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1.
Environ Toxicol Chem ; 40(3): 564-605, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32897586

RESUMO

Per- and poly-fluoroalkyl substances (PFAS) encompass a large, heterogenous group of chemicals of potential concern to human health and the environment. Based on information for a few relatively well-understood PFAS such as perfluorooctane sulfonate and perfluorooctanoate, there is ample basis to suspect that at least a subset can be considered persistent, bioaccumulative, and/or toxic. However, data suitable for determining risks in either prospective or retrospective assessments are lacking for the majority of PFAS. In August 2019, the Society of Environmental Toxicology and Chemistry sponsored a workshop that focused on the state-of-the-science supporting risk assessment of PFAS. The present review summarizes discussions concerning the ecotoxicology and ecological risks of PFAS. First, we summarize currently available information relevant to problem formulation/prioritization, exposure, and hazard/effects of PFAS in the context of regulatory and ecological risk assessment activities from around the world. We then describe critical gaps and uncertainties relative to ecological risk assessments for PFAS and propose approaches to address these needs. Recommendations include the development of more comprehensive monitoring programs to support exposure assessment, an emphasis on research to support the formulation of predictive models for bioaccumulation, and the development of in silico, in vitro, and in vivo methods to efficiently assess biological effects for potentially sensitive species/endpoints. Addressing needs associated with assessing the ecological risk of PFAS will require cross-disciplinary approaches that employ both conventional and new methods in an integrated, resource-effective manner. Environ Toxicol Chem 2021;40:564-605. © 2020 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.


Assuntos
Fluorocarbonos , Bioacumulação , Ecotoxicologia , Fluorocarbonos/toxicidade , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco
2.
Environ Toxicol Chem ; 38(8): 1606-1624, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361364

RESUMO

Anticipating, identifying, and prioritizing strategic needs represent essential activities by research organizations. Decided benefits emerge when these pursuits engage globally important environment and health goals, including the United Nations Sustainable Development Goals. To this end, horizon scanning efforts can facilitate identification of specific research needs to address grand challenges. We report and discuss 40 priority research questions following engagement of scientists and engineers in North America. These timely questions identify the importance of stimulating innovation and developing new methods, tools, and concepts in environmental chemistry and toxicology to improve assessment and management of chemical contaminants and other diverse environmental stressors. Grand challenges to achieving sustainable management of the environment are becoming increasingly complex and structured by global megatrends, which collectively challenge existing sustainable environmental quality efforts. Transdisciplinary, systems-based approaches will be required to define and avoid adverse biological effects across temporal and spatial gradients. Similarly, coordinated research activities among organizations within and among countries are necessary to address the priority research needs reported here. Acquiring answers to these 40 research questions will not be trivial, but doing so promises to advance sustainable environmental quality in the 21st century. Environ Toxicol Chem 2019;38:1606-1624. © 2019 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.


Assuntos
Conservação dos Recursos Naturais , Ecotoxicologia , Pesquisa , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/métodos , Conservação dos Recursos Naturais/tendências , Humanos , América do Norte , Desenvolvimento Sustentável
4.
Environ Sci Technol ; 50(12): 6124-45, 2016 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-27177237

RESUMO

Engineered nanomaterials (ENMs) are increasingly entering the environment with uncertain consequences including potential ecological effects. Various research communities view differently whether ecotoxicological testing of ENMs should be conducted using environmentally relevant concentrations-where observing outcomes is difficult-versus higher ENM doses, where responses are observable. What exposure conditions are typically used in assessing ENM hazards to populations? What conditions are used to test ecosystem-scale hazards? What is known regarding actual ENMs in the environment, via measurements or modeling simulations? How should exposure conditions, ENM transformation, dose, and body burden be used in interpreting biological and computational findings for assessing risks? These questions were addressed in the context of this critical review. As a result, three main recommendations emerged. First, researchers should improve ecotoxicology of ENMs by choosing test end points, duration, and study conditions-including ENM test concentrations-that align with realistic exposure scenarios. Second, testing should proceed via tiers with iterative feedback that informs experiments at other levels of biological organization. Finally, environmental realism in ENM hazard assessments should involve greater coordination among ENM quantitative analysts, exposure modelers, and ecotoxicologists, across government, industry, and academia.


