Formaldehyde exposure in a gross anatomy laboratory--personal exposure level is higher than indoor concentration

Evaluation of formaldehyde exposure among gross dissection after modified embalming solution and health assessment

Mainly embalming fixative contains formaldehyde which is classified as a carcinogen. People who work with cadavers have been at higher risk of cancer after formaldehyde exposure. We have formulated a less-formalin fixative (contained 3.6% formaldehyde,23.8% ethanol, 15% glycerin, and 0.2% phenol in the water) for preserving cadavers. Therefore, the objective of the present study was to evaluate the level of atmospheric formaldehyde indoors and the breathing exposure of medical students during dissection classes. We also analyzed the pulmonary parameters and effects of formaldehyde. The levels of atmospheric formaldehyde indoors and personal breathing exposure were sampled during anatomy dissection classes (musculoskeletal system, respiratory system, and abdominopelvic organ system) using sorbent tubes with air sampling pumps. Samples were then analyzed using Gas Chromatography with Flame Ionization Detector (GC-FID). The mean level of formaldehyde indoor air among the three classes was 0.518 ± 0.156 ppm whereas the formaldehyde level in the personal breathing zone was 0.956±0.408 ppm, which exceeded the recommended exposure standards of international agencies, including NIOSH agency and PEL of Thailand legislation. The laboratory had high humidity, high room temperature, and poor air ventilation. There was a significant difference in FVC, FEV1, and PEF (p < 0.05) between the sexes of students. Comparison pulmonary parameters between students and instructors showed that all parameters of the pulmonary function test had no significant differences. General fatigue and burnings of eyes and nose associated with strong odor were the most common symptoms reported during the dissection classes. The modified embalming fixative was used less formalin with ethanol-glycerin mixture, and it was suitable for the study of medical students, with few side effects of respiratory problems. However, the modified exhaust ventilation with local table-exhaust ventilation and heating-ventilation-air conditioning system performance were urgent issues for reducing levels of formaldehyde indoor air in the dissection room.

Occupational scenarios and exposure assessment to formaldehyde: A systematic review

The objectives of the systematic review were to: identify the work sectors at risk for exposure to formaldehyde; investigate the procedures applied to assess occupational exposure; evaluate the reported exposure levels among the different settings. An electronic search of Pubmed, Scopus, Web of Science and ToxNet was carried out for collecting all the articles on the investigated issue published from January 1, 2004 to September 30, 2019. Forty-three papers were included in the review, and evidenced a great number of occupational scenarios at risk for formaldehyde exposure. All the included studies collected data on formaldehyde exposure levels by a similar approach: environmental and personal sampling followed by chromatographic analyses. Results ranged from not detectable values until to some mg m^-3 of airborne formaldehyde. The riskiest occupational settings for formaldehyde exposure were the gross anatomy and pathology laboratories, the hairdressing salons and some specific productive settings, such as wooden furniture factories, dairy facilities and fish hatcheries. Notice that formaldehyde, a well-known carcinogen, was recovered in air at levels higher than outdoor in almost all the studied scenarios/activities; thus, when formaldehyde cannot be removed or substituted, targeted strategies for exposure elimination or mitigation must be adopted.

Comparison of Haptic and Biometric Properties, Bacterial Load, and Student Perception of Fixative Solutions: Formaldehyde Versus Chilean Conservative Fixative Solution with and without Formaldehyde in Pig Kidneys

One of the most widely used solutions to fix and preserve organic tissues is formaldehyde, despite reservations regarding its toxicity and the fact that formaldehyde-embalmed bodies lose their original characteristics. Anatomy laboratories have been replacing formaldehyde with solutions that retain the characteristics of fresh tissue. For this purpose, alternative solutions with a very low concentration of formaldehyde or without any formaldehyde have been analyzed. The objective of this study was to compare biometry, coloration, haptic properties, and bacterial load on animal specimens (pig kidneys) embalmed with formaldehyde, and with Chilean Conservative Fixative Solution with and without formaldehyde (formaldehyde chCFS and formaldehyde-free chCFS). Also, the perception of health and biological science students toward specimens treated with different solutions was assessed. The results indicated that there were no significant differences in specimens' retraction, or bacterial load. Students showed a preference for organs embalmed in formaldehyde chCFS and formaldehyde-free chCFS; indicating that with these treatments they could better visualize structures and that the prosections had greater flexibility and the colors were more similar to those of fresh tissue. Additionally, students recommended the material embalmed in formaldehyde chCFS and formaldehyde-free chCFS for anatomy learning. In contrast, students indicated that formaldehyde-fixation negatively affected their practical experience. In conclusion, embalming with formaldehyde chCFS or formaldehyde-free chCFS provides an advantageous practical experience over the use of formaldehyde and may be an alternative to replace the use of formaldehyde in anatomy laboratories.

Arterial stiffness and carotid distensibility following acute formaldehyde exposure in female adults

Formaldehyde (FA) is a ubiquitous organic preservative used in several industries and represents an occupational health hazard. Short-term exposure to FA can increase oxidative stress and cause a decrease in conduit vessel function. These decrements in vascular function may extend to the arterial architecture, predisposing individuals to increased risk of cardiovascular disease. The purpose of this study was to investigate the impact of an acute 90-minute FA exposure period (259 ± 95 ppb) on indices of arterial architecture. Arterial stiffness and carotid distensibility as determined by central pressures, augmentation index (AIx), and carotid-femoral pulse wave velocity (cfPWV) (n=13F, 24 ± 1 year) as well as carotid stiffness and intima media thickness (IMT) (n = 9F, 23 ± 1 year) were assessed prior to (Pre-FA) and immediately following (Post-FA) exposure to FA in human cadaver dissection laboratories. Central pressures and cfPWV (Pre-FA: 5.2 ± 0.8 m.s^-1, Post-FA: 5.2 ± 1.1 m s^-1) were unchanged by acute FA exposure (p > 0.05). Carotid stiffness parameters and distension were unchanged by acute FA exposure (p > 0.05), although distensibility (Pre-FA: 33.9 ± 10.5[10-3*kPa^-1], Post-FA: 25.9 ± 5.5[10-3*kPa-1], p < 0.05), and IMT (Pre-FA: 0.42 ± 0.05 mm, Post-FA: 0.51 ± 0.11 mm, p < 0.05) decreased and increased, respectively. Individual Pre- to Post-FA changes in these markers of arterial architecture did not correlate with levels of FA exposure ([FA]: 20-473 ppb) (p > 0.05). Our group previously found vascular function decrements following acute FA exposure in human cadaver laboratories; here we found that carotid distensibility and intima media thickness are altered following FA exposure.

