Persistent Organic Pollutants in Austrian Human Breast Milk Collected between 2013 and 2016

Breast milk holds an immense nutritional value as it contains health-promoting substances in a unique, optimal form. Additionally, breast milk's significance extends to health and environmental protection, as it serves as an indicator of both maternal and infant exposure. In this study, breast milk samples collected in 2013 and in 2014-2016 from mothers in Vienna (Austria) were analysed for polybrominated diphenyl ethers (PBDE) and per- and polyfluoroalkyl substances (PFAS), as well as further substances which have been listed under the Stockholm Convention on Persistent Organic Pollutants (POPs) due to their persistent, bioaccumulative and toxic properties. The total concentration of the PBDE congeners in the samples (n = 18, sampled 2013) ranged from 0.055 to 52 ng/g lipid, and from 0.002 to 2.5 ng/g breast milk. In the pooled sample, the sum of PBDEs was detected at a level of 4.4 ng/g lipid. Based on the 2014-2016 study population, certain PFAS were detected in all samples (n = 40). Exposure to the sum of four specific PFAS including perfluorooctanesulphonate (PFOS), perfluorooctanoic acid (PFOA), perfluoro-n-nonanoic acid (PFNA) and perfluoro-1-hexanesulfonate (PFHxS) ranged between 0.014 and 0.12 ng/L breast milk. In the pooled sample, PFOS and PFOA were found in concentrations of 0.025 ng/g and of 0.045 ng/g, respectively. In addition, the first generation of POPs, mainly organochlorine compounds, was measured in a pooled sample of breast milk from participants sampled in 2014-2016 as part of the WHO/UNEP breast milk monitoring program and compared to the POPs measured in pooled samples collected in 1987/1988 and 1992/1993, respectively. Therefore, this paper demonstrates the effectiveness of the Stockholm Convention on POPs by comparing the Austrian results from the WHO/UNEP global breast milk study from 1987 to 2016. However, the data also show that, despite these reductions, health-relevant levels are still being reached, particularly in terms of children's health when the presence of the new generation of POPs, such as PBDEs and PFAS, in human breast milk is taken into account.

[The history of emerging substances in Austria]

Over time, many different groups of substances became the focus of interest, so their occurrence, behaviour and effects were studied. While in the 1990s, it was detergents and the formation of foam in water, later the causes of discolouration around tanneries were researched, as well as the presence of chemicals and pollutants near industrial plants. Organochlorine pesticides, brominated flame retardants, perfluoroalkyl substances or PFAS, organotin compounds are some examples of such Emerging substances. After pesticides and industrial chemicals, active pharmaceutical ingredients, cosmetics and personal care products have also become "Emerging substances". Ultimately, however, it is the effect of the substances-whether persistent, bioaccumulative, mobile, toxic or even endocrine disruption-that attracts attention and triggers legal regulations. As the substances and the methods for their detection changed, so did the corresponding legislation. This in turn led to the use of new or slightly modified substances and substance groups. Innovative methods such as non-targeted analytics and biological effect tests or bioassays are now being utilised to address the variety and combined effects of the existing substances. In order to ensure comprehensive groundwater and water protection, the investigation and assessment methods must be developed. Furthermore, the existing and newly acquired knowledge need to be translated into regulatory consequences more quickly. Beyond that, a comprehensive societal transformation with regard to the sustainable use of natural water resources is essential for environmentally sound and healthy development. This must therefore be implemented on many different levels; with knowledge transfer and awareness-raising also having a significant role to play.

Gene Variants Determine Placental Transfer of Perfluoroalkyl Substances (PFAS), Mercury (Hg) and Lead (Pb), and Birth Outcome: Findings From the UmMuKi Bratislava-Vienna Study

Prenatal exposure to perfluoroalkyl substances (PFAS), bisphenol A (BPA), lead (Pb), total mercury (THg), and methylmercury (MeHg) can affect fetal development. Factors influencing placental transfer rate of these toxins are poorly investigated. Whether prenatal exposure to pollutants has an effect on birth weight is incompletely understood. We therefore aimed (1) to determine placental transfer rates of PFAS, BPA, Pb, THg, and MeHg, (2) to analyze relationships between fetal exposure and birth outcome and (3) to analyze gene variants as mediators of placental transfer rates and birth outcome. Two hundred healthy pregnant women and their newborns participated in the study. BPA, 16 PFAS, THg, MeHg, and Pb were determined using HPLCMS/MS (BPA, PFAS), HPLC-CV-ICPMS (MeHg), CV-AFS (THg), and GF-AAS (Pb). Questionnaires and medical records were used to survey exposure sources and birth outcome. 20 single nucleotide polymorphisms and two deletion polymorphisms were determined by real-time PCR from both maternal and newborn blood. Genotype-phenotype associations were analyzed by categorical regression and logistic regression analysis. Specific gene variants were associated with altered placental transfer of PFAS (ALAD Lys59Asn, ABCG2 Gln141Lys), THg (UGT Tyr85Asp, GSTT1del, ABCC1 rs246221) and Pb (GSTP1 Ala114Val). A certain combination of three gene polymorphisms (ABCC1 rs246221, GCLM rs41303970, HFE His63Asp) was over-represented in newborns small for gestational age. 36% of Austrian and 75% of Slovakian mothers had levels exceeding the HBM guidance value I (2 μg/L) of the German HBM Commission for PFOA. 13% of newborns and 39% of women had Ery-Pb levels above 24 μg/kg, an approximation for the BMDL₀₁ of 12 μg/L set by the European Food Safety Authority (EFSA). Our findings point to the need to minimize perinatal exposures to protect fetal health, especially those genetically predisposed to increased transplacental exposure.

