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Azole therapy is widely utilized in hematopoietic stem cell transplant (HCT) recipients for the treatment of aspergillus. Complications of voriconazole treatment related to its elevated fluoride content have been described in adults, including reports of symptomatic skeletal fluorosis. We review fluoride levels, clinical, and laboratory data in five pediatric HCT recipients on long-term voriconazole therapy, all found to have elevated serum fluoride levels. Two patients had toxic fluoride levels, one infant had symptoms of significant pain with movement and radiographs confirmed skeletal fluorosis. Monitoring fluoride levels in children, especially with skeletal symptoms, should be considered in patients on long-term voriconazole., (© 2014 Wiley Periodicals, Inc.)

Introduction: Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72h) of sevoflurane., Methods: For this experimental, prospective, randomized, controlled trial, 22 Landrace x Large-White female pigs were randomly assigned to two groups: intravenous propofol (P) or inhaled sevoflurane via the AnaConDa™ device (S, end-tidal 2.5 vol%). The P group remained sedated for 108h with propofol. In the S group, sevoflurane was administered for 72h and then changed to propofol for the remaining 36h in order to observe the kinetics of fluoride after discontinuation of sevoflurane. Serum creatinine was the primary outcome variable, but inorganic fluoride concentrations and other renal, hepatic, and cardiorespiratory variables were also measured., Results: Both groups of animals were comparable at baseline. No differences were found between the two groups for plasma creatinine and urea or creatinine clearance throughout the study. Fluoride levels were significantly higher in the sevoflurane group. No correlation was found between inorganic fluoride and serum creatinine values. No significant differences were observed for hepatic function. Hemodynamic, respiratory, and blood gas variables were comparable between the groups., Conclusions: Long-term sedation with sevoflurane using AnaConDa™ or propofol does not negatively affect renal or hepatic function., (Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Formation of crystals in the enamel space releases protons that need to be buffered to sustain mineral accretion. We hypothesized that apical cystic fibrosis transmembrane conductance regulator (CFTR) in maturation ameloblasts transduces chloride into forming enamel as a critical step to secrete bicarbonates. We tested this by determining the calcium, chloride, and fluoride levels in developing enamel of Cftr-null mice by quantitative electron probe microanalysis. Maturation-stage enamel from Cftr-null mice contained less chloride and calcium than did wild-type enamel, was more acidic when stained with pH dyes ex vivo, and formed no fluorescent modulation bands after in vivo injection of the mice with calcein. To acidify the enamel further we exposed Cftr-null mice to fluoride in drinking water to stimulate proton release during formation of hypermineralized lines. In Cftr-deficient mice, fluoride further lowered enamel calcium without further reducing chloride levels. The data support the view that apical CFTR in maturation ameloblasts tranduces chloride into developing enamel as part of the machinery to buffer protons released during mineral accretion., (© 2014 Eur J Oral Sci.)

