Wildfire Induces Changes in Receiving Waters: A Review With Considerations for Water Quality Management.

Wildfires have increased in frequency in many ecosystems, with implications for human health and the environment, including water quality. Increased fire frequency and urbanization also raise the prospect of fires burning into urban areas, mobilizing pollutants few have considered to date. As a result, water quality managers lack information to anticipate, respond to and potentially mitigate wildfire impacts. Here, we reviewed the scientific literature to assess wildfire effects on response endpoints of a conceptual model linking fire to water quality, quantifying response directionality, magnitude and duration. Physically, water yield, sediments, and temperature all increased post-fire. Chemically, nutrients, ions, organic chemicals, and metals increased in burned watersheds, sometimes by orders of magnitude over pre-fire or reference conditions. In select cases, post-fire concentrations exceeded aquatic life criteria or drinking water standards, at times even in the finished drinking water. Biological assemblages commonly declined after post-fire runoff events. The duration of effects was less than 5 yr for most endpoints (e.g., metals) on average following fire, although effects did extend 15 yr or more in some individual cases. We found only a few studies on pollutants mobilized from wildfire impacted urban areas with benzene contamination in drinking water and high metal concentrations in ash prominent exceptions. Overall, this review provides a resource for understanding wildfire impacts on water quality endpoints, with the goal of informing the response of managers and other decision makers to this growing problem.

Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey.

BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.

The impact of prostate cancer on men's everyday life.

Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty-seven men were interviewed at different stages in their disease pathway: nine men prior to radiotherapy, eight men at 6-8 months post radiotherapy and 10 men at 12-18 months post radiotherapy. A grounded theory approach was used to collect and analyse the data. Regardless of the point at which they were interviewed four areas emerged as important to the men: the pathway to diagnosis; the diagnosis; the impact of prostate cancer and its treatment on daily life; and living with prostate cancer. Prostate cancer was diagnosed using the prostate-specific antigen (PSA) test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies were viewed as the worst part of the disease experience. Radiotherapy was considered less invasive than other treatments, although preparatory regimes were associated with stress and inconvenience. Men used various strategies to deal with treatment-induced threats to their masculinity in the long term.

Variations in intraocular pressure during closed-system surgical procedures.

True intraocular pressure (IOP) during closed-chamber anterior segment surgery and vitrectomy was measured in rabbits by inserting a miniature pressure sensor directly into the anterior chamber or into the vitreous. Infusion fluid pressure was also measured simultaneously with a sensor in the infusion line. Significant and rapid changes in IOP up to 110 mm Hg were observed during routine anterior segment and vitreous procedures. None of these IOP changes affected infusion line pressure, which was governed solely by the infusion bottle height. Furthermore, raising the infusion bottle produced minimal IOP elevation whenever fluid was flowing into and out of the eye via a surgical instrument or a wound. These results show the limitations of monitoring of infusion line pressure as a means for assessing IOP and stress the need for IOP control during surgery.

Bacterial collagenase. Proposed adjunct to vitrectomy with membranectomy.

Clostridiopeptidase A digested preretinal cicatricial tissue without causing morphological alteration of normal retina during a 30-minute incubation in the rabbit. Light and transmission electron microscopy were used to determine effects on the inner limiting membrane and retinal ganglion and Müller's cells and to evaluate enzyme digestion of preretinal scarring. Removal of the injected collangenase by vitrectomy resulted in normal electroretinograms and retinal morphology 48 hours postoperatively. If the enzyme was left in the eye for 24 hours, lens opacities, partial erosion of the inner limiting membrane, and extensive hemorrhage resulted. The specificity of action of the collagenase is due to the high degree of purity of the enzyme used and a substantial biochemical difference between scar collagen and basement membrane collagen. The injection of purified collagenase capable of digesting vitreal scar tissue while leaving the retina undamaged could represent a new approach to vitrectomy, specifically to facilitate certain cases of membranectomy.

Enzyme-assisted vitrectomy with bacterial collagenase. Time course and toxicity studies.

Electron microscopic analysis of intravitreal strands produced by the injection of autogenous fibroblasts showed thin, immature collagen after two weeks and the mature banded variety after four weeks. With the use of this intravitreal strand model, it was found that highly purified bacterial collagenase caused extensive digestion of scar tissue after incubation periods of 10, 15, and 30 minutes. There was no morphologic damage to cicatricial cellular elements or to the inner limiting membrane of the retina. A 45-minute exposure of retinas previously injured by photocoagulation to collagenase also did not result in morphologic evidence of damage. The use of collagenase as an adjunct to vitrectomy in cases of extreme vitreal scarring or retinal traction may decrease the complication rate of a procedure that is still extremely hazardous.

Effects of topical treatment with beta-aminopropionitrile after radial keratotomy in the rabbit.