Evidence for the existence of a new genus Chlamydiifrater gen. nov. inside the family Chlamydiaceae with two new species isolated from flamingo (Phoenicopterus roseus): Chlamydiifrater phoenicopteri sp. nov. and Chlamydiifrater volucris sp. nov

The family Chlamydiaceae currently comprises a single genus Chlamydia, with 11 validly published species and seven more taxa. It includes the human pathogens Chlamydia (C.) trachomatis, C. pneumoniae and C. psittaci, a zoonotic agent causing avian chlamydiosis and human psittacosis, as well as other proven or potential pathogens in ruminants, birds, snakes, reptiles and turtles. During routine testing of 15 apparently healthy captive flamingos in a zoo in 2011, an atypical strain of Chlamydiaceae was detected by real-time PCR of cloacal swab samples. Sequence analysis of the 16S rRNA gene revealed high similarity to the uncultured Chlamydiales bacterium clone 122, which previously had been found in gulls. As more samples were collected during annual campaigns of the flamingo ringing program in southern France from 2012 to 2015, Chlamydiaceae-specific DNA was detected by PCR in 30.9% of wild birds. From these samples, three strains were successfully grown in cell culture. Ultrastructural analysis, comparison of 16S and 23S rRNA gene sequences, whole-genome analysis based on de novo hybrid-assembled sequences of the new strains as well as subsequent calculation of taxonomic parameters revealed that the relatedness of the flamingo isolates to established members of the family Chlamydiaceae was sufficiently distant to indicate that the three strains belong to two distinct species within a new genus. Based on these data, we propose the introduction of Chlamydiifrater gen. nov., as a new genus, and Chlamydiifrater phoenicopteri sp. nov. and Chlamydiifrater volucris sp. nov., as two new species of the genus.

Bis(4-chlorophenyl) sulfone (BCPS) concentrations found in Austrian freshwater fish and cormorants (Phalacrocorax carbo sinensis) indicating trophic transport and biomagnification - A screening pilot-study

Bis(4-chlorophenyl) sulfone (BCPS, CAS No. 80-07-9) is used as monomer for the production of several groups of polymers like polysulphones and polyethersulphones. Residual amounts of monomer remain in the polymer matrix and might migrate out from the polymer matrix. In the present study, freshwater fish and fish-eating birds were examined. Following fish species (top predators) were collected at two Austrian locations: Sander lucioperca, Silurus glanis, and Lota lota. Whole fish samples were analysed for BCPS. Levels in freshwater fish ranged between 1.3 and 9.3 ng/g fat. In addition, breast muscle and liver samples from six cormorants (Phalacrocorax carbo sinensis) were investigated. BCPS levels in cormorants breast muscle were in the range of 4.3-40 ng/g fat (mean: 16.3 ng/g fat, n = 6) and 28-86 ng/g fat (mean: 53.5 ng/g fat, n = 6) in the liver samples. BCPS concentration in liver was 3.3-fold higher than in muscle tissue. One of the cormorants had ingested fish with a BCPS level of 5.5 ng/g fat; BCPS levels in the cormorant were 23 ng/g fat (breast muscle) and 28 ng/g fat (liver), suggesting biomagnification values (BMF) of 4.2 (fish/breast muscle) and 5.1 (fish/liver), respectively. A BMF value higher than 1 can be considered as an indication for very high biomagnification. Comparing the BCPS concentrations of cormorants' breast muscle from 2019 (mean: 16 ng/g fat) to the concentrations from 2001 to 2005 (mean: 8.9 ng/g fat), indicates that BCPS levels might be increasing in Europe.

1178 Predictors Of Being Seen By A Board-certified Sleep Medicine Provider

Introduction

Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers.

Methods

Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI).

Results

A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses.

Conclusion

Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients.

Support

This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

Austrian reference values for phthalate metabolite exposure in children/adolescents and adults

Reference values (RV₉₅) are statistically derived values comprising the rounded 95th percentiles within the 95% confidence interval and indicate the upper margin of background exposure to chemical substances in a population at a given time period. Based on representative national human biomonitoring data on several urinary phthalate metabolites in children, adolescents and adults from 2010 to 2011, RV₉₅ were derived for the Austrian population based on a IUPAC guideline and the recommendation of the German Human Biomonitoring Commission. The RV₉₅ (rounded values) for phthalate metabolites in children and adolescents aged 6-15 years are 110 μg/l (confidence interval of 95th population percentile: 83.7-163) for mono-ethyl phthalate (MEP), 45 μg/l (40.9-60.6) for mono-n-butyl phthalate (MnBP), 130 μg/l (126-161) for mono-isobutyl phthalate (MiBP), 25 μg/l (17.8-33.6) for mono-benzyl phthalate (MBzP), 100 μg/l (94.0-126) for the sum of the di(2-ethylhexyl) phthalate (DEHP) metabolites including mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP), mono(2-ethyl-5-oxohexyl) phthalate (5oxo-MEHP) and mono(2-ethyl-5-carboxypentyl) phthalate (5cx-MEPP), and 1.5 μg/l (0.64-1.6) for mono-cyclohexyl phthalate (MCHP). In adults aged 18-81 years, RV₉₅ are 440 μg/l (353-636) for MEP, 40 μg/l (33.1-52.1) for MnBP, 110 μg/l (87.3-118) for MiBP, 10 μg/l (7.2-11.8) for MBzP, 50 μg/l (44.6-68.3) for the sum of MEHP, 5OH-MEHP, 5oxo-MEHP and 5cx-MEPP, and 1.5 μg/l (0.95-1.8) for MCHP. For almost all investigated metabolites, children and adolescents exhibit higher RV₉₅ than adults, with the exceptions being MEP and MCHP. Compared to available RV₉₅ for Germany and Canada, Austrian values are lower for all investigated population groups.