Indoor Formaldehyde Concentration, Personal Formaldehyde Exposure and Clinical Symptoms during Anatomy Dissection Sessions, University of Medicine 1, Yangon

The formaldehyde (FA) embalming method, the world's most common protocol for the fixation of cadavers, has been consistently used in medical universities in Myanmar. This study was designed to examine the indoor FA concentrations in anatomy dissection rooms, an exposed site, and lecture theater, an unexposed control site, and to access personal exposure levels of FA and clinical symptoms of medical students and instructors. In total, 208 second year medical students (1/2019 batch) and 18 instructors from Department of Anatomy, University of Medicine 1, participated. Thirteen dissection sessions were investigated from February 2019 to January 2020. Diffusive sampling devices were used as air samplers and high-performance liquid chromatography was used for measurement of FA. Average indoor FA concentration of four dissection rooms was 0.43 (0.09-1.22) ppm and all dissection rooms showed indoor concentrations above the occupational exposure limits and short-term exposure limit for general population. Personal FA exposure values were higher than indoor FA concentrations and the instructors (0.68, 0.04-2.11 ppm) had higher exposure than the students (0.44, 0.06-1.72 ppm). Unpleasant odor, eye and nose irritations and inability to concentrate were frequently reported FA-related symptoms, and the students were found to have significantly higher risks (p < 0.05) of having these symptoms during the dissection sessions than during lecture.

Low cost and effective reduction of formaldehyde in gross anatomy: long throw nozzles and formaldehyde destruction using InfuTrace™

Formaldehyde is extraordinarily effective for fixation of human corpses and is routinely used in embalming solutions in anatomical dissection courses all over the world. High concentrations in vapors emitted from corpses embalmed with formaldehyde make it necessary to reduce the emission from cadavers for fulfilling tightening permissible exposure limits (PEL) worldwide. The study provides possible solutions to a problem faced by many anatomy labs. The emission of 50 human corpses was examined using 240 active personal and stationary samples with sampling tubes placed in the breathing area of probands or directly above the corpses. For measuring formaldehyde exposures along the dissection course, air samples were collected during the progress of dissection. Best results were achieved by a combination of post-embalming treatment with InfuTrace™, a formaldehyde binding solution applied to corpses fixed with 3% formaldehyde, and a modified ventilation system consisting of three long throw nozzles mounted vertically at the ceiling above the longitudinal axis of each dissection table. In this scenario, the inhalative exposure for students and teachers did not exceed 0.1 ppm during muscle dissection and 0.041 ppm during organ dissection, which are both dissection steps linked to high emission rates. The data emphasizes the necessity to use a combination of different methods - chemical polymerization of formaldehyde combined with a modified ventilation system - to reduce formaldehyde air loads far below the German PEL (0.3 ppm) and even the Japanese PEL (0.1 ppm) when using a standard 3%-formaldehyde fixation.

Phenoxyethanol-Based Embalming for Anatomy Teaching: An 18 Years' Experience with Crosado Embalming at the University of Otago in New Zealand

Embalming fixatives such as formaldehyde and phenol have been associated with occupational health hazards. While anatomists aim at replacing these chemicals, this seems presently unfeasible in particular for formaldehyde. Furthermore, fixation protocols usually require well-equipped facilities with highly experienced staff to achieve good fixation results in spite of only a minimal use of formaldehyde. Combining these aspects, a technique robust enough to be carried out by morticians is presented, resulting in durable tissues with minimal formaldehyde use. An embalming protocol involving phenoxyethanol was established, using concentrations of 7 and 1.5 Vol% of phenoxyethanol in the fixative and the conservation fluid, respectively. Visual, haptic, histological, and biomechanical properties and their perceived potential to positively influence student learning outcomes were compared to standard embalming techniques. The phenoxyethanol technique provides esthetic, durable, and odorless tissues. Bleaching is less pronounced compared to ethanol- or formaldehyde-based protocols. The tissues remain pliable following the phenoxyethanol-based embalming and can be used for biomechanical experiments to some extent. Phenoxyethanol-fixed tissues are well suited for undergraduate teaching with perceived positive learning outcomes and partly for postgraduate training. Phenoxyethanol tissues provide the option to obtain well-preserved histology samples, similar to those derived from formaldehyde. The provided protocol helps replace the use of phenol and formaldehyde for conservation purposes and minimizes the use of formaldehyde for the initial injection fixation. Phenoxyethanol-based embalming forms an effective alternative to standard embalming techniques for human cadavers. It is simple to use, allowing fixation procedures to be carried out in less sophisticated facilities with non-anatomy staff.

