Consensus criteria for chronic rhinosinusitis disease control: an international Delphi Study

BACKGROUND

Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control.

METHODS

Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate.

RESULTS

Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items.

CONCLUSIONS

Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.

The Management of Chronic Rhinosinusitis With Nasal Polyps (CRSwNP) With Biologics

Chronic rhinosinusitis with nasal polyps affects a significant portion of the worldwide population. This illness is associated with several chronic conditions and has an important impact on patient quality of life, leading to a great societal economic burden. In recent years, biologic medications have been developed and found to be effective in the treatment of chronic rhinosinusitis with nasal polyps. This review focuses on these treatment options and their ability to improve patient outcomes, including quality of life. It also reviews available evidence with regards to patient selection, monitoring of patients after treatment initiation, and comparison of different biologics and with other treatment options such as sinus surgery.

The EUFOREA pocket guide for chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is known to affect around 5 % of the total population, with major impact on the quality of life of those severely affected (1). Despite a substantial burden on individuals, society and health economies, CRS often remains underdiagnosed, under-estimated and under-treated (2). International guidelines like the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) (3) and the International Consensus statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR) (4) offer physicians insight into the recommended treatment options for CRS, with an overview of effective strategies and guidance of diagnosis and care throughout the disease journey of CRS.

Outer retinal transduction by AAV2-7m8 following intravitreal injection in a sheep model of CNGA3 achromatopsia

Sheep carrying a mutated CNGA3 gene exhibit diminished cone function and provide a naturally occurring large animal model of achromatopsia. Subretinal injection of a vector carrying the CNGA3 transgene resulted in long-term recovery of cone function and photopic vision in these sheep. Research is underway to develop efficacious vectors that would enable safer transgene delivery, while avoiding potential drawbacks of subretinal injections. The current study evaluated two modified vectors, adeno-associated virus 2-7m8 (AAV2-7m8) and AAV9-7m8. Intravitreal injection of AAV2-7m8 carrying enhanced green fluorescent protein under a cone-specific promoter resulted in moderate photoreceptor transduction in wild-type sheep, whereas peripheral subretinal delivery of AAV9-7m8 resulted in the radial spread of the vector beyond the point of deposition. Intravitreal injection of AAV2-7m8 carrying human CNGA3 in mutant sheep resulted in mild photoreceptor transduction, but did not lead to the clinical rescue of photopic vision, while day-blind sheep treated with a subretinal injection exhibited functional recovery of photopic vision. Transgene messenger RNA levels in retinas of intravitreally treated eyes amounted to 4-23% of the endogenous CNGA3 levels, indicating that expression levels >23% are needed to achieve clinical rescue. Overall, our results indicate intravitreal injections of AAV2.7m8 transduce ovine photoreceptors, but not with sufficient efficacy to achieve clinical rescue in CNGA3 mutant sheep.

Target and Nontarget Screening of PFAS in Biosolids, Composts, and Other Organic Waste Products for Land Application in France

Zwitterionic, cationic, and anionic per- and polyfluoroalkyl substances (PFAS) are increasingly reported in terrestrial and aquatic environments, but their inputs to agricultural lands are not fully understood. Here, we characterized PFAS in 47 organic waste products (OWP) applied in agricultural fields of France, including historical and recent materials. Overall, 160 PFAS from 42 classes were detected from target screening and homologue-based nontarget screening. Target PFAS were low in agriculture-derived wastes such as pig slurry, poultry manure, or dairy cattle manure (median ∑₄₆PFAS: 0.66 μg/kg dry matter). Higher PFAS levels were reported in urban and industrial wastes, paper mill sludge, sewage sludge, or residual household waste composts (median ∑₄₆PFAS: 220 μg/kg). Historical municipal biosolids and composts (1976-1998) were dominated by perfluorooctanesulfonate (PFOS), N-ethyl perfluorooctanesulfonamido acetic acid (EtFOSAA), and cationic and zwitterionic electrochemical fluorination precursors to PFOS. Contemporaneous urban OWP (2009-2017) were rather dominated by zwitterionic fluorotelomers, which represented on average 55% of ∑₁₆₀PFAS (max: 97%). The fluorotelomer sulfonamidopropyl betaines (X:2 FTSA-PrB, median: 110 μg/kg, max: 1300 μg/kg) were the emerging class with the highest occurrence and prevalence in contemporary urban OWP. They were also detected as early as 1985. The study informs for the first time that urban sludges and composts can be a significant repository of zwitterionic and cationic PFAS.

An introduction to the sources, fate, occurrence and effects of endocrine disrupting chemicals released into the environment

Many classes of compounds are known or suspected to disrupt the endocrine system of vertebrate and invertebrate organisms. This review of the sources and fate of selected endocrine disrupting chemicals (EDCs) in the environment includes classes of compounds that are "legacy" contaminants, as well as contaminants of emerging concern. EDCs included for discussion are organochlorine compounds, halogenated aromatic hydrocarbons, brominated flame retardants, per- and polyfluoroalkyl substances, alkylphenols, phthalates, bisphenol A and analogues, pharmaceuticals, drugs of abuse and steroid hormones, personal care products, and organotins. An exhaustive survey of the fate of these contaminants in all environmental media (e.g., air, water, soil, biota, foods and beverages) is beyond the scope of this review, so the priority is to highlight the fate of EDCs in environmental media for which there is a clear link between exposure and endocrine effects in humans or in biota from other taxa. Where appropriate, linkages are also made between the fate of EDCs and regulatory limits such as environmental quality guidelines for water and sediments and total daily intake values for humans.

