The use of immunomodulation therapy in women with recurrent implantation failure undergoing assisted conception: A multicentre cohort study.

PROBLEM: Recurrent implantation failure (RIF) after multiple embryo transfers remains a vexing problem and immunomodulators have been used with conflicting results. This study aims to assess the effect of immunomodulation therapy on live birth rate (LBR) in women with RIF undergoing assisted reproduction treatment (ART). METHOD OF STUDY DESIGN: This is a retrospective cohort study in multicentre network of private assisted conception units in the UK. The study included women who had at least two failed attempts of embryo transfers at CARE fertility network in the period from 1997 to 2018. Women in the treatment group had immunomodulator drugs in the form of corticosteroids, low molecular weight heparin (LMWH), and intravenous intralipid (IVIL) infusions, either separately or in combination, after immunological testing, in addition to standard ART whilst women in the control group had only ART without immunomodulators. The primary outcome was LBR per cycle. Secondary outcomes included the rates of clinical pregnancy (CPR), cumulative live birth (CLBR), and miscarriage. RESULTS: A total of 27 163 ART cycles fulfilled the inclusion criteria, of which 5083 had immunomodulation treatment in addition to standard ART treatment, and 22 080 had standard ART treatment alone. Women in the treatment group were significantly older (mean age 38.5 vs. 37.1 years, p < .001), and had a higher number of previous failed ART cycles (mean 4.3 vs. 3.8, p < .01). There was a higher LBR in women who received immunomodulation therapy when compared with the control group (20.9% vs. 15.8%, odds ratio [OR] 1.4, 95% confidence interval [CI] 1.29-1.53, p < .001). Multivariate regression analysis showed that immunomodulation treatment was a significant independent predictor of live birth after adjusting for other confounders (adjusted OR [aOR] 1.33, 95% CI 1.15-1.54, p < .001). Survival analysis showed a higher CLBR in the treatment group (adjusted hazard ratio [aHR] 1.78, 95% CI 1.62-1.94, p < .001). CONCLUSION(S): This study provides evidence of a potential beneficial effect of immunomodulation therapy in women with RIF after immunological testing. There remains a need for high quality, adequately powered multicentre RCTs to robustly address the role of immunomodulation in women with RIF. There is also an urgent need for standardised screening tests for immune disorders that could preclude implantation.

The effect of frozen embryo transfer regimen on the association between serum progesterone and live birth: a multicentre prospective cohort study (ProFET).

