1
|
Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
2
|
Mangelsdorf I, Schröder K, Escher SE, Kolossa-Gehring M, Debiak M. Risk assessment for irritating chemicals - Derivation of extrapolation factors. Int J Hyg Environ Health 2020; 232:113668. [PMID: 33333487 DOI: 10.1016/j.ijheh.2020.113668] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
Irritation of the eyes and the upper respiratory tract are important endpoints for setting guide values for chemicals. To optimize the use of the often-limited data, we analysed controlled human exposure studies (CHS) with 1-4 h inhalation of the test substance, repeated dose inhalation studies in rodents, and Alarie-Tests and derived extrapolation factors (EF) for exposure duration, inter- and intraspecies differences. For the endpoint irritating effects in the respiratory tract in rodents, geometric mean (GM) values of 1.9 were obtained for the EF for subacute→subchronic (n = 16), 2.1 for subchronic→chronic (n = 40), and 2.9 for subacute→chronic (n = 10) extrapolation. Based on these data we suggest an EF of 2 for subchronic→chronic and of 4 for subacute→chronic extrapolation. In CHS, exposure concentration determines the effects rather than exposure duration. Slight reversible effects during 4 h exposure indicate that an EF of 1 can be considered for assessing chronic exposures. To assess species extrapolation, 10 chemicals were identified with both, reliable rat inhalation studies and CHS. The GM of the ratio between the No Observed Adverse Effect Concentration (NOAEC) in rats and humans was 2.3 and increased to 3.6 when expanding the dataset to all available EF (n = 25). Based on these analyses, an EF of 3 is suggested to extrapolate from a NOAEC in a chronic rat study to a NOAEC in a CHS. The analysis of EFs for the extrapolation from a 50% decrease in respiratory frequency in the Alarie test in mice (RD50) to a NOAEC in a CHS resulted in a GM of 40, for both, the reliable (n = 11) and the overall dataset (n = 19). We propose to use the RD50 from the Alarie test for setting guide values and to use 40 as EF. Efs for intraspecies differences in the human population must account for susceptible persons, most importantly for persons with chemical intolerance (CI), who show subjective signs of irritation at low concentrations. The limited data available do not justify to deviate from an EF of 10 - 20 as currently used in different regulatory settings.
Collapse
Affiliation(s)
- Inge Mangelsdorf
- Toxicology Consulting, Hamburg, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.
| | - Katrin Schröder
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Sylvia E Escher
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | | | | |
Collapse
|
3
|
Nordin S. Mechanisms underlying nontoxic indoor air health problems: A review. Int J Hyg Environ Health 2020; 226:113489. [DOI: 10.1016/j.ijheh.2020.113489] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
|
4
|
Sprays purificateurs de l’air intérieur, état des connaissances. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/j.actpha.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_23-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Steinemann A. Health and societal effects from exposure to fragranced consumer products. Prev Med Rep 2016; 5:45-47. [PMID: 27896043 PMCID: PMC5122698 DOI: 10.1016/j.pmedr.2016.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/05/2016] [Accepted: 11/12/2016] [Indexed: 11/24/2022] Open
Abstract
Fragranced consumer products—such as air fresheners, cleaning supplies, and personal care products— pervade society. This study investigated the occurrence and types of adverse effects associated with exposure to fragranced products in Australia, and opportunities for prevention. Data were collected in June 2016 using an on-line survey with a representative national sample (n = 1098). Overall, 33% of Australians report health problems, such as migraine headaches and asthma attacks, when exposed to fragranced products. Of these health effects, more than half (17.1%) could be considered disabling under the Australian Disability Discrimination Act. Additionally, 7.7% of Australians have lost workdays or a job due to illness from fragranced product exposure in the workplace, 16.4% reported health problems when exposed to air fresheners or deodorizers, 15.3% from being in a room after it was cleaned with scented products, and 16.7% would enter but then leave a business as quickly as possible due to fragranced products. About twice as many respondents would prefer that workplaces, health care facilities and professionals, hotels, and airplanes were fragrance-free rather than fragranced. While 73.7% were not aware that fragranced products, even ones called green and organic, emitted hazardous air pollutants, 56.3% would not continue to use a product if they knew it did. This is the first study in Australia to assess the extent of adverse effects associated with exposure to common fragranced products. It provides compelling evidence for the importance and value of reducing fragranced product exposure in order to reduce and prevent adverse health effects and costs. One-third of the Australian population report adverse health effects from fragranced products. Common effects include respiratory problems, migraine headaches, and asthma attacks. Fragranced products resulted in lost workdays and jobs, and restricted access in society. About twice as many people would prefer fragrance-free rather than fragranced indoor environments Over 70% were not aware that fragranced products emitted hazardous air pollutants.