Assuntos
Ecologia , Nanoestruturas , Ecossistema , Ecotoxicologia , Meio Ambiente , Humanos
5.
Chemosphere ; 149: 336-42, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26874062

RESUMO

The fluoropolymer manufacturing industry is moving to alternative polymerization processing aid technologies with more favorable toxicological and environmental profiles as part of a commitment to curtail the use of long-chain perfluoroalkyl acids (PFAAs). To facilitate the environmental product stewardship assessment and premanufacture notification (PMN) process for a candidate replacement chemical, we conducted acute and chronic aquatic toxicity tests to evaluate the toxicity of ammonium 2,3,3,3-tetrafluoro-2-(heptafluoropropoxy)-propanoate (C6HF11O3.H3N) or the acid form of the substance to the cladoceran, Daphnia magna, the green alga, Pseudokirchneriella subcapitata, and a number of freshwater fish species including the rainbow trout, Oncorhynchus mykiss, In addition, testing with the common carp, Cyprinus carpio, was conducted to determine the bioconcentration potential of the acid form of the compound. Based on the relevant criteria in current regulatory frameworks, the results of the aquatic toxicity and bioconcentration studies indicate the substance is of low concern for aquatic hazard and bioconcentration in aquatic organisms. Evaluation of environmental monitoring data in conjunction with the predicted no effect concentration (PNEC) based on the available data suggest low risk to aquatic organisms.


Assuntos
Compostos de Amônio/toxicidade , Hidrocarbonetos Fluorados/toxicidade , Propionatos/toxicidade , Poluentes Químicos da Água/toxicidade , Compostos de Amônio/metabolismo , Animais , Organismos Aquáticos/efeitos dos fármacos , Carpas , Clorófitas/efeitos dos fármacos , Daphnia/efeitos dos fármacos , Água Doce/química , Hidrocarbonetos Fluorados/metabolismo , Oncorhynchus mykiss/metabolismo , Propionatos/metabolismo , Medição de Risco , Testes de Toxicidade , Poluentes Químicos da Água/metabolismo
6.
Environ Toxicol Chem ; 35(1): 212-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26513338

RESUMO

The present study was undertaken to provide the foundation for development of genome-scale resources for the fathead minnow (Pimephales promelas), an important model organism widely used in both aquatic toxicology research and regulatory testing. The authors report on the first sequencing and 2 draft assemblies for the reference genome of this species. Approximately 120× sequence coverage was achieved via Illumina sequencing of a combination of paired-end, mate-pair, and fosmid libraries. Evaluation and comparison of these assemblies demonstrate that they are of sufficient quality to be useful for genome-enabled studies, with 418 of 458 (91%) conserved eukaryotic genes mapping to at least 1 of the assemblies. In addition to its immediate utility, the present work provides a strong foundation on which to build further refinements of a reference genome for the fathead minnow.


Assuntos
Cyprinidae/genética , Genoma/genética , Animais , Mapeamento Cromossômico , DNA/genética , Genes , Biblioteca Genômica , Família Multigênica/genética , Valores de Referência , Análise de Sequência de DNA
7.
Integr Environ Assess Manag ; 12(1): 109-22, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26272585

RESUMO

In the last decade, interest has been renewed in approaches for the assessment of the bioaccumulation potential of chemicals, principally driven by the need to evaluate large numbers of chemicals as part of new chemical legislation, while reducing vertebrate test organism use called for in animal welfare legislation. This renewed interest has inspired research activities and advances in bioaccumulation science for neutral organic chemicals in aquatic environments. In January 2013, ILSI Health and Environmental Sciences Institute convened experts to identify the state of the science and existing shortcomings in terrestrial bioaccumulation assessment of neutral organic chemicals. Potential modifications to existing laboratory methods were identified, including areas in which new laboratory approaches or test methods could be developed to address terrestrial bioaccumulation. The utility of "non-ecotoxicity" data (e.g., mammalian laboratory data) was also discussed. The highlights of the workshop discussions are presented along with potential modifications in laboratory approaches and new test guidelines that could be used for assessing the bioaccumulation of chemicals in terrestrial organisms.