STUDY QUESTION: What is the association between serum progesterone levels on the day of frozen embryo transfer (FET) and the probability of live birth in women undergoing different FET regimens? SUMMARY ANSWER: Overall, serum progesterone levels <7.8 ng/ml were associated with reduced odds of live birth, although the association between serum progesterone levels and the probability of live birth appeared to vary according to the route of progesterone administration. WHAT IS KNOWN ALREADY: Progesterone is essential for pregnancy success. A recent systematic review showed that in FET cycles using vaginal progesterone for endometrial preparation, lower serum progesterone levels (<10 ng/ml) were associated with a reduction in live birth rates and higher chance of miscarriage. However, there was uncertainty about the association between serum progesterone levels and treatment outcomes in natural cycle FET (NC-FET) and HRT-FET using non-vaginal routes of progesterone administration. STUDY DESIGN SIZE DURATION: This was a multicentre (n = 8) prospective cohort study conducted in the UK between January 2020 and February 2021. PARTICIPANTS/MATERIALS SETTING METHODS: We included women having NC-FET or HRT-FET treatment with progesterone administration by any available route. Women underwent venepuncture on the day of embryo transfer. Participants and clinical personnel were blinded to the serum progesterone levels. We conducted unadjusted and multivariable logistic regression analyses to investigate the association between serum progesterone levels on the day of FET and treatment outcomes according to the type of cycle and route of exogenous progesterone administration. Our primary outcome was the live birth rate per participant. MAIN RESULTS AND THE ROLE OF CHANCE: We studied a total of 402 women. The mean (SD) serum progesterone level was 14.9 (7.5) ng/ml. Overall, the mean adjusted probability of live birth increased non-linearly from 37.6% (95% CI 26.3-48.9%) to 45.5% (95% CI 32.1-58.9%) as serum progesterone rose between the 10th (7.8 ng/ml) and 90th (24.0 ng/ml) centiles. In comparison to participants whose serum progesterone level was ≥7.8 ng/ml, those with lower progesterone (<7.8 ng/ml, 10th centile) experienced fewer live births (28.2% versus 40.0%, adjusted odds ratio [aOR] 0.41, 95% CI 0.18-0.91, P = 0.028), lower odds of clinical pregnancy (30.8% versus 45.1%, aOR 0.36, 95% CI 0.16-0.79, P = 0.011) and a trend towards increased odds of miscarriage (42.1% versus 28.7%, aOR 2.58, 95% CI 0.88-7.62, P = 0.086). In women receiving vaginal progesterone, the mean adjusted probability of live birth increased as serum progesterone levels rose, whereas women having exclusively subcutaneous progesterone experienced a reduction in the mean probability of live birth as progesterone levels rose beyond 16.3 ng/ml. The combination of vaginal and subcutaneous routes appeared to exert little impact upon the mean probability of live birth in relation to serum progesterone levels. LIMITATIONS REASONS FOR CAUTION: The final sample size was smaller than originally planned, although our study was adequately powered to confidently identify a difference in live birth between optimal and inadequate progesterone levels. Furthermore, our cohort did not include women receiving oral or rectal progestogens. WIDER IMPLICATIONS OF THE FINDINGS: Our results corroborate existing evidence suggesting that lower serum progesterone levels hinder FET success. However, the relationship between serum progesterone and the probability of live birth appears to be non-linear in women receiving exclusively subcutaneous progesterone, suggesting that in this subgroup of women, high serum progesterone may also be detrimental to treatment success. STUDY FUNDING/COMPETING INTERESTS: This work was supported by CARE Fertility and a doctoral research fellowship (awarded to P.M.) by the Tommy's Charity and the University of Birmingham. M.J.P. is supported by the NIHR Birmingham Biomedical Research Centre. S.F. is a minor shareholder of CARE Fertility but has no financial or other interest with progesterone testing or manufacturing companies. P.L. reports personal fees from Pharmasure, outside the submitted work. G.P. reports personal fees from Besins Healthcare, outside the submitted work. M.W. reports personal fees from Ferring Pharmaceuticals, outside the submitted work. The remaining authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT04170517.

Legacy halogenated organic contaminants in urban-influenced waters using passive polyethylene samplers: Emerging evidence of anthropogenic land-use-based sources and ecological risks.

Legacy halogenated organic pollutants, including organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs), remain ubiquitous in the environment and continue to pose potential (eco-)toxicological threats because of their ongoing releases from land-based sources. This study investigated the spatial trends of freely dissolved PCBs and OCPs by polyethylene passive samplers, and provided evidence of their land-use-based sources and ecological risk in an urbanized estuary area of Narragansett Bay. Dissolved Σ29PCB concentrations ranged from 0.01 to 1.37 ng L-1, and exhibited higher concentrations in the upper, more urban/built-up watershed, and in north coastal areas. Major inputs of PCBs were urban stormwater or treated wastewater that might carry past releases of Aroclors, pigment manufacturing byproducts, and volatilization-associated PCBs from ageing buildings from the Narragansett watershed to the bay. The dioxin toxicity equivalent values of Σ5PCBs were 8.6E-03 pg L-1 in water. Dissolved OCP concentrations had similar spatial trends to PCBs and were dominated by DDTs (average 230 pg L-1), followed by chlordanes (average 230 pg L-1), and HCB (average 22 pg L-1). Secondary sources of past usage and historic contamination were expected to re-enter the surface water via atmospheric transport and deposition. The risk quotients of DDE, DDD, DDT and α-Endosulfane showed medium to high ecological risks in the northern area, while chlordane, HCB, oxychlordane, and heptachlor epoxide showed low to negligible risks in all zones. This study presented new insights into the presence, sources and transport of legacy halogenated organic contaminants in an urban estuary's watershed by combining passive samplers and geographic information system (GIS) technology. The approach is promising and could be extended to get better understand of terrestrial pollutant mobilization into estuaries affected by anthropogenic activities.

Serum luteal phase progesterone in women undergoing frozen embryo transfer in assisted conception: a systematic review and meta-analysis.