Leukocyte Alkaline Phosphatase and Carcinoembryonic Antigen in Metastatic Colorectal Cancer Patients

Peripheral blood leukocyte alkaline phosphatase scores and plasma carcinoembryonic antigen levels in 26 patients with metastatic colorectal cancer were compared to those in 30 healthy controls. Patients had metastases to the liver and abdomen. The mean leukocyte alkaline phosphatase score in the metastatic colorectal cancer patients was significantly higher than in the control group (246 ± 65 vs, 52 ± 26, p < 0.001); and the mean carcinoembryonic antigen level in the patients was also significantly higher than in the controls (110 ± 100 vs, 4.9 ± 3 ng/ml, p < 0.001). One hundred percent of the metastatic cancer patients had elevated LAP scores and 73% of these patients had elevated CEA levels. There was a difference between the mean CEA levels in the patients with liver metastases and those with abdominal metastases (162 ± 135 vs, 39 ± 53 ng/ml, p < 0.04). The results suggest that although both markers are elevated in metastatic colorectal cancer, the LAP score seems to be more useful in detecting metastatic disease, since we found 11 % false negatives with the CEA level and 0 % false negatives with the LAP score.

First determination of fullerenes in the Austrian market and environment: quantitative analysis and assessment

This study forms the first report on analyzing fullerenes in the Austrian environment and cosmetic products available on the Austrian market. We developed, optimized, and validated a novel method for the analysis of C₆₀ and C₇₀ fullerenes and N-methylfulleropyrrolidine C₆₀ (NMFP) for measuring sensitivities in the low nanograms per liter range in order to prove their presence in the environment (12 wastewater- and 12 sewage sludge samples) and in 11 selected fullerene-containing cosmetic products from three different brands. The optimized method relies on a liquid-liquid extraction (LLE) or solid-liquid extraction (SLE) and, for the first time, introduced the Carrez-clarification, followed by liquid chromatography (LC) and coupled to a hybrid triple quadrupole mass spectrometry (MS) quantification. The total variability of the new established LC-MS/MS method based on all the tested matrices was below 10%. We found recoveries generally higher than 70% for both tap water and surface water. The limits of quantitation (LOQ) for the wastewater samples were measured to be from 0.8 to 1.6 ng/L, for the sewage sludge samples, from 1.4 to 2.6 ng/g DM (drymass), and for the cosmetic samples from 0.2 to 0.4 ng/g. None of the analyzed samples of wastewater or sewage sludge samples contained fullerenes. But in 70% of the tested cosmetics, fullerene concentrations between 10 and 340 ng/g were detected. These values were much lower than concentrations causing toxicity in water animals.

Research Article. Perfluoroalkylated substances in human urine: results of a biomonitoring pilot study

Perfluoroalkylated substances (PFASs) are a class of synthetic chemicals used in a wide range of processes and products due to their unique physicalchemical properties. Through intake of PFASs via food or several consumer products, humans can be exposed. Long-chain PFASs have been associated with adverse effects in laboratory animals, and there is also evidence for adverse health effects in humans. Although investigations of human exposure are mainly conducted in blood samples, some studies have shown that especially short-chain PFASs can be detected in human urine. In the present study, a sensitive analytical method was adapted for the measurement of 12 PFASs in human urine samples by HPLC-MS/MS. For verifying this method, concentrations in 11 male and female participants aged 25-46 years were analysed. In the study population, ranges of urinary PFASs concentrations were n.d.- 8.5 ng/l for perfluoropentanoic acid, <LOQ-3.0 ng/l for perfluorohexanoic acid, n.d.-1.8 ng/l for perfluorohexane sulphonate, n.d.-0.99 ng/l for perfluoroheptanoic acid, 0.79-5.1 ng/l for perfluorooctanoic acid, <LOQ-4.9 ng/l for perfluorooctane suphonate, and <LOQ-0.57 ng/l for perfluorononanoic acid. For the other investigated PFASs, no urinary exposure could be identified in any of the samples. The present study shows that several shortchain PFASs are detectable in human urine.

Life without plastic: A family experiment and biomonitoring study

Exposure to bisphenol-A (BPA) and phthalates has been associated with negative health outcomes in animal and human studies, and human bio-monitoring studies demonstrate widespread exposure in the US and Europe. Out of concern for the environment and health, individuals may attempt to modify their environment, diet, and consumer choices to avoid such exposures, but these natural experiments are rarely if ever quantitatively evaluated. The aim of the study was to evaluate the difference in urinary concentrations of BPA and phthalate metabolites following an exposure reduction intervention among an Austrian family of five. Urine samples were taken shortly after the family had removed all plastic kitchenware, toys, and bathroom products, and started a concerted effort to eat less food packaged in plastic. Two-months later, urine samples were collected at a follow-up visit, and concentrations of BPA and phthalate metabolites were compared. Shortly after removal of plastic urinary concentrations of BPA were below limit of quantification in all samples. Phthalate concentrations were low, however, 10 of 14 investigated metabolites could be found above limit of quantification. After the two-month intervention, phthalate urinary concentrations had declined in some but not all family members. In the mother most phthalate metabolites increased. The low levels might be partly due to the environmentally conscious lifestyle of the family and partly due to the fact that body levels had dropped already because of the delay of four days between finishing removal and first measurement. Further two months avoidance of dietary exposure and exposure to environmental plastics reduced urinary concentrations for all but one metabolite in the oldest son only, but decreased somewhat in all family members except the mother.

Human biomonitoring of bisphenol A exposure in an Austrian population

Bisphenol A (BPA) is an industrial chemical widely used as a monomer in polycarbonate, epoxy resin and thermal paper production, and as a stabiliser in polyvinyl chloride (PVC) production. Thus, BPA is present in a wide range of common consumer products. Due to contact with BPA-containing products, humans are regularly exposed via different routes. BPA is an endocrine active substance and can potentially lead to different adverse health outcomes. In the present study, total BPA levels were analysed by on-line SPE-HPLC-MS/MS in spontaneous urine samples in order to investigate the exposure to an Austrian population aged 6-15 and 18-81 years. In the total study population (n=594), total BPA were found in 15.7% of all samples, with concentrations up to 17 μg/l (median: n.d., 95th percentile: 3.7 μg/l). These results show generally low BPA levels among the investigated study population. However, children and adolescents exhibited higher exposure levels. Daily BPA intakes were estimated and compared to acceptable exposure levels, whereat no exceedances could be identified. Although BPA exposure was shown to be low in the Austrian population, the wide distribution and the ongoing discussion related to possible negative health effects even at low doses indicate need for further monitoring and investigations.

