Quantum dots as new guests in the body: structural and functional data

Many promising applications of quantum dots (QDs) in nanomedicine and in vivo imaging for further diagnostic are being developed. Despite the immense potential for the medical applications of QDs, little is known about the bioavailability and health consequences of QDs in animals and humans. Although some investigators reported that QDs do not appear to cause toxicity, others demonstrated a variety of cytotoxic effects. In this study, QDs800 (InVitrogen) have been used. Previous data from our group evaluated the bio-distribution by optical imaging, transmission electron microscopy, inductively coupled plasma mass spectroscopy analysis in mice, and the effects on novel object recognition memory, EEG activity, and some histopatological analysis on mice in different organs (liver, spleen, lungs, testis, brain). Here, we studied the systemic inflammation caused by QDs in different organs, and then focussed our attention to the brain. It is known that brain inflammation leads to microglia and astrocyte activation, which in turn are sensitive to the changes in the CNS microenvironment and rapidly activated in all conditions that affect normal neuronal functions. We demonstrated that the presence of QDs could impair synaptic response and neuronal excitability; secondly, we are currently investigating whether the electrical changes are induced by QDs by themselves or by the inflammation induced by their presence

Chromosomal instability in untreated primary prostate cancer as an indicator of metastatic potential.

BackgroundMetastatic prostate cancer (PC) is highly lethal. The ability to identify primary tumors capable of dissemination is an unmet need in the quest to understand lethal biology and improve patient outcomes. Previous studies have linked chromosomal instability (CIN), which generates aneuploidy following chromosomal missegregation during mitosis, to PC progression. Evidence of CIN includes broad copy number alterations (CNAs) spanning > 300 base pairs of DNA, which may also be measured via RNA expression signatures associated with CNA frequency. Signatures of CIN in metastatic PC, however, have not been interrogated or well defined. We examined a published 70-gene CIN signature (CIN70) in untreated and castration-resistant prostate cancer (CRPC) cohorts from The Cancer Genome Atlas (TCGA) and previously published reports. We also performed transcriptome and CNA analysis in a unique cohort of untreated primary tumors collected from diagnostic prostate needle biopsies (PNBX) of localized (M0) and metastatic (M1) cases to determine if CIN was linked to clinical stage and outcome.MethodsPNBX were collected from 99 patients treated in the VA Greater Los Angeles (GLA-VA) Healthcare System between 2000 and 2016. Total RNA was extracted from high-grade cancer areas in PNBX cores, followed by RNA sequencing and/or copy number analysis using OncoScan. Multivariate logistic regression analyses permitted calculation of odds ratios for CIN status (high versus low) in an expanded GLA-VA PNBX cohort (n = 121).ResultsThe CIN70 signature was significantly enriched in primary tumors and CRPC metastases from M1 PC cases. An intersection of gene signatures comprised of differentially expressed genes (DEGs) generated through comparison of M1 versus M0 PNBX and primary CRPC tumors versus metastases revealed a 157-gene "metastasis" signature that was further distilled to 7-genes (PC-CIN) regulating centrosomes, chromosomal segregation, and mitotic spindle assembly. High PC-CIN scores correlated with CRPC, PC-death and all-cause mortality in the expanded GLA-VA PNBX cohort. Interestingly, approximately 1/3 of M1 PNBX cases exhibited low CIN, illuminating differential pathways of lethal PC progression.ConclusionsMeasuring CIN in PNBX by transcriptome profiling is feasible, and the PC-CIN signature may identify patients with a high risk of lethal progression at the time of diagnosis

The HBM4EU chromates study – Outcomes and impacts on EU policies and occupational health practices