Collapse
|
7
|
Delmas C, Weiler AS, Ortega S, Duong O, Dazy A, Ott M, Schneider C, Moritz R, Leclerc N, Rivière E, de Blay F. Mesure de la concentration aérienne de COV terpéniques (dont le limonène) selon plusieurs procédures lors de pulvérisations d’un mélange d’huiles essentielles. REVUE FRANCAISE D ALLERGOLOGIE 2016. [DOI: 10.1016/j.reval.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Criteria for the Research Institute for Fragrance Materials, Inc. (RIFM) safety evaluation process for fragrance ingredients. Food Chem Toxicol 2015; 82 Suppl:S1-S19. [DOI: 10.1016/j.fct.2014.11.014] [Citation(s) in RCA: 1123] [Impact Index Per Article: 124.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022]
|
9
|
Vethanayagam D, Vliagoftis H, Mah D, Beach J, Smith L, Moqbel R. Fragrance materials in asthma: a pilot study using a surrogate aerosol product. J Asthma 2013; 50:975-82. [PMID: 23829679 DOI: 10.3109/02770903.2013.822079] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Many household products contain fragrances. Little is known about exposure to fragrances on human health, particularly within the airways. This study aimed to evaluate how common household fragrance products (i.e. air fresheners, cleaning products) affect people with asthma, who frequently report sensitivity to these products. Many of these products have volatile organic compounds or semi-volatile organic compounds. This study evaluated nine fragrance materials in an aerosol formulation to assess effects on airway physiology, airway inflammation and symptom perception in normal controls and those with asthma. METHODS The effects of fragrances were evaluated in people without asthma, people with mild asthma and people with moderate asthma in a four-way crossover placebo-controlled study. Subjects were exposed twice to a fragranced aerosol and twice to a placebo aerosol (15 and 30 min each). Subjects completed a questionnaire for 29 symptoms during and up to 3 h after each exposure scenario. Spirometry was performed prior to and 3 h post-exposure; sputum induction was conducted 3 h post-exposure. RESULTS Nasal symptoms showed the greatest frequency of response in all three subject groups, and moderate asthmatics reported the greatest symptom severity and symptom types. No significant differences were noted in physiology or cellular inflammation. CONCLUSION A trend for increased symptoms was noted in moderate asthmatics, suggesting that asthma severity may play a factor in fragrance sensitivity.
Collapse
|
10
|
Laird K, Phillips C. Vapour phase: a potential future use for essential oils as antimicrobials? Lett Appl Microbiol 2012; 54:169-74. [PMID: 22133088 DOI: 10.1111/j.1472-765x.2011.03190.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Essential oil (EO) vapours have been known for their antimicrobial properties since the 4th century B.C.; however, it was not until the early 1960s that research into the potential of these volatile oils was explored. More recently, the use of EOs such as tea tree, bergamot, lavender and eucalyptus in vapour form has been shown to have antimicrobial effects against both bacteria and fungi, with range of methods being developed for dispersal and efficacy testing. To date, many applications for EO vapours as antimicrobials have been identified including in the food and clinical arenas.
Collapse
Affiliation(s)
- K Laird
- The Leicester School of Pharmacy, Faculty of Health and Life Sciences, Hawthorn Building, De Montfort University, Leicester, UK.
| | | |
Collapse
|
11
|
Tyagi AK, Malik A. Bactericidal action of lemon grass oil vapors and negative air ions. INNOV FOOD SCI EMERG 2012. [DOI: 10.1016/j.ifset.2011.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Widdicombe J, Tatar M, Fontana G, Hanacek J, Davenport P, Lavorini F, Bolser D. Workshop: tuning the 'cough center'. Pulm Pharmacol Ther 2011; 24:344-52. [PMID: 21215322 DOI: 10.1016/j.pupt.2010.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 12/28/2010] [Indexed: 01/10/2023]
Abstract
The Workshop considered the mechanisms whereby the 'cough center' could be tuned by various afferent inputs. There were particular presentations on the effects of inputs from the nose, mouth, respiratory tract and lungs, cerebral cortex, somatic tissues and the pharynx. From all these sites cough induced from the lungs could be increased or decreased in its strength or modified in its pattern. Thus 'tuning' of cough could be due to the interaction of afferent inputs, or to the sensitization or desensitization of brainstem neural pathways. The pattern of response depended on the 'type' of cough being studied and, in some instances, on the timing of the sensory input into the brainstem. Cough inputs could also affect various 'non-cough' motor outputs from the brain, although this was not the main theme of the Workshop. The main conclusion was that cough is not a stereotyped output from the medullary 'cough center', but that its pattern and strength depend on many afferent inputs acting on the 'cough center'.