Occurrence of polycyclic musks in wastewater and receiving water bodies and fate during wastewater treatment

The occurrence of cashmerane (DPMI), celestolide, phantolide, traesolide (ATII), galaxolide (HHCB) and tonalide (AHTN) in sewage and surface waters and their fate during wastewater treatment and anaerobic sludge digestion is investigated. AHTN and HHCB are the most important representatives and influent concentrations of 0.41-1.8 and 0.9-13 μgL(-1) are observed. DPMI is detected in influent and effluent samples but in notably lower concentrations than AHTN and HHCB. Major sources of polycyclic musks are households, whereas industrial emitters seem to be of minor importance. This conclusion is supported by the analysis of selected industrial wastewaters (metal, textile and paper industry). Specific emissions of 0.36 ± 0.19 and 1.6 ± 1.0 mg cap(-1)d(-1) for AHTN and HHCB are calculated. Overall removal efficiencies between approx 50% and more than 95% are observed during biological wastewater treatment and removal with the excess sludge is the major removal pathway. Log K(D) values of 3.73-4.3 for AHTN, 3.87-4.34 for HHCB and 2.42-3.22 for DPMI are observed in secondary sludge. During sludge digestion no or only slight removal occurred. Mean polycyclic musk concentrations in digested sludge amounted to 1.9 ± 0.9 (AHTN), 14.2 ± 5.8 (HHCB), 0.8 ± 0.4 (ATII) and 0.2 ± 0.09 (DPMI) mgkg(-1) dry matter. In the receiving water systems a comparable distribution as during wastewater treatment is observed. AHTN, HHCB and DPMI are detected in surface waters (ND (not detected) - <0.04, ND - 0.32 and ND - 0.02 μg L(-1)) as well as AHTN and HHCB in sediments (ND - 20, ND - 120 μg kg(-1)). For HHCB an apparent K(OC) value of 4.1-4.4 is calculated for sediments. Major source for polycyclic musks in surface waters are discharges from wastewater treatment plants. For HHCB and DPMI 100% of the load observed in the sampled surface waters derive from discharges of treated wastewater.

Legionella pneumophila-induced IκBζ-dependent expression of interleukin-6 in lung epithelium

Severe community- and hospital-acquired pneumonia is caused by Legionella pneumophila. Lung airway and alveolar epithelial cells comprise an important sentinel system in airborne infections. Although interleukin (IL)-6 is known as a central regulator of the immune response in pneumonia, its regulation in the lung is widely unknown. Herein, we demonstrate that different L. pneumophila strains induce delayed expression of IL-6 in comparison with IL-8 by human lung epithelial cells. IL-6 expression depended, at early time points, on flagellin recognition by Toll-like receptor (TLR)5, activity of mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK)1 and p38 mitogen-activated protein (MAP) kinase, and, at later time points, on the type-IV secretion system. In the same manner, but more rapidly, the recently described transcription factor IκBζ was induced by Legionella infection and, binding to the nuclear factor (NF)-κB subunit p50 - recruited to the il6 promoter together with CCAAT-enhancer-binding protein β and phosphorylated activator protein-1 subunit cJun. Similarly, histone modifications and NF-κB subunit p65/RelA appeared at the iκbζ and subsequently at the il6 gene promoter, thereby initiating gene expression. Gene silencing of IκBζ reduced Legionella-related IL-6 expression by 41%. Overall, these data indicate a sequence of flagellin/TLR5- and type IV-dependent IκBζ expression, recruitment of IκBζ/p50 to the il6 promoter, chromatin remodelling and subsequent IL-6 transcription in L. pneumophila-infected lung epithelial cells.

High levels of xenoestrogens in patients with low-grade endometrial stromal sarcoma--report of two cases

BACKGROUND

Endometrial stromal sarcomas (ESS) are rare uterine tumors with unknown etiological risk factors, but estrogen-dependent growth promotion.

CASES

We present two patients with advanced ESS, who had increased levels of p,p-DDE; hexachlorobenzene; PCB 28; PCB 52; PCB 101; PCB 138; PCB 153 and PCB 180 in abdominal adipose tissue. Other xenoestrogens were within expected limits for the non-exposed European population.

CONCLUSION

Increased levels of xenoestrogens in patients with ESS may be involved in the pathogenesis of ESS. Chronic exposure to xenoestrogens may be a risk factor for tumor progression.

Perfluorinated alkylated substances in the aquatic environment: an Austrian case study

Perfluorinated alkylated substances (PFAS) are of global interest due to their occurrence and persistency in the environment. This study includes surface waters and sediments for the analysis of eleven PFAS. The PFAS studied can be grouped in perfluoroalkyl carboxylates (PFCAs), perfluoroalkyl sulfonates (PFS) and perfluoroalkyl sulfonamides (PFSA). The two most important compounds are perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS). These two substances showed the most significant values for surface water samples with maximum concentrations of 21 ng l(-1) for PFOA and 37 ng l(-1) for PFOS. Sediment samples from seven Austrian lakes and the river Danube were studied. Whereas PFSA and PFS were not detected in any sediment sample PFCAs were detected in most of the lake samples in concentrations up to 1.7 microg kg(-1) dry wt. PFOA, perfluorohexanoic acid (PFHxA) and perfluoroheptanoic acid (PFHpA) were detected in all Danube river sediment samples in concentrations varying from 0.1 up to 5.1 microg kg(-1) dry wt. For the various sampling points the proportional mass flows deriving from wastewater discharges were calculated. Whereas only up to 10% of the average flow is discharged wastewater up to more than 50% of the PFAS mass flows in the rivers can be attributed to wastewater discharges. Besides wastewater different other pathways as emissions from point sources, further degradation of precursor products, runoff from contaminated sites or surface runoff as well as dry and wet deposition have to be considered as relevant sources for PFAS contamination in surface waters.