This study assessed the effect of beta-aminopropionitrile treatment on the long-term curvature and compliance of corneal tissue subjected to radial keratotomy (RK). beta-Aminopropionitrile is known to inhibit cross-linking of collagen and is expected to enhance the flexibility of scar tissue, thereby reducing wound contracture and regression after RK. Seventeen adult New Zealand rabbits, weighing about 4.5 kg each, underwent RK in both eyes (eight incisions, 90% deep, 3-mm pupillary zone). Their mean preoperative corneal curvature was 44.25 diopters (+/- 0.32D at 95% confidence level). Nine of the rabbits were treated topically with beta-aminopropionitrile ointment (33 weight % in petroleum three times daily), while the control group received the petrolatum base only. The remainder of the animals received bland petrolatum gel as a control. The animals were given periodic keratometric examinations and were killed after six to eight weeks. At that time, the beta-aminopropionitrile group showed a mean reduction of 1.85 +/- 0.13 D in corneal curvature, compared with 1.18 +/- 0.08 D in the control group. The compliance and strength of the corneas were measured in vitro immediately after death. In the pressure range from 10 to 40 mm Hg, the beta-aminopropionitrile-treated corneas changed in curvature by an average of 1.4 D as compared with 0.5-D flattening for the controls. These results indicate the effectiveness of beta-aminopropionitrile treatment in enhancing longterm compliance and reducing refractive regression after RK.

Effects of beta-aminopropionitrile after posterior penetrating injury in the rabbit.

Beta-aminopropionitrile, an inhibitor of collagen cross-linking, effectively limited the degree of posttraumatic vitreous proliferation in rabbits three weeks after double perforating injury. Light microscopic examination of the sites of perforating injury after five weeks showed minimal intravitreal fibrous proliferation in treated animals. Electron micrographs of the cicatricial vitreous collagen showed fragmentation of collagen into smaller fibrils and disintegration into amorphous areas. Inhibition of collagen cross-linking may undermine the strength of the vitreous scaffold by making vitreous and cicatricial collagen more sensitive to tissue collagenases produced during inflammation. The failure of fibrovascular membranes to grow into the vitreous may be a secondary effect of weakened vitreous support.

The effects of intravitreal irrigation during vitrectomy on the electroretinogram.

Intravitreal irrigation with Balanced Salt Solution Plus (BSS Plus) produced less decrease in b-wave amplitude than either normal saline solution or Balanced Salt Solution. BSS Plus was more suitable for intravitreal irrigation because it contained the appropriate bicarbonate, pH, and ionic composition necessary for maintenance of normal retinal electrical activity, and it contained glutathione, which is necessary for maintenance of endothelial cell adenosine triphosphatase and for protection against free radical damage and oxidative stress.

Hydrodynamic analysis of intraocular pressure changes during anterior chamber procedures.

Variations in intraocular pressure (IOP), observed by us and other authors in closed-system anterior chamber procedures, are explained using a simple hydrodynamic analysis based on the Bernoulli equation. Calculations show that the sudden increases in IOP (pressure spikes) measured during anterior segment surgery are due primarily to the small size of the infusion cannulas and are exacerbated by high infusion rates. Accurate measurement of these IOP variations requires placement of the pressure sensors in situ and is not possible by remote pressure sensing at the infusion line or the console. This work indicates that closed-system procedures could benefit from accurate monitoring of intraoperative IOP and could use these measurements for automatic IOP control during surgery.

Inhibition of collagen cross-linking: a new approach to ocular scarring.

A method for the production of alkali-induced conjunctival scarring in rabbits with minimal corneal involvement is presented. The lathyritic agent Beta-aminopropionitrile (BAPN), an inhibitor of collagen cross-linking, was applied topically for a period of 21 days after induction of injury. There was a statistically significant (p less than .025) increase in both the interpalpebral fissure length and width of scarred treated animals compared with the scarred control group. BAPN did not affect the interpalpebral fissure measurements of unscarred rabbit eyes. No clinical adverse effects were observed after the treatment period. Histological evaluation of the treated scar tissue was consistent with lathyrism.

Enzyme-assisted vitrectomy with bacterial collagenase. Pilot human studies.

Clostridiopeptidase A, a bacterial collagenase, was used to assist vitrectomy with membrane stripping in six patients with dense intravitreal fibroproliferative tissue associated with retinopathy of prematurity, diabetic retinopathy, or proliferative vitreoretinopathy. When it was injected intra-operatively, allowed to incubate for 15 minutes, and then removed by irrigation/aspiration, no side effects of lens opacity, lens dislocation, or retinal hemorrhage were observed. Use of this enzyme may facilitate removal of fibroproliferative tissue in certain difficult vitrectomy cases.

Effects of beta-aminopropionitrile after glaucoma filtration surgery: pilot human trial.

Beta-aminopropionitrile fumarate, an inhibitor of collagen cross-linking, was used topically in patients after filtration surgery for difficult cases of glaucoma (aphakic, repeat surgery, neovascular). Twenty-three patients received the drug for a total treatment period of three months following surgery. The mean preoperative intraocular pressure was 40.0 +/- 14.1 mm Hg (mean +/- standard deviation). The mean postoperative pressure was 19.0 +/- 8.9 mm Hg, with the mean follow-up at 26.4 +/- 11 weeks. The overall success rate was 74%, with success being defined as an intraocular pressure of 22 mm Hg or less at the last visit. Side effects consisted primarily of stinging immediately after the medication was applied. Inhibition of collagen cross-linking may represent an alternative method to the use of injectable 5-fluorouracil to maintain patency of filtration blebs.