, dissolved organic carbon) on the toxicity of Ni has prompted the development and use of bioavailability models, such as biotic ligand models (BLMs), which have been demonstrated to accurately predict Ni toxicity in broadly different ecosystems, including Europe, North America, and Australia. China, a leading producer of Ni, is considering bioavailability-based approaches for regulating Ni emissions. Adoption of bioavailability-based approaches in China requires information to demonstrate the validity of bioavailability models for the local water chemistry conditions. The present study investigates the toxicity of Ni to three standard test species (Daphnia magna, Pseudokirchneriella subcapitata, and Danio rerio) in field-collected natural waters that are broadly representative of the range of water chemistries and bioavailabilities encountered in Chinese lakes and rivers. All experimental data are within a factor of 3 of the BLM predicted values for all tests with all species. For D. magna, six of seven waters were predicted within a factor of 2 of the experimental result. Comparison of experimental data against BLM predictions shows that the existing Ni bioavailability models are able to explain the differences in toxicity that result from water chemistry conditions in China. Validation of bioavailability models to water chemistries and bioavailability ranges within China provides technical support for the derivation of site-specific Ni water quality criteria in China. Environ Toxicol Chem 2023;42:1257-1265. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Updating the Chronic Freshwater Ecotoxicity Database and Biotic Ligand Model for Nickel for Regulatory Applications in Europe.

Bioavailability has been taken into account in the regulation of nickel in freshwater ecosystems in Europe for over a decade; during that time a significant amount of new information has become available covering both the sensitivity of aquatic organisms to nickel toxicity and bioavailability normalization. The ecotoxicity database for chronic nickel toxicity to freshwater organisms has been updated and now includes 358 individual data points covering a total of 53 different species, all of which are suitable for bioavailability normalization to different water chemistry conditions. The bioavailability normalization procedure has also been updated to include updates to the bioavailability models that enable more sensitive water chemistry conditions to be covered by the model predictions. The updated database and bioavailability normalization procedure are applicable to more than 95% of regulated European surface water conditions and have been used to calculate site-specific criteria for a variety of different water chemistry scenarios, to provide an indication of how the sensitivity to nickel varies between different water types. The hazardous concentration for 5% of a species (HC5) values for this diverse selection of water types range from 1.6 to 36 µg L-1 , clearly demonstrating the importance of accounting for nickel bioavailability in freshwaters. This updated database and bioavailability normalization procedure provide a robust basis for the derivation of regulatory thresholds for chronic nickel toxicity in freshwaters such as predicted no-effect concentrations and Environmental Quality Standards and are protective of the results of several mesocosm studies. Environ Toxicol Chem 2023;42:566-580. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

AP3×ML3 reduction quality classification for femoral trochanteric fractures: validation for reliability focusing on positive medial cortical support.

INTRODUCTION: This study evaluated the validity of the AP3 × ML3 reduction quality classification, which applies the concept of positive medial cortical support. METHODS: A total of 120 trochanteric fractures classified as AO Foundation/Orthopedic Trauma Association 31A1 and A2 were retrospectively analyzed. The validity of the AP3 × ML3 classification was evaluated by comparison with the Baumgaertner reduction quality criteria. When using the AP3 × ML3 classification, reduction quality was divided into three classes based on the degree of anterior cortical contact between the proximal and distal fragments. Reduction quality was also divided into three classes when using the Baumgaertner criteria. The frequency of mechanical complications, including cut-out, delayed union, and excessive migration of the lag screw, was retrospectively assessed. Intra-observer and inter-observer reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS: Mechanical complications included 4 cases of cutout (3.3%) and 1 of delayed union (0.8%). Mechanical complications occurred for all levels of reduction quality in both classifications, except for the acceptable of the Baumgaertner criteria. When reduction quality was rated as good, acceptable, and poor the incidence of mechanical complications was 2.5%, 5.7%, and 16%, respectively, under the AP3 × ML3 classification and 3.3%, 0%, and 15.0%, respectively, under the Baumgaertner criteria. The ICC was 0.80 for intra-observer reliability and 0.57 for inter-observer reliability when using the AP3 × ML3 classification and 0.85 and 0.34, respectively, when using the Baumgaertner criteria. CONCLUSION: The AP3 × ML3 classification was reliable and easy to use compared with the widely used Baumgaertner reduction quality criteria. Level of evidence 4.