PKC(alpha) and PKC(epsilon) differentially regulate Legionella pneumophila-induced GM-CSF

Legionella pneumophila is an important causative agent of severe pneumonia in humans. The human alveolar epithelium is an effective barrier for inhaled microorganisms and actively participates in the initiation of innate host defense. Although secretion of granulocyte-macrophage colony-stimulating factor (GM-CSF) is essential for the elimination of invading Legionella spp., mechanisms of Legionella pneumophila-induced release of this cytokine are widely unknown. In this study, we have demonstrated a toll-like receptor (TLR)2- and TLR5-dependent release of GM-CSF in L. pneumophila-infected human alveolar epithelial cells. GM-CSF secretion was not dependent on the bacteria type II or type IV secretion system. Furthermore, an increase in protein kinase C (PKC) activity, particularly PKC(alpha) and PKC(epsilon), was noted. Blocking of PKC(alpha) and PKC(epsilon) activity or expression, but not of PKC(beta), PKC(delta), PKC(eta), PKC(theta), and PKC(zeta), significantly reduced the synthesis of GM-CSF in infected cells. While PKC(alpha) was critical for the initiation of a nuclear factor-kappaB-mediated GM-CSF expression, PKC(epsilon) regulated GM-CSF production via activator protein 1. Thus, differential regulation of GM-CSF, production by PKC isoforms, contributes to the host response in Legionnaires' disease.

What do healthcare workers think? A survey of facial protection equipment user preferences

Data on healthcare workers'(HCWs) self-reported knowledge regarding selection of facial protection equipment, usage preferences and compliance are limited. We used a questionnaire on the use of facial protection equipment at a 700-bed adult tertiary care hospital employing approximately 7000 HCWs. Clinical areas targeted were those with frequent users of N95 respirators: intensive care unit, emergency room, respiratory services, and internal medicine. Respiratory therapists were also invited. In all, 137 questionnaires (68.5%) were returned. Most (72.8%) reported that training on the use of facial protection equipment was 'sufficient' to 'excellent'. The PFR95 and 3M 1860 Cone were used most frequently (56%) followed by the 3M 1870 Pocket (42%). While 95% reported having been fit-tested, only 60% were tested annually. PRF95 use exceeded the number of HCWs fit-tested for the item. Overall comfort and compliance scores were 13.6/20 and 21.5/25, respectively, for respirators and 7.7/10 and 18.5/25 for protective eyewear. No relationship between comfort and years of use of either respirators or protective eyewear was found. The results highlight potential failures in effectiveness in the use of personal protective equipment that could compromise HCW safety, and support observations that compliance in the workplace is usually less than in the research setting.

Is there any role for computed tomography measurements of medial temporal lobe atrophy in dementia? A review of the literature and case series from a memory clinic

Neuroimaging in dementia has focused on documenting any burden of vascular disease or excluding any reversible intracranial pathology. We review the use of computed tomography to examine for medial temporal lobe atrophy in dementia and compare this with a case series of such measurements from our memory clinic. Measures of medial temporal lobe atrophy were used to separate patients with Alzheimer's disease from those with normal cognition, mood disorders or other forms of early dementia.

Emissions of perfluorinated alkylated substances (PFAS) from point sources--identification of relevant branches

Effluents of wastewater treatment plants are relevant point sources for the emission of hazardous xenobiotic substances to the aquatic environment. One group of substances, which recently entered scientific and political discussions, is the group of the perfluorinated alkylated substances (PFAS). The most studied compounds from this group are perfluorooctanoic acid (PFOA) and perfluorooctane sulphonate (PFOS), which are the most important degradation products of PFAS. These two substances are known to be persistent, bioaccumulative and toxic (PBT). In the present study, eleven PFAS were investigated in effluents of municipal wastewater treatment plants (WWTP) and in industrial wastewaters. PFOS and PFOA proved to be the dominant compounds in all sampled wastewaters. Concentrations of up to 340 ng/L of PFOS and up to 220 ng/L of PFOA were observed. Besides these two compounds, perfluorohexanoic acid (PFHxA) was also present in nearly all effluents and maximum concentrations of up to 280 ng/L were measured. Only N-ethylperfluorooctane sulphonamide (N-EtPFOSA) and its degradation/metabolisation product perfluorooctane sulphonamide (PFOSA) were either detected below the limit of quantification or were not even detected at all. Beside the effluents of the municipal WWTPs, nine industrial wastewaters from six different industrial branches were also investigated. Significantly, the highest emissions or PFOS were observed from metal industry whereas paper industry showed the highest PFOA emission. Several PFAS, especially perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorododecanoic acid (PFDoA) and PFOS are predominantly emitted from industrial sources, with concentrations being a factor of 10 higher than those observed in the municipal WWTP effluents. Perfluorodecane sulphonate (PFDS), N-Et-PFOSA and PFOSA were not detected in any of the sampled industrial point sources.