A gas chromatography-mass spectrometric method was developed in this study in order to determine fluoride in plasma and urine after derivatization with 2-(bromomethyl)naphthalene. 2-Fluoronaphthalene was chosen as the internal standard. The derivatization of fluoride was performed in the biological sample and the best reaction conditions (10.0 mg mL(-1) of 2-(bromomethyl)naphthalene, 1.0 mg mL(-1) of 15-crown-5-ether as a phase transfer catalyst, pH of 7.0, reaction temperature of 70°C, and heating time of 70 min) were established. The organic derivative was extracted with dichloromethane and then measured by a gas chromatography-mass spectrometry. Under the established condition, the detection limits were 11 μg L(-1) and 7 μg L(-1) by using 0.2 mL of plasma or urine, respectively. The accuracy was in a range of 100.8-107.6%, and the precision of the assay was less than 4.3% in plasma or urine. Fluoride was detected in a concentration range of 0.12-0.53 mg L(-1) in six urine samples after intake of natural mineral water containing 0.7 mg L(-1) of fluoride., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Voriconazole is a triazole antifungal medication used for prophylaxis or to treat invasive fungal infections. Inflammation of the periosteum resulting in skeletal pain, known as periostitis, is a reported side effect of long-term voriconazole therapy. The trifluorinated molecular structure of voriconazole suggests a possible link between excess fluoride and periostitis, as elevated blood fluoride has been reported among patients with periostitis who received voriconazole., Methods: Two hundred sixty-four patients from Michigan were impacted by the multistate outbreak of fungal infections as a result of contaminated methylprednisolone injections. A retrospective study was conducted among 195 patients who received voriconazole therapy at St Joseph Mercy Hospital during this outbreak. Twenty-eight patients who received both bone scan and plasma fluoride measurements for skeletal pain were included in the statistical analyses. Increased tracer uptake on bone scan was considered positive for periostitis. The primary outcome measure was the correlation between plasma fluoride and bone scan results., Results: Blood fluoride (P < .001), alkaline phosphatase (P = .020), daily voriconazole dose (P < .001), and cumulative voriconazole dose (P = .027) were significantly elevated in patients who had periostitis compared with those who did not. Discontinuation or dose reduction of voriconazole resulted in improvement of pain in 89% of patients., Conclusions: High plasma fluoride levels coupled with skeletal pain among patients who are on long-term voriconazole therapy is highly suggestive of periostitis. Initial measurement of fluoride may be considered when bone scan is not readily available. Early detection should be sought, as discontinuation of voriconazole is effective at reversing the disease., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The purpose of this study was to explore the effects of high fluoride and high fat on triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total antioxidant capacity (T-AOC), lipid peroxide (LPO) and malondialdehyde (MDA) in rabbits. A factorial experimental design was used, with two factors (fluoride and fat) and three levels. Seventy-two male rabbits were randomly assigned into nine groups according to initial weight and serum lipid levels. The rabbits were fed with basic feed, moderate fat feed or high fat feed and drank tap water, fluoridated water at levels of 50 and 100mgfluorion/L freely. Biological materials were collected after 5 months, and serum lipid, T-AOC, LPO, and MDA levels were then measured. Using these data, the separate and interactive effects of high fluoride and high fat were analyzed. High fluoride and high fat both increased serum levels of TC, HDL-C and LDL-C significantly (P<0.05), and there was also a synergistic effect between high fluoride and high fat (P<0.05). High fluoride and high fat had different effects on TG levels: high fat significantly increased TG levels (P<0.01) whereas high fluoride had nothing to do with TG levels (P>0.05). High fat significantly elevated LPO and MDA levels and lowered T-AOC levels in serum (P<0.05). Similarly, high fluoride significantly increased LPO and MDA levels in serum (P<0.05). However, there was no interactive effect between high fat and high fluoride on these indexes. In summary, high fluoride and high fat increased serum TC and LDL-C levels individually and synergistically, and this would cause and aggravate hypercholesterolemia in rabbits. At the same time, high fluoride and high fat both made the accumulation of product of oxidative stress in experimental animals., (Copyright © 2014 Elsevier B.V. All rights reserved.)

It is known that fluoride produces oxidative stress. Inflammation in bone tissue and an impairment of the respiratory chain of liver have been described in treatments with fluoride. Whether the impairment of the respiratory chain and oxidative stress are related is not known. The aim of this work was to study the effects of fluoride on the production of superoxide radical, the function of the respiratory chain and the increase in oxidative stress in ROS 17/2.8 osteoblastic cells. We measured the effect of fluoride (100 µM) on superoxide production, oxygen consumption, lipid peroxidation and antioxidant enzymes activities of cultured cells following the treatment with fluoride. Fluoride decreased oxygen consumption and increased superoxide production immediately after its addition. Furthermore, chronic treatment with fluoride increased oxidative stress status in osteoblastic cells. These results indicate that fluoride could damage bone tissue by inhibiting the respiratory chain, increasing the production of superoxide radicals and thus of the others reactive oxygen species.