OBJECTIVE: To investigate the association between luteal serum progesterone levels and frozen embryo transfer (FET) outcomes. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women undergoing FET. INTERVENTION(S): We conducted electronic searches of MEDLINE, PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov, and grey literature (not widely available) from inception to March 2021 to identify cohort studies in which the serum luteal progesterone level was measured around the time of FET. MAIN OUTCOME MEASURE(S): Ongoing pregnancy or live birth rate, clinical pregnancy rate, and miscarriage rate. RESULT(S): Among the studies analyzing serum progesterone level thresholds <10 ng/mL, a higher serum progesterone level was associated with increased rates of ongoing pregnancy or live birth (relative risk [RR] 1.47, 95% confidence interval [CI] 1.28 to 1.70), higher chance of clinical pregnancy (RR 1.31, 95% CI 1.16 to 1.49), and lower risk of miscarriage (RR 0.62, 95% CI 0.50 to 0.77) in cycles using exclusively vaginal progesterone and blastocyst embryos. There was uncertainty about whether progesterone thresholds ≥10 ng/mL were associated with FET outcomes in sensitivity analyses including all studies, owing to high interstudy heterogeneity and wide CIs. CONCLUSION(S): Our findings indicate that there may be a minimum clinically important luteal serum concentration of progesterone required to ensure an optimal endocrine milieu during embryo implantation and early pregnancy after FET treatment. Future clinical trials are required to assess whether administering higher-dose luteal phase support improves outcomes in women with a low serum progesterone level at the time of FET. PROSPERO NUMBER: CRD42019157071.

The value of serum progesterone level on day of human chorionic gonadotrophin administration / metaphase II oocyte ratio in predicting IVF/ICSI outcome in patients with normal ovarian reserve.

BACKGROUND: The clinical implication of the increased serum progesterone level on the day of HCG administration in assisted reproduction treatment (ART) is still controversial. The current study aimed to compare the predictive value of serum progesterone on day of HCG administration / metaphase II oocyte (P/MII) ratio on IVF/ ICSI outcome to serum progesterone (P) level alone and the ratio of serum progesterone/estradiol level (P/E2) ratio in prediction of pregnancy rates after ART. MATERIAL & METHODS: Two hundred patients admitted to the IVF/ICSI program at Minia IVF center in Egypt in the period from October 2016 to May 2018 were included in this study. Serum Progesterone (P) and Estradiol (E2) levels were estimated on the day of HCG administration. The ratio between serum P and the number of MII oocytes (P/MII ratio) was calculated and the predictive values of the three parameters (P, P/E2 ratio and P/MII ratio) in prediction of cycle outcomes were measured. RESULTS: P/ MII oocyte ratio was significantly lower in patients who attained clinical pregnancy (n = 97) as compared with those who couldn't whilst there was no significant difference in P and P/E2 ratio between the two groups. Using a cut off value of 0.125, the sensitivity and specificity of progesterone/ MII ratio in prediction of no pregnancy in IVF/ICSI were 75.7 and 77.1% respectively with the area under The Receiver operating curve (ROC-AUC) = 0.808. The respective values of the ROC-AUC for the P and P/E2 ratio were 0.651 and 0.712 with sensitivity and specificity of 71.2 and 73.5%for P level and of 72.5 and 75.3% for P/E2 ratio. Implantation or clinical pregnancy rates were significantly different between patients with high and low P/MII ratio irrespective of day of embryo transfer (day 3 or 5). CONCLUSIONS: In patients with normal ovarian response, serum progesterone on day of HCG / MII oocyte ratio can be a useful predictor of pregnancy outcomes and in deciding on freezing of all embryos for later transfer instead of high progesterone level alone.

Role of suppression of endometriosis with progestins before IVF-ET: a non-inferiority randomized controlled trial.

BACKGROUND: Endometriosis affects the responsiveness to ovarian stimulation. This study aimed to assess the role of Dienogest pretreatment for endometriosis suppression as compared to Gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis pursuing IVF treatment. METHODS: In this randomized controlled trial, 134 women with endometriosis-related infertility were randomly allocated to group A (n = 67) who had monthly depot GnRHa for 3 months before ovarian stimulation in IVF treatment (Ultra-long protocol), and Group B (n = 67) who had daily oral Dienogest 2 mg/d for 3 months before starting standard long protocol for IVF. The primary outcome measure was the number of oocytes retrieved. The secondary outcome measures included the number of mature oocytes, fertilization rate, quality of life assessed by FertiQoL scores, cost of treatment, and pregnancy outcomes. RESULTS: Although there was no statistically significant difference between both groups regarding ovarian stimulation, response parameters, and pregnancy outcomes, the Dienogest group had a lower cost of treatment (2773 vs. 3664 EGP, P < 0.001), lower side effects (29.9% vs. 59.7%, P < 0.001), higher FertiQoL treatment scores (33.2 vs. 25.1, P < 0.001) and higher tolerability scores (14.1 vs. 9.4, P < 0.001 < 0.001). CONCLUSION: Our study indicates that Dienogest is a suitable and safe substitute for GnRHa pretreatment in endometriosis patients. TRIAL REGISTRATION: NCT04500743 "Retrospectively registered on August 5, 2020".

