Ecological drivers of mercury concentrations in fish species in subsistence harvests from Kotzebue Sound, Alaska.

The State of Alaska assesses human exposure to mercury (Hg) via fish consumption producing consumption guidelines for fish tailored for children and women of childbearing age. Under these guidelines, unrestricted consumption is suggested for many fish species, while limited consumption is recommended for others. Subsequent questions have arisen regarding ecological drivers influencing [Hg] in fishes consumed by Alaskans. This community-assisted public health study evaluates [Hg] in fishes from Kotzebue Sound to examine factors that may drive observed [Hg]. We examined eight species of subsistence harvested fish (least cisco, chum salmon, Pacific herring, humpback whitefish, sheefish, starry flounder, Pacific tomcod, and fourhorn sculpin) from Kotzebue Sound. We report total Hg concentrations ([THg]) and monomethyl Hg+ concentrations ([MeHg+]) in the context of various factors (such as species, fork length, carbon and nitrogen stable isotope (δ15N or δ13C)) values that may influence [Hg] and [MeHg+]. Across all 297 fish, [THg] ranged from 3.4 - 235.2 ng/g ww. [THg] was positively correlated with fork length in six of eight fish species, as well as with trophic level (indicated by δ15N values) in five species. [MeHg+] was positively correlated with fork length in four species, and with δ15N values over all specimens examined, and specifically for three individual species. In six of the seven species analyzed, %MeHg was >80% of [THg]. This value decreased with fork length in three species, with no relationship for δ15N values in any species. Among top ranked models based on Akaike Information Criterion correction (AICc), fork length was more frequently included as an explanatory factor for [Hg] than δ15N or δ13C values. The food web magnification factor for [THg] was 11.3, and 12.6 for [MeHg+]. Biomagnification is likely driving [THg] and [MeHg+] over the entire food web, while within species, bioaccumulation is likely a stronger driver of [THg] and [MeHg+] than feeding ecology or trophic position. The [THg] for all species fell within the established unrestricted consumption guideline of 200 ng/g weight wet as established by the State of Alaska's fish consumption guidelines for Hg.

Per- and Polyfluoroalkyl Substances and Mercury in Arctic Alaska Coastal Fish of Subsistence Importance.

Per- and polyfluoroalkyl substances (PFAS) and mercury (Hg) are harmful compounds that are widely present in the environment, partly due to spills and atmospheric pollution. The presence of PFAS and Hg in the tissues of animals that are harvested by rural and Indigenous Alaskans is of great concern, yet fish in Arctic Alaska have not previously been assessed for concentrations of PFAS. Fish species of subsistence and recreational importance were collected from nearshore Beaufort and Chukchi Sea, Alaska habitats and assessed for PFAS and total mercury concentrations [THg]. We found multiple PFAS compounds present at low levels (<3 µg/kg) in the muscle tissue of inconnu, broad whitefish, Dolly Varden char, Arctic flounder, saffron cod, humpback whitefish, and least cisco. In addition, [THg] levels in these fish were well below levels triggering local fish consumption guidelines (<170 µg/kg). These initial results indicate no evidence of the Alaska Arctic nearshore fish species examined as an avenue of PFAS or Hg exposure to people who harvest them. However, sources and trends of these contaminants in the Arctic require further investigation. Environ Toxicol Chem 2023;42:2329-2335. © 2023 SETAC.

Contributions and perspectives of Indigenous Peoples to the study of mercury in the Arctic.