Purpose: RGD peptide-based radiotracers are well established as integrin αvβ3 imaging probes to evaluate tumor angiogenesis or tissue remodeling after ischemia or infarction. In order to optimize the labeling process and pharmacokinetics of the imaging probes, we synthesized three dimeric RGD peptides with or without PEGylation and performed in vivo screening., Procedures: Radiolabeling was achieved through the reaction of F-18 aluminum-fluoride complex with the cyclic chelator, 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA). Three imaging probes were synthesized as (18)F-AlF-NOTA-E[c(RGDfK)]2, (18)F-AlF-NOTA-PEG4-E[c(RGDfK)]2, and (18)F-AlF-NOTA-E[PEG4-c(RGDfk)]2. The receptor binding affinity was determined by competitive cell binding assay, and the stability was evaluated by mouse serum incubation. Tumor uptake and whole body distribution of the three tracers were compared through direct tissue sampling and PET quantification of U87MG tumor-bearing mice., Results: All three compounds remained intact after 120 min incubation with mouse serum. They all had a rapid and relatively high tracer uptake in U87MG tumors with good target-to-background ratios. Compared with the other two tracers, (18)F-AlF-NOTA-E[PEG4-c(RGDfk)]2 had the highest tumor uptake and the lowest accumulation in the liver. The integrin receptor specificity was confirmed by co-injection of unlabeled dimeric RGD peptide., Conclusion: The rapid one-step radiolabeling strategy by the complexation of (18)F-aluminum fluoride with NOTA-peptide conjugates was successfully applied to synthesize three dimeric RGD peptides. Among the three probes developed, (18)F-AlF-NOTA-E[PEG4-c(RGDfk)]2 with relatively low liver uptake and high tumor accumulation appears to be a promising candidate for further translational research.

Objective: The aim of the study was to examine whether (18)F-fluoride PET ((18)F-PET) static scan measurements of bone plasma clearance (Ki) can be corrected for tracer efflux from bone from the time of injection., Materials and Methods: The efflux of tracer from bone mineral to plasma was described by a first-order rate constant kloss. A modified Patlak analysis was applied to 60-min dynamic (18)F-PET scans of the spine and hip acquired during trials on the bone anabolic agent teriparatide to find the best-fit values of kloss at the lumbar spine, total hip and femoral shaft. The resulting values of kloss were used to extrapolate the modified Patlak plots to 120 min after injection and derive a sequence of static scan estimates of Ki at 4-min intervals that were compared with the Patlak Ki values from the 60-min dynamic scans. A comparison was made with the results of the standard static scan analysis, which assumes kloss=0., Results: The best-fit values of kloss for the spine and hip regions of interest averaged 0.006/min and did not change when patients were treated with teriparatide. Static scan values of Ki calculated using the modified analysis with kloss=0.006/min were independent of time between 10 and 120 min after injection and were in close agreement with findings from the dynamic scans. In contrast, by 2 h after injection the static scan Ki values calculated using the standard analysis underestimated the dynamic scan results by 20%., Conclusion: Using a modified analysis that corrects for F efflux from bone, estimates of Ki from static PET scans can be corrected for time up to 2 h after injection. This simplified approach may obviate the need to perform dynamic scans and hence shorten the scanning procedure for the patient and reduce the cost of studies. It also enables reliable estimates of Ki to be obtained from multiple skeletal sites with a single injection of tracer.