An analysis of the use of the relative source contribution term in derivation of drinking water standards using perfluorooctanoic acid as an example.

The relative source contribution (RSC) term has long been used by the US Environmental Protection Agency (USEPA) and state regulatory agencies in setting criteria in water. The RSC reflects the proportion of the total daily intake of a chemical that can be derived from water when all other sources of exposure (e.g., food, air) are considered. This term is applied by the USEPA and state regulatory agencies when deriving ambient water quality criteria, maximum contaminant level goals, and drinking water health advisories for noncarcinogenic and threshold carcinogenic compounds. The value assigned to the RSC term affects the calculated criteria directly, with the allowable concentration in water decreasing with a decreasing RSC. A default RSC value of 20%-applied by regulatory entities in the USA for more than 40 years-assumes that 80% of an individual's exposure to a chemical's reference dose is from nonwater sources. Although the RSC is a chemical-specific parameter, there are few instances where a value other than the default of 20% has been approved and used. In 2000, USEPA outlined the process for developing chemical-specific RSC values, yet primary use of the default RSC value has continued since then. This article reviews USEPA's methodology for deriving chemical-specific RSC values and provides a case example using perfluorooctanoic acid (PFOA) to explore how the USEPA and state regulatory agencies are applying USEPA's guidance. The case study highlights inconsistent derivation of the RSC term, rooted in limitations in the current methodology. We suggest additional clarification of and more thoughtful use of the available data that may not meet USEPA's current adequacy requirements. We also recommend that the USEPA discuss recommendations for using biomonitoring data to set RSCs. Integr Environ Assess Manag 2023;19:605-612. © 2022 SETAC.

Human health ambient water quality criteria and risk assessment of pentachlorophenol in Poyang Lake Basin, China.

Pentachlorophenol (PCP) has been widely used as an insecticide for killing oncomelania (the intermediate host of schistosome) in China and leads to severe environmental contamination. Poyang Lake, as the largest freshwater lake and bird habitat in China, was once a schistosomiasis epidemic area. In this study, the concentrations of PCP in water and aquatic products from Poyang Lake were determined and analyzed, and then the human health ambient water quality criteria (AWQC) was derived based on native parameters of Poyang Lake basin. Finally, a comprehensive analysis of the health risks of drinking water and different types of aquatic products consumption was carried out. The results showed that PCP concentrations were ranged from 0.01 to 0.43 µg/L in surface water and 3.90 to 85.95 µg/kg in aquatic products. Due to the carcinogenicity of PCP, the human health AWQC for PCP are 0.02 µg/L for consumption of water and organisms and 0.03 µg/L for consumption of organisms only. Deterministic and probabilistic risk analysis indicated that the non-carcinogenic risk of PCP were acceptable in Poyang Lake, while the carcinogenic risk cannot be ignored. The health risks of PCP caused by aquatic products consumption were higher than that by drinking water. The percentages of acceptable risk for the population in Poyang Lake Basin were 99.95% at acceptable level of 10-4. Based on the sensitivity analysis, the impact of PCP concentrations on health risk values ranged from 53 to 82%. The study provided valuable information for regional water quality criteria development and water quality assessment.

Microplastics in the riverine environment: Meta-analysis and quality criteria for developing robust field sampling procedures.

Current sampling approaches for quantifying microplastics (MP) in the riverine water column and riverbed are unstandardised and fail to document key river properties that impact on the hydrodynamic and transport processes of MP particles, hindering our understanding of MP behaviour in riverine systems. Using ten criteria based on the reportage of the catchment area, river characteristics of sampling sites and approach, we reviewed the sampling procedures employed in 36 field-based river studies that quantify MP presence in the water column and benthic sediment. Our results showed that a limited number of studies conducted reliable sampling procedures in accordance with the proposed quality criteria, with 35 of the 36 studies receiving a score of zero for at least one criterion, indicating the omission of critical information relating to the study's sample size and the physical and hydraulic characteristics of the sampled river. On the other hand, a good number of studies adequately documented the spatial information of the sampling sites, the vertical location of sample collection, and sampling equipment used. An idealised MP sampling approach is presented to ensure that future studies are harmonised and variables underpinning MP transport in rivers are reported. In addition, a meta-analysis on MP particle characteristics from these studies found that concentrations in the riverine water column and benthic sediment are highly variable, varying by five and seven orders of magnitude respectively, and are heavily dependent on the sampling equipment used. Polypropylene (PP), polyethene, (PE), polystyrene (PS), polyethylene terephthalate (PET) and polyvinyl chloride (PVC) were the most frequently reported MP polymers, while irregular-shaped particles, fibres, spheres, and films were the most commonly reported shapes in the river studies. These results highlight the urgent need to standardise sampling procedures and include key contextual information to improve our understanding of MP behaviour and transport in the freshwater environment.