Net volatilization of PAHs from the North Pacific to the Arctic Ocean observed by passive sampling.

The North Pacific-Arctic Oceans are important compartments for semi-volatile organic compounds' (SVOCs) global marine inventory, but whether they act as a "source" or "sink" remains controversial. To study the air-sea exchange and fate of SVOCs during their poleward long-range transport, low-altitude atmosphere and surface seawater were measured for polycyclic aromatic hydrocarbons (PAHs) by passive sampling from July to September in 2014. Gaseous PAH concentrations (0.67-13 ng m-3) were dominated by phenanthrene (Phe) and fluorene (Flu), which displayed an inverse correlation with latitude, as well as a significant linear relationship with partial pressure and inverse temperature. Concentrations of PAHs in seawater (1.8-16 ng L-1) showed regional characteristics, with higher levels near the East Asia and lower values in the Bering Strait. The potential impact from the East Asian monsoon was suggested for gaseous PAHs, which - similar to PAHs in surface seawater - were derived from combustion sources. In addition, the data implied net volatilization of PAHs from seawater into the air along the entire cruise; fluxes displayed a similar pattern to regional and monthly distribution of PAHs in seawater. Our results further emphasized that air-sea exchange is an important process for PAHs in the open marine environments.

Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia.

OBJECTIVE: To assess the efficacy of first-trimester three-dimensional (3D) placental volume as well as 3D power Doppler of placental vascular indices for early prediction of pre-eclampsia. METHODS: The prospective cohort study included over 2019 women with a singleton pregnancy in their first trimester at 11-13+ weeks of pregnancy. All women were examined by 3D abdominal ultrasound, including Doppler techniques for the placental volume and placental vascular indices. Uterine artery Doppler indices were also assessed. All participants were cared for until delivery for assessment of pregnancy outcomes. RESULTS: In all, 163 women developed pre-eclampsia while 1856 women remained normotensive. The women with pre-eclampsia had significantly lower placental volume (77.09 ml vs. 99.8 ml, p < 0.001), and placental vascular indices (vascularization index, flow index, and vascularization flow index were 7.41 vs. 9.89, 39.03 vs. 46.63, and 2.77 vs. 4.4, respectively, p < 0.001). In contrast, women with pre-eclampsia had significantly high mean uterine pulsatility index and resistance index (2.02 vs. 1.11, 0.83 vs. 0.64, respectively, p < 0.001) compared with the normotensive women. The placental vascular indices were highly sensitive, whereas the placental volume and the mean uterine pulsatility index and resistance index had higher specificity for the prediction of pre-eclampsia. CONCLUSION: First-trimester assessment through 3D placental volume and power Doppler of placental vascular indices, especially in combination with uterine artery Doppler assessment, revealed an increase in the accuracy of early detection of women at risk for developing pre-eclampsia.

Assessing Benthic Bioaccumulation of Polychlorinated Dioxins/Furans and Polychlorinated Biphenyls in the Lower Passaic River (NJ, USA) Based on In Situ Passive Sampling.

Passive sampling has emerged as a promising tool to assess the presence of hydrophobic organic contaminants (HOC) in water, sediment, and biota, such as polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) or polychlorinated biphenyls (PCBs). Previous work evaluated the ability of passive samplers to predict the bioavailability of sedimentary HOCs mostly in the laboratory, often for marine organisms. The present study assessed the use of low-density polyethylene (LDPE) to derive freely dissolved concentrations of PCDD/Fs and PCBs in porewater in situ versus ex situ and in river water. An LDPE-based multisampler system was deployed at 4 locations along the lower Passaic River (NJ, USA) in sediment and the water column, where sediment and benthic species samples were also collected. Good agreement was generally observed for PCDD/F and PCB concentrations comparing in situ and ex situ approaches (within 0.30-39%). Significant linear relationships were derived between log LDPE-based and log lipid-based concentrations of PCDD/Fs and PCBs. The in situ multisampler system showed promise to derive HOC concentrations in porewater and river water and to predict the bioaccumulation potential of HOCs in benthic biota. Environ Toxicol Chem 2020;39:1174-1185. © 2020 SETAC.