Assuntos
Monitoramento Ambiental/métodos , Poluentes Ambientais/análise , Cadeia Alimentar , Compostos Orgânicos/análise , Animais , Poluentes Ambientais/toxicidade , Humanos , Laboratórios , Compostos Orgânicos/toxicidade , Medição de Risco/métodos
8.
Chemosphere ; 128: 258-65, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25725394

RESUMO

This study assessed the aquatic toxicity and bioaccumulation potential of 6:2 fluorotelomer sulfonate (6:2 FTSA). Acute and chronic aquatic hazard endpoints indicate 6:2 FTSA is not classified for aquatic hazard according to GHS or European CLP legislation. The aqueous bioconcentration factors for 6:2 FTSA were <40 and the dietary assimilation efficiency, growth corrected half-life and dietary biomagnification factor (BMF) were 0.435, 23.1d and 0.295, respectively. These data indicate that 6:2 FTSA is not bioaccumulative in aquatic organisms. Comparison of PNECs with the reported surface water concentrations (non-spill situations) suggests low risk to aquatic organisms from 6:2 FTSA. Future studies are needed to elucidate the biotic and abiotic fate of commercial AFFF surfactants in the environment.


Assuntos
Alcanossulfonatos/farmacocinética , Alcanossulfonatos/toxicidade , Organismos Aquáticos/metabolismo , Poluentes Químicos da Água/farmacocinética , Poluentes Químicos da Água/toxicidade , Alcanossulfonatos/análise , Animais , Meia-Vida , Medição de Risco , Poluentes Químicos da Água/análise
9.
Environ Toxicol Chem ; 31(9): 1957-65, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22730026

RESUMO

A next-generation mobile automobile air-conditioning (MAC) refrigerant, HFO-1234yf (CF(3) CF = CH(2)), is being developed with improved environmental characteristics. In the atmosphere, it ultimately forms trifluoroacetic acid (TFA(A); CF(3)COOH), which is subsequently scavenged by precipitation and deposited on land and water as trifluoroacetate (TFA; CF(3)COO(-)). Trifluoroacetate is environmentally stable and has the potential to accumulate in terminal water bodies, that is, aquatic systems receiving inflow but with little or no outflow and with high rates of evaporation. Previous studies have estimated the emission rates of HFO-1234yf and have modeled the deposition concentrations and rates of TFA across North America. The present study uses multimedia modeling and geographic information system (GIS)-based modeling to assess the potential concentrations of TFA in terminal water bodies over extended periods. After 10 years of emissions, predicted concentrations of TFA in terminal water bodies across North America are estimated to range between current background levels (i.e., 0.01-0.22 µg/L) and 1 to 6 µg/L. After 50 years of continuous emissions, aquatic concentrations of 1 to 15 µg/L are predicted, with extreme concentrations of up to 50 to 200 µg/L in settings such as the Sonoran Desert along the California/Arizona (USA) border. Based on the relative insensitivity of aquatic organisms to TFA, predicted concentrations of TFA in terminal water bodies are not expected to impair aquatic systems, even considering potential emissions over extended periods.


Assuntos
Fluorocarbonos/análise , Lagos/química , Ácido Trifluoracético/análise , Poluentes Químicos da Água/análise , Ar Condicionado , Atmosfera , Automóveis , California , Poluentes Ambientais/análise , Fluorocarbonos/toxicidade , Sedimentos Geológicos/química , Modelos Teóricos , Água do Mar/química , Solo/química , Ácido Trifluoracético/toxicidade , Estados Unidos , Poluentes Químicos da Água/toxicidade
10.
Chemosphere ; 87(7): 725-33, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22280982