The postoperative prognosis of older intertrochanteric fracture patients as evaluated by the Chang reduction quality criteria.

OBJECTIVE: The aim of this study was to investigate the relationship between the Chang reduction quality criteria (CRQC) and the outcome of intertrochanteric fractures in older adults according to follow-up time. METHODS: This was a retrospective analysis of 389 older adult patients with intertrochanteric fractures treated surgically from January 2019 to June 2021, including 130 males and 259 females aged 84.6 (77.5-89.7) years. Patient survival was determined by telephone as the time between admission to hospital for fracture and death or until the study deadline (June 1, 2022). According to the CRQC, the patients were divided into the Poor, Acceptable, and Excellent groups. Univariate and multivariate Cox proportional hazard models were used to assess the association between CRQC and all-cause mortality in older adult intertrochanteric fractures at 1 year and the total follow-up time. Further subgroup analysis was performed according to different clinical and biological characteristics to improve the accuracy of the results. RESULTS: The mortality rates were 24.7% and 15.4% at 1 year and the total follow-up time, respectively. Both at one year and the total follow-up time, the mortality of the CRQC-Excellent group was significantly lower than that of the CRQC-Acceptable group (p.adj < 0.05) and the CRQC-Poor group (p.adj < 0.05). After multifactor adjustment, CRQC grades of Acceptable and Poor were independent risk factors affecting the overall and 1-year mortality. In addition, advanced age, ≥ 1 comorbidities, ASA 3 + 4, and prolonged preoperative waiting time were independent risk factors for survival at the total follow-up time. At 1 year, only ASA 3 + 4 and prolonged preoperative waiting time were independent risk factors for survival. Subgroup analysis according to different characteristics at the total follow-up time and at one year showed that in most subgroups, a decrease in the CRQC grade was significantly associated with an increase in all-cause mortality (p for trend < 0.05). CONCLUSIONS: This study highlights that CRQC grades of Acceptable and Poor are associated with increased all-cause mortality in older adult intertrochanteric fractures. We should attempt to achieve good reduction of these fractures.

Occurrence, health risk assessment and water quality criteria derivation of six personal care products (PCPs) in Huangpu River, China.

Personal care products (PCPs) have shown adverse health effects on humans. However, their health risk associated with fish consumption and relevant water quality criteria are still not well documented. This study investigated the occurrence and health risk of six PCPs (triclosan, bisphenol-A, and four commonly used organic ultraviolet (UV) filters, i.e., homosalate (HMS), 4-methylbenzylidene camphor (4-MBC), oxybenzone (BP-3), and octocrylene (OC)). River water and three trophic levels of fish species were collected from Huangpu River in Shanghai. The concentration range of the six PCPs were 1.48-89.76 ng/L in water and 0.40-10.75 ng/g dry weight in fish. Estimated daily intake (EDI) and target hazard quotient (THQ) of the PCPs indicated that consuming these fish would not pose non-carcinogenic risks. The maximum allowable fish consumption rates ranged from 85 to 1760 and 155 to 3230 meals per month for children and adults, respectively. As to the four organic UV filters, it is the first time to report the fish consumption advisories. Finally, the human health ambient water quality criteria (AWQC) values of HMS, 4-MBC, BP-3, OC, TCS, and BPA (i.e., 0.1218, 0.7311, 0.3494, 0.0477, 235.8, and 154.7 µg/L, respectively) were proposed, and they can serve as a valuable technical reference for global development and revision of aquatic environmental quality standards for these emerging contaminants.

CC-CLEAR (Colon Capsule Cleansing Assessment and Report): the novel scale to evaluate the clinical impact of bowel preparation in capsule colonoscopy - a multicentric validation study.