Methods for the analysis of endocrine disrupting chemicals in selected environmental matrixes

Endocrine disrupting chemicals (EDCs) are heterogenous in structure, chemical and physical properties, and their capacity to partition into various environmental matrixes. In many cases, these chemicals can disrupt the endocrine systems of vertebrate and invertebrate organisms when present at very low concentrations. Therefore, sensitive and varied analytical methods are required to detect these compounds in the environment. This review summarizes the analytical methods and instruments that are most used to monitor for EDCs in selected environmental matrixes. Only those matrixes for which there is a clear link between exposures and endocrine effects are included in this review. Also discussed are emerging methods for sample preparation and advanced analytical instruments that provide greater selectivity and sensitivity.

Identifying barriers to care for complex airway disease and multidisciplinary solutions to optimize therapy in Canada

Background

Complex airway disease such as Chronic Rhinosinusitis with Asthma or Aspirin Exacerbated Respiratory Disease requires a multidisciplinary approach to management and treatment. Many centers in the USA have created collaborative multidisciplinary clinics to support the management of these patients; however, similar structures do not appear to exist in Canada.

Methods

This mixed methods study used a combination of structured interviews and a cross-sectional national survey. Interviewees included members of the Canadian Rhinology Working Group and survey participants were a combination of academic and community Rhinologists, Respirologists and Allergists. All participation was voluntary and selection criteria was based on their involvement in treating complex airway disease. Our objective was to identify the current state of diagnosis and treatment of complex airway patients in Canada between Rhinology, Respirology and Allergy and understand the barriers, challenges and propose solutions to establishing a multidisciplinary airway clinic in Canada.

Results

Four Rhinologists participated in qualitative interviews and a convenience sample of 42 specialists through our known network responded to our quantitative survey. From our survey, 54.8% believed multidisciplinary clinics were necessary in the management of complex airway disease, providing better outcomes and cost-savings (69%, 45.2%). Most specialties agreed that history, physical, pulmonary function and skin prick testing was important for diagnosis (92.9%, 92.9%, 88.1%). If clinicians were to participate in a multidisciplinary clinic, they would be willing to forego an average of 14.2% of their mean daily income for that clinic. The ideal clinic location was split between a neutral shared location vs. a Rhinology clinic space (38.1%, 45.2%).

Conclusions

Complex airway diseases are currently managed in subspecialty silos resulting in fragmented care. Our study highlights gaps in management, areas for improvement and support for establishing multidisciplinary complex airway disease clinics in Canada to better treat this population.

Novel and legacy per- and polyfluoroalkyl substances (PFAS) in freshwater sporting fish from background and firefighting foam impacted ecosystems in Eastern Canada

Emerging PFAS were recently reported at sites impacted by aqueous film-forming foams (AFFFs) and near major manufacturing centers; however, few studies have evaluated whether these can occur far from release sites. Here, newly identified PFAS were investigated in wild sporting fish from boreal freshwater ecosystems (background sites, 2013-2014 summer seasons), compared to fish impacted by a major AFFF release (summer 2013 and autumn 2014). Different freshwater wild sporting fish species (Esox lucius, Esox masquinongy, Micropterus dolomieu, Sander vitreus, Perca flavescens, and Semotilus corporalis, n = 74) were collected from 13 ecosystems (lakes, reservoirs, and rivers) across Eastern Canada. Of 29 quantitative PFAS, 15 compounds were detected in fish from background sites, including perfluorocarboxylates (C_6,8-14), perfluoroalkane sulfonates (C_6,8,10), perfluorooctane sulfonamide (FOSA), 6:2 fluorotelomer sulfonate (6:2 FTSA), 7:3 fluorotelomer carboxylic acid (7:3 FTCA), and a zwitterionic PFAS-perfluorooctane sulfonamidoalkyl betaine (PFOSB). To our knowledge, this is the first report of PFOSB in biota. It is also one of the first reports of anionic fluorotelomers (6:2 FTSA, 7:3 FTCA, 9:3 FTCA) in wildlife from background sites. Long-chain fluorotelomer sulfonamidoalkyl betaines (e.g., 8:2 and 10:2 FTAB), fluorotelomer betaines (e.g., 9:3 and 9:1:2 FTB), and fluorotelomer sulfone propanoic acids (e.g., 8:2 FT(SO₂)-PA, 10:2 FT(SO₂)-PA)) were solely prevalent (up to 97% of summed suspect PFAS) in Smallmouth Bass (M. dolomieu) from the AFFF-impacted site. Perfluorobutane sulfonamide (FBSA), perfluorohexane sulfonamide (FHxSA), 6:2 FTSA and 7:3 FTCA were detected in at least one Smallmouth Bass sample both at the AFFF-impacted and background sites. According to the estimated chronic daily intake and current tolerable daily intake suggested by national agencies, the observed PFOS levels would not pose a health risk to anglers who might consume these wild-caught fish.