Funding Information: The recently completed EU human biomonitoring initiative (HBM4EU, www.hbm4eu.eu/about-hbm4eu/), was a European Joint Programme that aimed to harmonise the collection and use of biomonitoring data to better understand human exposure to chemicals in the environment, in occupational settings and through the use of consumer products to improve chemical risk assessment and management efforts, and to support policy making (Ganzleben et al., 2017). Within the context of the HBM4EU project several priority substances were selected for investigation based on the most important needs of policy makers and risk assessors, as well as common needs of participating countries and a broad range of other stakeholders including trade unions (Ougier et al., 2021). Many of the priority substances, along with having an important economic role, also pose health risks for workers due to their occupational use. One of the priority substances was hexavalent chromium (Cr(VI)), which was the main focus of the first of a series of three different HBM4EU occupational studies (Santonen et al. 2019a, 2022), the other two being focussed on electronic waste (E-waste) and diisocyanates exposures (Jones et al., 2022; Scheepers et al., 2021). In addition to Cr(VI), it was recognised that in chrome plating activities there may also be exposure to another group of HBM4EU priority chemicals, per- and polyfluoroalkyl substances (PFASs). PFASs, including PFOS (perfluorooctane sulfonate), have been used as mist suppressants in chrome plating baths to prevent the evaporation of Cr(VI) vapours (Blepp et al., 2017; Gluge et al., 2020). Although PFOS has now been largely replaced in the EU, many of its substitutes in chrome plating activities are also PFASs which may cause similar health and environmental concerns.Occupational exposure to Cr(VI) has been associated with an increased risk of lung and sinonasal cancers and is suspected to lead to gastrointestinal tract cancers (den Braver-Sewradj et al., 2021; ECHA 2013; IARC 2012). In addition, it is a common cause of occupational asthma, allergic dermatitis and there is a concern for adverse effects on reproductive health (Sun and Costa 2022). Exposure to Cr(VI) may occur in several occupational activities, e.g., in welding, Cr(VI) electroplating and other surface treatment processes such as paint application and removal of old paint containing Cr(VI) (SCOEL 2017). In order to limit the workers’ exposure to Cr(VI) in the EU, Cr(VI) is currently regulated under both the European regulation (EC 1907/2006) on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) and the EU Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogens, mutagens or reprotoxic substances at work (CMRD) (EU 2004). The current binding Occupational Exposure Limit (OEL) set under the EU Directive 2004/37/EC is 10 μg/m3 (8-h time-weighted average (8-h TWA)) until January 17, 2025. After that period, the OEL (8-h TWA) will be reduced to 5 μg/m3. For welding, plasma-cutting processes and similar work processes that generate fumes, there is a derogation with an OEL of 25 μg/m³ (8-h TWA) until January 2025; after that date the OEL (8-h TWA) of 5 μg/m3 will be applicable. France, the Netherlands and Denmark already have stricter limits, with an OEL of 1 μg/m3 (8-h TWA) for Cr(VI) in all uses (Beskæftigelsesministeriet 2020; Ministère du travail, 2012; MinSZW 2016). In the US, the American Conference of Governmental Industrial Hygienists (ACGIH) has published, for inhalable Cr(VI) compounds, a threshold limit value (TLV) of 0.2 μg/m3 (8-h TWA) and a TLV Short-Term Exposure Limit (STEL) of 0.5 μg/m3 (ACGIH 2021). No EU-wide biological limit values (BLVs) for Cr(VI) are available, however some Member States have set BLVs for occupational exposure to Cr(VI), measured as urinary chromium (U–Cr). For example, France and Finland have derived BLVs of 2.5 μg/L and 10 μg/L corresponding to their respective OELs of 1 μg/m3 and 5 μg/m3 for Cr(VI) (ANSES 2017; STM 2020). The German Research Foundation (DFG 2020) has established biological exposure equivalents for carcinogenic substances (EKA values), ranging from 12 to 40 μg/L for U–Cr. These correspond to exposures ranging between 30 and 100 μg/m3 soluble alkaline chromate and/or Cr(VI) containing welding fumes over an 8-h work shift (Bolt and Lewalter 2012). Since these current national BLVs are mainly based on studies from plating workers, they include uncertainties especially concerning their applicability to workplaces other than the electroplating industry. One of the main aims of the HBM4EU chromates study was to provide EU relevant data on the current occupational Cr(VI) exposure to support the regulatory risk assessment and decision-making process. In addition, exposure to PFASs was evaluated in a subset of workers performing chrome plating activities.This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. The project team would like to thank all the companies and workers who participated in the HBM4EU chromates study and all the experts who have contributed to the conduct of the study. Participants of the HBM4EU chromates study workshop and policy questionnaires are also acknowledged. Mr. Jouko Remes and Dr. Kia Gluschkoff (Finnish Institute of Occupational Health) are acknowledged for their assistance with the statistical analyses and figures. Funding Information: This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. Publisher Copyright: © 2022 The AuthorsWithin the EU human biomonitoring initiative (HBM4EU), a targeted, multi-national study on occupational exposure to hexavalent chromium (Cr(VI)) was performed. Cr(VI) is currently regulated in EU under REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) and under occupational safety and health (OSH) legislation. It has recently been subject to regulatory actions to improve its risk management in European workplaces. Analysis of the data obtained within the HBM4EU chromates study provides support both for the implementation of these regulatory actions and for national enforcement programs and may also contribute to the updating of occupational limit values (OELs) and biological limit values for Cr(VI). It also provides useful insights on the contribution of different risk management measures (RMMs) to further reduce the exposure to Cr(VI) and may support the evaluation of applications for authorisation under REACH. Findings on chrome platers’ additional per- and polyfluoroalkyl substances (PFAS) exposure highlight the need to also pay attention to this substance group in the metals sector. A survey performed to evaluate the policy relevance of the HBM4EU chromates study findings supports the usefulness of the study results. According to the responses received from the survey, the HBM4EU chromates study was able to demonstrate the added value of the human biomonitoring (HBM) approach in assessment and management of occupational exposure to Cr(VI). For future occupational studies, we emphasise the need for engagement of policy makers and regulators throughout the whole research process to ensure awareness, relevance and uptake of the results in future policies.publishersversionepub_ahead_of_prin

International consensus conference recommendations on ultrasound education for undergraduate medical students

Objectives: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results: A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions: The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries