Health risk assessment of uranium intake from private residential drinking groundwater facilities based on geological characteristics across the Republic of Korea.

Groundwater contributes to an average of 8 % of the total water source capacity in the Republic of Korea. Hence, private residential households in rural areas in Korea are still using groundwater for drinking without any regular water quality inspection. This can increase the risk of exposure to natural radionuclides like uranium through drinking groundwater. This study investigated the uranium level in drinking groundwater all over the country by analyzing 11,451 samples from private residential drinking groundwater facilities and compared the exposure amount and its associated carcinogenic and non-carcinogenic risk based on the geological characteristics of the aquifer. Results yield that although the average hazard quotient (HQ) and excess cancer risk (ECR) of exposure to natural uranium through drinking groundwater were respectively below 1 and 1 × 10-6 and do not indicate a potential health hazard, significantly high HQ and ECR up to respectively 70 and 4 × 10-4 in samples where the aquifer is the Jurassic granite observed. Accordingly, regular water quality investigation and onsite treatment methods are required to provide healthy drinking water in such areas.

Assessment of poly(hexamethylenebicyanoguanide-hexamethylenediamine) hydrochloride-induced developmental neurotoxicity via oxidative stress mechanism: Integrative approaches with neuronal cells and zebrafish.

Poly(hexamethylenebicyanoguanide-hexamethylenediamine) hydrochloride (PHMB) is a biocide with a broad spectrum of antibacterial activity. Its use as a disinfectant and preservative in consumer products results in human exposure to PHMB. Toxicity studies on PHMB mainly focus on systemic toxicity or skin irritation; however, its effects on developmental neurotoxicity (DNT) and the underlying mechanisms are poorly understood. In this study, the DNT effects of PHMB were evaluated using IMR-32 and SH-SY5Y cell lines and zebrafish. In both cell lines, PHMB concentrations ≥ 10 µM reduced neurite outgrowth, and cytotoxicity was observed at concentrations up to 40 µM. PHMB regulated expression of neurodevelopmental genes and induced reactive oxygen species (ROS) production and mitochondrial dysfunction. Treatment with N-acetylcysteine reversed the toxic effects of PHMB. Toxicity tests on zebrafish embryos showed that PHMB reduced viability and heart rate and caused irregular hatching. PHMB concentrations of 1-4 µM reduced the width of the brain and spinal cord of transgenic zebrafish and attenuated myelination processes. Furthermore, PHMB modulated expression of neurodevelopmental genes in zebrafish and induced ROS accumulation. These results suggested that PHMB exerted DNT effects in vitro and in vivo through a ROS-dependent mechanism, highlighting the risk of PHMB exposure.

Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study.

OBJECTIVE: Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans. METHODS: We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS). RESULTS: Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years. CONCLUSION: OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2-5, can achieve satisfactory fusion rates within 2 years after surgery.

Comparison of Preoperative Imaging Modalities for the Assessment of Malignant Potential of Pancreatic Cystic Lesions: A Network Meta-analysis.

PURPOSE: The aims of this study are to compare the performance of various preoperative imaging modalities for assessing the malignant potential of pancreatic cystic lesions (PCLs) through a network meta-analysis (NMA) and to clarify the role of 18 F-FDG PET in the management of patients with PCL. METHODS: PubMed, EMBASE, and Cochrane Library were searched for the studies evaluating the performance of preoperative imaging modalities for identifying malignant PCLs. The NMA was performed for 4 representative categories of various imaging modalities in terms of diagnostic performance for differentiating malignant from benign PCL and intraductal papillary mucinous neoplasms only as a subgroup analysis. To calculate the probability of each imaging modality being the most effective diagnostic method, the surface under the cumulative ranking curve values were obtained. RESULTS: A total of 1018 patients from 17 direct comparison studies using 2 or more preoperative imaging modalities were included for differentiating malignant from benign PCL. The positive predictive value (PPV) and accuracy of 18 F-FDG PET were significantly higher than that of CT (PPV: odds ratio [OR], 2.66; 95% credible interval [CrI], 1.21-6.17; accuracy: OR, 2.63; 95% CrI, 1.41-5.38) or MRI (PPV: OR, 2.50; 95% CrI, 1.09-6.26; accuracy: OR, 2.50; 95% CrI, 1.28-5.47) in all PCLs, as well as in the subgroup analysis for intraductal papillary mucinous neoplasm only. 18 F-FDG PET showed the highest surface under the cumulative ranking curve values in all diagnostic performance areas of sensitivity, specificity, PPV, negative predictive value, and accuracy, followed by MRI or CT. CONCLUSIONS: The results from this NMA suggest that 18 F-FDG PET is the best preoperative imaging modality for differentiating malignant from benign PCLs and that it can be used for the preoperative evaluation of PCLs.