Reduced bioaccumulation of fluorotelomer sulfonates and perfluoroalkyl acids in earthworms (Eisenia fetida) from soils amended with modified clays

Soils contaminated by per- and polyfluoroalkyl substances (PFAS) pose long-term sources to adjacent water bodies and soil invertebrates. The study investigated the stabilization using a modified clay adsorbent (FLUORO-SORB100®) in reducing the bioaccumulation of 13 anionic PFAS by earthworms (Eisenia fetida), as compared to coal-based granular activated carbon. The target PFAS included four perfluoroalkyl sulfonates such as perfluorooctane sulfonate (PFOS), six perfluoroalkyl carboxylates (e.g., perfluorooctanoate PFOA), and three (X:2) fluorotelomer sulfonates. Laboratory-spiked surface soil and the soil collected from a site contaminated by aqueous film-forming foams were examined. Both adsorbents resulted in reduced earthworm PFAS body burdens at the end of the 28-day uptake phase. The highest adsorbent amendment concentration (4 w/w%) was most effective, achieving >95% reduction of PFAS body burden. Soil leaching tests indicated better immobilization performance by the clay adsorbent for most analytes; in comparison, the activated carbon performed better at reducing total PFAS body burdens, possibly owing to the avoidance of larger-sized particles by earthworms. Strong positive logarithm relationships were observed between leachate concentrations and earthworm body burdens for most PFAS in the spiked soil. The study demonstrated that stabilization of PFAS using modified clay adsorbents can achieve concurrent benefits of lowering leachability and reducing bioaccumulation.

Dupilumab reduces systemic corticosteroid use and sinonasal surgery rate in CRSwNP

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease with a high symptom burden and poor quality of life. Treatment options include recurrent surgeries and/or frequent systemic corticosteroids (SCS). Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2-mediated inflammation. We report results of pooled analyses from 2 randomised, double-blind, placebo-controlled phase 3 studies (SINUS 24 [NCT02912468]; SINUS-52 [NCT02898454]) to evaluate dupilumab effect versus placebo in adults with CRSwNP with/without SCS use and sinonasal surgery.

METHODOLOGY

SINUS-24 patients were randomised 1:1 to subcutaneous dupilumab 300 mg (n=143) or placebo (n=133) every 2 weeks (q2w) for 24 weeks. SINUS-52 patients were randomised 1:1:1 to 52 weeks of subcutaneous dupilumab 300 mg q2w (n=150), 24 weeks q2w followed by 28 weeks of dupilumab 300 mg every 4 weeks (n=145) or 52 weeks of placebo q2w (n=153).

RESULTS

Dupilumab reduced the number of patients undergoing sinonasal surgery (82.6%), the need for in-study SCS use (73.9%), and SCS courses (75.3%). Significant improvements were observed with dupilumab vs placebo regardless of prior sinonasal surgery or SCS use in nasal polyp, nasal congestion, Lund-MacKay, and Sinonasal Outcome Test (22-items) scores, and the University of Pennsylvania Smell Identification Test.

CONCLUSIONS

Dupilumab demonstrated significant improvements in disease signs and symptoms and reduced the need for sino-nasal surgery and SCS use versus placebo in patients with severe CRSwNP, regardless of SCS use in the previous 2 years, or prior sinonasal surgery.

Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis

BACKGROUND

Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment.

METHODS

A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1-10 and provided comments. A rating within 1-3 indicated disagreement, 8-10 demonstrated agreement and 4-7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system".

RESULTS

After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS.

CONCLUSION

This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.

Trophic transfer of polybrominated diphenyl ethers in a recently modified freshwater food web from the St. Lawrence River, Canada

Introduction of invasive species can have a profound impact on food web structure and therefore on trophic transfer of contaminants. In the St. Lawrence River (Canada), 20 years after its first detection in the system, invasive round goby (Neogobius melanostomus) has become the main prey for several piscivorous species. To evaluate the accumulation, trophic transfer, and the ecological risk of polybrominated diphenyl ethers (PBDEs) in this recently modified freshwater food web, samples of sediment, invertebrates, fish and aquatic bird eggs and plasma were collected. Sampling sites were located upstream and at two locations downstream of the Montreal wastewater treatment plant outfall. The results suggest that the influence of the WWTP effluent on PBDEs concentrations varied among the various compartments of this recently modified freshwater food web. The results also suggest that although predatory fish have switched to consuming round goby as a prey item instead of native yellow perch, this new feeding behaviour is not expected to have important impacts on the level of transfer of PBDE within this food web. The biota-sediment accumulation factors (BSAFs) ranged from 0.6 to 436, whereas biomagnification factors (BMFs) varied between 0.2 and 475. Despite our conservative method of risk assessment, we calculated an important risk for piscivorous fish and gull eggs within this study area.

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

Bioaccumulation of Zwitterionic Polyfluoroalkyl Substances in Earthworms Exposed to Aqueous Film-Forming Foam Impacted Soils

Critical knowledge gaps remain regarding the fate and effects of zwitterionic, cationic, and anionic perfluoroalkyl and polyfluoroalkyl substances (PFASs), including assessment of their bioaccumulation potential. Here, biota soil accumulation factors (BSAFs) were assessed in earthworms (Eisenia fetida) exposed to soil microcosms amended with zwitterionic fluorotelomers and anionic perfluoroalkyl acids. The 6:2 fluorotelomer sulfonamidoalkyl betaine (6:2 FTAB) bioaccumulated in earthworms [BSAF ∼ 2.5-5.4 (g_dw,worm/g_dw,soil)^-1] but to a lesser extent than perfluorooctane sulfonate (PFOS: BSAF ∼ 21-29). The BSAF of perfluorocarboxylates increased from ∼2.0 for C₄-C₆ analogues to ∼92 for perfluorotridecanoate (C₁₃). In earthworms exposed to Ansulite and Arctic Foam aqueous film-forming foams (AFFFs), the BSAF was related to perfluorinated chain length for n:3 fluorotelomer betaines (FtBs), n:1:2 FtB, and n:2 FTAB. Earthworms were also collected in situ from a fire-equipment testing site at a major Canadian airport. Summed PFAS concentrations were between 65 000 and 830 000 ng g^-1 wet weight, possibly the highest burden recorded in terrestrial biota. Fluorotelomer sulfonates (6:2 FTS, 8:2 FTS, and 10:2 FTS) and FtB were particularly prevalent. Field worms also displayed elevated concentrations of n:3 acids (n = 3-11), but not those from laboratory microcosms exposed to fluorotelomer-based AFFFs. The findings provide an important confirmation to recent data suggesting that fluorotelomer compounds may accumulate in invertebrate species with limited metabolization.