RESUMO

Short-term 48, 72 and 96-h aquatic toxicity tests were conducted to evaluate the acute toxicity of eight fluorinated acids to the cladoceran, Daphnia magna, the green alga, Pseudokirchneriella subcapitata, and the rainbow trout, Oncorhynchus mykiss or the fathead minnow, Pimephales promelas. The eight fluorinated acids studied were tridecafluorohexyl ethanoic acid (6:2 FTCA), heptadecafluorooctyl ethanoic acid (8:2 FTCA), 2H-dodecafluoro-2-octenoic acid (6:2 FTUCA), 2H-hexadecafluoro-2-decenoic acid (8:2 FTUCA), 2H,2H,3H,3H-undecafluoro octanoic acid (5:3 acid), 2H,2H,3H,3H-pentadecafluoro decanoic acid (7:3 acid), n-perfluoropentanoic acid (PFPeA) and n-perfluorodecanoic acid (PFDA). The results of the acute toxicity tests conducted during this study suggest that the polyfluorinated acids, 8:2 FTCA, 8:2 FTUCA, 6:2 FTCA, 6:2 FTUCA, 7:3 acid and 5:3 acid, and the perfluorinated acids PFPeA and PFDA, are generally of low to medium concern based on evaluation of their acute freshwater toxicity (EC/LC50s typically between 1 and >100 mg L(-1)) using the USEPA TSCA aquatic toxicity evaluation paradigm. For the polyfluorinated acids, aquatic toxicity generally decreased as the number of fluorinated carbons decreased and as the overall carbon chain length decreased from 12 to 8. Acute aquatic toxicity of the 5 and 10 carbon perfluorocarboxylic acids (EC/LC50s between 10.6 and >100 mg L(-1)) was greater or similar to that of the 6-9 carbon perfluorocarboxylic acids (EC/LC50s>96.5 mg L(-1)). This study also provides the first report of the acute aquatic toxicity of the 5:3 acid (EC/LC50s of 22.5 to >103 mg L(-1)) which demonstrated less aquatic toxicity than the 7:3 acid (EC/LC50s of 0.4-32 mg L(-1)). The cladoceran, D. magna and the green alga, P. subcapitata had generally similar EC50 values for a given substance while fish were typically equally or less sensitive with the exception that PFPeA was most toxic to fish. Predicted no-effect concentrations (PNECs) were estimated using approaches consistent with REACH guidance and when compared with available environmental concentrations, these PNECs suggest that the fluorinated acids tested pose little risk for aquatic organisms.


Assuntos
Fluorocarbonos/toxicidade , Água Doce/química , Poluentes Químicos da Água/toxicidade , Animais , Clorófitas , Cyprinidae , Daphnia , Concentração de Íons de Hidrogênio , Nível de Efeito Adverso não Observado , Medição de Risco , Testes de Toxicidade Aguda
11.
Integr Environ Assess Manag ; 8(1): 13-6, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21538830

RESUMO

Once they are released into the environment, a number of chemicals are known to bioaccumulate in organisms, sometimes to concentrations that may threaten the individual or their predators. However, use of physical or chemical properties or results from laboratory bioaccumulation tests to predict concentrations sometimes found in wild organisms remains a challenge. How well laboratory studies and field measurements agree or disagree, and the cause of any discrepancies, is a subject of great interest and discussion from both a scientific and a regulatory perspective. A workshop sponsored by the ILSI Health and Environmental Sciences Institute, US Environmental Protection Agency, and the Society of Environmental Toxicology and Chemistry assembled scientists from academia, industry, and government to compare and contrast laboratory and field bioaccumulation data. The results of this workshop are summarized in a series of 5 articles published in this issue of Integrated Environmental Assessment and Management. The articles describe: 1) a weight-of-evidence approach that uses fugacity ratios to bring field measurements into the assessment of biomagnification potential for legacy chemicals; 2) a detailed comparison between laboratory and field data for the most commonly measured bioaccumulation endpoint, the biota-sediment accumulation factor; 3) a study that identifies and quantifies the differences between laboratory and field metrics of bioaccumulation for aquatic and terrestrial organisms; and 4) 2 reports on trophic magnification factors: the 1st addresses how trophic magnification factors are determined and interpreted and the 2nd describes how they could be used in regulatory assessments. Collectively, these articles present the workshop participants' current understanding and assessment of bioaccumulation science and make a number of recommendations on how to improve the collection and interpretation of bioaccumulation data.


Assuntos
Monitoramento Ambiental/métodos , Poluentes Ambientais/toxicidade , Medição de Risco/métodos , Poluentes Ambientais/análise
12.
Integr Environ Assess Manag ; 8(1): 32-41, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21538837

RESUMO

Standardized laboratory protocols for measuring the accumulation of chemicals from sediments are used in assessing new and existing chemicals, evaluating navigational dredging materials, and establishing site-specific biota-sediment accumulation factors (BSAFs) for contaminated sediment sites. The BSAFs resulting from the testing protocols provide insight into the behavior and risks associated with individual chemicals. In addition to laboratory measurement, BSAFs can also be calculated from field data, including samples from studies using in situ exposure chambers and caging studies. The objective of this report is to compare and evaluate paired laboratory and field measurement of BSAFs and to evaluate the extent of their agreement. The peer-reviewed literature was searched for studies that conducted laboratory and field measurements of chemical bioaccumulation using the same or taxonomically related organisms. In addition, numerous Superfund and contaminated sediment site study reports were examined for relevant data. A limited number of studies were identified with paired laboratory and field measurements of BSAFs. BSAF comparisons were made between field-collected oligochaetes and the laboratory test organism Lumbriculus variegatus and field-collected bivalves and the laboratory test organisms Macoma nasuta and Corbicula fluminea. Our analysis suggests that laboratory BSAFs for the oligochaete L. variegatus are typically within a factor of 2 of the BSAFs for field-collected oligochaetes. Bivalve study results also suggest that laboratory BSAFs can provide reasonable estimates of field BSAF values if certain precautions are taken, such as ensuring that steady-state values are compared and that extrapolation among bivalve species is conducted with caution.