Vascular dysfunction and oxidative stress caused by acute formaldehyde exposure in female adults

Formaldehyde (FA) is a common, volatile organic compound used in organic preservation with known health effects of eye, nose, and throat irritation linked to oxidative stress and inflammation. Indeed, long-term FA exposure may provoke skin disorders, cancer, and cardiovascular disease. However, the effects of short-term FA exposure on the vasculature have yet to be investigated. We sought to investigate the impact of an acute FA exposure on 1) macrovascular function in the arm (brachial artery flow-mediated dilation, FMD), 2) microvascular function in the arm (brachial artery reactive hyperemia, RH) and leg (common femoral artery, supine passive limb movement, PLM), and 3) circulating markers of oxidative stress (xanthine oxidase, XO; protein carbonyl, PC; and malondialdehyde, MDA) and inflammation (C-reactive protein, CRP). Ten (n = 10) healthy females (23 ± 1 yr) were studied before and immediately after a 90-min FA exposure [(FA): 197 ± 79 ppb] in cadaver dissection laboratories. Brachial artery FMD% decreased following FA exposure (Pre-FA Exp: 9.41 ± 4.21%, Post-FA Exp: 6.74 ± 2.57%; P = 0.043), and FMD/shear decreased following FA exposure (Pre-FA Exp: 0.13 ± 0.07 AU, Post-FA Exp: 0.07 ± 0.03 AU; P = 0.016). The area under the curve for brachial artery RH (Pre-FA Exp: 481 ± 191 ml, Post-FA Exp: 499 ± 165 ml) and common femoral artery PLM (Pre-FA Exp: 139 ± 95 ml, Post-FA Exp: 129 ± 64 ml) were unchanged by FA exposure (P > 0.05). Circulating MDA increased (Pre-FA Exp: 4.8 ± 1.3 µM, Post-FA Exp: 6.3 ± 2.2 µM; P = 0.047) while XO, PC, and CRP were unchanged by FA exposure (P > 0.05). These initial data suggest a short FA exposure can adversely alter vascular function and oxidative stress, influencing cardiovascular health.NEW & NOTEWORTHY This study was the first to investigate the implications of acute formaldehyde (FA) exposure on adult female vascular function in the arms and legs. The main findings of this study were a decrease in conduit vessel function without any alteration to microvascular function following a 90-min FA exposure. Additionally, the oxidative stress marker malondialdehyde increased after FA exposure. Taken together, these results suggest acute FA exposure have deleterious implications for the vasculature and redox balance.Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/formaldehyde-exposure-decreases-vascular-function/.

Occupational Exposure and Risk Assessment of Formaldehyde in the Pathology Departments of Hospitals

Background and Objective:

Exposure to formaldehyde has adverse effects on health both acutely and over the long term (e.g., carcinogenicity). The substance is widely used in pathology and histology departments. This study focused on cancer risk of formaldehyde in pathology department of five hospitals in Rasht.

Materials and Methods:

Sampling and determination of formaldehyde in pathology department were carried out based on the NIOSH method of 3500. The working condition and working environment were investigated and a semi quantitative risk assessment were used to health risk assessment of formaldehyde and The individual lifetime cancer probability, which is defined as the increase in the probability of developing cancer during continuous exposure to an air pollutant were used to assess health risks with formaldehyde.

Results:

The results showed that the exposure level of all subjects were higher than the Occupational Exposure Limit for 8 hours exposure time of formaldehyde. However, in the five occupational groups, the highest weekly exposure index was observed for the Lab Technicians (0.664 ppm) at Hospital no. 5, which could have been due to more daily working hours at this sampling site and a lack of adequate ventilation. The formaldehyde concentration was in the 0.0192 to 0.326 ppm ranges for five hospital pathology departments. The cancer risk ranged from 9.52×10^-5 to 1.53×10^-3, and it was greater than the WHO acceptable cancer risk level.

Conclusions:

The results of the risk assessments can be used for managing the chemical exposure of allocated resources for defining control actions. This process plays an important role in reducing the level of exposure to formaldehyde in pathology departments.

One academic year laboratory and student breathing zone formaldehyde level, measured by gas-piston hand pump at gross anatomy laboratory, Siriraj Hospital, Thailand

This study used a formaldehyde detector tube with a gas-piston hand pump to assess ceiling levels of student breathing zone and gross laboratory environment across the 2018 academic year. The room dimension was 28.6 × 55.48 × 5.5 m. It contained 90 cadavers, each placed on a hinged cover table. We measured before and during nine body region dissections. There was a significant difference (p < 0.01) between student exposure and laboratory environment levels. The highest level was student exposure during body wall dissection (2.7 ppm), the first laboratory; students may accidentally enter body cavities. The latter two were in abdominal (1.85 ppm) and lower limb dissections (1.49 ppm). The three highest environment levels were in different regions; spinal cord removal (1.13 ppm), lower limb (0.72 ppm), and thorax (0.71 ppm) dissection. Only the perineum environment level (0.09 ppm) was below the NIOSH ceiling level (0.1 ppm), which may result from the table covers that had been opened for 2 weeks before measurement. This study finding signified the importance of student personal exposure monitoring and encouraged the academic year measurement. Because each laboratory has unique factors, those affect formaldehyde levels; dissection steps, dissection table design, cadaver storage protocol, and heating-ventilation-air conditioning system performance, for instance.

Comparison of a Novel Cadaver Model (Fix for Life) With the Formalin-Fixed Cadaver and Manikin Model for Suitability and Realism in Airway Management Training

BACKGROUND

Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemask ventilation, tracheal intubation, and laryngeal mask insertion compared to a manikin (SimMan 3G) and formalin-fixed cadavers.

METHODS

Thirty anesthesiologists and experienced residents ("operators") were instructed to perform the 3 airway techniques in 10 F4L, 10 formalin-fixed cadavers, and 1 manikin. The order of the model type was randomized per operator. Primary outcomes were the operators' ranking of each model type as a teaching model (total rank), ranking of the model types per technique, and an operator's average verbal rating score for suitability and realism of learning the technique on the model. Secondary outcomes were the percentages of successfully performed procedures per technique and per model (success rates in completing the respective airway maneuvers). For each of the airway techniques, the Friedman analysis of variance was used to compare the 3 models on mean operator ranking and mean verbal rating scores.

RESULTS

Twenty-seven of 30 operators (90%) performed all airway techniques on all of the available models, whereas 3 operators performed the majority but not all of the airway maneuvers on all models for logistical reasons. The total number of attempts for each technique was 30 on the manikin, 292 in the F4L, and 282 on the formalin-fixed cadavers. The operators' median total ranking of each model type as a teaching model was 1 for F4L, 2 for the manikin and, 3 for the formalin-fixed cadavers (P < .001). F4L was considered the best model for mask ventilation (P = .029) and had a higher mean verbal rating score for realism in laryngeal mask airway insertion (P = .043). The F4L and manikin did not differ significantly in other scores for suitability and realism. The formalin-fixed cadaver was ranked last and received lowest scores in all procedures (all P < .001). Success rates of the procedures were highest in the manikin.