Assessing anthropogenic pressure in the St. Lawrence River using traits of benthic macroinvertebrates

This study aims to evaluate the anthropogenic pressure in the St. Lawrence River by assessing the relationships between chemical contamination of sediments and benthic community structure with the trait-based approach. Organic and inorganic contaminants as well as other sediment variables (sediment grain size, total organic carbon, nutrients, etc.) and benthic invertebrate assemblages were determined in 59 sites along the river. Biological and ecological traits of taxa were coded, taking into account regional climate and ecosystem conditions. The aims of this study were to (1) describe the relationships between traits and macroinvertebrate taxa and identify homogeneous clusters of taxa with the same combinations of functional traits, (2) describe spatial patterns in traits of macroinvertebrates in the St. Lawrence River, (3) link trait-based metrics and site groups to sediment quality and (4) define a trait-based strategy for diagnosing the ecological quality of the St. Lawrence River. Seven groups of taxa sharing similar trait-category attributes were defined. Moreover, four groups of sites were identified using the 'K-mean' non-hierarchical clustering approach. The 'IndVal' method enabled us to specifically defined trait categories corresponding to site groups on the basis of their indicator value. The relative abundances of taxa from five functional groups significantly varied among site groups. For example, some indicator traits such as multivoltine cycle, long life span, fixed clutches, tegumental respiration, asexual reproduction, and collector/gatherer feeding habit were associated to the most heavily polluted sites located in the Montreal harbour which showed the highest sediment concentrations in Pb, Zn and Cu. Three trait-based pressure-specific models were built, based on the random forest approach, for respectively (1) heavy metals, (2) BPCs and PAHs, and (3) TBTs occurring in the environment. These models could be applied to assess sediment quality using macroinvertebrate assemblages in a large Canadian river.

Accumulation and sublethal effects of triclosan and its transformation product methyl-triclosan in the earthworm Eisenia andrei exposed to environmental concentrations in an artificial soil

Municipal biosolids are increasingly used as a low-cost fertilizer in agricultural soil. Biosolids are contaminated by low concentrations (nanograms per gram dry wt range) of a large variety of organic contaminants, such as triclosan. The effect of exposure to low concentrations of organic contaminants on soil biota remains largely undocumented. We evaluated the sublethal effects of triclosan on the earthworm Eisenia andrei using an artificial soil amended with a nominal concentration of triclosan of 50 ng g^-1 dry weight soil. Using a 56-d reproduction test, we monitored the effect of triclosan exposure on adult earthworm survival, growth, and reproduction. The bioaccumulation of triclosan in earthworm tissue (adults and juveniles) and degradation of triclosan were monitored. The genotoxicity of triclosan was evaluated using a comet assay (DNA damage) on adult earthworm coelomocytes. Exposure to a low concentration of triclosan had no significant effects on adult earthworm survival and DNA damage but significantly stimulated growth (p < 0.05) by 2-fold compared with controls. It also significantly affected E. andrei reproduction parameters (p < 0.05), as evidenced by an increase in the number of cocoons and juveniles and a decrease in the mean dry weight of juveniles. The bioaccumulation of triclosan in earthworms was moderate (bioaccumulation factor ∼2). In biosolid-borne trials, the bioaccumulation of methyl-triclosan in earthworm tissues was higher than that of the parent compound triclosan. We conclude that exposure to low concentrations of triclosan in artificial soil can significantly affect the growth and reproductive performance of earthworms (i.e., E. andrei). More research is required with natural soils to assess triclosan bioavailability for earthworms. Environ Toxicol Chem 2018;37:1940-1948. © 2018 SETAC.

Field biomonitoring using the zebra mussel Dreissena polymorpha and the quagga mussel Dreissena bugensis following immunotoxic reponses. Is there a need to separate the two species?

The zebra mussel, Dreissena polymorpha constitutes an extensively used sentinel species for biomonitoring in European and North American freshwater systems. However, this invasive species is gradually replaced in freshwater ecosystem by Dreissena bugensis, a closely related dreissenid species that shares common morphological characteristics but possess some physiological differences. However, few are known about differences on more integrated physiological processes that are generally used as biomarkers in biological monitoring studies. Declining of zebra mussel populations raises the question of the sustainability of using one or both species indifferently to maintain the quality of environmental pollution monitoring data. In our study, we performed a field comparative study measuring immune-related markers and bioaccumulation of PCBs, PAHs and PBDEs in sympatrically occurring mussel populations from three sites of the St. Lawrence River. For tested organisms, species were identified using RFLP analysis. Measurement of bioaccumulated organic compounds indicated a higher accumulation of PCBs and PBDEs in D. bugensis soft tissues compared to D. polymorpha while no differences were noticed for PAHs. Results of hemocytic parameters highlighted that differences of hemocyte distributions were associated to modulations of phagocytic activities. Moreover, marked differences occurred in measurement of hemocytic oxidative activity, indicating divergences between the two species for ROS regulation strategies. This physiological characteristic may deeply influence species responses facing environmental or pollution related stress and induce bias if the two species are not differentiated in further biomarker or bioaccumulation measurement-based studies.