Determination of selected organophosphate esters in the aquatic environment of Austria

Organophosphate esters are used in multitude of applications such as flame retardants, plasticizers and lubricants. In recent years concerns have been raised in regards to the environmental impact of some of the more commonly used phosphoric acid triesters, because many of them are toxic and persistent. Liquid-liquid extraction and ultrasound-assisted solvent extraction followed by liquid chromatography coupled to tandem mass spectrometry detection (LC-MS/MS) were used for the determination of nine priority organophosphate esters in waste and surface water, as well as in sediment samples for first time in Austria. Recoveries ranged from 63% to 94% in water and from 74 to 104% in sediment with estimated quantification limits between 2.6 and 7.9 ng/l in surface water, 4.1 and 13 ng/l in effluent waste water, and between 0.48 and 11 microg/kg in sediment. The validated method was applied to determine the occurrence of the selected organophosphorus flame retardants (OPFRs) and plasticizers in the aquatic environment of Austria. The impact of the discharge of waste water treatment plants into the receiving water bodies was also studied.

Occurrence of selected surfactants in untreated and treated sewage

Several surfactants were monitored in treated and untreated sewage in nine municipal wastewater treatment plants (WWTPs) in western Austria. The nine sampled WWTPs cover a wide variety referring to size and applied treatment technology. The investigation focused on linear alkylbenzene sulphonate (LAS), quaternary ammonia compounds (QAC), nonylphenol (NP), octylphenol (OP), nonylphenolmono- (NP(1)EO) and -diethoxylates (NP(2)EO). Whereas LAS, NP, OP and NP(1,2)EO were analysed separately in the liquid phase and in the solid phase, the QACs were measured in the total sample. Total influent concentrations of LAS varied between 2.4 mg l(-1) up to 6.7 mg l(-1) whereas total effluent concentrations were in the lower microg l(-1) range (11-50 microg l(-1)). Whichever the type of treatment, a clear removal during treatment was observed. Solid liquid distribution coefficients K(d) were calculated for untreated sewage. The calculated K(d) values varied between 1300 and 3900 l kg(-1). OP was of minor importance with total influent concentrations below 1microg l(-1). NP and NP(1,2)EO were present in all analysed influents in concentrations between 1 and 35microg l(-1). Effluent concentrations were notably lower than the measured influent concentrations. K(d) values for NP varied between 500 and 6600 l kg(-1), for NP(1)EO between 800 and 2700 l kg(-1) and for NP(2)EO between 100 and 1800 l kg(-1). From the QACs several alkyl benzyl (BAC), dialkyl (DDAC) and trialkyl (ATAC) ammonium chlorides with varying alkyl chain lengths were analysed. Highest total concentrations in the influents to the WWTPs were observed for the BAC-C12 and the ATAC-C16 homologues. Effluent concentrations were notably lower compared to influent concentrations, indicating removal by adsorption and/or biodegradation. The influence of the removal by adsorption increased with increasing alkyl chain length.

Mass antibiotic treatment to stop an outbreak of meningococcal disease: a molecular analysis

The occurrence of three cases of meningococcal disease among children in a small community, two of whom attended the same day-care centre, prompted a programme of mass antibiotic prophylaxis. Nasopharyngeal and throat swabs were obtained on three occasions from all children registered at the day-care centre. Serogroup B Neisseria meningitidis was isolated from 13 of 61 children before prophylaxis, from three children after 2 weeks, and from 19 children after 3 months. Repetitive extragenic palindromic PCR analysis identified several meningococcal strains before treatment, one of which became predominant after 3 months. Mass antibiotic prophylaxis initially suppressed meningococcal carriage, but the carriage rate subsequently rebounded.

Environmental monitoring study of selected veterinary antibiotics in animal manure and soils in Austria

LC-MS/MS was used for determination of selected tetracyclines, sulfonamides, trimethoprim, and fluoroquinolones in manure samples of pig, chicken and turkey, as well as arable soils fertilized with manure. Recoveries from spiked samples ranged from 61 to 105%. Method quantification limits were set to 100 microg/kg for all substances. Analysis of 30 pig manure, 20 chicken and turkey dung, and 30 lyophilized soil samples taken in Austria revealed that in pig manure up to 46 mg/kg chlortetracycline, 29 mg/kg oxytetracycline and 23 mg/kg tetracycline could be detected. As representatives of the group of sulfonamides, sulfadimidine in pig manure and sulfadiazine in chicken and turkey dung were detected in significant amounts (maximum concentration, 20 and 91 mg/kg, respectively). Enrofloxacin was particularly observed in chicken and turkey samples. Positive detection of chlortetracycline, enrofloxacin, and ciprofloxacin, in soil samples should be outlined as most important results of this study.

Monitoring atmospheric pollutants in the biosphere reserve Wienerwald by a combined approach of biomonitoring methods and technical measurements

In this study a combined approach of bioindication results correlated with an extensive set of data on air pollution and climate was used to assess the pollution status of the Man and Biosphere Reserve Wienerwald (Austria). Bryophytes served as impact indicators (via the Index of Atmospheric Purity-method IAP) at 30 sites as well as accumulation monitors for airborne trace elements (Al, Pb, V, S, Zn, Fe, Cu, Cr, Ni, Co, Mo, Cd, As, Sb and 16 EPA-PAHs) at 10 sites within the reserve. The results of these bioindication methods were subsequently correlated with further pollution (NO(2), SO(2) and dust) and climate data (precipitation, temperature and humidity). The findings obtained clearly indicate the following: Bryophyte distribution is solely influenced by the status of air quality, without interference by climatic or site-related factors, which is in contrast to several previous investigations. IAP-values correlated significantly with NO(2) (0.553; P=0.004), SO(2) winter values (0.511; P=0.013) and PM10 (dust) (0.561; P=0.013). The results obtained via chemical analyses revealed a strong correlation with data derived from the IAP methodology. In terms of the overall air quality within the biosphere reserve Wienerwald, the north-eastern part appears to be the most affected one with a most likely pollution contribution emitted by the capital city Vienna, agriculture and neighbouring countries.