Background: Fluorosis ranks high among the major environmental health problems in India. Non-ulcer dyspeptic complaints are common in humans and it is a known fact that fluoride in drinking water, food and other items can cause these symptoms., Methods: Fifty adult outpatients (mean age: 35.2±12.7 y) with chronic abdominal pain of unexplained origin were tested for their serum, urinary, and drinking water fluoride (F) concentrations. These concentrations were compared with those of 50 asymptomatic outpatients (mean age: 37.4±11.5 y) and analysed statistically., Results: Serum F concentrations were higher than normal in 62% of the study group I and in 42% of the control group II with a mean of 0.065±0.03 ppm (range: 0.010-0.421) in the former and 0.023±0.028 ppm in the latter. Statistical analysis of the data by Student's t-test (unpaired) revealed a significant correlation (p<0.05) between chronic abdominal pain and elevated serum F. Urinary fluoride concentrations in group I were 0.87±1.67 (0.01-3.7) ppm. Seventy-three percent of the patients examined for urinary fluoride concentrations were having higher values than normal, whereas 27% patients had normal range urinary fluoride concentrations despite raised serum fluoride concentrations., Conclusions: In the cases of chronic pain abdomen, chronic fluoride ingestion from drinking water and other sources can be the cause and should be evaluated in patients in which other parameters are normal., (Copyright © 2013 Elsevier B.V. All rights reserved.)

We investigated the protective effects of resveratrol on hematological and biochemical changes induced by fluoride in rats. A total of 28 rats were divided into 4 groups: control, resveratrol, fluoride, and fluoride/resveratrol (n = 7 each), for a total of 21 days of treatment. Blood samples were taken and hematological and biochemical parameters were measured. Compared to the control group, the fluoride-treated group showed significant differences in several hematological parameters, including decreases in WBC, RBC, and PLT counts and neutrophil ratio. The group that received resveratrol alone showed a decrease in WBC count compared to the control group. Furthermore, in comparison to the control group, the fluoride group showed significantly increased ALT enzyme activity and decreased inorganic phosphorus level. The hematological and biochemical parameters in the fluoride + resveratrol treated group were similar to control group. In the fluoride + resveratrol group, resveratrol restored the changes observed following fluoride treatment, including decreased counts of WBC, RBC, and PLT, decreased neutrophil ratio and inorganic phosphorus levels, and elevated ALT enzyme activity. The present study showed that fluoride caused adverse effects in rats and that resveratrol reduced hematological and biochemical alterations produced by fluoride exposure.

Although cadmium (Cd) and fluoride may both have adverse effects on bone, most studies focus on a single agent. In this study, we investigated the effects of cadmium and fluoride on bone at a relative low level. Sprague-Dawley male rats were assigned randomly into four groups which were given sodium chloride, cadmium (50mg/L), and fluoride (20mg/L) alone, or in combination via drinking water. At the 12th week, urine, blood, and bone tissues were collected for biomarker assay, biomechanical assay, and histological assay. Cadmium had significantly adverse effects on bone mineral density, bone biomechanical property, and bone microstructure. Fluoride slightly increased vertebral bone mineral density but negatively affected bone biomechanical property and bone microstructure. Fluoride could reverse the decrease of vertebral bone mineral density caused by cadmium but could not improve the damage of bone biomechanical property and microstructure caused by cadmium. Tartrate-resistant acid phosphatase 5b levels in rats treated with cadmium and fluoride or in combination were 1-2.5 folds higher than the control. Our data suggest that low level of fluoride could reverse the decrease of vertebral bone mineral density caused by cadmium exposure but has no influence on appendicular skeleton damage caused by cadmium.