Management of bleeding from morbidly adherent placenta during elective repeat caesarean section: retrospective -record -based study.

BACKGROUND: Controlling massive haemorrhage from morbidly adherent placenta (MAP) at caesarean section is a major surgical challenge to obstetricians. This study compares different intra-operative interventions to control haemorrhage from morbidly adherent placenta and its impact on maternal morbidity. METHODS: Retrospective analysis was done for baseline characteristics, intra-operative and postoperative complications of 125 patients with morbidly adherent placenta who had elective CS at 35-38 weeks gestation in the period from 01/2012 to 01/2017. The included patients were categorized into three groups according to intra-operative interventions they had for controlling bleeding; Group A (n = 42) had only balloon tamponade, Group B (n = 40) had balloon tamponade and bilateral uterine artery ligation, in Group C (n = 43) all cases were managed by bilateral uterine artery ligation and inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment using the cervix as a natural tamponade. RESULTS: There were no differences of baseline characteristics of patients in all groups. Group C had significantly better outcomes as compared with groups A and B; less total blood loss (Group C 2869.5 ml vs Group B 4580 ml, Group A 4812 ml, P <  0.001), less requirement of blood transfusion more than 4 units (Group C 4/43, Group B 10/40,Group A 12/42, P <  0.02), significant reduction in prolonged hospital stay over 10 days (Group C 2/43, Group B 9/40,Group A 14/42, P < 0.001) and lower risk of coagulopathy (Group C 4/43, B 8/40, A 9/42), visceral injuries (Group C 4/43 vs B 8/40, A 10/42,P < 0.01) and need for hysterectomy (Group C 4/43 vs B 11/40, A 13/42,P < 0.001). CONCLUSION: A combination bilateral uterine artery ligation and using the cervix as a natural tamponade are very effective and simple methods in controlling bleeding resulting from separated placenta accreta. TRIAL REGISTRATION: The findings are part of the research project registered in ClinicalTrials.gov NCT02590484 . Registered 28 October 2015.

Uptake of hydrophobic organic compounds, including organochlorine pesticides, polybrominated diphenyl ethers, and perfluoroalkyl acids in fish and blue crabs of the lower Passaic River, New Jersey, USA.

The bioavailability and bioaccumulation of sedimentary hydrophobic organic compounds (HOCs) is of concern at contaminated sites. Passive samplers have emerged as a promising tool to measure the bioavailability of sedimentary HOCs and possibly to estimate their bioaccumulation. We thus analyzed HOCs including organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), and polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) in sediment, porewater, and river water using low-density polyethylene passive samplers and in 11 different finfish species and blue crab from the lower Passaic River. In addition, perfluorinated alkyl acids (PFAAs) were measured in grab water samples, sediment, and fish. Best predictors of bioaccumulation in biota were either porewater concentrations (for PCBs and OCPs) or sediment organic carbon (PBDEs and PFAAs), including black carbon (OCPs, PCBs, and some PCDD/F congeners)-normalized concentrations. Measured lipid-based concentrations of the majority of HOCs exceeded the chemicals' activities in porewater by at least 2-fold, suggesting dietary uptake. Trophic magnification factors were >1 for moderately hydrophobic analytes (log octanol-water partitioning coefficient [KOW ] = 6.5-8.2) with low metabolic transformation rates (<0.01 d-1 ), including longer alkyl chain PFAAs. For analytes with lower (4.5-6.5) and higher (>8.2) KOW s, metabolic transformation was more important in reducing trophic magnification. Environ Toxicol Chem 2019;38:872-882. © 2019 SETAC.

Organophosphate flame retardants in the indoor and outdoor dust and gas-phase of Alexandria, Egypt.