Worldwide drinking water occurrence and levels of newly-identified perfluoroalkyl and polyfluoroalkyl substances

In the last decade or so, concerns have arisen with respect to the widespread occurrence of perfluoroalkyl acids (PFAAs) in the environment, food, drinking water, and humans. In this study, the occurrence and levels of a large range of perfluoroalkyl and polyfluoroalkyl substances (PFASs) were investigated in drinking water (bottled and tap water samples) from various locations around the world. Automated off-line solid phase extraction followed by ultra-high-performance liquid chromatography coupled to high-resolution mass spectrometry was used to analyze PFASs of various chain lengths and functional groups. In total, 29 target and 104 suspect-target PFASs were screened in drinking water samples (n=97) from Canada and other countries (Burkina Faso, Chile, Ivory Coast, France, Japan, Mexico, Norway, and the USA) in 2015-2016. Out of the 29 PFASs quantitatively analyzed, perfluorocarboxylates (PFCAs: C_4/14), perfluoroalkane sulfonates (PFSAs: C₄, C₆, C₈), and perfluoroalkyl acid precursors (e.g., 5:3 fluorotelomer carboxylate (5:3 FTCA)) were recurrently detected in drinking water samples (concentration range: <LOD to 39ngL^-1). Tap water samples from Canada showed noteworthy differences depending on their source; for instance, ∑₂₉PFASwas significantly greater in those produced from the Great Lakes/St. Lawrence River ecosystem than those produced from other types of sources (14 versus 5.3ngL^-1, respectively). A suspect-target screening approach indicated that other perfluoroalkane sulfonamides (FBSA, FHxSA), perfluoroethyl cyclohexane sulfonate (PFECHS), ultrashort chain (C₂-C₃) PFSAs (PFEtS, PFPrS), and two additional PFSAs (PFPeS (C₅) and PFHpS (C₇)) were repeatedly present in tap water samples (concentration ranges: <LOD to 4.0ngL^-1). To the authors' best knowledge, this constitutes the first observation of a cyclic perfluoroalkane sulfonate (PFECHS) and C₄-C₆ perfluoroalkane sulfonamides (FBSA, FHxSA) in drinking water. According to the newly updated US EPA health advisory for PFOS and PFOA (70ngL^-1), the drinking water samples collected in the present monitoring would not pose a health risk to consumers as regards PFAA levels.

Synthetic hospital wastewater treatment by coupling submerged membrane bioreactor and electrochemical advanced oxidation process: Kinetic study and toxicity assessment

In this work, the combination of membrane bioreactor (MBR) and electro-oxidation (EO) process was studied for the treatment of a synthetic hospital wastewater fortified with four pharmaceutical pollutants namely carbamazepine (CBZ), ibuprofen (IBU), estradiol (E-E) at a concentration of 10 μg L^-1 venlafaxine (VEN) at 0.2 μg L^-1. Two treatment configurations were studied: EO process as pre-treatment and post-treatment. Wastewater treatment with MBR alone shows high removal percentages of IBU and E-E (∼90%). Unlikely for CBZ and VEN, a low elimination percentage (∼10%) was observed. The hydraulic and the solid retention times (HRT and SRT) were 18 h and 140 d respectively, while the biomass concentration in the MBR was 16.5 g L^-1. To enhance pharmaceuticals elimination, an EO pretreatment was conducted during 40 min at 2 A. This configuration allowed a 92% removal for VEN, which was far greater than both treatments alone, with lower than 30% and 50% for MBR and EO, respectively. The MBR-EO coupling (EO as post-treatment) allows high removal percentages (∼97%) of the four pharmaceutical pollutants after 40 min of treatment at a current intensity of 0.5 A with Nb/BDD as electrodes. This configuration appears to be very effective compared to the first configuration (EO-MBR) where EO process is used as a pre-treatment. Toxicity assessment showed that the treated effluent of this configuration is not toxic to Daphnia magna except at 100% v/v. The MBR-EO coupling appears to be a promising treatment for contaminated hospital effluents.

Selective bioaccumulation of neonicotinoids and sub-lethal effects in the earthworm Eisenia andrei exposed to environmental concentrations in an artificial soil

In this study, we evaluated the bioaccumulation of neonicotinoid insecticides in the earthworm Eisenia andrei exposed to environmental concentrations (<200 ng g^-1 dry weight, nominal concentration) in an artificial soil. We tested the selectivity for neonicotinoids by exposing earthworms to 7 neonicotinoids alone and in more complex mixtures of 54 pesticides then 69 organic contaminants (OCs) (54 pesticides and 15 pharmaceuticals). We applied long-term (56-day) toxicity tests to further evaluate the effect of OCs on earthworms. We monitored adult survival, adult DNA damage using a comet assay on earthworm coelomocyte cells, and reproduction performance (i.e. number of cocoons and number and dry weight of juveniles). A selective bioaccumulation of neonicotinoid insecticides in adult and juvenile earthworms was found. This bioaccumulation is concomitant with a significant increase in adult DNA damage and significant effects on reproduction when earthworms were exposed to neonicotinoid insecticides alone. This study reveals a new potential point of entry of neonicotinoid insecticides into the wildlife food chain and also shows that E. andrei reproduction could be affected by long-term exposure to environmental concentrations of OCs.

Bacterial immune evasion via an IL-10 mediated host response, a novel pathophysiologic mechanism for chronic rhinosinusitis

BACKGROUND

Staphylococcus aureus is a frequently implicated pathogen in chronic rhinosinusitis (CRS). S. aureus may promote commensalism by downregulating pro-inflammatory T cell host responses via an IL-10 mediated pathway. This finding, coupled with the observation that S. aureus and CD8+ T cell numbers are inversely correlated in CRS mucosa, suggests that S. aureus may evade immune destruction via IL-10 induction. To support this hypothesis, we evaluated i) whether IL-10 levels differ in CRS compared to controls (CTL) using microarray and immunohistochemistry and ii) whether IL-10 levels correlate with S. aureus and CD8+ T cell levels.