Assuntos
Monitoramento Ambiental/métodos , Poluentes Ambientais/metabolismo , Poluentes Ambientais/toxicidade , Medição de Risco/métodos , Animais , Bivalves/efeitos dos fármacos , Bivalves/metabolismo , Poluentes Ambientais/análise , Cadeia Alimentar , Sedimentos Geológicos , Oligoquetos/efeitos dos fármacos , Oligoquetos/metabolismo , Especificidade da Espécie
13.
Integr Environ Assess Manag ; 8(1): 17-31, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21793200

RESUMO

An approach for comparing laboratory and field measures of bioaccumulation is presented to facilitate the interpretation of different sources of bioaccumulation data. Differences in numerical scales and units are eliminated by converting the data to dimensionless fugacity (or concentration-normalized) ratios. The approach expresses bioaccumulation metrics in terms of the equilibrium status of the chemical, with respect to a reference phase. When the fugacity ratios of the bioaccumulation metrics are plotted, the degree of variability within and across metrics is easily visualized for a given chemical because their numerical scales are the same for all endpoints. Fugacity ratios greater than 1 indicate an increase in chemical thermodynamic activity in organisms with respect to a reference phase (e.g., biomagnification). Fugacity ratios less than 1 indicate a decrease in chemical thermodynamic activity in organisms with respect to a reference phase (e.g., biodilution). This method provides a holistic, weight-of-evidence approach for assessing the biomagnification potential of individual chemicals because bioconcentration factors, bioaccumulation factors, biota-sediment accumulation factors, biomagnification factors, biota-suspended solids accumulation factors, and trophic magnification factors can be included in the evaluation. The approach is illustrated using a total 2393 measured data points from 171 reports, for 15 nonionic organic chemicals that were selected based on data availability, a range of physicochemical partitioning properties, and biotransformation rates. Laboratory and field fugacity ratios derived from the various bioaccumulation metrics were generally consistent in categorizing substances with respect to either an increased or decreased thermodynamic status in biota, i.e., biomagnification or biodilution, respectively. The proposed comparative bioaccumulation endpoint assessment method could therefore be considered for decision making in a chemicals management context.


Assuntos
Monitoramento Ambiental/métodos , Poluentes Ambientais/metabolismo , Poluentes Ambientais/toxicidade , Medição de Risco/métodos , Animais , Poluentes Ambientais/análise , Cadeia Alimentar , Humanos , Especificidade da Espécie
14.
Toxicology ; 292(1): 42-52, 2012 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-22154915

RESUMO

The toxicity of tridecafluorohexylethyl methacrylate (6:2 FTMAC), an acrylic monomer used in producing polymeric substances, was evaluated. 6:2 FTMAC has low acute oral and dermal toxicity (LD50>5000 mg/kg), was not a skin or eye irritant, and did not demonstrate skin sensitization potential in a local lymph node assay (LLNA). 6:2 FTMAC was not mutagenic in the bacterial reverse mutation (Ames) test or in the mouse lymphoma assay. 6:2 FTMAC induced structural aberrations in human peripheral blood lymphocytes in vitro in the absence of metabolic activation but not in the presence of S9 metabolic activation. No numerical aberrations were detected under any testing condition. Also, no increase occurred in structural or numerical chromosomal aberrations in an in vivo mouse micronucleus assay in 6:2 FTMAC treated animals compared to controls. 6:2 FTMAC was administered at 0, 100, 500 and 1000 mg/kg/day via gavage to male and female SD rats for 14 days. No test substance-related effects on mortality, clinical signs, body weights, nutritional parameters, or clinical pathology were observed at any dose. Test substance-related increases in liver weights in males and females at all dose levels and thyroid and kidney weights in 500 and 1000 mg/kg/day males were noted. While there was no histopathological correlate for thyroid and kidney weight changes, minimal hypertrophy was noted in liver in males and females at 1000 mg/kg/day group. The changes noted in teeth (altered mineralization; retention of basophilic material) and femur (increased mineralization) in all treated groups were not associated with clinical signs or microscopic changes and were likely related to free fluoride formed from 6:2 FTMAC metabolism. Plasma (3-4-fold) and urine (30-50-fold) fluoride was higher in treated groups versus controls. Therefore, the changes noted in organ weights, teeth, femur, plasma or urine were not considered adverse. In the repeated dose toxicity study, the no-observed-adverse-effect-level (NOAEL) was 1000 mg/kg/day. Based on mean measured concentrations, the 96-h LC50 in fathead minnow was >14.5 mg/L and the 72-h EC50 in Pseudokirchneriella subcapitata was >24.6 mg/L, while the 48-h EC50 in Daphnia magna, based on nominal concentrations, was >120 mg/L. Overall, 6:2 FTMAC is considered to have low toxicity potential based on these studies.