CONCLUSIONS

F4L cadavers were ranked highest for mask ventilation and were considered the most realistic model for training laryngeal mask insertion. Formalin-fixed cadavers are inappropriate for airway management training.

Soft embalming of cadavers for training purposes: Optimising for long-term use in tropical weather

Background:

Surgical and anatomical training has been found to be most optimally simulated in a cadaver than any other available methods. Soft embalming methods have made the bodies more ‘lifelike’ and better suited for training. The widely accepted soft embalming techniques, including Thiel embalming, are designed for temperate climates. Their use in tropical locations has been found to be associated with poor short-term and long-term preservation of the bodies. In fact, adequate reports from tropical countries on effective methods for soft embalming are lacking.

Materials and Methods:

This article details the modifications made in the Thiel embalming technique over a period of 2 years which has enabled us to preserve the anatomical features of bodies in an optimal way for longer periods in tropical conditions. This study was carried out in a tertiary care referral centre located in a tropical climate zone. A total of 13 frozen and thawed cadavers were used over a period of 2 years for developing such soft embalming technique. The efficacy of the technique was tested using these cadavers for varying types of surgical exercises on multiple occasions.

Results:

The conventionally described technique of Thiel embalming did not provide desired results. Hence, various modifications to this technique were instituted which helped us to get superior quality of soft-embalmed cadavers. In the final year, these cadavers were used successfully for workshops in flap dissection. Head and neck access surgery, arthroscopic and laparoscopic procedures as well as mock face and hand transplant dissections.

Conclusions:

The Theil embalming technique for obtaining soft embalmed cadavers, even though found to be best in many centres in the world, has not been found to be suitable to tropical weather. By modifying it, we have succeeded in developing a technique suitable to the tropical weather. This technique yields cadavers suitable for various surgical simulation exercises. This technique also allows the body to be optimally used over several months in multiple occasions. These modifications are very simple and have been described in detail enabling it to be adopted by any surgical skill laboratory in the tropical countries.

Changes in Work Practices for Safe Use of Formaldehyde in a University-Based Anatomy Teaching and Research Facility

Anatomy teaching and research relies on the use of formaldehyde (FA) as a preservation agent for human and animal tissues. Due to the recent classification of FA as a carcinogen, university hospitals are facing a challenge to (further) reduce exposure to FA. The aim of this study was to reduce exposure to FA in the anatomy teaching and research facility. Workers participated in the development of improved work practices, both technical and organizational solutions. Over a period of 6 years mitigating measures were introduced, including improvement of a down-flow ventilation system, introduction of local exhaust ventilation, collection of drain liquid from displayed specimens in closed containers and leak prevention. Furthermore, some organizational changes were made to reduce the number of FA peak exposures. Stationary and personal air sampling was performed in three different campaigns to assess the effect of these new work practices on inhalation exposure to FA. Samples were collected over 8 h (full shift) and 15 min (task-based) to support mitigation of exposure and improvement of work practices. Air was collected on an adsorbent coated with 2,4-dinitrophenylhydrazine (DNPH) and analyzed by HPLC-UV. Geometric mean (GM) concentrations of FA in the breathing zone over a work-shift were 123 µg/m³ in 2012 and 114 µg/m³ in 2014, exceeding the workplace standard of 150 µg/m³ (8 h time-weighted average, TWA) on 46% of the workdays in 2012 and 38% of the workdays in 2014. This exposure was reduced to an average of 28.8 µg/m³ in 2017 with an estimated probability of exceeding the OEL of 0.6%. Task-based measurements resulted in a mean peak exposures of 291 µg/m³ in 2012 (n = 19) and a mean of 272 µg/m³ in 2014 (n = 21), occasionally exceeding the standard of 500 µg/m³ (15 min TWA), and were reduced to a mean of 88.7 µg/m³ in 2017 (n = 12) with an estimated probability of exceeding the OEL of 1.6%.

Saturated Salt Solution Cadaver-Embalming Method Improves Orthopaedic Surgical Skills Training

BACKGROUND

Human cadaver surgical skills training offers the highest-fidelity simulation of the operative environment, with the potential to enhance surgeon training and to reduce operative risks to patients. Embalming extends the duration that a cadaveric specimen may be used for surgical skills training and reduces the risk of disease transmission, but it can alter the properties of the cadaver tissue, reducing the simulation fidelity and training quality. The purpose of this controlled laboratory study was to evaluate 3 embalming methods, formaldehyde solution, alcohol-glycol solution, and saturated salt solution, and to compare their relative performance in a 2-week orthopaedic surgical skills training course.

METHODS

The 3 embalming methods were applied to 3 cadavers each. Joint range of motion and joint stiffness were measured prior to dissection. The cadavers were assessed by 4 orthopaedic surgeons on the first and last days of the training course in 4 domains: tissue visual fidelity, tissue tactile fidelity, odor, and overall suitability for surgical skills training using 7-point Likert scales. Sterile specimens for bacterial and fungal culture were obtained from cadaver muscle tissue on the fourth and fifteenth days of use.

RESULTS

All cadaver groups were successfully preserved without putrefaction and were utilized over the duration of the training course. The saturated salt solution cadavers had supple joints with excellent motion and were rated highly across all domains. The saturated salt solution cadaver joint motion, stiffness, visual and tactile tissue fidelity, odor, and suitability for surgical skills training were significantly superior (p < 0.05) to the formaldehyde solution and alcohol-glycol solution cadavers.

CONCLUSIONS

The saturated salt embalming method is inexpensive and logistically straightforward and preserves human cadavers at room temperature in a state suitable for high-fidelity orthopaedic surgical skills training.