Calcium phosphate (CaP) coatings were prepared on Mg-Zn-Zr magnesium alloy by micro-arc oxidation (MAO) in electrolyte containing calcium acetate monohydrate (CH3COO)2Ca·H2O) and different phosphates (i.e. disodium hydrogen phosphate dodecahydrate (Na2HPO4·12H2O), sodium phosphate (Na3PO4·H2O) and sodium hexametaphosphate((NaPO3)6)). Scanning electron microscope (SEM), energy-dispersive X-ray spectrometry (EDS) and X-ray diffractometer (XRD) were employed to characterize the microstructure, elemental distribution and phase composition of the CaP coatings. Simulated body fluid (SBF) immersion test was used to evaluate the coating bioactivity and degradability. Systemic toxicity test was used to evaluate the coating biocompatibility. Fluoride ion selective electrode (ISE) was used to measure F(-) ions concentration during 30 days SBF immersion. The CaP coatings effectively reduced the corrosion rate and the surfaces of CaP coatings were covered by a new layer formed of numerous needle-like and scale-like apatites. The formation of these calcium phosphate apatites indicates that the coatings have excellent bioactivity. The coatings formed in (NaPO3)6-containging electrolyte exhibit thicker thickness, higher adhesive strength, slower degradation rate, better apatite-inducing ability and biocompatibility., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The ratio of osteoprotegerin ligand (OPGL) to osteoprotegerin (OPG) determines the delicate balance between bone resorption and synthesis. The main objective of the present study is to investigate the possible role of OPGL and OPG in the bone metabolism of rats exposed to fluoride and the protective or aggravating effect of calcium (Ca). In a 6-month study, 270 weanling male Sprague-Dawley rats weighing between 70 and 90 g were divided randomly into six groups of 45 rats in each group. Three groups (groups I, III, and V)served as controls and drank deionized water and were fed purified rodent diets containing either 1,000 mg Ca/kg (low Ca), 5,000 mg Ca/kg (normal Ca), or 20,000 mg Ca/kg (high Ca). The three experimental groups (groups II, IV, and VI) were given the same diets but they drank water containing 100 mg F ion/L (from NaF). Every 2 months 15 rats were randomly selected from each group and sacrificed for the study. The ratio of OPGL mRNA to OPG mRNA was significantly increased by the sixth month in the distal femur joints of the F-exposed rats. Serum tartrate-resistant acid phosphatase activity and serum calcitonin activity in the F-exposed groups was increased, although changes were not apparent in the serum alkaline phosphatase or Gla-containing proteins, especially in the low calcium and high calcium diet F-exposed groups. The results indicated that OPG and OPGL may play important roles in skeletal fluorosis, and that fluoride may enhance osteoclast formation and induce osteoclastic bone destruction. A high Ca diet did not play a protective role, but rather may aggravate the damage of fluoride.

Evidence has been accumulating for the role of Sclerostin and Dickkopf-1 as the antagonists of Wnt/β-Catenin signaling pathway, which suppresses bone formation through inhibiting osteoblastic function. To get deep-inside information about the expression of the antagonists in patients with fluorine bone injury, a case-control study was conducted in two counties in Hubei Province. Urinary and serum fluoride were significantly higher in patients with fluorine bone injury than in healthy controls. Additionally, patients with fluorine bone injury had significantly lower serum Sclerostin and Dickkopf-1 levels compared with healthy controls (P<0.001). Serum Sclerostin and Dickkopf-1 levels were significantly correlated with serum fluoride in all studied subjects (n=186). Low Sclerostin and Dickkopf-1 levels were associated with a significantly increased risk of fluorine bone injury. In conclusion, serum Sclerostin and Dickkopf-1 might be used as important markers of bone metabolism change and potential therapeutic targets to treat fluorine bone injury., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: There is growing interest in the use of diammine silver fluoride (DSF) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world. While DSF has been available in various formulations for many years, most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized., Methods: This preliminary study determined the applied doses (3 teeth treated), maximum serum concentrations, and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode, and silver was determined using inductively coupled plasma-mass spectrometry. The mean amount of DSF solution applied to the 3 teeth was 7.57 mg (6.04 μL)., Results: Over the 4 hour observation period, the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver. These maximums were reached 3.0 h and 2.5 h for fluoride and silver, respectively., Conclusions: Fluoride exposure was below the U.S. Environmental Protection Agency (EPA) oral reference dose. Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime, but for occasional use was well below concentrations associated with toxicity. This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults., Clinical Trials Registration: NCT01664871.