Assuntos
Metacrilatos/toxicidade , Testes de Toxicidade/métodos , Animais , Carcinógenos/toxicidade , Células Cultivadas , Clorófitas , Cladocera , Cyprinidae , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos CBA , Camundongos Endogâmicos ICR , Testes para Micronúcleos/métodos , Ratos , Ratos Sprague-Dawley , Especificidade da Espécie
15.
Clin Res Cardiol ; 101(2): 139-47, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22048696

RESUMO

PURPOSE: To study the association between baseline heart rate and outcome in patients with multiple organ dysfunction (MODS) as well as the course of heart rate over the first 4 days during MODS. METHODS: Prospective observational study in 89 patients with MODS, defined as an APACHE-II score ≥20. Baseline heart rate (HR(0)) was determined over a 60-minute period at the time of MODS diagnosis. 28-day all-cause mortality was the primary endpoint of the study, a fall of the APACHE-II score by 4 points or more from day 0 to day 4 constituted the secondary endpoint. Hazard ratios for heart rate of 90 beats per minute (bpm) or greater relative to less than 90 bpm were calculated using Cox proportional hazards model and adjusted for confounding variables. RESULTS: Median baseline heart rate was 83 bpm in survivors and 92 bpm in non-survivors (p = 0.048). 28-day mortality was 32 and 61% in patients with HR(0) < 90 bpm and HR(0) ≥ 90 bpm, respectively. The adjusted hazard ratio for 28-day mortality was 2.30 (95% confidence interval 1.21-4.36, p = 0.001) for HR(0) ≥ 90 bpm relative to HR(0) < 90 bpm. No correlation was found between baseline heart rate and the secondary endpoint. From day 0 to day 4, heart rate remained elevated in all patients, as well as in survivors and non-survivors. CONCLUSIONS: A heart rate ≥90 bpm at the time of MODS diagnosis is an independent risk factor for increased 28-day mortality. As in patients with cardiovascular conditions such as coronary heart disease or chronic heart failure, heart rate might constitute a target for heart rate-lowering therapy in the narrow initial treatment window of MODS.


Assuntos
Frequência Cardíaca , Insuficiência de Múltiplos Órgãos/fisiopatologia , APACHE , Idoso , Distribuição de Qui-Quadrado , Feminino , Alemanha/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
16.
Clin Res Cardiol ; 100(10): 915-23, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21638157

RESUMO

BACKGROUND: Heart rate (HR) is of relevant prognostic value not only in the general population and patients with cardiovascular disease, but also in critically ill patients with multiple organ dysfunction syndrome (MODS). An elevated HR in MODS patients is associated with a worse prognosis. Beta-blocker (BB) administration has been shown to reduce mortality in MODS. In most cases, negative inotropic effects prevent administration of BBs in MODS patients. In this trial we investigate, whether the "funny current" (I (f)) channel inhibitor ivabradine is able and apt to reduce pathologically elevated HR in MODS patients. We hypothesize that critically ill patients could derive particular benefit from the specific HR-lowering agent ivabradine. METHODS: MODI (f)Y is a prospective, single centre, open label, randomized, controlled two arms, phase II-trial to evaluate the potential of ivabradine to reduce an elevated HR in MODS patients. The primary end point is the proportion of patients with a reduction of HR by at least 10 beats per minute (bpm) within 4 days. This trial will randomize 70 patients (men and women, aged ≥18 years) with newly diagnosed MODS, with an elevated HR (sinus rhythm with HR ≥90 bpm) and contraindications to BB therapy. Treatment period will last for 4 days. All patients will be followed for 6 months. RESULTS: The first patient was randomized on May 21, 2010. CONCLUSIONS: The MODI (f)Y trial is the first application of ivabradine as a pure heart rate reducing agent in MODS patients.