Collapse
Affiliation(s)
- J Widdicombe
- University of London, 116 Pepys Road, London SW20 8NY, UK.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2011. [DOI: 10.1007/978-3-642-03827-3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
14
|
Schnabel E, Schoefer Y, Chen CM, Schäfer T, Behrendt H, Ring J, Wichmann HE, Heinrich J. Sensitization to contact allergens and bronchial hyper-responsiveness. Contact Dermatitis 2010; 63:157-63. [PMID: 20690939 DOI: 10.1111/j.1600-0536.2010.01772.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exposure to contact allergens and specific allergic sensitization to them are common, but possible related health effects have been rarely studied. OBJECTIVES We aimed to analyse possible associations between contact sensitization to nickel sulfate and fragrance mix I and lung function parameters or bronchial hyper-responsiveness. METHODS Within a population-based study in Augsburg, 1052 adults performed lung function tests, including forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC) and bronchial hyper-responsiveness (BHR). Patch tests were performed, and information was assessed by medical examinations and interviews. Logistic regression models were applied to study associations between contact allergies and lung function parameters. RESULTS Women were sensitized significantly more often than men to nickel [odds ratio (OR) 3.97, 95% confidence interval (CI) 2.50-6.29] and fragrance mix I (OR 2.28, 95% CI 1.50-3.46). Patch test results for nickel and fragrance mix I did not influence mean FEV(1) and FVC % predicted values. However, in women, a higher rate of BHR was associated with positive patch test reactions to fragrance mix I (OR 2.24, 95% CI 1.11-4.52). CONCLUSIONS Contact sensitization to fragrance mix I is associated with a higher rate of BHR in women. Thus, in women with contact allergy to fragrances, airway obstruction should be considered as a possible co-morbidity.
Collapse
Affiliation(s)
- Eva Schnabel
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Responsibility for obtaining the surgical informed consent. AORN J 2010; 92:585-6. [PMID: 21040823 DOI: 10.1016/j.aorn.2010.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 08/31/2010] [Indexed: 11/24/2022]
|
16
|
Larsson C, Mårtensson L. Experiences of problems in individuals with hypersensitivity to odours and chemicals. J Clin Nurs 2010; 18:737-44. [PMID: 19239540 DOI: 10.1111/j.1365-2702.2008.02599.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of the study was to describe how individuals with hypersensitivity to odours and chemicals handle their problems. BACKGROUND One group of patients we often encounter consists of those with upper and lower respiratory problems who also have a pronounced sensitivity to odours and chemicals. Earlier studies have shown that these symptoms can be related to sensory hyperreactivity (SHR). This hyperreactivity is characterised by respiratory tract symptoms triggered by odours and chemicals, along with high sensitivity to inhaled capsaicin and a positive score on the chemical sensitivity scale for SHR. However, there is still a lack of studies in which SHR sufferers describe their situations in their own words. DESIGN The study was conducted using a qualitative approach. METHODS Eight individuals with confirmed SHR were selected from a population-based epidemiological study and interviewed. A qualitative content analysis was performed on the data. RESULTS Four themes emerged from the data analysis: Limitations in one's life situation, Lack of understanding from others, Concern that the symptoms will develop into a serious disease and Disparagement of one's own personal experience. The results show how individuals manage their daily lives with the help of various strategies, how they relate to other people, how they cope with their concerns and the fact that they sometimes choose to disparage their own experience of their problems. CONCLUSION The results indicate that people with SHR experience limitations in their life situations. These limitations consist of the adjustments they make to avoid triggering factors. RELEVANCE TO CLINICAL PRACTICE To improve care, nurses need to know how people experience SHR and how they cope with their hypersensitivity to odours and chemicals.
Collapse
Affiliation(s)
- Christel Larsson
- Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden
| | | |
Collapse
|
17
|
Ternesten-Hasséus E, Larsson C, Bende M, Millqvist E. Capsaicin provocation using two different inhalation devices. Respir Med 2008; 102:1784-90. [PMID: 18703328 DOI: 10.1016/j.rmed.2008.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 06/03/2008] [Accepted: 06/27/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sensory hyperreactivity (SHR) has been suggested as one explanation for chemically induced airway symptoms; it can be diagnosed with a capsaicin inhalation test. Previous capsaicin inhalation studies of SHR have used a Pari Boy device. This model of inhalator device has become outdated, hence it is necessary to abandon it in favour of a new device. The aim of this study was to transfer the capsaicin inhalation test using the Pari Boy device to a corresponding model using the Maxin MA3 device. METHODS Twenty-one patients with SHR and 44 healthy controls visited the clinic twice and underwent a randomised protocol. The participants were provoked with saline and capsaicin using one of two devices, Pari Boy and Maxin MA3. Eight patients also underwent two additional capsaicin provocations with Maxin MA3. A new series of capsaicin concentrations was chosen for Maxin MA3. The results from each device were analysed, the agreement between the two devices and the repeatability of the Maxin MA3 were evaluated. RESULTS Among all participants, the mean number of coughs with the Pari Boy was 5.5 (95% CI: 2.7; 8.2) after inhalation of 0.4 micromol/L capsaicin and 20.0 (95% CI: 14.1; 25.9) after 2.0 micromol/L. With the Maxin MA3, the mean number of coughs was 3.6 (95% CI: 1.3; 4.0) after 0.06 micromol/L capsaicin, and 17.8 (95% CI: 12.0; 23.6) after 0.3 micromol/L. The Maxin MA3 showed good repeatability and the agreement between the devices with the capsaicin concentrations chosen for each device was considered to be good.