Little is known about the presence of organophosphate flame retardants (OPFRs) as a substitute for polybrominated diphenyl ethers in developing countries. This study investigated - for the first time - concentrations, sources and exposure levels of OPFRs in the indoor and outdoor environments of Alexandria, Egypt, in dust and gas-phase samples. Passive samplers were deployed (n = 78) to determine gaseous concentrations, and various dust samples were collected from apartments (n = 25), working places (n = 14), cars (n = 18), and outdoors (OD, n = 30). Indoor concentrations (air: 7.0-64 pg/m3; dust: 150-1850 ng/g) were significantly higher than outdoor (2.0-16 pg/m3 and 83-475 ng/g) concentrations. Tris-1,3-dichloropropyl phosphate (TDCIPP), tris(1-chloro-2-propyl) phosphate (TCIPP), tri (2-butoxyethyl) phosphate (TBOEP) and triphenyl phosphate (TPHP) dominated in all samples with more indoor variabilities. Profiles of OPFRs in OD and floor dust (collected from carpets and floors) were similar but differed from elevated fine dust (collected 1 m above the floor from all available surfaces), possibly due to the influence of carryover of OD by shoes. Despite the high uncertainty in dust - air partitioning coefficients, log transformed values showed significant linear relationships with log octanol - air-partitioning coefficients in all microenvironments, indicating an equilibrium partitioning between dust and vapor. Exposure assessment indicated the importance of the dermal exposure route for adults and ingestion route for children.

Optimal endometrial thickness to maximize live births and minimize pregnancy losses: Analysis of 25,767 fresh embryo transfers.

RESEARCH QUESTION: What is the association of endometrial thickness with pregnancy losses and live births in IVF treatment and the optimal threshold that optimizes the IVF outcome? DESIGN: Data were analysed from 25,767 IVF cycles from centres of the CARE Fertility Group in the UK between 2007 and 2016. Transvaginal ultrasound was conducted to measure the maximum endometrial thickness during gonadotrophin stimulation. Live birth rates were per embryo transfer. Pregnancy loss rates included the combination of biochemical and clinical pregnancy losses. RESULTS: The live birth rate was 15.6% with 5 mm or less endometrial thickness and gradually increased to 33.1% with an endometrial thickness of 10 mm. On the other hand, the pregnancy loss rate was 41.7% with 5 mm or less endometrial thickness and gradually decreased to 26.5% with an endometrial thickness of 10 mm. Statistical modelling for optimal endometrial thickness threshold found 10 mm or more maximized live births and minimized pregnancy losses. This association was independent after adjusting for confounders such as age, oocyte number, number of transferred embryos, ovarian stimulation protocol and embryo quality for live births (crude RR 1.27; 95% CI 1.21 to 1.33; Adjusted RR 1.18; 95% CI 1.12 to 1.23) and pregnancy losses (crude RR 0.83; 95% CI 0.77 to 0.89; adjusted RR 0.86; 95% CI 0.8 to 0.92). CONCLUSIONS: Endometrial thickness is strongly associated with pregnancy losses and live births in IVF, and the optimal endometrial thickness threshold of 10 mm or more maximized live births and minimized pregnancy losses.

Time Trends of Polybrominated Diphenyl Ethers (PBDEs) in Antarctic Biota.

Polybrominated diphenyl ethers (PBDEs) are "emerged" contaminants that were produced and used as flame retardants in numerous consumer and industrial applications for decades until banned. They remain ubiquitously present in the environment today. Here, a unique set of >200 biotic samples from the Antarctic was analyzed for PBDEs, including phytoplankton, krill, fish, and fur seal milk, spanning several sampling seasons over 14 years. PBDE-47 and -99 were the dominant congeners determined in all samples, constituting >60% of total PBDEs. A temporal trend was observed for ∑7PBDE concentrations in fur seal milk, where concentrations significantly increased (R2 = 0.57, p < 0.05) over time (2000-2014). Results for krill and phytoplankton also suggested increasing PBDE concentrations over time. Trends of PBDEs in fur seal milk of individual seals sampled 1 or more years apart showed no clear temporal trends. Overall, there was no indication of PBDEs decreasing in Antarctic biota yet, whereas numerous studies have reported decreasing trends in the northern hemisphere. Similar PBDE concentrations in perinatal versus nonperinatal milk implied the importance of local PBDE sources for bioaccumulation. These results indicate the need for continued assessment of contaminant trends, such as PBDEs, and their replacements, in Antarctica.

Selected organohalogenated flame retardants in Egyptian indoor and outdoor environments: Levels, sources and implications for human exposure.