Arctic Indigenous Peoples are among the most exposed humans when it comes to foodborne mercury (Hg). In response, Hg monitoring and research have been on-going in the circumpolar Arctic since about 1991; this work has been mainly possible through the involvement of Arctic Indigenous Peoples. The present overview was initially conducted in the context of a broader assessment of Hg research organized by the Arctic Monitoring and Assessment Programme. This article provides examples of Indigenous Peoples' contributions to Hg monitoring and research in the Arctic, and discusses approaches that could be used, and improved upon, when carrying out future activities. Over 40 mercury projects conducted with/by Indigenous Peoples are identified for different circumpolar regions including the U.S., Canada, Greenland, Sweden, Finland, and Russia as well as instances where Indigenous Knowledge contributed to the understanding of Hg contamination in the Arctic. Perspectives and visions of future Hg research as well as recommendations are presented. The establishment of collaborative processes and partnership/co-production approaches with scientists and Indigenous Peoples, using good communication practices and transparency in research activities, are key to the success of research and monitoring activities in the Arctic. Sustainable funding for community-driven monitoring and research programs in Arctic countries would be beneficial and assist in developing more research/monitoring capacity and would promote a more holistic approach to understanding Hg in the Arctic. These activities should be well connected to circumpolar/international initiatives to ensure broader availability of the information and uptake in policy development.

Inorganic nutrients and contaminants in subsistence species of Alaska: linking wildlife and human health.

OBJECTIVES: To determine inorganic nutrient and contaminant concentrations in subsistence foods consumed by Alaska Natives, concentration changes related to common preparation methods and provide a basic risk-benefit analysis for these foods. STUDY DESIGN: Eleven essential and six non-essential elements were measured in foods derived from spotted seals and sheefish. METHODS: Essential nutrients in foodstuffs were compared to Daily Recommended Intake (DRI) criteria. Non-essential elements were compared to Tolerable Daily Intake Limits (TDIL). These comparisons serve as a risk-benefit analysis, not as consumption advice. RESULTS: Cooking altered nutrient and contaminant concentrations. Spotted seal muscle and kidney are rich in Fe and Se; liver in Cu, Fe, Mo and Se; and sheefish muscle in Se. TDIL was exceeded in a 100 g serving of seal for THg in raw and fried liver and boiled kidney; MeHg in dried muscle and raw and fried liver; Cd in raw and boiled kidney; and As in raw and rendered blubber. Arsenic exceeded TDIL in sheefish muscle. However, toxicity potential is likely reduced by the element form (i.e., organic As, inorganic Hg) and the presence of protective nutrients such as Se. CONCLUSIONS: Preparation methods alter wildlife tissues from their raw state, significantly affecting element concentrations. Direct evaluation of actual food items is warranted to determine risk-benefit ratios of traditional diets. Traditional foods provide many essential nutrients with a very limited risk from contaminants. We encourage continued consumption of traditional foods, and urge public health agencies to develop applicable models for providing consumption advice, incorporating food processing considerations.

Organic nutrients and contaminants in subsistence species of Alaska: concentrations and relationship to food preparation method.

OBJECTIVES: To determine nutrient and contaminant concentrations, document concentration changes related to common preparation methods and provide a basic risk-benefit analysis for select subsistence foods consumed by residents of Kotzebue, Alaska. STUDY DESIGN: Eleven organic nutrients and 156 persistent organic pollutants (POPs) were measured in foods derived from spotted seals and sheefish. METHODS: Nutrients in foodstuffs were compared to Daily Recommended Intake criteria. POPs were compared to Tolerable Daily Intake Limits (TDIL). RESULTS: Cooking, as well as absence/presence of skin during sheefish processing, altered nutrient and contaminant concentrations in seals and fish. Sheefish muscle and seal blubber were particularly rich in omega-3 fatty acids and seal liver in vitamin A. Seal liver exceeded the recommended upper limit for vitamin A. POP contribution to TDIL was >25% in all tissues except blubber, in which 4 POPS were present at >25% TDIL. No POPs exceeded TDIL in a serving of any tissue studied. The most prominent concerns identified were levels of vitamin A in spotted seal liver and certain POPs in blubber, warranting consideration when determining how much and how often these foods should be consumed. CONCLUSIONS: Preparation methods altering tissues from their raw state significantly affect nutrient and contaminant concentrations, thus direct evaluation of actual food items is highly recommended to determine risk-benefits ratios of traditional diets. Traditional foods provide essential nutrients with very limited risk from contaminants. We encourage the consumption of traditional foods and urge public health agencies to develop applicable models to assess overall food safety and quality.