Collapse
Affiliation(s)
- Ewa Ternesten-Hasséus
- Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
| | | | | | | |
Collapse
|
18
|
Shedd AD, Peters JI, Wood P, Inscore S, Forkner E, Smith B, Galbreath AD. Impact of home environment characteristics on asthma quality of life and symptom scores. J Asthma 2007; 44:183-7. [PMID: 17454335 DOI: 10.1080/02770900701209699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We explore the relationship between home-based triggers, asthma symptoms, and quality of life (QOL) with data from 177 adult and pediatric participants who received a home environmental assessment. Outcomes included the Asthma Quality of life Questionnaire, the Prediatric Asthma Quality of Life Questionnaire, the Paediatric Asthma Caregiver's Quality of Questionnaires and the Lara Asthma Symptom Scale. The absence of roaches and the use of dust mite covers were positively associated with QOL in pediatric and adult participants. Frequent bed sheet washing was associated with increased symptoms and decreased quality of life in adults and caregivers of pediatric participants. These findings confirm existing wisdom on roaches and dust mite covers and raise important questions about bed sheet washing recommendations.
Collapse
Affiliation(s)
- Angela D Shedd
- University of Texas Health Science Center at San Antonio, TX 78229, USA.
| | | | | | | | | | | | | |
Collapse
|
19
|
Elberling J, Duus Johansen J, Dirksen A, Mosbech H. Exposure of eyes to perfume: a double-blind, placebo-controlled experiment. INDOOR AIR 2006; 16:276-81. [PMID: 16842608 DOI: 10.1111/j.1600-0668.2006.00424.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Environmental perfume exposure can elicit bothersome respiratory symptoms. Symptoms are induced at exposure levels which most people find tolerable, and the mechanisms are unclear. The aim of the study was to investigate patients with eye and respiratory symptoms related to environmental perfume, by exposing the eyes to perfume in a double-blind, placebo-controlled study.Twenty-one eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case-control study. The participants completed a symptom questionnaire, and underwent a double-blind, placebo-controlled exposure to perfume. Of the 42 individuals tested, 10 had more eye symptoms (irritation, itching, and tears) during perfume exposure than during placebo exposures, and eight of these individuals (P = 0.07, Fisher's exact test) belonged to the patient group. A true positive eye reaction to perfume was significantly associated with identification of perfume as an active exposure (P < 0.05). In this study, vapor of perfume elicited irritation in the eyes independently of olfaction, but the relative importance of ocular chemoperception in relation to elicitation of respiratory symptoms from common environmental exposures to perfume remains unclear. We investigated the hypothesis of an association between respiratory symptoms related to perfume and ocular perfume sensitivity by exposing the eyes to perfume in a double blind, placebo-controlled experiment. Vapors of perfume provoked symptoms in the relevant eye in some patients and healthy control persons, but under our exposure conditions, ocular chemesthesis failed to elicit respiratory symptoms.
Collapse
Affiliation(s)
- J Elberling
- The National Allergy Research Centre, Gentofte University Hospital, Gentofte, Denmark.
| | | | | | | |
Collapse
|
20
|
Griffiths DE. Psi-Screen, an In Vitro Toxicity Test System: Applications in the Bioassay of Perfumes and Fragrance Chemicals. Altern Lab Anim 2005; 33:471-86. [PMID: 16268759 DOI: 10.1177/026119290503300506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The effects of 65 perfume formulations (perfume oils, perfumes, eau de parfum, eau de toilette) on mitochondrial membrane potential (ΔΨm) and mitochondrial respiration have been investigated using a mitochondria-based assay for ΔΨm, termed Psi-Screen. All the perfume formulations tested are highly active in the Psi-Screen assay, and the major site of inhibition in all cases is NADH-ubiquinone reductase (Complex I). This is confirmed in studies on the inhibition of NADH oxidase and NADH-ubiquinone reductase. Some formulations also inhibit succinate oxidation at either Complex II or Complex III. Evidence for the inhibition of mitochondrial ATPase is presented, as well as for the induction of reactive oxygen species production by perfume inhibition of Complex I. Thus, perfume formulations are multiple inhibitor mixtures which inhibit multiple bioenergetic functions at high dilutions (103 to 7 × 104). The implications of these findings are discussed with respect to cell toxicity via necrosis and/or apoptosis. Twenty candidate fragrance chemicals were investigated and all inhibited Complex I (5 at < 35μM). Mass screening strategies and high-throughput screening assays are discussed.
Collapse
Affiliation(s)
- David E Griffiths
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL, UK.