Neutralizing formaldehyde in chicken cadaver with urea and urea fertilizer solution

This study demonstrated the potential of using urea and urea fertilizer to neutralize formaldehyde (Fd) in chicken cadavers. Initially, in vitro Fd neutralization with various concentrations of urea solution (US) and urea fertilizer solution (UFS) was conducted; subsequently, 18% US and 27% UFS were selected for infusing into the formalinized chickens. The measurement at 48 hr after infusion showed that both solutions could effectively lower Fd in chicken cadavers to below a permissible exposure limit without affecting cadaveric and histological quality. In addition, neutralizing power of 18% US was approximately 1.3 times that of 27% UFS. This is the first demonstration of neutralizing potential of US and UFS against Fd both in vitro and in vivo.

Levels of formaldehyde vapor released from embalmed cadavers in each dissection stage

Formaldehyde (FA) is an aldehyde used in antiseptics and adhesives. The World Health Organization (WHO) and other institutes have linked FA to sick building syndrome and allergic diseases. Recent studies have reported that cadavers embalmed using formalin and ethanol-based preservative solutions release FA vapor during dissection and that FA vapor may adversely affect students and lecturers in gross anatomy laboratories. However, few details have been reported correlating dissection stage with increased FA vapor release. In this study, we evaluated the vapor level of FA released in each dissection stage. Six cadavers for which consent was given for use in anatomy research and education were examined in this study. Using an active sampling method, FA vapor was collected above the thoracoabdominal region of each dissected cadaver. FA was eluted from each sampler using acetonitrile and analyzed by high-performance liquid chromatography. Our data show that FA levels significantly increase after skin incision and that the vapor level of FA released differs between male and female cadavers. We also found that subcutaneous adipose tissues of the thoracoabdominal-region release FA vapor and that female cadavers release significantly higher levels of FA per kilogram of subcutaneous adipose tissue than do male cadavers. Based on these data, we propose the methods be developed to prevent exposure to FA vapors released from cadavers.

Formaldehyde exposure in gross anatomy laboratory of Suranaree University of Technology: a comparison of area and personal sampling

Cadavers are usually preserved by embalming solution which is composed of formaldehyde (FA), phenol, and glycerol. Therefore, medical students and instructors have a higher risk of exposure to FA inhalation from cadavers during dissection. Therefore, the objective of this study was to evaluate the FA exposure in indoor air and breathing zone of medical students and instructors during dissection classes in order to investigate the relationship between them. The indoor air and personal air samples in breathing zone were collected three times during anatomy dissection classes (in January, August, and October of 2014) with sorbent tubes, which were analyzed by high-performance liquid chromatography (HPLC). The air cleaner machines were determined by weight measurement. Pulmonary function tests and irritation effects were also investigated. The mean of FA concentrations ranged from 0.117 to 0.415 ppm in the indoor air and from 0.126 to 1.176 ppm in the breathing zone of students and instructors. All the personal exposure data obtained exceeded the threshold limit of NIOSH and WHO agencies. The air cleaner machines were not significant difference. The pulmonary function of instructors showed a decrease during attention of classes and statistically significant decreasing in the instructors more than those of the students. Clinical symptoms that were observed in nose and eyes were irritations with general fatigue. We suggested that the modified exhaust ventilation and a locally ventilated dissection work table were considered for reducing FA levels in the gross anatomy dissection room.

Comparison of modified Thiel embalming and ethanol-glycerin fixation in an anatomy environment: Potentials and limitations of two complementary techniques

Thiel-fixed specimens have outstandingly lifelike visual and haptic properties. However, the original Thiel method is expensive and requires an elaborate setup. It is therefore of principal interest to modify the Thiel method in order to make it available to a broader user group. A modified Thiel embalming method will be described in detail and compared to ethanol-glycerin fixation with the help of illustrative examples. The visual properties, haptic properties, the usability for performing histological investigations, costs and potential health aspects will be considered. Tissues fixed with the modified Thiel technique gave results similar to the original method, providing more realistic visual and haptic properties than ethanol-glycerin embalming. However, Thiel fixation is significantly more expensive and requires more precautions to minimize potential health hazards than ethanol-glycerin-fixed tissues. In contrast to ethanol-glycerin-fixed specimens, the Thiel-fixed specimens are not suitable for histological investigations. Both modes of fixation are inappropriate for biomechanical testing. Modified Thiel embalming simplifies the availability of body donors with lifelike properties and has cost-saving advantages to the original technique. Thiel-embalmed body donors are ideally suited for clinical workshops but have restrictions for student dissection courses in facilities with limited storage space, air circulation or technical staff. Vice versa, ethanol-glycerin-fixed body donors are well suited for student dissection courses in such an environment but are limited in their use for clinical workshops. Modified Thiel embalming therefore ideally complements ethanol-glycerin fixation in order to provide customized solutions for clinical workshops and student dissection courses in a wide range of applications.

Human body preservation - old and new techniques

This review deals with the art of (anatomical) embalming. The first part contains a brief historical review of the history of embalming, starting with ancient cultures such as the Egyptians and the lesser known Chinchorro culture, then going down the centuries and describing the anatomical techniques developed over the last two centuries. The second part deals in detail with the chemicals used for embalming purposes. The third part deals with several approaches to evaluating embalming methods, their suitability for biomechanical testing, antimicrobial properties, histological appearance, and usability. The fourth and final part analyze the European Biocidal Products Directive (98/8/EC) in the light of embalming.

Formaldehyde in the ambient atmosphere: from an indoor pollutant to an outdoor pollutant?

Formaldehyde has been discussed as a typical indoor pollutant for decades. Legal requirements and ever-lower limits for formaldehyde in indoor air have led to a continual reduction in the amount of formaldehyde released from furniture, building materials, and household products over many years. Slowly, and without much attention from research on indoor air, a change of paradigm is taking place, however. Today, the formaldehyde concentrations in outdoor air, particularly in polluted urban areas, sometimes already reach indoor levels. This is largely a result of photochemical processes and the use of biofuels. In the medium term, this development might have consequences for the way buildings are ventilated and lead to a change in the way we evaluate human exposure.