There is scant information on the presence of the polybrominated diphenyl ethers (PBDEs) and other alternative flame-retardants (NFRs) in Africa. Hence, to investigate their levels, sources, and human exposure scenarios, elevated fine dust (EFD) samples from apartments (n = 12), working places (n = 9) and cars (n = 12), floor dust (FD) samples (n = 5) and outdoor dust samples (n = 21) were collected from Alexandria, Egypt, during 2014. Gaseous concentrations were estimated using low density polyethylene sheets (n = 33 and 21 for indoor and outdoor sites, respectively). Indoor gaseous and dust PBDE (7.0-300 pg/m3; 4.0-770 ng/g), and NFR (0.40-48 pg/m3; 0.50-8.5 ng/g) concentrations were significantly higher (p = 0.004-0.02) than outdoor concentrations (PBDEs: 3.0-41 pg/m3, 1.5-195 ng/g; NFRs: 0.20-13 pg/m3, 0.50-4.0 ng/g). Median PBDE concentration in cars (210 ng/g) was higher than in apartments and working places (130  ng/g respectively). PBDE concentrations in FD were 7.0-14-folds lower than EFD concentrations. Outdoor PBDE concentrations were significantly higher (p < 0.01) at residential-industrial places with older buildings. All samples were dominated by BDE-47 and 99. HBB, BTBPE and DDC-CO were the most abundant NFRs in EFD samples. Profiles of PBDE and NFR in FD closely matched those of outdoor dust, indicating a possible carryover from the outdoor environment. Although factors such as number of electronics, construction year and floor type significantly correlated with the majority of PBDE congeners and some NFRs in apartments and working places, sources were not clearly identified for NFRs. Significant log-linear relationships were obtained between theoretical and calculated dust-air partitioning coefficients for all samples indicating an equilibrium state between dust and vapor. Low possibility of occurrence of adverse health effects was concluded, with the inhalation pathway (for adults) and dust ingestion (for children) acting as the most important exposure routes.

Land-use-based sources and trends of dissolved PBDEs and PAHs in an urbanized watershed using passive polyethylene samplers.

Narragansett Bay is a temperate estuary on the Atlantic coast of Rhode Island in the north-eastern United States, which receives organic pollutants from urban and industrial activities in its watershed, though detailed knowledge on sources and fluxes is missing. Twenty-four polyethylene passive samplers were deployed in the surface water of the watershed around Narragansett Bay during June-July of 2014, to examine the spatial variability and possible sources of priority pollutants, namely dissolved polycyclic aromatic hydrocarbons (PAHs) and polybrominated diphenyl ethers (PBDEs). Dissolved ∑22PAH concentrations ranged from 3.6 to 340 ng L-1, and from 2.9 to 220 pg L-1 for ∑12PBDE. The spatial variability of the concentrations was correlated to land use pattern and population distribution, in particular with human activities within 2 km of sampling sites. River discharges derived from the concentrations of PAHs and PBDEs measured here were 10-20 times greater than their previously measured concentrations in the open waters of Narragansett Bay. These results imply that river waters are the main source of PAHs and PDBEs to the Bay and that major sink terms (e.g., sedimentation, degradation) affect their concentrations in the estuary. Predicted PAH and PBDE toxicity based on dissolved concentrations did not exceed 1 toxic unit, suggested that no toxicity occurred at the sampling sites.

Advancing the Use of Passive Sampling in Risk Assessment and Management of Sediments Contaminated with Hydrophobic Organic Chemicals: Results of an International Ex Situ Passive Sampling Interlaboratory Comparison.

This work presents the results of an international interlaboratory comparison on ex situ passive sampling in sediments. The main objectives were to map the state of the science in passively sampling sediments, identify sources of variability, provide recommendations and practical guidance for standardized passive sampling, and advance the use of passive sampling in regulatory decision making by increasing confidence in the use of the technique. The study was performed by a consortium of 11 laboratories and included experiments with 14 passive sampling formats on 3 sediments for 25 target chemicals (PAHs and PCBs). The resulting overall interlaboratory variability was large (a factor of ∼10), but standardization of methods halved this variability. The remaining variability was primarily due to factors not related to passive sampling itself, i.e., sediment heterogeneity and analytical chemistry. Excluding the latter source of variability, by performing all analyses in one laboratory, showed that passive sampling results can have a high precision and a very low intermethod variability (

Using Polyethylene Passive Samplers To Study the Partitioning and Fluxes of Polybrominated Diphenyl Ethers in an Urban River.