Determination of selected quaternary ammonium compounds by liquid chromatography with mass spectrometry. Part II. Application to sediment and sludge samples in Austria

Soxhlet extraction and high-performance liquid chromatography (HPLC) coupled to tandem mass spectrometry detection (MS/MS) was used for the determination of selected quaternary ammonium compounds (QACs) in solid samples. The method was applied for the determination of alkyl benzyl, dialkyl and trialkyl quaternary ammonium compounds in sediment and sludge samples in Austria. The overall method quantification limits range from 0.6 to 3 microg/kg for sediments and from 2 to 5 microg/kg for sewage sludges. Mean recoveries between 67% and 95% are achieved. In general sediments were especially contaminated by C12 chain benzalkonium chloride (BAC-C12) as well as by the long C-chain dialkyldimethylammonium chloride (DDAC-C18) with a maximum concentration of 3.6 mg/kg and 2.1mg/kg, respectively. Maxima of 27 mg/kg for DDAC-C10, 25 mg/kg for BAC-C12 and 23 mg/kg for BAC-C14 were determined for sludge samples. The sums of the 12 selected target compounds range from 22 mg/kg to 103 mg/kg in the sludge samples.

Determination of selected quaternary ammonium compounds by liquid chromatography with mass spectrometry. Part I. Application to surface, waste and indirect discharge water samples in Austria

A method for simultaneous quantitative determination of alkyl benzyl, dialkyl and trialkyl quaternary ammonium compounds (QACs) has been developed, validated and subsequently applied to real water samples in Austria. The method employs liquid-liquid extraction (LLE) followed by liquid chromatography/tandem mass spectrometry (LC-MS/MS), using electrospray ionization (ESI) in positive mode. The overall method quantification limits range from 4 to 19ng/L for the enrichment of 500mL water samples and analyte recoveries are between 80 and 99%. The method was applied to 62 of the respective water samples without filtration to avoid the loss of the analytes due to the high adsorption capacity of these compounds. Maxima in the mg/L range, especially in the wastewater of hospitals and laundries, could be detected for the selected target compounds.

Luteal phase support for patients undergoing frozen-thawed embryo transfer cycles--the required progesterone dose

OBJECTIVE

With the recent trend toward single-embryo transfer (ET), cryopreservation of extraneous embryos is becoming increasingly prevalent. Several replacement protocols for frozen-thawed ET exist, with no consensus regarding the dosage or delivery mode of progesterone.

PATIENTS AND METHODS

Hormonal replacement with only estrogen and progesterone is the most frequently used protocol in women with and without functioning ovaries in our unit. Since August 2005, we have doubled the usual daily dose of progesterone for luteal support due to a high prevalence of patients experiencing withdrawal bleeding 11-13 days after ET. We compared the outcome of frozen-thawed ET cycles using different doses of progesterone for luteal support.

RESULTS

While the prevalence of embryos that survived the thawing process was significantly higher in the earlier (69%) as compared to the later period (58%), positive b-hCG pregnancy rates (17.5% vs 44.8%, respectively) and clinical pregnancy rates per transfer (7.9% vs 41.4%, respectively) were significantly higher in the later period.

CONCLUSION

We conclude that high-dose progesterone supplementation in the luteal phase of frozen-thawed ET cycles results in a significantly higher clinical pregnancy rate.

Method optimization for determination of selected perfluorinated alkylated substances in water samples

In recent years perfluorinated alkylated substances (PFAS) have appeared as a new class of global pollutant. Besides being an industrially important group of compounds, PFAS are regarded as highly toxic and extraordinarily persistent chemicals that pervasively contaminate human blood and wildlife throughout the world. They are therefore regarded as PBT (persistent, bioaccumulative, and toxic) chemicals. Two comprehensive methods have been developed for determination of eleven of the most environmentally relevant PFAS (seven perfluoroalkylcarboxylates, two perfluoroalkylsulfonates, and two perfluoroctanesulfonamides) in aqueous samples. The compounds were isolated by liquid-liquid extraction (LLE) and solid-phase extraction (SPE), and identification and quantification of the target analytes were achieved by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS). With LLE detection limits ranged from 0.26 to 0.62 ng L(-1) for enrichment of 900-mL water samples; recovery of PFAS with a carbon chain longer than C7 was excellent (80-93%). With SPE, carboxylates with carbon chains <C10 could be extracted efficiently (70-98%) under acidic conditions, and PFOS and PFOSA could be extracted efficiently (81% and 96%, respectively) under basic conditions, resulting in MDLs between 0.25 and 0.64 ng L(-1). The LLE method was applied successfully to Austrian wastewater effluent samples.

Pilot study on road traffic emissions (PAHs, heavy metals) measured by using mosses in a tunnel experiment in Vienna, Austria

BACKGROUND, AIMS AND SCOPE

Over the last few years there has been extensive research for new indicators providing information about deposition resulting from road traffic and tunnel experiments received special attention in emission research. Mosses have been used for the estimation of atmospheric heavy metal and PAH depositions for more than three decades, although they were used only a few times for estimating ambient air pollution caused by traffic. In the current study, the suitability of using a moss species for monitoring road traffic emissions inside a tunnel was evaluated. This was a first-time ever attempt to use plants (mosses) as bioindicators in a tunnel experiment. Specifically, two relevant questions were examined: 1) Do mosses accumulate toxic substances derived from road traffic emissions under the extremely adverse conditions which can be found in a tunnel, and 2) Which substances can mainly be attributed to road traffic emissions and therefore be taken as efficient and reliable indicators for motor vehicles?

METHODS

For the first time a biomonitor (the moss species Hylocomium splendens (Hedwig) B.S.G.) was used in a road tunnel experiment to analyse emissions from road traffic. Moss samples were exposed for four weeks in wooden frames (size 10 cm x 10 cm), covered by a thin plastic net with a mesh size of 1 cm x 1 cm. 17 elements, mainly heavy metals, and the 16 EPA-PAHs together with coronene were analysed by ICP-AES, AAS and GC-MSD.