Ecological Risk Assessment of Amoxicillin, Enrofloxacin, and Neomycin: Are Their Current Levels in the Freshwater Environment Safe?

Veterinary pharmaceuticals may cause unexpected adverse effects on non-target aquatic species. While these pharmaceuticals were previously identified as priority compounds in ambient water, their ecological risks are relatively unknown. In this study, a series of chronic toxicity tests were conducted for these pharmaceuticals using algae, two cladocerans, and a fish. After a 21-d exposure to amoxicillin, enrofloxacin, and neomycin, no observed effect concentration (NOEC) for the reproduction of Daphnia magna was detected at 27.2, 3.3, and 0.15 mg/L, respectively. For the survival of juvenile Oryzias latipes following the 40-d exposure, NOEC was found at 21.8, 3.2, and 0.87 mg/L, respectively. Based on the results of the chronic toxicity tests and those reported in the literature, predicted no-effect concentrations (PNECs) were determined at 0.078, 4.9, and 3.0 µg/L for amoxicillin, enrofloxacin, and neomycin, respectively. Their hazard quotients (HQs) were less than 1 at their average levels of occurrence in ambient freshwater. However, HQs based on the maximum detected levels of amoxicillin and enrofloxacin were determined at 21.2 and 6.1, respectively, suggesting potential ecological risks. As the potential ecological risks of these veterinary pharmaceuticals at heavily contaminated sites cannot be ignored, hotspot delineation and its management are required.

Clinicopathologic risk factors of radioactive iodine therapy based on response assessment in patients with differentiated thyroid cancer: a multicenter retrospective cohort study.

PURPOSE: We investigated whether predictive clinicopathologic factors can be affected by different response criteria and how the clinical usefulness of radioactive iodine (RAI) therapy should be evaluated considering variable factors in patients with differentiated thyroid carcinoma (DTC). METHODS: A total of 1563 patients with DTC who underwent first RAI therapy after total or near total thyroidectomy were retrospectively enrolled from 25 hospitals. Response to therapy was evaluated with two different protocols based on combination of biochemical and imaging studies: (1) serum thyroglobulin (Tg) and neck ultrasonography (US) and (2) serum Tg, neck US, and radioiodine scan. The responses to therapy were classified into excellent and non-excellent or acceptable and non-acceptable to minimize the effect of non-specific imaging findings. We investigated which factors were associated with response to therapy depending on the follow-up protocols as well as response classifications. Multivariate logistic regression analysis was performed to identify factors significantly predicting response to therapy. RESULTS: The proportion of patients in the excellent response group significantly decreased from 76.5 to 59.6% when radioiodine scan was added to the follow-up protocol (P < 0.001). Preparation method (recombinant human TSH vs. thyroid hormone withdrawal) was a significant factor for excellent response prediction evaluated with radioiodine scan (OR 2.129; 95% CI 1.687-2.685; P < 0.001) but was not for other types of response classifications. Administered RAI activity, which was classified as low (1.11 GBq) or high (3.7 GBq or higher), significantly predicted both excellent and acceptable responses regardless of the follow-up protocol. CONCLUSIONS: The clinical impact of factors related to response prediction differed depending on the follow-up protocol or classification of response criteria. A high administered activity of RAI was a significant factor predicting a favorable response to therapy regardless of the follow-up protocol or classification of response criteria.

Comparisons of human risk assessment models for heavy metal contamination within abandoned metal mine areas in Korea.

This study was initiated to develop a model specialized to conduct human risk assessments (HRAs) of abandoned metal mine areas in Korea. The Korean guideline (KG) model used in study was formulated via modification of the original Korean guidelines on HRAs of soil contamination. In addition, the newly developed model was applied to the HRAs of two abandoned metal mines contaminated with arsenic (As) and heavy metals (Cd, Cu, Pb, and Zn). The results of the KG model were compared with those of two internationally renowned models [Contaminated land exposure assessment (CLEA) and CSOIL models]. The HRA results of the three models indicated that the areas of concern were unsafe when it came to both carcinogenic and non-carcinogenic hazards. Furthermore, the hazards in both areas were mostly attributed to As and the predominant exposure pathways were identified as crop intake in the KG model and surface soil dermal contact in CLEA and CSOIL models. Accordingly, measures to protect against As exposure should be established immediately to prevent adverse health effects on inhabitants in these areas. A comparison of HRA results revealed significant differences between KG, CLEA, and CSOIL models due to the various types of exposure pathways, contaminants, and input data, such as exposure factors and receptor parameters. This study suggests that set-up of an exposure scenario is crucial for the successful performance of HRAs, and the most relevant HRA model should be deliberately selected to attain risk assessment goals.