Objective: To understand the distribution of chemical elements in soil. To investigate the differences between patients under different state of fluorosis and normal population after preventive measurement was implemented to get rid of some chemical elements and to lower the urine fluoride levels so as to illustrate the pathogenesis of the disease., Methods: Both ecological and comparative studies had been used to analyze the rates and levels of chemical elements. Teeth and skeletal from the patients with fluorosis and controls were taken and florin ion-selective-electrode method was used to determine urine the content of fluorine. Atomic Absorption Spectrometry was used to determine the copper, zinc, calcium, magnesium and iron contents in the whole blood. Differences of contents were analyzed., Results: In Wushan county, the soil contents of nickel (r = 0.553, P = 0.050), iodine (r = 0.571, P = 0.041), fluorine (r = 0.303, P = 0.005), pH value (r = 0.304, P = 0.005) and the rates of fluorosis showed weaker positive relationship. In Fengjie county, the soil contents of mercury (r = 0.285, P = 0.001), nickel (r = 0.212, P = 0.00) and the rates of fluorosis also showed weaker positive relationship. In Wushan county, the urine fluoride level in the patients group [(0.64 ± 0.34) mg/L] was higher than that in the control group [(0.44 ± 0.59) mg/L], (P < 0.05). In Fengjie county, copper [(29.63 ± 3.32) µmol/L] and urine fluoride [(0.83 ± 0.37) mg/L] levels in the patients group showed higher than that in the control group [(26.76 ± 3.63) µmol/L, (0.53 ± 0.23) mg/L], (P < 0.05). zinc (Zn) [(76.13 ± 11.24) µmol/L], calcium (Ca) [(1.87 ± 0.25) mmol/L], magnesium (Mg) [(1.41 ± 0.18) mmol/L] and fluoride[(0.83 ± 0.37) mg/L]levels in urine of the patients in children were higher in Fengjie than that in Wushan [(71.95 ± 7.53) µmol/L, (1.43 ± 1.34) mmol/L, (1.34 ± 0.15) mmol/L, (0.64 ± 0.34) mg/L], (P < 0.05). Mg [(1.56 ± 1.96) mmol/L], ferrum [(8.15 ± 1.00) mmol/L] and fluoride [(2.17 ± 0.99) mg/L] levels among adult patients were significantly higher than in the control group [(1.46 ± 0.16) mmol/L, (7.64 ± 1.00) mmol/L, (1.44 ± 1.22) mg/L] (P < 0.05)., Conclusion: Soil, rich in alkaline and fluorosis could increase the intake of fluorine while nickel, cadmium, iodine content in soil might relate to the occurrence of fluorosis. Residents living in endemic areas where anti-fluorine elements as Zn, Ca and Mg were in shortage, might be affected by these chemical elements that related with fluorosis.

We here investigate the occurrence of fluoride intake-associated alterations in patients with hematologic disease on triazol antifungal medication. Clinical, laboratory, and radiology data of overall 43 patients with hematologic malignancies taking voriconazole (n = 20), posaconazole (n = 8), and itraconazole (n = 4), and a hematologic patient control group (n = 11) are described. Bone pain and radiologic evidence of periostitis were exclusively observed in patients receiving long-term voriconazole. Cessation of treatment led to clinical improvement in all cases. In line with clinical evidence, fluoride serum concentration was elevated in patients receiving voriconazole (median, 156.5 μg/L; interquartile range, 96.8 μg/L; normal < 30 μg/L) but not in the other treatment groups (P < .001 for all comparisons vs voriconazole). We conclude that serum fluoride levels were elevated on average 5-fold above normal levels in hematologic patients receiving voriconazole. Clinically relevant skeletal disease was associated with renal insufficiency and above 10-fold elevated fluoride levels, and was reversible on termination of voriconazole treatment.