BACKGROUND: Colon Capsule Cleansing Assessment and Report (CC-CLEAR) is a novel quantitative bowel preparation scale for colon capsule. AIM: The aim of this study is to validate the association between CC-CLEAR's classification and major CC outcomes: lesion detection rate, surveillance recommendations and post-CC endoscopic treatment. METHODS: Multicentric cohort of consecutive CCs. An expert's panel decided post-CC recommendations. Data included CC-CLEAR and Leighton-REX scales. Major CC outcomes were associated with the different cleansing grades. RESULTS: From 168 CC's included, findings were reported in 123 (73.2%), 67 (54.4%) of those being colorectal polyps. CC-CLEAR influenced CC's lesion detection (OR 1.25 95% IC [1.07-1.46], p-value .004) and polyp detection rate (OR 1.22 95% IC [1.04-1.43], p-value.014). Thirty-two (19%) post-CC colonoscopies were recommended, including 22 (68.75%) with at least one polypectomy. CC-CLEAR was associated with post-CC colonoscopy treatment (OR 1.40 95% IC [1.07-1.84], p-value .015). Regarding surveillance, CC-CLEAR influenced the decision for immediate CC repetition (OR 0.21 95% IC [0.12-0.36], p-value < .001) and the recommendation for CC in 3-5 years' time (OR 1.47 95% IC [1.50-1.86], p-value < .002). The Leighton-Rex scale was not correlated with major CC outcomes. CONCLUSION: CC-CLEAR impacts major CC outcomes: lesion detection, surveillance recommendations and post-CC endoscopic treatment.

Lungs from polytrauma donors with significant chest trauma can be safely used for transplantation.

BACKGROUND: The use of organs from polytrauma donors for lung transplantation is controversial in the literature. For many centers, the radiologic manifestation of lung contusions is a clear reason to reject an organ offer. This results in the loss of potentially viable organs for the donor pool. METHODS: We analyzed 1152 donor lungs procured by our transplant center between January 2010 and June 2018. These included 118 lungs with a history of polytrauma involving the chest. Sixteen polytrauma donor lungs were rejected after procurement. A total of 102 lungs were transplanted, divided into 2 groups: the polytrauma contusion group (n = 44), comprising polytrauma donors with radiologic signs of lung contusion at the time of offer, and the polytrauma clear group (n = 58), comprising polytrauma donors without lung contusion. Nontrauma donor lungs transplanted during the study period were assigned to a polytrauma control group (n = 650). Short- and long-term outcomes of the 3 groups were compared. RESULTS: Basic demographic data and preoperative factors were similar in the 3 groups. Rates of primary graft dysfunction grade 3 at 72 hours did not differ among the 3 groups (0.0% vs 3.4% vs 3.9%; P = .409). The duration of ventilation was similar the 3 groups: 45 hours (interquartile range [IQR], 28-94 hours), 37 hours (IQR, 22-71 hours), and 42 hours (IQR, 22-96 hours), respectively (P = .674). Long-term graft survival was not impaired in the trauma groups compared with controls. One-year survival rates were 84.1% for the polytrauma contusion group, 93.1% for the polytrauma clear group, and 83.1% for the no polytrauma group. Five-year graft survival in the 3 groups was 74.7%, 87.2%, and 70.0%, respectively. CONCLUSIONS: Lung transplantation using organs from polytrauma donors is associated with similar short- and long-term results as transplantation from nontrauma donors. The presence or absence of radiologic signs of lung contusion at the time of offer has no impact on primary graft function and long-term survival.

Weathering pathways and protocols for environmentally relevant microplastics and nanoplastics: What are we missing?

To date, most studies of microplastics have been carried out with pristine particles. However, most plastics in the environment will be aged to some extent; hence, understanding the effects of weathering and accurately mimicking weathering processes are crucial. By using microplastics that lack environmental relevance, we are unable to fully assess the risks associated with microplastic pollution in the environment. Emerging studies advocate for harmonization of experimental methods, however, the subject of reliable weathering protocols for realistic assessment has not been addressed. In this work, we critically analysed the current knowledge regarding protocols used for generating environmentally relevant microplastics and leachates for effects studies. We present the expected and overlooked weathering pathways that plastics will undergo throughout their lifecycle. International standard weathering protocols developed for polymers were critically analysed for their appropriateness for use in microplastics research. We show that most studies using weathered microplastics involve sorption experiments followed by toxicity assays. The most frequently reported weathered plastic types in the literature are polystyrene>polyethylene>polypropylene>polyvinyl chloride, which does not reflect the global plastic production and plastic types detected globally. Only ~10% of published effect studies have used aged microplastics and of these, only 12 use aged nanoplastics. This highlights the need to embrace the use of environmentally relevant microplastics and to pay critical attention to the appropriateness of the weathering methods adopted moving forward. We advocate for quality reporting of weathering protocols and characterisation for harmonization and reproducibility across different research efforts.