Habitat selection and seasonal movements of young bearded seals (Erignathus barbatus) in the Bering Sea.

The first year of life is typically the most critical to a pinniped's survival, especially for Arctic phocids which are weaned at only a few weeks of age and left to locate and capture prey on their own. Their seasonal movements and habitat selection are therefore important factors in their survival. During a cooperative effort between scientists and subsistence hunters in October 2004, 2005, and 2006, 13 female and 13 male young (i.e., age <2) bearded seals (Erignathus barbatus) were tagged with satellite-linked dive recorders (SDRs) in Kotzebue Sound, Alaska. Shortly after being released, most seals moved south with the advancing sea-ice through the Bering Strait and into the Bering Sea where they spent the winter and early spring. The SDRs of 17 (8 female and 9 male) seals provided frequent high-quality positions in the Bering Sea; their data were used in our analysis. To investigate habitat selection, we simulated 20 tracks per seal by randomly selecting from the pooled distributions of the absolute bearings and swim speeds of the tagged seals. For each point in the observed and simulated tracks, we obtained the depth, sea-ice concentration, and the distances to sea-ice, open water, the shelf break and coastline. Using logistic regression with a stepwise model selection procedure, we compared the simulated tracks to those of the tagged seals and obtained a model for describing habitat selection. The regression coefficients indicated that the bearded seals in our study selected locations near the ice edge. In contrast, aerial surveys of the bearded seal population, predominantly composed of adults, indicated higher abundances in areas farther north and in heavier pack ice. We hypothesize that this discrepancy is the result of behavioral differences related to age. Ice concentration was also shown to be a statistically significant variable in our model. All else being equal, areas of higher ice concentration are selected for up to about 80%. The effects of sex and bathymetry were not statistically significant. The close association of young bearded seals to the ice edge in the Bering Sea is important given the likely effects of climate warming on the extent of sea-ice and subsequent changes in ice edge habitat.

Ecotoxicoparasitology of the gastrointestinal tracts of pinnipeds: the effect of parasites on the potential bioavailability of total mercury (THg).

Acanthocephalans, cestodes, and some species of nematodes acquire nutrients from the lumen contents in the gastrointestinal (GI) tract of their definitive host. These parasites are exposed to toxicants, such as mercury (Hg), through passive or active feeding mechanisms; therefore, the focus of this study was to determine if there is an effect of parasites on the dietary availability of total mercury (THg) within piscivorous pinniped hosts. THg concentrations ([THg]) in selected host tissues, parasites, and GI lumen contents from 22 California sea lions (Zalophus californianus), 15 ringed seals (Phoca hispida), and 4 spotted seals (Phoca largha) were determined. Among all pinnipeds, [THg] in acanthocephalans of the large intestine were significantly higher than concentrations in other samples (host lumen contents, other parasites and host intestinal wall), irrespective of location within the host GI tract. δ15N values of parasites depended both on parasite group and location within the GI tract. δ15N values were consistently higher in parasites inhabiting the large intestine, compared to elsewhere in the GI tract, for both sea lions and seals. δ13C values in parasites did not differ significantly from host GI tissues. Based on both [THg] and stable isotope values, parasites are likely affecting the Hg bioavailability within the GI lumen contents and host tissues, and toxicant-parasite interactions appear to depend on both parasitic taxon as well as their location within the host intestine.

Variation in bioaccumulation of persistent organic pollutants based on octanol-air partitioning: Influence of respiratory elimination in marine species.