Ethanol-glycerin fixation with thymol conservation: a potential alternative to formaldehyde and phenol embalming

Anatomical fixation and conservation are required to prevent specimens from undergoing autolysis and decomposition. While fixation is the primary arrest of the structures responsible for autolysis and decomposition, conservation preserves the state of fixation. Although commonly used, formaldehyde has been classified as carcinogenic to humans. For this reason, an adequate substitute was developed. Ethanol-glycerin fixation and thymol conservation are described and compared with formaldehyde and phenol in this technical report. The setup, tissue qualities, financial aspects, and health concerns of this method are discussed. Ethanol-glycerin fixation and thymol conservation provide outstanding haptic and optic tissue qualities. Typical formaldehyde and phenol effects, such as skin, airway, and eye irritation, as well as carcinogenic effects, can be circumvented by using ethanol-glycerin and thymol instead. Ethanol-glycerin fixation is more expensive than formaldehyde and requires an explosion-proof facility. However, the absence of health effects and its convincing tissue qualities balance these higher costs. Therefore, ethanol-glycerin fixation and thymol conservation provide a potential alternative and complement established fixation techniques. The use of carcinogenic formaldehyde and toxic phenol can be effectively restricted through the use of the described method.

Student perceptions of an upper-level, undergraduate human anatomy laboratory course without cadavers

Several programs in health professional education require or are considering requiring upper-level human anatomy as prerequisite for their applicants. Undergraduate students are confronted with few institutions offering such a course, in part because of the expense and logistical issues associated with a cadaver-based human anatomy course. This study describes the development of and student reactions to an upper-level human anatomy laboratory course for undergraduate students that used a regional approach and contemporary, alternative teaching methods to a cadaver-based course. The alternative pedagogy to deliver the curriculum included use of commercially available, three-dimensional anatomical virtual dissection software, anatomical models coupled with a learning management system to offer Web-based learning, and a new laboratory manual with collaborative exercises designed to develop the student's anatomical skills and collaborative team skills. A Likert-scale survey with open-ended questions was used to ascertain student perceptions of the course and its various aspects. Students perceived that the noncadaver-based, upper-level human anatomy course with an engaging, regional approach is highly valuable in their learning of anatomy. anatomy.

Preliminary study: Formaldehyde exposure in laboratories of Sharjah university in UAE

Objectives

Laboratory technicians, students, and instructors are at high risk, because they deal with chemicals including formaldehyde. Thus, this preliminary study was conducted to measure the concentration of formaldehyde in the laboratories of the University of Sharjah in UAE.

Materials and Methods:

Thirty-two air samples were collected and analyzed for formaldehyde using National Institute for Occupational Safety and Health (NIOSH) method 3500. In this method, formaldehyde reacts with chromotropic acid in the presence of sulfuric acid to form a colored solution. The absorbance of the colored solution is read in spectrophotometer at wavelength 580 nm and is proportional to the quantity of the formaldehyde in the solution.

Results:

For the anatomy laboratory and in the presence of the covered cadaver, the mean concentration of formaldehyde was found to be 0.100 ppm with a range of 0.095–0.105 ppm. Whereas for the other laboratories, the highest mean concentration of formaldehyde was 0.024 ppm in the general microbiology laboratory and the lowest mean concentration of formaldehyde was 0.001 ppm in the environmental health laboratory. The 8-hour (time-weighted average) concentration of formaldehyde was found to be ranging between 0.0003 ppm in environmental health laboratory and 0.026 ppm in the anatomy laboratory.

Conclusions:

The highest level of concentration of formaldehyde in the presence of the covered cadaver in anatomy laboratory exceeded the recommended ceiling standard established by USA-NIOSH which is 0.1 ppm, but below the ceiling standard established by American Conference of Governmental Industrial Hygienists which is 0.3 ppm. Thus, it is recommended that formaldehyde levels should be measured periodically specially during the dissection in the anatomy laboratory, and local exhaust ventilation system should be installed and personal protective equipment such as safety glass and gloves should be available and be used to prevent direct skin or eye contact.

Occupational exposure to formaldehyde in an institute of morphology in Brazil: a comparison of area and personal sampling

BACKGROUND, AIMS, AND SCOPE

Formaldehyde (FA) is a harmful chemical, which is classified as carcinogenic to humans (Group 1) by the International Agency for Research on Cancer. Solutions of FA that are used to preserve cadavers in research and education morphological institutes represent a risk to occupational health of professionals and students. During the dissection of cadavers in the anatomy laboratories, FA vapors are emitted, resulting in the exposure of students and their instructors to elevated levels of FA. The World Health Organization recommends an air quality guideline value of 0.1 mg m(-3) for exposure to FA. The limit of occupational exposure adopted by the Brazilian legislation (2.3 mg m(-3)) is markedly higher than those adopted by institutions of other countries around the world. The purpose of this study was to determine the levels of personal exposure and the area concentration of FA in the morphology department of the Federal Fluminense University, Brazil, and investigate and compare the relationship between them.

METHODS

Four rooms distributed in the three floors of the Morphology Department were evaluated: the embalming laboratory, the anatomy laboratories, the corridor of the teachers' rooms, and the entrance hall. Thirty-six samples in total were collected in the second semester of 2010 and first semester of 2011. The air sampling and FA analysis were performed according to the EPA TO-11A Protocol, using a diffusive sampling device for carbonyl compounds. Personal samples were collected from monitors using a sampling device pinned on each person's lapel. The samples were analyzed using rapid resolution liquid chromatography with UV-DAD detection at 360 nm.