| |
Collapse
|
21
|
Joffres MR, Sampalli T, Fox RA. Physiologic and symptomatic responses to low-level substances in individuals with and without chemical sensitivities: a randomized controlled blinded pilot booth study. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:1178-83. [PMID: 16140624 PMCID: PMC1280398 DOI: 10.1289/ehp.7198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We conducted a pilot study using a randomized, single-blind, placebo-controlled exposure among 10 individuals with and 7 without reported chemical sensitivities in a dedicated testing chamber. Objectives of the study were to explore the length of the adaptation period to obtain stable readings, evaluate responses to different substances, and measure the level and type of symptomatic and physiologic reactions to low-level exposures. Reported and observed symptoms, electrodermal response, heart rate, skin temperature, surface electromyogram, respiratory rate, contrast sensitivity, and the Brown-Peterson cognitive test were used and compared between cases and controls and between test substances (glue, body wash solution, dryer sheet) and control substances (unscented shampoo and clean air). Subjects with chemical sensitivities (cases) took longer to adapt to baseline protocols than did controls. After adaptation, despite small study numbers, cases displayed statistically significant responses (all measures, p < 0.02) in tonic electrodermal response to test substances compared with controls and compared with the control substance. Symptoms were also higher in cases than in controls for the body wash solution (p = 0.05) and dryer sheets (p = 0.02). Test-retest showed good agreement for both symptoms and tonic electrodermal responses (McNemar's test, p = 0.32 and p = 0.33, respectively). Outside of skin conductance, other measures had no consistent patterns between test and control substances and between cases and controls. This study shows the importance of using an adaptation period in testing individuals with reported chemical sensitivities and, despite small numbers, raises questions about underlying mechanisms and level of reactivity to low-level chemical exposures in sensitive individuals.
Collapse
Affiliation(s)
- Michel R Joffres
- Nova Scotia Environmental Health Centre, Fall River, Nova Scotia, Canada.
| | | | | |
Collapse
|
22
|
Elberling J, Linneberg A, Dirksen A, Johansen JD, Frølund L, Madsen F, Nielsen NH, Mosbech H. Mucosal symptoms elicited by fragrance products in a population-based sample in relation to atopy and bronchial hyper-reactivity. Clin Exp Allergy 2005; 35:75-81. [PMID: 15649270 DOI: 10.1111/j.1365-2222.2005.02138.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to perfume and fragrance products may, in some individuals, cause symptoms from the eyes and airways. The localization, character and risk factors of such symptoms in the general population are unknown. OBJECTIVE To investigate both the localization and character of symptoms from the eyes and airways elicited by fragrance products, and the associations between such symptoms and skin prick test reactivity (atopy), methacholine bronchial hyper-reactivity (BHR), allergic rhinitis and asthma. METHODS A questionnaire on mucosal symptoms elicited by fragrance products was posted to 1189 persons who had participated in a Danish population-based study of allergic diseases in 1997/1998. The study included measurement of BHR, atopy, forced expiratory volume in 1 s (FEV1), and serum eosinophilic cationic protein (serum ECP). RESULTS The response rate was 79.6%. Symptoms from the eyes or airways elicited by fragrance products were reported by 42%. BHR (adjusted odds ratio 2.3, 95% confidence interval 1.5-3.5) was independently associated with symptoms from the eyes and airways elicited by fragrance products. There were no significant associations between these symptoms and atopy, FEV1 or serum ECP. CONCLUSIONS Mucosal symptoms from the eyes and airways were common in this population. BHR was a significant and independent predictor of these symptoms. The lack of association with atopy suggested that IgE-mediated allergic mechanisms do not play a major role in the development of these symptoms.
Collapse
Affiliation(s)
- J Elberling
- The National Allergy Research Centre, Gentofte University Hospital, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Sherriff A, Farrow A, Golding J, Henderson J. Frequent use of chemical household products is associated with persistent wheezing in pre-school age children. Thorax 2005; 60:45-9. [PMID: 15618582 PMCID: PMC1747149 DOI: 10.1136/thx.2004.021154] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In the UK and other developed countries the prevalence of asthma symptoms has increased in recent years. This is likely to be the result of increased exposure to environmental factors. A study was undertaken to investigate the association between maternal use of chemical based products in the prenatal period and patterns of wheeze in early childhood. METHODS In the population based Avon Longitudinal Study of Parents and Children (ALSPAC), the frequency of use of 11 chemical based domestic products was determined from questionnaires completed by women during pregnancy and a total chemical burden (TCB) score was derived. Four mutually exclusive wheezing patterns were defined for the period from birth to 42 months based on parental questionnaire responses (never wheezed, transient early wheeze, persistent wheeze, and late onset wheeze). Multinomial logistic regression models were used to assess the relationship between these wheezing outcomes and TCB exposure while accounting for numerous potential confounding variables. Complete data for analysis was available for 7019 of 13, 971 (50%) children. RESULTS The mean (SD) TCB score was 9.4 (4.1), range 0-30. Increased use of domestic chemical based products was associated with persistent wheezing during early childhood (adjusted odds ratio (OR) per unit increase of TCB 1.06 (95% confidence interval (CI) 1.03 to 1.09)) but not with transient early wheeze or late onset wheeze. Children whose mothers had high TCB scores (>90th centile) were more than twice as likely to wheeze persistently throughout early childhood than children whose mothers had a low TCB score (<10th centile) (adjusted OR 2.3 (95% CI 1.2 to 4.4)). CONCLUSION These findings suggest that frequent use of chemical based products in the prenatal period is associated with persistent wheezing in young children. Follow up of this cohort is underway to determine whether TCB is associated with wheezing, asthma, and atopy at later stages in childhood.