Assuntos
Antiarrítmicos/uso terapêutico , Benzazepinas/uso terapêutico , Canais de Cátion Regulados por Nucleotídeos Cíclicos/antagonistas & inibidores , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Projetos de Pesquisa , Antagonistas Adrenérgicos beta , Adulto , Idoso , Contraindicações , Estado Terminal , Canais de Cátion Regulados por Nucleotídeos Cíclicos/metabolismo , Feminino , Alemanha , Sistema de Condução Cardíaco/metabolismo , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização , Ivabradina , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/metabolismo , Insuficiência de Múltiplos Órgãos/fisiopatologia , Seleção de Pacientes , Canais de Potássio/metabolismo , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Clin Res Cardiol ; 100(8): 661-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21308379

RESUMO

INTRODUCTION: In sepsis, severe reduction of afterload may often mask cardiac impairment. By establishing the parameter "afterload-related cardiac performance (ACP)" we wanted to determine the extent, frequency, and prognostic relevance of septic cardiomyopathy. METHODS: Over a 12 months period, all patients of our medical intensive care ward were included into the study when they were classified as having "septic MODS" (sepsis score ≥12 as long as APACHE II score was ≥20). Hemodynamic assessments were performed using a pulmonary artery catheter. RESULTS: A total of 524 patients were screened, and from these 39 had septic MODS. In survivors, APACHE II score values declined from day 0 (day of diagnosis, 27.6 ± 8.0) to day 4 (17.8 ± 8.0), while in non-survivors, score values remained high (day 0: 31.8 ± 5.7; day 4: 33.2 ± 6.7; p < 0.001). Hemodynamic measurements showed an inverse correlation of cardiac output (CO(measured)) and SVR which can be described as CO = ß (0) × SVR( ß1). The upper limit of 80% tolerance range of CO was defined as the "normal" CO values (CO(normal)). The parameter "afterload-related cardiac performance (ACP)" was calculated as ACP (%) = CO(measured)/CO(normal) × 100. It turned out that ACP shows a stronger correlation with APACHE II- and sepsis-score than CO, cardiac index (CI), cardiac power (CPO), or cardiac power index (CPI). Furthermore, ACP correlated with sepsis-induced myocardial damage as indicated by elevations of troponin I and significantly differed between surviving (86.9 ± 1.6%) and non-surviving patients (69.2 ± 1.4%; p < 0.0001). While 75% of the surviving patients showed an ACP >60%, 38% of the non-survivors had a moderate (ACP 40-60%) and 25% a severe impairment of cardiac function (ACP < 40%). CONCLUSION: By using the parameter "afterload-related cardiac performance, ACP", the impairment of cardiac function can be reliably quantified showing that septic cardiomyopathy occurs frequently and is of prognostic relevance in patients with septic MODS.


Assuntos
Cardiomiopatias/fisiopatologia , Hemodinâmica/fisiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Sepse/fisiopatologia , Choque Séptico/fisiopatologia , APACHE , Débito Cardíaco/fisiologia , Cardiomiopatias/etiologia , Cardiomiopatias/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sepse/complicações , Sepse/mortalidade , Índice de Gravidade de Doença , Choque Séptico/complicações , Choque Séptico/mortalidade , Troponina I/sangue , Resistência Vascular/fisiologia
18.
Environ Toxicol Chem ; 30(1): 39-51, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20963851

RESUMO

Animals have evolved diverse protective mechanisms for responding to toxic chemicals of both natural and anthropogenic origin. From a governmental regulatory perspective, these protective responses complicate efforts to establish acceptable levels of chemical exposure. To explore this issue, we considered vertebrate endocrine systems as potential targets for environmental contaminants. Using the hypothalamic-pituitary-thyroid (HPT), hypothalamic-pituitary-gonad (HPG), and hypothalamic-pituitary-adrenal (HPA) axes as case examples, we identified features of these systems that allow them to accommodate and recover from chemical insults. In doing so, a distinction was made between effects on adults and those on developing organisms. This distinction was required because endocrine system disruption in early life stages may alter development of organs and organ systems, resulting in permanent changes in phenotypic expression later in life. Risk assessments of chemicals that impact highly regulated systems must consider the dynamics of these systems in relation to complex environmental exposures. A largely unanswered question is whether successful accommodation to a toxic insult exerts a fitness cost on individual animals, resulting in adverse consequences for populations. Mechanistically based mathematical models of endocrine systems provide a means for better understanding accommodation and recovery. In the short term, these models can be used to design experiments and interpret study findings. Over the long term, a set of validated models could be used to extrapolate limited in vitro and in vivo testing data to a broader range of untested chemicals, species, and exposure scenarios. With appropriate modification, Tier 2 assays developed in support of the U.S. Environmental Protection Agency's Endocrine Disruptor Screening Program could be used to assess the potential for accommodation and recovery and inform the development of mechanistically based models.