METHODOLOGY

Sinus epithelial brush samples from 12 patients undergoing ESS for CRS and 10 CTLs underwent microarray analysis of IL-10 gene expression. Microarray results were verified on simultaneously obtained surgical biopsy samples by immunohistochemistry staining for IL-10. Potential mechanisms were assessed by immunohistochemistry for CD8+ T cells and S. aureus.

RESULTS

IL-10 gene expression was significantly higher in CRS vs CTL subjects at the time of surgery. Immunohistochemistry confirmed increased levels of intraepithelial IL-10. A strong inverse correlation was observed between intraepithelial IL-10 and CD8+ T cell levels as was intraepithelial IL-10 and S. aureus.

CONCLUSION

Elevated IL-10 levels in sinus mucosa may be a potential pathophysiologic feature of CRS in association with a significant downregulation of host CD8+ T cell levels. While S. aureus is believed to play a role in IL-10 induction, a comparatively weaker relationship between S. aureus and IL-10 levels suggests other bacterial species may also induce IL-10 production as a common survival strategy in CRS.

Novel Fluoroalkylated Surfactants in Soils Following Firefighting Foam Deployment During the Lac-Mégantic Railway Accident

The derailment of an unmanned train carrying crude oil and subsequent fire in the town of Lac-Mégantic, Quebec, led to the use of 33 000 L of aqueous film forming foam (AFFF) concentrate. While it is known that per- and polyfluoroalkyl substances (PFASs) contained in AFFFs pose a potential environmental and health risk, critical knowledge gaps remain as regards to their environmental fate after release. The accident in Lac-Mégantic provided valuable information regarding the identity and concentration of PFASs present in the soil after the AFFF deployment, as well as their possible transformation over time. The current study analyzed four sets of samples from Lac-Mégantic: soil collected days after the accident from a heavily impacted area, soil sampled two years later from the treatment biopiles, soil collected two years after the accident from downtown Lac-Mégantic, and nonimpacted soil from a nearby area. A total of 33 PFASs were quantified in the soils. The highest observed concentrations correspond to those of 6:2 fluorotelomer sulfonamidoalkyl betaine, 6:2 and 8:2 fluorotelomer sulfonates, and short chain perfluorocarboxylic acids. The soils collected in Lac-Mégantic two years after the accident show a total PFAS concentration that is ∼50 times lower than soils collected in 2013, while the proportion of perfluoroalkyl acids in those samples shows an increase. Qualitative analysis revealed the presence in soil of 55 additional PFASs that had been previously identified in AFFF formulations. The present study highlights the need to perform detailed analysis of AFFF impacted sites, instead of focusing solely on perfluoroalkyl acids.

Securing an OTL-HNS residency: how competitive is it? Comparing medical student perceptions to actual Canadian statistics

BACKGROUND

The residency match is an important event in an aspiring physician's career. Otolaryngology - Head and Neck Surgery (OTL-HNS) is a surgical specialty that has enjoyed high numbers of applicants to its residency programs. However, recent trends in Canada show a decline in first-choice applicants to several surgical fields. Factors thought to influence a medical student's choice include role models, career opportunities and work-life balance. The notion of perceived competitiveness is a factor that has not yet been explored. This study sought to compare competitiveness of OTL-HNS, as perceived by Canadian medical students to residency match statistics published yearly by CaRMS (Canadian Residency Matching Service), with the hope of informing future decisions of surgical residency programs.

METHODS

An electronic survey was created and distributed to all medical students enrolled in the 17 Canadian medical schools. After gathering demographic information, students were asked to rank what they perceived to be the five most competitive disciplines offered by CaRMS. They were also asked to rank surgical specialties from most to least competitive. Publically available data from CaRMS was then collected and analyzed to determine actual competitiveness of admissions to Canadian OTL-HNS residency programs.

RESULTS

1194 students, from first to fourth year of medical school, completed the survey. CaRMS statistics over the period from 2008 to 2014 demonstrated that the five most competitive specialties were Plastic Surgery, Dermatology, Ophthalmology, Emergency Medicine and OTL-HNS. Among surgical disciplines, OTL-HNS was third most competitive, where on average 72% of students match to their first-choice discipline. When students were questioned, 35% ranked OTL-HNS amongst the top five most competitive. On the other hand 72%, 74% and 80% recognized Opthalmology, Dermatology and Plastic Surgery as being among the five most competitive, respectively. We found that fourth-year medical students were significantly more knowledgeable about the competitiveness of both OTL-HNS and Plastic Surgery compared to first-year students (p < 0.01).

CONCLUSION

Overall, Canadian medical students may underestimate the competitiveness of OTL-HNS. Furthermore, competitiveness would appear to be a concept that resonates with medical students during the match process.