Collapse
Affiliation(s)
- A Sherriff
- Unit of Paediatric and Perinatal Epidemiology, Division of Child Health, University of Bristol, Bristol BS8 1BR, UK.
| | | | | | | |
Collapse
|
24
|
Nordin S, Martinkauppi M, Olofsson J, Hummel T, Millqvist E, Bende M. Chemosensory perception and event-related potentials in self-reported chemical hypersensitivity. Int J Psychophysiol 2005; 55:243-55. [PMID: 15649555 DOI: 10.1016/j.ijpsycho.2004.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Revised: 07/28/2004] [Accepted: 08/03/2004] [Indexed: 11/18/2022]
Abstract
Anormal chemosensory perception has been identified as a possible mechanism underlying odor intolerance, but research in this domain has yet been rather limited. The main objective of the present study was to investigate total perceived intensity, unpleasantness, sensory irritation, and cortical activity assessed with chemosensory event-related potentials (ERPs) for three concentrations of pyridine ranging from predominantly olfactory to trigeminal in activation. Results from 19 individuals with self-reported chemical hypersensitivity and 19 controls with self-reported normal chemical sensitivity show that the hypersensitive group, compared to controls, rated the pyridine stimuli to be more intense and unpleasant, and that these group differences increased with pyridine concentration. Sensory irritation was also the perceptual dimension found to correlate strongest with score on the chemical sensitivity scale. However, no group differences were found in ERP amplitudes or latencies. These findings suggest that self-reported chemical hypersensitivity (1) can be associated with anormal chemosensory perception, (2) may be more closely related to trigeminal function than to olfaction, and (3) has a neural basis at a higher cortical level than that captured by chemosensory ERPs.
Collapse
Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
| | | | | | | | | | | |
Collapse
|
25
|
Nordin S, Millqvist E, Löwhagen O, Bende M. A short Chemical Sensitivity Scale for assessment of airway sensory hyperreactivity. Int Arch Occup Environ Health 2004; 77:249-54. [PMID: 15024570 DOI: 10.1007/s00420-004-0504-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2003] [Accepted: 01/16/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES A short version of the 21-item Chemical Sensitivity Scale (CSS), called the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), was developed and evaluated for the quantifying of self-reported affective reactions to and behavioral disruptions in daily activities by odorous/pungent substances among patients with sensory hyperreactivity (SHR) for clinical and epidemiological studies. METHODS Twenty-two patients with clinically diagnosed SHR and 124 control participants responded to the CSS and to additional questions about chemical sensitivity for the evaluation of the CSS-SHR. RESULTS Eleven of the 21 items of the CSS were selected, on statistical grounds, to constitute the CSS-SHR, which was found to generate approximately normal distributions, have good test-retest reliability (r(xy)=0.87), satisfying internal consistency (r(alpha)=0.76-0.84) and predictive and concurrent validity, and to be uni-dimensional. The metric properties of the CSS-SHR were, despite its few items, comparable with those of the CSS. A proposed diagnostic cut-off score for SHR demonstrated a high correct classification rate (92%) for the CSS-SHR. CONCLUSIONS The favorable metric properties of the CSS-SHR and its sensitivity/specificity suggests that it is useful for clinical diagnosis and epidemiological study of sensory hyperreactivity in combination with other diagnostic tools.
Collapse
Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, 901 87, Umeå, Sweden.
| | | | | | | |
Collapse
|
26
|
Opiekun RE, Smeets M, Sulewski M, Rogers R, Prasad N, Vedula U, Dalton P. Assessment of ocular and nasal irritation in asthmatics resulting from fragrance exposure. Clin Exp Allergy 2003; 33:1256-65. [PMID: 12956748 DOI: 10.1046/j.1365-2222.2003.01753.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many asthmatics report worsening of symptoms following exposure to odours and sensory irritants commonly found in household and cosmetic products. Despite this, little evidence exists to confirm the degree to which such subjective reports are correlated with localized, objective changes in the upper or lower airways following a fragranced product exposure. OBJECTIVE Subjective symptom reports were compared to objective measures in mild asthmatics, moderate asthmatics and non-asthmatics following exposure to one of two fragranced household aerosol mixtures and a clean air control condition to determine if asthmatics reported greater subjective symptoms of nasal congestion or exhibited objective measures of elevated ocular irritation and nasal congestion following exposure than did healthy controls. METHODS Measures of nasal mucosal swelling, using acoustic rhinometry, and photographic assessments of ocular hyperemia, using macro-photography, were taken before exposure, immediately after an initial 5-min exposure and again following a 30-min exposure to either of two, fragranced aerosol products and a clean air control. Self-reports of nasal patency at each time-point were also obtained. RESULTS Although moderate asthmatics tended to report more nasal congestion following fragranced product exposure than did non-asthmatics, no exposure-related changes in ocular redness or nasal mucosal swelling were observed among the three groups. Spirometry readings also failed to show evidence of any exposure-related changes in pulmonary function. CONCLUSION Despite claims that exposure to fragranced products may trigger ocular and respiratory symptoms among asthmatics, we found no evidence that 30 min of exposure to one of two fragranced aerosols elicited objective adverse effects in the ocular or nasal mucosa of mild and moderate asthmatics. While physiological mechanisms of fragrance impact may yet be responsible for some of the adverse reports among asthmatics following fragrance exposure, such reports may also reflect a non-physiological locus of symptom perception triggered by other sensory cues.