Assuntos
Sistema Endócrino/efeitos dos fármacos , Monitoramento Ambiental/métodos , Poluentes Ambientais/toxicidade , Vertebrados/fisiologia , Animais , Disruptores Endócrinos/toxicidade , Exposição Ambiental/análise , Medição de Risco , Testes de Toxicidade/métodos
19.
Integr Environ Assess Manag ; 7(3): 466-77, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21082667

RESUMO

This study assessed ambient waters in an urbanized area of the Delaware River, to determine whether river water samples exhibited chronic lethal or sublethal toxicity when measured in laboratory experiments. Toxicity was assessed at 16 fixed stations in the main-stem river and 29 stations in tributaries of the tidal Delaware River with salinities from 0 to 15 parts per 1000 (ppt) using Pimephales promelas, Americamysis bahia, Menidia beryllina, and Ceriodaphnia dubia in 7-d tests; Pseudokirchneriella subcapitata in a 96-h test; and Hyalella azteca in a 10-d water-only test. The toxicity tests measured organism survival, growth, and reproduction. Results from testing water samples collected in 4 different y indicated that the samples from sites tested in the main-stem of the Delaware River and from the majority of its tributaries did not produce chronic toxicity. The surveys identified tributaries that warrant further assessment for toxicity.


Assuntos
Monitoramento Ambiental/métodos , Rios/química , Poluentes Químicos da Água/toxicidade , Animais , Delaware , Salinidade , Fatores de Tempo , Água/química
20.
Integr Environ Assess Manag ; 6(1): 164-79, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19689170

RESUMO

Effective environmental management and restoration of urbanized systems such as the Delaware River Estuary requires a holistic understanding of the relative importance of various stressor-related impacts throughout the watershed, both historical and ongoing. To that end, it is important to involve as many stakeholders as possible in the management process and to develop a system for sharing of scientific data and information, as well as effective technical tools for evaluating and disseminating the data needed to make management decisions. In this study, we describe a preliminary assessment that was undertaken to evaluate the relative risks for the variety of stressors currently operating within the Delaware Estuary using a relative risk model (RRM) framework. This model was constructed using existing data and information on the ecological conditions and stressors in the main-stem Delaware River below the head of tide at Trenton, New Jersey, USA. A large database was developed with pertinent data from a variety of library, scientific, and regulatory sources. Data were compiled, reviewed, and characterized before development of the Estuary-specific RRM. Our primary goals and objectives in developing this preliminary RRM for the Estuary were to 1) determine if the RRM framework can be adapted to a large complex estuarine system such as the Delaware River, 2) identify the issues associated with adapting the model framework to the various management issues and regional areas/habitats of the River, 3) help identify data needs and potential refinements that might be needed to more specifically quantify relative stressor risks in various areas and habitats of the Estuary to better inform future management goals/actions by Stakeholders. The key conclusions of our preliminary assessment are 1) a diverse suite of stressors is likely affecting the ecological conditions of the Delaware Estuary, 2) chemical (toxicants/contaminants) and physical (sedimentation, habitat loss) stressors were found to be on par with regards to their ranking, and 3) the RRM, in its current form, made it difficult to effectively balance the inequality in the sizes of the study subareas considered in the assessment. Management objectives and related research activities should focus on collecting the necessary data and information to further refine the RRM and assess the relative impacts of these stressors at various scales in the Estuary. By having such a framework and tool available, we believe that stakeholders within the Delaware River watershed will be able to make more informed and risk-based management decisions regarding restoration options for the Estuary.


Assuntos
Ecologia/métodos , Monitoramento Ambiental/métodos , Medição de Risco/métodos , Rios , Delaware , Poluentes Químicos da Água
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