Environmental Occurrence of Perfluoroalkyl Acids and Novel Fluorotelomer Surfactants in the Freshwater Fish Catostomus commersonii and Sediments Following Firefighting Foam Deployment at the Lac-Mégantic Railway Accident

On July 6th 2013, an unmanned train laden with almost 8 million liters of crude oil careened off the rails downtown Lac-Mégantic (Québec, Canada). In the aftermath of the derailment accident, the emergency response entailed the deployment of 33 000 L of aqueous film forming foam (AFFF) concentrate that contained proprietary fluorosurfactants. The present study examines the environmental occurrence of perfluoroalkyl acids (PFAAs) and newly identified per and polyfluoroalkyl substances (PFASs) in the benthic fish white sucker (Catostomus commersonii) and sediments from Lake Mégantic and Chaudière River. In sediments, PFAAs displayed relatively low concentrations (∑PFAAs = 0.06-0.5 ng g^-1 dw) while the sum of fluorotelomer-based PFASs was in the range < LOD-6.2 ng g^-1 dw. Notably, fluorotelomer sulfonamide betaines (8:2-FTAB and 10:2-FTAB), fluorotelomer betaines (9:3-FTB, 11:3-FTB and 9:1:2 FTB) and 6:2 fluorotelomer sulfonate (6:2-FTSA) were ubiquitously identified in the sediment samples surveyed. Levels of PFAAs remained moderate in fish muscle (e.g.

, PFOS

0.28-2.1 ng g^-1 wet-weight), with little or no differences when comparing 2013 or 2014 fish samples with 2011 archived samples. In contrast, n:2-FTSAs emerged in the immediate weeks or months that followed the accident, as did several betaine-based PFASs (8:2-FTAB, 10:2-FTAB, 9:3-FTB, 11:3-FTB, 7:1:2 FTB and 9:1:2 FTB), observed for the first time in situ. Fluorotelomer thioether amido sulfonate (10:2-FTSAS) and fluorotelomer sulfoxide amido sulfonate (10:2-FTSAS-sulfoxide) were also occasionally reported after the AFFF spill. With time, levels of betaine-based PFASs gradually decreased in fish, possibly indicating attenuation by biodegradation of the fluorine-free moiety, supported by the observation of likely metabolites such as n:3-fluorotelomer carboxylates and n:2-fluorotelomer sulfonamides.

Analysis of emerging contaminants in water and solid samples using high resolution mass spectrometry with a Q Exactive orbital ion trap and estrogenic activity with YES-assay

Trace emerging contaminants (ECs) occur in both waste and surface waters that are rich in particulates that have been found to sorb several organic contaminants. An analytical method based on off-line solid-phase extraction (SPE) followed by liquid chromatography-mass spectrometry (LC-MS) analysis was developed for the detection and quantification of 31 ECs from surface water, wastewater, suspended particulate matter (SPM) as well as sediments. Lyophilized sediments and air-dried SPM were subjected to ultrasonic extraction. Water samples and extracts were then concentrated and cleaned-up by off-line SPE. Quantification was realized using a Q Exactive mass spectrometer in both full scan (FS) and MS² modes. These two modes were optimized and compared to determine which one was the most suitable for each matrix studied. Yeast estrogen screen assay (YES-assay) adapted from the direct measurement of estrogenic activity without sample extraction was tested on filtered wastewater samples. An endocrine disrupting effect was detected in all effluent samples analyzed with estradiol equivalent concentrations ranging from 4.4 to 720 ng eq E2 L^-1 for the WWTP-1 and 6.5-42 ng eq E2 L^-1 for the WWTP-2. The analytical methods were also applied on six samples of surface water, the corresponding SPM, the sediments and thirty-nine effluent samples from two wastewater treatment plants (WWTPs) sampled over a period of five months (February to June 2014).

QuEChERS extraction for multi-residue analysis of PCBs, PAHs, PBDEs and PCDD/Fs in biological samples

In this study, a fast and rugged method is presented for the analysis of PCBs, PAHs, PBDEs and PCDD/Fs in biological tissues using a simple Quick, Easy, Cheap, Efficient, Rugged and Safe (QuEChERS) extraction and a clean-up by Gel Permeation Chromatography (GPC) and silica Solid Phase Extraction (SPE). Development was performed on blue mussels (Mytilus edulis) and Atlantic salmon (Salmo salar) for evaluation of two ranges of lipid and water content of biological tissues. Statistical validation was performed with Atlantic salmon samples. Forty-five PAHs were analyzed including the priority list of the US EPA and the European Union with 41 PCBs, 24 PBDEs and 17 PCDD/Fs. Instrumental analyses were performed on Gas Chromatography - High Resolution Mass Spectrometry (GC-HRMS). Accuracy was evaluated for PCBs and PCDD/Fs with a certified reference material furnished by the National Research Council Canada (NRCC) and also compared with results obtained by the conventional Soxhlet extraction. Statistical validation showed recoveries for PCBs, PAHs, PBDEs and PCDD/Fs close to 100% with average Relative Standard Deviation (RSD) lower than 10% and internal standard recoveries in the range of 70% with average RSD ranging from 5-15%. Average calculated Method Detection Limits (MDLs) were lower than 0.05μg/Kg for PCBs, 0.2μg/Kg for PAHs and PBDEs and 1ng/Kg for PCDD/Fs. The method is a faster and cheaper alternative to the time-consuming conventional method that has been used in most environmental laboratories.

Analytical method development for the determination of polycyclic aromatic hydrocarbons in biological samples

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Development of an analytical method for the determination of low-level of dioxin and furans in marine and freshwater species

Not available

A review of what is an emerging contaminant

A review is presented of how one defines emerging contaminants and what can be included in that group of contaminants which is preferably termed “contaminants of emerging concern”. An historical perspective is given on the evolution of the issues surrounding emerging contaminants and how environmental scientists have tackled this issue. This begins with global lead contamination from the Romans two millennia ago, moves on to arsenic-based and DDT issues and more recently to pharmaceuticals, cyanotoxins, personal care products, nanoparticles, flame retardants, etc. Contaminants of emerging concern will remain a moving target as new chemical compounds are continuously being produced and science continuously improves its understanding of current and past contaminants.