F-18 FDG PET for assessment of disease activity of large vessel vasculitis: A systematic review and meta-analysis.

BACKGROUND: The aim of this study is to investigate the performance of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) or positron emission tomography/computed tomography (PET/CT) for the assessment of disease activity in patients with large vessel vasculitis (LVV) through a meta-analysis. METHODS: The MEDLINE via PubMed and EMBASE were searched for the studies evaluating the performance of F-18 FDG PET or PET/CT in the assessment of disease activity in patients with LVV. Pooled sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver-operating characteristic (sROC) curve were estimated across the included studies. Possible publication bias was assessed by Deek's funnel plot asymmetry tests. RESULTS: A total of 439 PET images from 298 patients pooled from nine studies showed that the pooled sensitivity was 0.88 [95% confidence interval (CI) 0.79-0.93] without heterogeneity (χ2 = 14.42, P = .07) and the pooled specificity was 0.81 (95% CI 0.64-0.91) with heterogeneity (χ2 = 63.72, P = .00) for the detection of active LVV. The pooled DOR was 30 (95% CI 8-107). Hierarchical sROC curve indicates that the area under the curve was 0.91 (95% CI 0.89-0.94). There was no significant publication bias (P = .42), and meta-regression analysis revealed that none of the variables was the source of the study heterogeneity. CONCLUSIONS: F-18 FDG PET has a good performance for the detection of active disease status in patients with LVV. Revised criteria for the assessment of disease activity incorporated with F-18 FDG PET or PET/CT should be introduced and validated. Further studies are warranted to determine if PET-based treatment of LVV can improve outcomes.

Validity of Quantitative Lymphoscintigraphy as a Lymphedema Assessment Tool for Patients With Breast Cancer.

OBJECTIVE: To evaluate the validity of quantitative lymphoscintigraphy as a useful lymphedema assessment tool for patients with breast cancer surgery including axillary lymph node dissection (ALND). METHODS: We recruited 72 patients with lymphedema after breast cancer surgery that included ALND. Circumferences in their upper limbs were measured in five areas: 15 cm proximal to the lateral epicondyle (LE), the elbow, 10 cm distal to the LE, the wrist, and the metacarpophalangeal joint. Then, maximal circumference difference (MCD) was calculated by subtracting the unaffected side from the affected side. Quantitative asymmetry indices (QAI) were defined as the radiopharmaceutical uptake ratios of the affected side to the unaffected side. Patients were divided into 3 groups by qualitative lymphoscintigraphic patterns: normal, decreased function, and obstruction. RESULTS: The MCD was highest in the qualitative obstruction (2.76±2.48) pattern with significant differences from the normal (0.69±0.78) and decreased function (1.65±1.17) patterns. The QAIs of the axillary LNs showed significant differences among the normal (0.82±0.29), decreased function (0.42±0.41), and obstruction (0.18±0.16) patterns. As the QAI of the axillary LN increased, the MCD decreased. The QAIs of the upper limbs were significantly higher in the obstruction (3.12±3.07) pattern compared with the normal (1.15±0.10) and decreased function (0.79±0.30) patterns. CONCLUSION: Quantitative lymphoscintigraphic analysis is well correlated with both commonly used qualitative lymphoscintigraphic analysis and circumference differences in the upper limbs of patients with breast cancer surgery with ALND. Quantitative lymphoscintigraphy may be a good alternative assessment tool for diagnosing lymphedema after breast cancer surgery with ALND.

Assessment of planarity of the golf swing based on the functional swing plane of the clubhead and motion planes of the body points.