RESULTS AND DISCUSSION

The concentrations of FA ranged from 0.20 and 0.18 mg m(-3) in the corridor between the teachers' rooms, 0.03 to 0.37 mg m(-3) in the entrance hall, 0.22 to 2.07 mg m(-3) in the anatomy laboratory, 2.21 to 2.52 mg m(-3), in the embalming room. The levels found in the corridor between the teachers' rooms and in the entrance hall were lower than in other compartments because of their large distances to the sources of FA and better ventilation. The other rooms presented higher levels of FA because of the activities carried there (embalming and dissection procedures). Even in the rooms that showed the lowest levels of FA, the values found were higher than those established by all international guideline limits, except the Brazilian legislation limit, although, the concentration level in the embalming room was even greater than the Brazilian guideline. These concentrations are 100-1,000-fold higher than those reported in an FA outdoor study. The exposure levels of monitors and students ranged from 1.89 to 4.82 mg m(-3), indicating that current practices at the Morphology Department at the university would represent a health risk. The simultaneous monitoring of area concentrations and personal exposure showed that the characteristics of classes and of cadavers' parts, the number of students in the room and even the activities of the monitors influence the FA concentrations.

CONCLUSION

This study revealed that the concentration of FA was low in the ventilated areas of the Morphology Department, and that the personal exposure when the person was close to the cadavers during the dissection procedure was higher than the mean FA concentration. This should be considered in the risk assessment of FA during these activities without effective protection equipment. It is suggested that the Brazilian legislation of exposure to formaldehyde requires an urgent update considering international legislation.

Pregnant students in the gross anatomy laboratory: policies and practices at chiropractic colleges

Chiropractic and medical colleges have experienced a significant increase in the number of female applicants in recent years, a percentage of whom are pregnant or become pregnant following admission. It is therefore important to ask the question: How do institutions that educate future health care providers address the issue of pregnancy and the gross anatomy laboratory? A survey instrument was developed and pretested. IRB approval was obtained. The administrators charged with overseeing the policies and practices for the gross anatomy laboratory at each of the 16 chiropractic colleges in the USA were identified and contacted. An email containing a link to the Web based survey was sent to each, using SurveyMonkey. The survey response rate was 100%. A majority of colleges (69%) have a written policy regarding pregnancy and the gross laboratory. Of these, 36% allow pregnant students to take the laboratory if a waiver is signed, 18% do not allow them to take the laboratory, 18% allow them to take it without a waiver, and 27% have other policies. In cases where students do not take the gross laboratory while pregnant, 64% of colleges require them to take the laboratory after completion of their pregnancy, 27% require them to complete an alternative (dry) laboratory, and 9% have other policies. Considerable diversity exists in the way colleges address this issue. It is at present unknown whether pregnant students or their fetuses are at any risk from laboratory chemicals. Risk assessment research is needed before consistent policies can be developed.

Occupational exposure to formaldehyde: genotoxic risk evaluation by comet assay and micronucleus test using human peripheral lymphocytes

Formaldehyde (FA) is a world high-production compound with numerous applications ranging from production of resins to medicines. Due to its sensitizing properties, irritating effects and potential cancer hazard FA is of great environmental health concern. Numerous studies in humans and experimental animals demonstrated that inhaled FA produced toxicity, genotoxicity, and cancer at distal sites. IARC, based on sufficient data, reclassified FA as a human carcinogen. The highest level of human exposure to this aldehyde occurs in occupational settings, namely, in pathology and anatomy laboratories, where FA is commonly used as a fixative and tissue preservative. Several studies consistently showed that the levels of airborne FA in anatomy laboratories exceeded recommended exposure criteria. In order to assess the genotoxic effects of chronic occupational exposure to FA, a group of pathology/anatomy workers was assessed using a micronucleus (MN) test and comet assay. The level of exposure to FA was also determined and the time-weighted average (TWA) of exposure was calculated for each subject. The TWA mean value for FA exposed workers was 0.43 ± 0.06 ppm, exceeding national and international recommended limit levels of 0.3 ppm. Both MN frequency and comet assay parameters were significantly higher in exposed subjects. Data obtained confirm a correlation between genetic damage and occupational exposure to FA. These data, along with recent implications of human carcinogenicity, point out the need for close monitoring of occupational exposure to FA. Implementation of security and hygiene measures as well as good practices campaigns may be crucial to decrease risk.

The role of exposure reconstruction in occupational human health risk assessment: current methods and a recommended framework

Exposure reconstruction for substances of interest to human health is a process that has been used, with various levels of sophistication, as far back as the 1930s. The importance of robust and high-quality exposure reconstruction has been recognized by many researchers. It has been noted that misclassification of reconstructed exposures is relatively common and can result in potentially significant effects on the conclusions of a human health risk assessment or epidemiology study. In this analysis, a review of the key exposure reconstruction approaches described in over 400 papers in the peer-reviewed literature is presented. These approaches have been critically evaluated and classified according to quantitative, semiquantitative, and qualitative approaches. Our analysis indicates that much can still be done to improve the overall quality and consistency of exposure reconstructions and that a systematic framework would help to standardize the exposure reconstruction process in the future. The seven recommended steps in the exposure reconstruction process include identifying the goals of the reconstruction, organizing and ranking the available data, identifying key data gaps, selecting the best information sources and methodology for the reconstruction, incorporating probabilistic methods into the reconstruction, conducting an uncertainty analysis, and validating the results of the reconstruction. Influential emerging techniques, such as Bayesian data analysis, are highlighted. Important issues that will likely influence the conduct of exposure reconstruction into the future include improving statistical analysis methods, addressing the issue of chemical mixtures, evaluating aggregate exposures, and ensuring transparency with respect to variability and uncertainty in the reconstruction effort.

Volatile pollutants emitted from selected liquid household products

BACKGROUND, AIM, AND SCOPE

To identify household products that may be potential sources of indoor air pollution, the chemical composition emitted from the products should be surveyed. Although this kind of survey has been conducted by certain research groups in Western Europe and the USA, there is still limited information in scientific literature. Moreover, chemical components and their proportions of household products are suspected to be different with different manufacturers. Consequently, the current study evaluated the emission composition for 42 liquid household products sold in Korea, focusing on five product classes (deodorizers, household cleaners, color removers, pesticides, and polishes).