Risk assessments of persistent organic pollutants (POPs) are often based on octanol-water (KOW) partitioning dynamics and may not adequately reflect bioaccumulation in air-breathing organisms. It has been suggested that compounds with low KOW and high octanol-air partitioning (KOA) coefficients have the potential to bioaccumulate in air-breathing organisms, including marine mammals. Here we evaluate differences in concentrations of POPs for two trophically matched Arctic species, spotted seal (Phoca largha) and sheefish (Stenodus leucichthys). We compared concentrations of 108 POPs in matched tissues (liver and muscle) across three ranges of KOW. We found a significant positive correlation between POP concentration and log KOA in spotted seal tissues for low log KOW compounds (log KOW <5.5, p<0.05). This provides further evidence for empirical models and observed bioaccumulation patterns in air-breathing organisms, and highlights the potential for bioaccumulation of these compounds in Arctic marine mammals.

Treatment of ruptured intracranial aneurysms with the pipeline embolization device.

BACKGROUND: The pipeline embolization device (PED) has been used for treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms. OBJECTIVE: To assess the safety and efficacy of the PED in ruptured intracranial aneurysms. METHODS: This is a case series with prospective data collection on 20 patients with freshly ruptured aneurysms who were treated with PED (with or without adjunctive coiling) at 2 cerebrovascular centers. Patients were loaded with aspirin and clopidogrel or received an infusion of tirofiban intraoperatively. RESULTS: Hunt and Hess grades were I in 7 patients (35%), II in 9 (45%), and III in 4 (20%). The mean duration from hemorrhage to PED placement was 7±7.0 days. A single device was used in all but 1 patient (95%). The procedure was staged in 20%. There was only 1 complication (5%); this was a fatal intraoperative aneurysm dome rupture that occurred during adjunctive coil deployment. Adjunctive coiling was used in 30%. No patient required an invasive procedure after PED placement. Follow-up angiography (mean, 5.3±4.2 months; range, 2-12 months) showed 100% occlusion in 12 (80%) and incomplete occlusion in 3 patients (20%). At latest follow-up, 19 patients achieved a favorable outcome (modified rankin scale 0-2). CONCLUSION: In our preliminary experience, treatment of ruptured aneurysms with the PED was associated with low complication rates, high occlusion rates, and favorable outcomes. These findings suggest that PED may be a safe and effective option for patients with favorable Hunt and Hess grades and aneurysms difficult to treat with conventional methods.

Safety and efficacy of the Pipeline Embolization Device in 100 small intracranial aneurysms.

OBJECT Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PED in small aneurysms. The purpose of this study was to assess the safety and efficacy of the PED in small aneurysms (≤ 7 mm). METHODS A total of 100 consecutive patients were treated with the PED at the authors' institution between May 2011 and September 2013. Data on procedural safety and efficacy were retrospectively collected. RESULTS The mean aneurysm size was 5.2 ± 1.5 mm. Seven patients (7%) had sustained a subarachnoid hemorrhage. All except 5 aneurysms (95%) arose from the anterior circulation. The number of PEDs used was 1.2 per aneurysm. Symptomatic procedure-related complications occurred in 3 patients (3%): 1 distal parenchymal hemorrhage that was managed conservatively and 2 ischemic events. At the latest follow-up (mean 6.3 months), 54 (72%) aneurysms were completely occluded (100%), 10 (13%) were nearly completely occluded (≥ 90%), and 11 (15%) were incompletely occluded (< 90%). Six aneurysms (8%) required further treatment. Increasing aneurysm size (OR 3.8, 95% CI 0.99-14; p = 0.05) predicted retreatment. All patients achieved a favorable outcome (modified Rankin Scale Score 0-2) at follow-up. CONCLUSIONS In this study, treatment of small aneurysms with the PED was associated with low complication rates and high aneurysm occlusion rates. These findings suggest that the PED is a safe and effective alternative to conventional endovascular techniques for small aneurysms. Randomized trials with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and the best clinical outcomes.

Flow-diversion for ophthalmic segment aneurysms.