Endemic fluorosis is a serious problem in public health. Previous studies have indicated that patients with thyroid goiters usually live in fluoride-affected areas. However, the mechanism of goitrogenesis caused independently by fluoride is still unclear. The principle objective of this study was to investigate the possible roles of nitric oxide (NO) and vascular endothelial growth factor (VEGF) in the genesis of fluoride-induced nodular goiters. Eighty SD rats (40 males and 40 females) at the age of 4 weeks were used to establish animal models via fluoride-supplemented drinking water. These rats were randomly divided into four groups of 20. Group 1 was used as the control and were given deionized water. Group 2 (LF), group 3 (MF), and group 4 (HF) were given deionized water containing 50mg/L, 100mg/L, and 200mg/L of sodium fluoride (NaF), respectively. Thyroid samples were collected on day 150. Pathological observation was performed to evaluate structural changes in the thyroid gland. The expression of VEGF mRNA in the thyroid glands was assessed by reverse transcriptional PCR. The serum NO level was analyzed by spectrometric methods. In addition, immunohistochemistry was conducted to evaluate expression and deposition of VEGF in the thyroid gland. The results showed that the average relative weight of the thyroid glands of rats in the fluoride-treated groups was significantly higher than that in control rats (p<0.05). The proliferation and dilatation of capillary blood vessels, enlarged follicles with excessive colloid, and obvious nodules were found in the thyroid glands of fluoride-treated rats. Compared to the control group, the expression of VEGF mRNA in the thyroid gland and the serum NO levels in the fluoride-treated groups were significantly increased (p<0.05). Furthermore, the deposition of VEGF in epithelial and follicular cells of the thyroid gland was significantly higher in fluoride-treated groups than in the control group. These results suggested that abnormal expression of VEGF induced by fluoride can lead to the proliferation of vascular endothelial cells in the thyroid gland. Accordingly, VEGF oversecreted locally by vascular endothelial cells might contribute to the proliferation of epithelial and follicular cells, resulting in the formation of hyperplastic nodules and enlargement of the thyroid gland. Furthermore, we proposed that there might be a positive feedback mechanism between NO and VEGF expression in fluoride-induced goiter formation. It was concluded that angiogenic and vasodilative factors such as VEGF and NO must be involved in fluoride-induced thyroid goitrogenesis., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Osteosarcoma is a rare malignant bone tumor most commonly occurring in children and young adults presenting with painful swelling. Various etiological factors for osteosarcoma are ionizing radiation, family history of bone disorders and cancer, chemicals (fluoride, beryllium, and vinyl chloride), and viruses. Status of fluoride levels in serum of osteosarcoma is still not clear. Recent reports have indicated that there is a link between fluoride exposure and osteosarcoma. Glycoproteins and glycosaminoglycans are an integral part of bone and prolonged exposure to fluoride for long duration has been shown to cause degradation of collagen and ground substance in bones. The present study was planned to analyze serum fluoride, sialic acid, calcium, phosphorus, and alkaline phosphatase levels in 25 patients of osteosarcoma and age- and sex-matched subjects with bone-forming tumours other than osteosarcoma and musculo-skeletal pain (controls, 25 each). Fluoride levels were analyzed by ISE and sialic acid was analyzed by Warren's method. Mean serum fluoride concentration was found to be significantly higher in patients with osteosarcoma as compared to the other two groups. The mean value of flouride in patients with other bone-forming tumors was approximately 50% of the group of osteosarcoma; however, it was significantly higher when compared with patients of group I. Serum sialic acid concentration was found to be significantly raised in patients with osteosarcoma as well as in the group with other bone-forming tumors as compared to the group of controls. There was, however, no significant difference in the group of patients of osteosarcoma when compared with group of patients with other bone-forming tumors. These results showing higher level of fluoride with osteosarcoma compared to others suggesting a role of fluoride in the disease.