Effects of silver nanoparticles on soil enzyme activities with and without added organic matter

The effects of silver nanoparticles (AgNPs) on terrestrial ecosystems need to be better understood and assessed. Cationic silver (Ag+) has well-documented toxicity against bacteria, but it is not clear what will be the effect of nanoscale Ag. In the present study, the potential effects of AgNPs were investigated in soils by measuring activity of the enzymes phosphomonoesterase, arylsulfatase, β-D-glucosidase, and leucine-aminopeptidase. The toxicity of AgNPs was compared with that of ionic Ag, and the ameliorating effects of soil organic matter were evaluated. To this end, 2 soils with different organic matter contents were artificially contaminated with either AgNPs or Ag-acetate at equivalent total Ag concentrations. In general, enzyme activities were inhibited as a function of the Ag concentration in the soil. In the AgNP exposures, only a small fraction of the AgNP was actually truly dissolved (found in the <1-nm fraction), suggesting that the particulate forms of AgNPs resulted in a significant inhibition of soil enzymes. The addition of organic matter to the soils appeared to enhance enzyme activities; however, the mechanism of organic matter action is not clear given that dissolved Ag concentrations were similar in both the organic-matter–amended and unamended soils. The present study shows that the AgNP produces significant negative effects on the soil enzyme activities tested. The Ag chemical speciation measurements suggested that the AgNP caused greater toxic effects to the soil enzymes at the low Ag concentrations. For the larger concentrations of total soil Ag, causes of the negative effects on enzyme activities are less obvious but suggest that colloidal forms of Ag play a role.

Traits-based approaches in bioassessment and ecological risk assessment: strengths, weaknesses, opportunities and threats

We discuss the application of traits-based bioassessment approaches in retrospective bioassessment as well as in prospective ecological risk assessments in regulatory frameworks. Both approaches address the interaction between species and stressors and their consequences at different levels of biological organization, but the fact that a specific species may be less abundant in a potentially impacted site compared with a reference site is, regrettably, insufficient to provide diagnostic information. Species traits may, however, overcome the problems associated with taxonomy-based bioassessment. Trait-based approaches could provide signals regarding what environmental factors may be responsible for the impairment and, thereby, provide causal insight into the interaction between species and stressors. For development of traits-based (TBA), traits should correspond to specific types of stressors or suites of stressors. In this paper, a strengths, weaknesses, opportunities, and threats (SWOT) analysis of TBA in both applications was used to identify challenges and potentials. This paper is part of a series describing the output of the TERA (Traits-based ecological risk assessment: Realising the potential of ecoinformatics approaches in ecotoxicology) Workshop held between 7 and 11 September, 2009, in Burlington, Ontario, Canada. The recognized strengths were that traits are transferrable across geographies, add mechanistic and diagnostic knowledge, require no new sampling methodology, have an old tradition, and can supplement taxonomic analysis. Weaknesses include autocorrelation, redundancy, and inability to protect biodiversity directly. Automated image analysis, combined with genetic and biotechnology tools and improved data analysis to solve autocorrelation problems were identified as opportunities, whereas low availability of trait data, their transferability, their quantitative interpretation, the risk of developing nonrelevant traits, low quality of historic databases, and their standardization were listed as threats.

Measurement of Supernatural Belief: Sex Differences and Locus of Control

Although we live in an age dominated by science and technology, there exists an increasingly popular anti-science sentiment. This study describes the development of a scale to assess the degree of personal acceptance of supernatural causality versus acceptance of scientific explanation. In addition to the psychometric data concerning validity and reliability of the scale, data are presented which showed the personality factor of supernaturalism to be independent of orthodox religious attitudes. Results indicated a significantly greater supernatural acceptance for women, and a positive relation of supernaturalism with external locus of control.

Efficiency of sediment quality guidelines for predicting toxicity: the case of the St. Lawrence River

Multitiered frameworks that are designed for risk assessment of contaminated sediment rely on sediment quality guidelines (SQGs) at the first tier or screening level. In the case of contamination by multiple pollutants, results can be aggregated under indices such as the mean quotient. A decision is then reached (e.g., to dispose of dredged materials in open water) without further investigation, provided that the SQGs or the specific values of indices or quotients derived from the SQGs are not exceeded. In this way, SQGs and quotients play a critical role in environmental protection. As part of the development of a tiered framework to assess the environmental risk of materials dredged from the St. Lawrence River, we evaluated various quotients based on SQGs available for this river with a data set that matches chemistry and toxicity test endpoints. The overall efficiency of all tested quotients was rather low, and we then examined factors such as sediment grain size, nutrients, metal-binding phases (e.g., Al, Fe), and dissolved organic carbon to explain misclassified samples. This examination led to the design of a modified tier 1 framework in which SQGs are used in combination with decision rules based on certain explanatory factors.

Tooth loss, apolipoprotein E, and decline in delayed word recall

Our previous research suggests an association between a low number of teeth and increased risk of dementia. The aim of the present study was to determine if a low number of teeth is specifically related to memory decline as evidenced by low Delayed Word Recall scores. In addition, we examined the combined effect of a low number of teeth and the apolipoprotein E epsilon4 allele on Delayed Word Recall scores. We hypothesized that the scores of those who had the allele and a low number of teeth (0-9) would decline more rapidly over time than those participants with a greater number of teeth who lacked the allele. We found that individuals with both risk factors (the allele and fewer teeth) had lower Delayed Word Recall scores at the first examination and declined more quickly compared with participants with neither of these risk factors or with either risk factor alone.