BACKGROUND: The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE: To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device (PED). METHODS: Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Patient's age, sex, mode of presentation, and aneurysm size were recorded. The complication rates, the need for retreatment (due to recurrence of the aneurysm or worsening symptoms), the aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. RESULTS: Forty-one patients harboring 44 OSA treated by flow-diversion were identified. Females constituted 87.80% (37/41) of the cohort. The mean age was 59.16 ± 12.54 years. At final angiographic follow-up, 77.27% (34/44) had complete occlusion, 6.81% (3/44) had near-complete occlusion, and 15.90% (7/44) had incomplete occlusion. Of the 22 symptomatic OSA, complete resolution or significant improvement was noted in 72.72% (16/22), while worsening of symptoms occurred in 4.54% (1/22). Five patients out of 22 (22.72%; 5/22) had no significant changes in their symptoms. The complication rate was 2.27% (1/44). The mortality rate was 0%. CONCLUSION: The low complication rate, the high obliteration rate, and the high rate of improvement in the visual symptoms make flow-diversion an appealing option for the treatment of OSA.

Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage.

OBJECTIVE: It is common practice to use a new contralateral bur hole for ventriculoperitoneal shunt (VPS) placement in subarachnoid hemorrhage (SAH) patients with an existing ventriculostomy. At Thomas Jefferson University and Jefferson Hospital for Neuroscience, the authors have primarily used the ventriculostomy site for the VPS. The purpose of this study was to compare the safety of the 2 techniques in patients with SAH. METHODS: The rates of VPS-related hemorrhage, infection, and proximal revision were compared between the 2 techniques in 523 patients undergoing VPS placement (same site in 464 and contralateral site in 59 patients). RESULTS: The rate of new VPS-related hemorrhage was significantly higher in the contralateral-site group (1.7%) than in the same-site group (0%; p = 0.006). The rate of VPS infection did not differ between the 2 groups (6.4% for same site vs 5.1% for contralateral site; p = 0.7). In multivariate analysis, higher Hunt and Hess grades (p = 0.05) and open versus endovascular treatment (p = 0.04) predicted shunt infection, but the VPS technique was not a predictive factor (p = 0.9). The rate of proximal shunt revision was 6% in the same-site group versus 8.5% in the contralateralsite group (p = 0.4). In multivariate analysis, open surgery was the only factor predicting proximal VPS revision (p = 0.05). CONCLUSIONS: The results of this study suggest that the use of the ventriculostomy site for VPS placement may be feasible and safe and may not add morbidity (infection or need for revision) compared with the use of a fresh contralateral site. This rapid and simple technique also was associated with a lower risk of shunt-related hemorrhage. While both techniques appear to be feasible and safe, a definitive answer to the question of which technique is superior awaits a higher level of medical evidence.

Fast-track programming and rehabilitation model: a novel approach to postoperative deep brain stimulation patient care.

OBJECTIVE: To propose a new model of integrated, multidisciplinary postoperative care of the patients with deep brain stimulation (DBS). DESIGN: Observational cohort study with follow-up at 3 months and 1 year. SETTING: Academic medical center movement disorder clinic. PARTICIPANTS: Seventy-three consecutive patients with medically refractory Parkinson's disease underwent bilateral DBS. Patients were then transferred directly to an inpatient rehabilitation facility. INTERVENTION: DBS and inpatient programming and rehabilitation. Simultaneous programming and rehabilitation was carried out by a multidisciplinary team. MAIN OUTCOME MEASURES: The FIM instrument, Unified Parkinson Disease Rating Scale (UPDRS), and levodopa dosage. RESULTS: The average rehabilitation stay was 17.3 days, with a mean of 6.2 stimulator adjustments during that time. FIM scores improved from 62.1 (admission) to 98.5 (discharge), an average improvement of 36.4 (58.6%). Average UPDRS scores improved from 52.5 (preoperative off) and 30.1 (preoperative on) to 20.4 (3mo postoperative on-medication, on-stimulation), a 32.2% improvement from the preoperative on score. Levodopa dosages decreased by an average of 48.3% (all P<.001). CONCLUSIONS: We describe our fast-track protocol, which allows for rapid DBS programming and tapering of Parkinson's medications. It also provides for treatment of concomitant medical and psychologic problems and optimized physical performance.