In the aquatic environment, the behavior of hydrophobic organic contaminants (HOCs), such as polybrominated diphenyl ethers (PBDEs), depends on the congeners' physicochemical properties, environmental conditions and the presence of competing natural sorbents, including particulate and dissolved organic carbon (DOC) and black carbon (BC). Although BC is known as an important sedimentary sorbent for HOCs, its affinity for PBDEs has been poorly constrained. To better understand the biogeochemical controls on PBDEs, 12 PBDE congeners were measured in air, water, sediment and porewater of the lower Passaic River. BDE-47 and BDE-99 dominated in all media. In sediments and water, the dual OC + BC approach better predicted PBDE partitioning compared to the simple OC isotherm. Field-derived KBC values for PBDEs were inversely correlated with aqueous solubility [log KBC sediments(water) = -log Cwsat * 0.95 (1.2) + 0.36 (-0.69)]; they reflected near background to highly contaminated regions across the Passaic River. In the water column, PBDEs appeared at equilibrium partitioning between particles and colloids: OC + BC were responsible for the sorption of 65% of PBDEs, followed by colloids (30%); only 5% of PDBEs were truly dissolved. Calculated sediment-water diffusive fluxes greatly overwhelmed the atmospheric depositional flux to the river.

Two week waits: What are we waiting for?

OBJECTIVES: To evaluate the two-week referral system by analysing the 2-week wait (2WW) referrals to the rapid access gynaecology clinic over one year. We have also sought to identify the risk factors for endometrial cancer to help setting criteria that can be used to prioritise urgent appointments, refine subsequent management strategies. STUDY DESIGN: Retrospective review of the data of all women referred for suspected gynaecological cancers over one year via the 2 WW office at Queen's Hospital, Romford, UK. Data of all other women in whom a diagnosis of a gynaecological malignancy was made during the same period following non-urgent (non-2WW) referrals were also collected. RESULTS: Over one year, a total of 1105 women were referred under the 2WW for suspected gynaecological malignancy. A total of 765 patients (69.23%) were referred with suspected endometrial cancer and the main indication for referral was postmenopausal bleeding. Hundred-seventy nine women (16.20%) were referred with suspected ovarian cancer. A pelvic mass found in 62 of these women and this was the main indication of referral. The number of women referred with suspected cervical cancer was 117 (10.59%) and the main indication for referral was postcoital bleeding. Forty-four women (3.98%) referred with suspected vulvo-vaginal cancer and the main presentation was vulval lesion. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulvo-vaginal malignancy was 8.1%, 9.5%, 5.98% and 13.64% and the overall predictive value for diagnosing gynaecological malignancy was 8.33%. The predictive values of the 2WW referrals for diagnosing different types of gynaecological cancers in premenopausal women are low compared to postmenopausal women (1.86% and 9.89% respectively, p<0.001). The number of cancers diagnosed through non-urgent system was higher than the number diagnosed through urgent system (95 vs. 92). Presence of diabetes mellitus, increased endometrial thickness, prolonged bleeding and advancing age represent the best model for predicting endometrial cancer. CONCLUSION: The overall predictive value of the 2WW system for suspected gynaecological malignancies is low particularly in premenopausal women. The current referral criteria need to be modified with a view to incorporating risk factors to prioritise urgent appointments and refine subsequent management plans.

Organochlorine pesticides and polychlorinated biphenyls in sewage sludge from Egypt.

The purpose of this study was to determine the levels, distribution and toxicological potential of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in sewage sludge samples from several WWTPs in the Alexandria area, Egypt. The POPs of interest were 26 PCBs and 16 OCPs. Analyses were performed by gas chromatography with electron impact mass spectrometric detection in the selected ion monitoring mode (GC-MS-SIM) using deuterated organochlorines as internal standards. Total concentrations of OCPs and Σ7 PCBs (ICES) in sludge ranged from 44.2 to 489 µg/kg dw. and 5,600 to 11,000 µg/kg dw., respectively. The highest concentration levels were found for PCBs, HCHs, DDTs, and HCB, in this order. The PCB homologue profiles in sludge samples were dominated by penta- and hexa-chlorinated biphenyls. Seasonal variations were observed for OCPs with higher levels in summer, which reflects more usage in warmer climates. Composite profiles of OCP metabolites indicated new inputs of lindane and technical endosulfan and earlier usage of DDT and technical chlordane. Contamination levels of OCPs and PCBs for Egyptian sludge can be categorized as moderate to high compared to other countries worldwide. The OCP content in none of the samples exceeded limits set by the European Commission for use of sludge in agriculture; while all the concentrations of PCBs in sludge samples were higher by one order of magnitude than the upper limit for land application.