Collapse
Affiliation(s)
- R E Opiekun
- Monell Chemical Senses Center, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Anderson RC, Anderson JH. Acute toxicity of marking pen emissions. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2003; 66:829-845. [PMID: 12746130 DOI: 10.1080/15287390306380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To evaluate complaints of adverse reactions to marking pen emissions, groups of mice were exposed for 1 h to the emissions of 8 brands of felt-tip markers or white-board cleaner. Pneumotachographs and a computerized version of ASTM E-981 test method were used to measure changes in respiration. Sensory irritation (SI), pulmonary irritation (PI), and/or air flow limitation (AFL) of differing intensities were documented with each of the eight brands tested. At the peak of the effects, the largest SI was observed with pen F (72% of the breaths); the largest PI occurred with pen D (13% of the breaths), and the largest AFL was seen with pen F (25% of the breaths). Pens G and H produced minimal SI, PI, or AFL. A functional observational battery was used to screen for signs of neurotoxicity. Emissions from all eight of the pens produced behavioral abnormalities such as altered posture and gait, tremors, falling, and hyperactivity. The exposure concentrations were similar to the total volatile organic compounds (TVOC) values near marking pens in actual use. Gas chromatography identified mixtures of alcohols, acetates, and/or ketones. Exposures to white-board cleaner solution resulted in similar toxicity ( SI, PI, AFL, and neurotoxicity). These results document that some marking pens and white-board cleaner emit mixtures of chemicals that can produce acute respiratory toxicity and acute behavioral abnormalities in normal mice. These results provide a toxicological explanation for some of the human complaints concerning respiratory and neurological reactions to marking pen emissions.
Collapse
|
28
|
|
29
|
Smith S, Sullivan K. Examining the influence of biological and psychological factors on cognitive performance in chronic fatigue syndrome: a randomized, double-blind, placebo-controlled, crossover study. Int J Behav Med 2003; 10:162-73. [PMID: 12763708 DOI: 10.1207/s15327558ijbm1002_05] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; however, both biological and psychological factors have been implicated in establishing or maintaining this condition. People with CFS report significant and disabling cognitive difficulties such as impaired concentration that in some cases are exacerbated by exposure to chemical triggers. The aim of this study was to determine if neuropsychological deficits in CFS are triggered by exposure to chemicals, or perceptions about the properties of these substances. Participants were 36 people with a primary diagnosis of CFS, defined according to Centers for Disease Control (CDC) criteria. A randomized, double-blind, placebo-controlled, crossover design was used, with objective assessment of neuropsychological function and participant rating of substance type, before and after exposure to placebo or chemical trigger. Results showed decrements in neuropsychological tests scores on three out of four outcome measures when participants rated the substance they had been exposed to as "chemical." No change in performance was found based on actual substance type. These results suggest that cognitive attributions about exposure substances in people with CFS may be associated with worse performance on neuropsychological tasks. In addition, these findings suggest that psychological interventions aimed at modifying substance-related cognitions may reduce some symptoms of CFS.
Collapse
Affiliation(s)
- Simon Smith
- University of Queensland, Australia; Karen Sullivan, Queensland University of Technology, Australia.
| | | |
Collapse
|
30
|
Johansson A, Löwhagen O, Millqvist E, Bende M. Capsaicin inhalation test for identification of sensory hyperreactivity. Respir Med 2002; 96:731-5. [PMID: 12243320 DOI: 10.1053/rmed.2002.1340] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with upper and lower airway symptoms and with pronounced sensitivity to chemical odours, such as perfumes, flower scents and tobacco smoke, have been suggested to have sensory hyperreactivity (SHR). The symptoms have been difficult to identify with physiological measurements and the effects of various medications are doubtful. However, these patients have been found to be more sensitive to inhalation of capsaicin than healthy people. The aim of this study was to establish limit values with the capsaicin inhalation test in patients with SHR. METHODS Ninety-five consecutive patients with upper and lower airway problems, who were admitted for allergy testing, underwent a capsaicin inhalation test with three different concentrations. The number of coughs was registered during each challenge. Score systems were used for symptoms and influence on social life of sensitivity to odours. In relation to scored symptoms, the patients were grouped as SHR or not, and compared with 73 healthy controls. RESULTS All patients and controls coughed on capsaicin in a dose-dependent manner. Symptom score of odour sensitivity in patients was positively correlated to the response of the test. Out of 95 patients, 15 (16%) were scored to SHR. Patients with SHR reacted more to the capsaicin inhalation test than the other patients and the healthy controls. The limit values for a positive capsaicin inhalation test for the SHR were determined to be 10, 35 and 55 coughs at 0.4, 2.0 and 10 microM capsaicin, respectively. CONCLUSION The capsaicin inhalation test well reflects the degree of airway sensitivity to chemicals and to what extent the social life is influenced. The cut-off values of the test can distinguish patients with pronounced sensitivity to odours.
