History on organotin compounds, from snails to humans

Organotin compounds are industrial chemicals used as biocides, polyvinyl chloride stabilizers and industrial catalysts for the manufacture of silicone and polyurethane foams. Despite multiple applications, organotin notoriety is due to tributyltin, a potent biocide used in antifouling paints. Because of the intensive use of tributyltin for the protection of ships’ hulls, tributyltin has been largely released into waters, resulting in adverse and even bizarre effects on aquatic organisms, such as imposex in gastropods. However, organotins include other compounds such as tributyltin derivatives, phenyltins and octyltins. Organotin use in plastics, silicone and foams results in their occurrence almost everywhere, e.g., clothes, toys, wallpaper, food containers, household piping and medical devices. Hence, humans are exposed to organotins not solely through ingestion of contaminated seafood but also through direct contact with treated products and by inhalation and ingestion of dust. As a consequence, organotins have been detected in human samples. Toxicity data reveal that organotins are endocrine disruptors, immunotoxicants, carcinogens and obesogens. Here, we review the levels, fate and effects of organotin compounds toward wildlife and humans, starting with a description of organotin applications, with particular incidence in antifouling paints. The global contamination of the marine environment and the deleterious effects of tributyltin onto nontarget organisms are addressed, with particular attention to the imposex phenomenon. The restrictions on tributyltin use in antifouling paints are also described alongside with the new regulations for organotins in consumer products. The sources and pathways of organotins in the environment are discussed, studies in human exposure are presented, and future research is proposed

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era