MATERIALS AND METHODS

The present study included two phase experiments. First, the chemical components and their proportions in household products were determined using a gas chromatograph and mass spectrometer system. For the 19 target compounds screened by the first phase of the experiment and other selection criteria, the second phase was done to identify their proportions in the purged-gas phase.

RESULTS

The number of chemicals in the household products surveyed ranged from 9 to 113. Eight (product class of pesticides) to 17 (product class of cleaning products) compounds were detected in the purged-gas phase of each product class. Several compounds were identified in more than one product class. Six chemicals (acetone, ethanol, limonene, perchloroethylene (PCE), phenol, and 1-propanol) were identified in all five product classes. There were 13 analytes occurring with a frequency of more than 10% in the household products: limonene (76.2%), ethanol (71.4%), PCE (66.7%), phenol (40.5%), 1-propanol (35.7%), decane (33%), acetone (28.6%), toluene (19.0%), 2-butoxy ethanol (16.7%), o-xylene (16.7%), chlorobenzene (14.3%), ethylbenzene (11.9%), and hexane (11.9%). All of the 42 household products analyzed were found to contain one or more of the 19 compounds.

DISCUSSION

The chemical composition varied broadly along with the product classes or product categories, and it was different from that reported in other studies abroad, although certain target chemicals were identified in both studies. This finding supports an assertion that chemical components emitted from household products may be different in different products and with different manufacturers. The chlorinated pollutants identified in the present study have not been reported to be components of cleaning products in papers published since the early 1990s. Limonene was identified as having the highest occurrence in the household products in the present study, although it was not detected in any of 67 household products sold in the U.S.

CONCLUSIONS

The emission composition of selected household products was successfully examined by purge-and-trap analysis. Along with other exposure information such as use pattern of household products and the indoor climate, this composition data can be used to estimate personal exposure levels of building occupants. This exposure data can be employed to link environmental exposure to health risk. It is noteworthy that many liquid household products sold in Korea emitted several toxic aromatic and chlorinated organic compounds. Moreover, the current finding suggests that product types and manufacturers should be considered, when evaluating building occupants' exposure to chemical components emitted from household products.

RECOMMENDATIONS AND PERSPECTIVES

The current findings can provide valuable information for the semiquantitative estimation of the population inhalation exposure to these compounds in indoor environments and for the selection of safer household products. However, although the chemical composition is known, the emissions of household products might include compounds formed during the use of the product or compounds not identified as ingredients by this study. Accordingly, further studies are required, and testing must be done to determine the actual composition being emitted. Similar to eco-labeling of shampoos, shower gels, and foam baths proposed by a previous study, eco-labeling of other household products is suggested.

Genotoxic damage in pathology anatomy laboratory workers exposed to formaldehyde

Formaldehyde (FA) is a chemical traditionally used in pathology and anatomy laboratories as a tissue preservative. Several epidemiological studies of occupational exposure to FA have indicated an increased risk of nasopharyngeal cancers in industrial workers, embalmers and pathology anatomists. There is also a clear evidence of nasal squamous cell carcinomas from inhalation studies in the rat. The postulated mode of action for nasal tumours in rats was considered biologically plausible and considered likely to be relevant to humans. Based on the available data IARC, the International Agency for Research on Cancer, has recently classified FA as a human carcinogen. Although the in vitro genotoxic as well as the in vivo carcinogenic potentials of FA are well documented in mammalian cells and in rodents, evidence for genotoxic effects and carcinogenic properties in humans is insufficient and conflicting thus remains to be more documented. To evaluate the genetic effects of long-term occupational exposure to FA a group of 30 Pathological Anatomy laboratory workers was tested for a variety of biological endpoints, cytogenetic tests (micronuclei, MN; sister chromatid exchange, SCE) and comet assay. The level of exposure to FA was evaluated near the breathing zone of workers, time weighted average of exposure was calculated for each subject. The association between the biomarkers and polymorphic genes of xenobiotic metabolising and DNA repair enzymes was also assessed. The mean level of exposure was 0.44+/-0.08ppm (0.04-1.58ppm). MN frequency was significantly higher (p=0.003) in the exposed subjects (5.47+/-0.76) when compared with controls (3.27+/-0.69). SCE mean value was significantly higher (p<0.05) among the exposed group (6.13+/-0.29) compared with control group (4.49+/-0.16). Comet assay data showed a significant increase (p<0.05) of TL in FA-exposed workers (60.00+/-2.31) with respect to the control group (41.85+/-1.97). A positive correlation was found between FA exposure levels and MN frequency (r=0.384, p=0.001) and TL (r=0.333, p=0.005). Regarding the genetic polymorphisms studied, no significant effect was found on the genotoxic endpoints. The results of the present biomonitoring study emphasize the need to develop safety programs.

Associations of symptoms related to isocyanate, ureaformol, and formophenolic exposures with respiratory symptoms and lung function in coal miners

The respiratory effects of diphenylmethane diisocyanate (MDI)-based resins and ureaformol- and formophenolic-based resins, used in coal mining, are unknown. This cross-sectional study of 354 miners evaluated respiratory health in miners with MDI-related symptoms (IS) and ureaformol/formophenolic-related symptoms (UFS). The protocol included clinical examination, chest radiograph, questionnaire on respiratory symptoms, smoking habit, job history, resin handling, and spirometry. Resin handling concerned 27.7% of the miners. IS affected 5.6%, and 1.4% also after work. UFS affected 22.6%, and 2.3% also after work. Wheezing affected 35.6%; chronic cough, expectoration, or bronchitis about 10%; dyspnea 5.4%; and asthma 2.8%. The miners with UFS had significantly more frequent chronic cough, expectoration, chronic bronchitis, dyspnea, and wheezing, whereas those with IS at and after work had markedly lower FVC, FEV1, MMEF, FEF50%, and FEF25%. These findings raise the possibility of deleterious effects of exposures to MDI and ureaformol/formophenolic resins on respiratory health and lung function in coal miners during their working life.