Collapse
Affiliation(s)
- A Johansson
- Allergy Centre, Central Hospital, Skövde, Sweden.
| | | | | | | |
Collapse
|
31
|
Abstract
The holdings of eight collections of fungi have been examined for organisms isolated from wood and/or trees. Further selection of these fungi has been made according to their reported ability to produce volatile, biologically active metabolites. It is emphasized that the isolates in the collections do not necessarily produce such metabolites. The list of fungi fulfilling these conditions is slightly augmented by reports we have found in the literature, where the fungi concerned have not yet been deposited. The biochemistry of these compounds is considered with particular emphasis on their biosynthesis including that by Homo sapiens. The physiological and toxicological activity of these metabolites is reviewed especially with reference to their potential role in the complex symbioses existent in, for example, a tree. The review concludes with a discussion of areas of botany deserving increased attention in the hope that this will stimulate further work. The statements in the review are based on 173 references.
Collapse
|
32
|
|
33
|
Wieslander G, Norbäck D, Lindgren T. Experimental exposure to propylene glycol mist in aviation emergency training: acute ocular and respiratory effects. Occup Environ Med 2001; 58:649-55. [PMID: 11555686 PMCID: PMC1740047 DOI: 10.1136/oem.58.10.649] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Propylene glycol (PG) (1-2 propanediol; CAS No 57-55-6) is a low toxicity compound widely used as a food additive, in pharmaceutical preparations, in cosmetics, and in the workplace-for example, water based paints, de-icing fluids, and cooling liquids. Exposure to PG mist may occur from smoke generators in discotheques, theatres, and aviation emergency training. Propylene glycol may cause contact allergy, but there is sparse information on health effects from occupational exposure to PG. METHODS Non-asthmatic volunteers (n=27) were exposed in an aircraft simulator to PG mist over 1 minute, during realistic training conditions. Geometric mean concentration of PG was 309 mg/m3 (range 176-851 mg/m3), with the highest concentrations in the afternoon. The medical investigation was performed both before and after the exposure (within 15 minutes). It included an estimate of tear film stability break up time, nasal patency by acoustic rhinometry, dynamic spirometry, and a doctor's administered questionnaire on symptoms. RESULTS After exposure to PG mist for 1 minute tear film stability decreased, ocular and throat symptoms increased, forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) was slightly reduced, and self rated severity of dyspnoea was slightly increased. No effect was found for nasal patency, vital capacity (VC), FVC, nasal symptoms, dermal symptoms, smell of solvent, or any systemic symptoms. Those exposed to the higher concentrations in the afternoon had a more pronounced increase of throat symptoms, and a more pronounced decrease of tear film stability. In four subjects who reported development of irritative cough during exposure to PG, FEV1 was decreased by 5%, but FEV1 was unchanged among those who did not develop a cough. Those who developed a cough also had an increased perception of mild dyspnoea. CONCLUSION Short exposure to PG mist from artificial smoke generators may cause acute ocular and upper airway irritation in non-asthmatic subjects. A few may also react with cough and slight airway obstruction.
Collapse
Affiliation(s)
- G Wieslander
- Department of Medical Sciences/Occupational and Environmental Medicine, Uppsala University, University Hospital, S-751 85, Uppsala, Sweden.
| | | | | |
Collapse
|
34
|
Millqvist E, Löwhagen O, Bende M. Quality of life and capsaicin sensitivity in patients with sensory airway hyperreactivity. Allergy 2000; 55:540-5. [PMID: 10858984 DOI: 10.1034/j.1398-9995.2000.00514.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A group of patients with asthma-like symptoms and sensitivity to chemical irritants has shown an increased cough sensitivity to inhaled capsaicin compared to patients with asthma and to healthy controls. The condition is called sensory hyperreactivity (SHR), and the patients often feel that they are socially handicapped because of the risk of exposure to chemical irritants in daily life. METHODS Twenty-six patients with asthma-like symptoms after exposure to nonspecific irritating stimuli, but without IgE-mediated allergy or demonstrable bronchial obstruction, were selected for a study of the response to a capsaicin test and measurement of quality of life by a general health profile (the Nottingham Health Profile [NHP]). We also investigated whether there was a correlation between quality of life and sensitivity to capsaicin. RESULTS The patients demonstrated a dose-dependent response to the capsaicin provocation, with coughing and respiratory and other symptoms, that significantly differed from 12 healthy controls. The health profile showed that patients with SHR had a significantly reduced quality of life compared to reference values, and there was a significant correlation between the health profile and sensitivity to capsaicin. CONCLUSIONS Patients with asthma-like symptoms verified by the capsaicin inhalation test for sensory hyperreactivity have a poor quality of life. The correlation between quality of life and sensitivity to capsaicin objectively demonstrates the validity of this general health profile study.
Collapse
Affiliation(s)
- E Millqvist
- Allergy Centre, Sahlgrenska University Hospital, Gothenburg
| | | | | |
Collapse
|
35
|
Millqvist E. Cough provocation with capsaicin is an objective way to test sensory hyperreactivity in patients with asthma-like symptoms. Allergy 2000. [DOI: 10.1111/j.1398-9995.2000.all2513.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|