RESULTS

Enrichment factors, calculated by comparing post-experiment concentrations to those of a background site, were high for most PAHs, especially benzo(g,h,i)perylene (150.7), coronene (134.7), benzo(a)anthracene (125.0), indeno(1,2,3-c,d)pyrene (79.8), chrysene (78.1), pyrene (69.6) and benzo(b)-fluoranthene (67.4), and among the other elements for Sb (73.1), Mo (59.6), Cr (33.9), As (24.1), Cu (19.6), and Zn (17.1). All these substances can thus be taken as indicators for road traffic pollution. Concentrations were also significantly higher in the tunnel mosses for all investigated substances than along busy roads outside tunnels. Cluster analysis revealed groups of substances which could sensibly be attributed to various sources (abrasion processes, Diesel combustion) and enrichment in the various particle size classes.

DISCUSSION

The extreme high concentrations in the analysed moss samples from inside the tunnel were due to higher concentrations in the ambient tunnel air, and the fact that already deposited chemical substances are not lost by rain, as well as efficient uptake capacities even under the extremely adverse conditions in a tunnel. In accordance with previous studies our results suggest that PAHs are better indicators for emissions from the burning process than heavy metals.

CONCLUSIONS

As in open fields, mosses are suitable indicators for monitoring traffic emissions in tunnels. In addition to biomonitoring in open fields, in tunnel experiments mosses are even better indicators, because the confounding effects of other sources of pollution and the 'noise' in the accumulation process (e.g. washout through wet deposition) are minimised. The results of our study demonstrate the usefulness of mosses for surveying heavy metals and PAH emissions and deposition arising from road traffic sources, even under the extremely adverse conditions of the tunnel environment.

RECOMMENDATION

It can be considered that biomonitors like mosses are a suitable alternative to technical particle filters inside tunnels. They are easy to handle, low in costs and valuable information regarding traffic emissions can be obtained.

PERSPECTIVE

The results of this pilot-study proved the feasibility of the method, however, should be corroborated by further investigations based on a sample set that allows for generalization of the findings and might even include other moss species. A comparison of technical measurements with the biomonitoring method could lead to a more general acceptance of the results.

Transcription linked to recombination: a gene-internal promoter coincides with the recombination hot spot II of the human MLL gene

The MLL gene is frequently involved in chromosomal translocations associated with high-risk acute leukaemia. Infant and therapy-related acute leukaemia patients display chromosomal breakpoints preferentially clustered in the telomeric portion of the MLL breakpoint cluster region (SCII). Here, we demonstrate that SCII colocalizes with a gene-internal promoter element in the mouse and human MLL gene, respectively. The mRNA generated encodes an N-terminally truncated version of MLL that still exhibits many functional regions, including the C-terminal SET-domain. Etoposide-induced DNA double-strand breaks colocalize with the binding site of RNA polymerase II and the transcription initiation region, but not with a nearby Topo II consensus sequence. Thus, the observed genomic instability of the human MLL gene is presumably linked to transcriptional processes. The consequences of this novel finding for the creation of chromosomal translocations, the biology of the MLL protein and for MLL-mediated acute leukaemia are discussed.

Burns from orthodontic pliers

A case of burn injury from orthodontic pliers resulting in a partial-thickness burn is presented. A brief description of the injury, a review of the pertinent literature, and general guidelines for out-patient management of such burns are also presented.

Environmental risk assessment for quaternary ammonium compounds: a case study from Austria

Quaternary ammonium compounds (QAC) are widely used as disinfectants, biocides, and detergents, among a variety of other applications. The cationic surface-activity of QAC determines their potential to act as a biocide on both target and non-target organisms. This study aims to provide a broad-based environmental risk characterization and evaluation for selected QAC with particular focus on the situation in Austrian rivers. A modular study design was employed involving environmental exposure characterization, QAC fate and effect analysis in wastewater, ecotoxicological effect characterization, and environmental risk evaluation. A wide array of Austrian surface waters and wastewater effluents were screened for the selected key compounds, benzalkonium chlorides and dialkyldimethylammonium chlorides with different C-chain lengths. Ecotoxicological effect characterization was based on both microbiotests for a set of representative aquatic organisms and a literature review. For risk evaluation, the PEC/PNEC ratio was above 1 for some rivers. Notably, small rivers with a high particulate matter were contaminated with QAC in the case of high water incidents. Hence, for the Austrian sites studied, a QAC-derived risk to sensitive aquatic non-target organisms could not be excluded.

Fine particles and meteorological conditions are associated with lung function in children with asthma living near two power plants

Fine particles are thought to pose a risk to health, especially for vulnerable groups such as children with asthma. These children are also known to be affected by meteorological and seasonal changes. We assessed the association between air pollution and lung function via peak expiratory flow (PEF), controlling for seasonal changes, meteorological conditions and personal physiological, clinical and sociodemographic measurements, in a panel of schoolchildren with asthma living near two power plants in Israel. Two hundred and eighty-five children with confirmed asthma performed PEF tests and completed a respiratory symptoms diary twice a day. Particulate matter <10 microm in diameter (PM10), particulate matter <2.5 microm in diameter (PM2.5) and meteorological conditions were measured at six fixed stations. Data were analysed using time series analysis-generalized linear model and generalized estimating equations. The models were built under the assumption that any health outcome belongs to a multivariate hierarchical system and depends on meteorological, geophysical and sociocultural variables and pollution factors. No significant differences were found in the demographic (age, gender, mean parental education level, parental smoking habits, place of birth and housing density), physiological (body mass index) and clinical factors (illness severity) between the communities participating in the study. A significant direct effect of PM2.5 on the PEF was found in Ashdod (P=0.000). In Sderot, this effect was through an interaction between PM10 and the sequential day of the year (P=0.000). The main conclusion of this study is that children with asthma are at risk from air pollution and geophysical conditions. Policy makers should take these results into consideration when setting thresholds for environmental protection.