Combined effects of copper, nickel, and zinc on growth of a freshwater mussel (Villosa iris) in an environmentally relevant context.

Trace metals rarely contaminate freshwaters independently, hence regulatory limits based on single-metal toxicity may be underprotective of aquatic life. This could be especially the case for rare and sensitive fauna like freshwater mussels, such as those suppressed in the Clinch and Powell Rivers in eastern USA where trace metals are long-term contaminants but at concentrations below regulatory limits. We hypothesized metal mixtures may be exerting combined effects on mussels, resulting in greater toxicity than would be predicted based on single-metal exposures. To test that hypothesis, we conducted two experiments exposing juvenile rainbow mussels (Villosa iris) for 42 days to dissolved copper, nickel, and zinc, individually and in three-metal mixtures, in an environmentally-relevant context of water with chemistry (hardness 155 mg/L as CaCO3, dissolved organic carbon 1.7-2.3 mg/L, pH 8.4) similar to that of the Clinch River, which receives alkaline mine drainage. We used a toxic unit approach, selecting test concentrations based on literature values for the lower of 28-day survival or growth (length) effect concentrations for Villosa iris or Lampsilis siliquoidea (fatmucket). Our first experiment confirmed survival and growth effects when acute and chronic water quality criteria, respectively, are approached and/or exceeded. Our second experiment, at lower concentrations, showed no effects on survival but combined effects on growth were evident: a mixture of Cu, Ni, and Zn (7.2 ± 1.2, 65.3 ± 6.1, 183 ± 32 µg/L, respectively) inhibited growth (dry weight) by 95% versus 73%, 74%, and 83% inhibition for single-metal exposures to Cu, Ni, and Zn of similar concentration (8.0 ± 1.1, 63.5 ± 4.8, 193 ± 31 µg/L, respectively). Furthermore, a mixture of Cu, Ni, and Zn with individual concentrations 21%, 29%, and 37% of their water quality criteria (3.4 ± 1.2, 21.8 ± 1.8, and 62.1 ± 8.4 µg/L, respectively) inhibited growth (dry weight) by 61% relative to controls. Our observation of combined effects suggests that regulatory limits based on single-metal toxicity may be underprotective of freshwater mussels when multiple metals are present.

Modeling the Bioavailability of Nickel and Zinc to Ceriodaphnia dubia and Neocloeon triangulifer in Toxicity Tests with Natural Waters.

We studied biotic ligand model (BLM) predictions of the toxicity of nickel (Ni) and zinc (Zn) in natural waters from Illinois and Minnesota, USA, which had combinations of pH, hardness, and dissolved organic carbon (DOC) more extreme than 99.7% of waters in a nationwide database. We conducted 7-day chronic tests with Ceriodaphnia dubia and 96-hour acute and 14-day chronic tests with Neocloeon triangulifer and estimated median lethal concentrations and 20% effect concentrations for both species. Toxicity of Ni and Zn to both species differed among test waters by factors from 8 (Zn tests with C. dubia) to 35 (Zn tests with N. triangulifer). For both species and metals, tests with Minnesota waters (low pH and hardness, high DOC) showed lower toxicity than Illinois waters (high pH and high hardness, low DOC). Recalibration of the Ni BLM to be more responsive to pH-related changes improved predictions of Ni toxicity, especially for C. dubia. For the Zn BLM, we compared several input data scenarios, which generally had minor effects on model performance scores (MPS). A scenario that included inputs of modeled dissolved inorganic carbon and measured Al and Fe(III) produced the highest MPS values for tests with both C. dubia and N. triangulifer. Overall, the BLM framework successfully modeled variation in toxicity for both Zn and Ni across wide ranges of water chemistry in tests with both standard and novel test organisms. Environ Toxicol Chem 2021;40:3049-3062. © 2021 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.