The purposes of this study were (1) to determine the functional swing plane (FSP) of the clubhead and the motion planes (MPs) of the shoulder/arm points and (2) to assess planarity of the golf swing based on the FSP and the MPs. The swing motions of 14 male skilled golfers (mean handicap = -0.5 +/- 2.0) using three different clubs (driver, 5-iron, and pitching wedge) were captured by an optical motion capture system (250Hz). The FSP and MPs along with their slope/relative inclination and direction/direction of inclination were obtained using a new trajectory-plane fitting method. The slope and direction of the FSP revealed a significant club effect (p < 0.001). The relative inclination and direction of inclination of the MP showed significant point (p < 0.001) and club (p < 0.001) effects and interaction (p < 0.001). Maximum deviations of the points from the FSP revealed a significant point effect (p < 0.001) and point-club interaction (p < 0.001). It was concluded that skilled golfers exhibited well-defined and consistent FSP and MPs, and the shoulder/arm points moved on vastly different MPs and exhibited large deviations from the FSP. Skilled golfers in general exhibited semi-planar downswings with two distinct phases: a transition phase and a planar execution phase.

Risk assessment of chlortetracycline, oxytetracycline, sulfamethazine, sulfathiazole, and erythromycin in aquatic environment: are the current environmental concentrations safe?

To understand potential risks of major pharmaceutical residues in waters, we evaluated ecotoxicities of five major veterinary pharmaceuticals, i.e., chlortetracycline, oxytetracycline, sulfamethazine, sulfathiazole, and erythromycin, which have been frequently detected in freshwater environment worldwide. We conducted acute and chronic toxicity tests using two freshwater invertebrates (Daphnia magna and Moina macrocopa) and a fish (Oryzias latipes). In general, D. magna exhibited greater sensitivity than M. macrocopa, and chronic reproduction was the most sensitive endpoints for both organisms. The population growth rate was adversely influenced by exposure to chlortetracycline, sulfamethazine, or sulfathiazole in water fleas, but reduction in population size was not expected. In O. latipes, the tested pharmaceuticals affected several reproduction related endpoints including time to hatch and growth. Based on the toxicity values from the present study and literature, algae appeared to be the most sensitive organism, followed by Daphnia and fish. Hazard quotients derived from measured environmental concentrations (MECs) and predicted no effect concentrations (PNECs) for erythromycin and oxytetracycline exceeded unity, suggesting that potential ecological effects at highly contaminated sites cannot be ruled out. Long-term consequences of veterinary pharmaceutical contamination in the environment deserve further investigation.

Ethnobotanical survey of medicinal plants at periodic markets of Honghe Prefecture in Yunnan Province, SW China.

In China, traditional markets are considered as important places for trading of medicinal plants harvested by rural villagers, which also play a social role of exchanging traditional use of herbal medicine among different cultural and social groups at local level. Market survey is often engaged in ethnobotanical studies for documenting locally used herbal plants and associated traditional knowledge. Information collected from market survey is also useful for plant conservation in the habitat areas. However, information on the market traded medicinal plants is not well documented from traditional markets in Honghe Prefecture, Yunnan. The study aimed to look into medicinal plants that are used by local people for curing various ailments. Ethnobotanical market survey methods, interviews, Participatory Action Research (PAR) and field visits were planned to elicit information on the uses of various medicinal plants. It was found that 216 plant species are commonly used by local people for curing various diseases, of which 173 species (80.1%) are wild plants and 43 species (19.9%) are home garden plants. A total of 278 records of medical uses in 60 herbal recipes for the treatment of 16 types of common diseases were recorded. In most of the recipes recorded, digestion diseases (30.6%) were used. The rest are rheumatological diseases (13.0%), respiratory system diseases (10.4%), infectious diseases (7.9%) and surgery uses (7.9%). The knowledge about the number of medicinal plants available in that area and used by interviewees was positively correlated with the threats on medicinal plants in the wild habitats of the study area, indicating that the diversity of medicinal plants and the associated traditional knowledge trends to disappear in the area.

Human risk assessment for heavy metals and as contamination in the abandoned metal mine areas, Korea.

Cleanup goals for the contaminated sites are established on the basis of risk assessments and rely on the estimated toxicity of the chemicals of concern (COC). Toxicity estimates are based on bioavailability causing risk of adverse health effects on humans. In this study, bioavailability of As, Cu, Pb and Zn in soil was determined by SBET (Simple Bioavailability Extraction Test), and chemical analysis for groundwater and stream water collected from the abandoned mine areas (Dukeum, Dongil, Dongjung, Myungbong and Songchun mine areas) was conducted. High values of cancer risk for As (1.16x10(-5)) were detected through soil ingestion pathways in the Songchun mine area and assessed through water exposure pathways in the all mines except Dukeum. The hazard index value for As in the Songchun mine area (3.625) exceeded 1.0. The results indicated that the ingestion of As-contaminated soil and water by local inhabitants can pose a potential health threat in these mine areas.