Background: We determined serum ionic fluoride (SIF) concentrations before and after treatment of osteoporosis with alendronate to clarify whether SIF concentrations directly reflect a change in bone metabolism., Methods: A total of 45 postmenopausal women with primary osteoporosis who were treated with alendronate over a 6-month period were enrolled (mean age, 64.2 years). SIF concentrations were measured by the flow injection method with an ion-selective electrode. Concentrations of bone turnover markers (serum bone alkaline phosphatase, serum osteocalcin, serum type I collagen cross-linked N-telopeptide and urinary deoxypryridinoline) and lumbar spine BMD (LsBMD) were also measured. SIF, bone turnover markers and LsBMD before and after treatment were compared., Results: Concentrations of SIF as well as concentrations of all bone turnover markers were significantly decreased after treatment: means (standard deviations) before and after treatment were 0.62 (0.13) and 0.32 (0.09) μmol/l, respectively (P<0.001) and the percent change was -46.3%. LsBMD was also significantly increased by 6.7% after treatment., Conclusions: The reduction of SIF concentrations is probably caused by inhibition of bone resorption due to the action of alendronate. The findings suggest that SIF concentrations directly reflect a change in bone metabolism., (Copyright © 2011 Elsevier B.V. All rights reserved.)

In this study, we evaluated apoptosis induction in human immune cells in children exposed to arsenic (As) and fluoride (F). Children living in two areas in Mexico (Soledad de Graciano Sanchez (SGS) in San Luis Potosí and Colonia 5 de Febrero in Durango) were studied. Water, urine and blood samples were collected. Approximately 90% of the water samples in 5 de Febrero had As and F levels above the World Health Organization intervention guideline (10 μg/L and 1.5mg/L, respectively). In SGS, 0% of the water samples exceeded Mexican guidelines. Urinary As and F levels in children living in 5 de Febrero were significantly higher than the levels found in children living in SGS. In addition, the level of apoptosis was higher in children from the 5 de Febrero community when compared with the level of apoptosis in children living in SGS. Thus, in a worldwide context, our study demonstrates the health risks to children living in these regions., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Perfluorinated compounds (PFCs) were measured in three National Institute of Standards and Technology (NIST) Standard Reference Materials (SRMs) (SRMs 1950 Metabolites in Human Plasma, SRM 1957 Organic Contaminants in Non-fortified Human Serum, and SRM 1958 Organic Contaminants in Fortified Human Serum) using two analytical approaches. The methods offer some independence, with two extraction types and two liquid chromatographic separation methods. The first extraction method investigated the acidification of the sample followed by solid-phase extraction (SPE) using a weak anion exchange cartridge. The second method used an acetonitrile extraction followed by SPE using a graphitized non-porous carbon cartridge. The extracts were separated using a reversed-phase C(8) stationary phase and a pentafluorophenyl (PFP) stationary phase. Measured values from both methods for the two human serum SRMs, 1957 and 1958, agreed with reference values on the Certificates of Analysis. Perfluorooctane sulfonate (PFOS) values were obtained for the first time in human plasma SRM 1950 with good reproducibility among the methods (below 5% relative standard deviation). The nominal mass interference from taurodeoxycholic acid, which has caused over estimation of the amount of PFOS in biological samples, was separated from PFOS using the PFP stationary phase. Other PFCs were also detected in SRM 1950 and are reported. SRM 1950 can be used as a control material for human biomonitoring studies and as an aid to develop new measurement methods.

Alpha-macroglobulins (AM) are proteins that inactivate proteinases. Sodium monofluorophosphate (MFP) binds to AM and transiently changes AM plasma levels. As a consequence MFP is useful to modify AM homeostasis. A mathematical model to study the homeostasis of AM is proposed in this paper. The model describes changes in plasma concentration of AM, MFP concentration in the gastrointestinal tract, MFP plasma concentration, plasma concentration of AMMFP and includes rate constants of the processes involved in AM homeostasis. Estimation of the rate constants values was achieved using experimental and mathematical resources. The homeostasis of AM after an oral dose of 80 μmol of MFP was analyzed with a simulation tool. Experimental conditions that modify the homeostasis of AM had been simulated and validated using specific drugs that change some parameter of the system. The mathematical model describes accurately the behavior of the biological model. The results allow concluding that the simplifications made did not underestimate the main processes involved in the homeostasis and, also that the assumptions made were correct., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The aim of the study was to determine the relationship of fluoride in drinking water to liver function in individuals living in normal and seven endemic fluorosis areas of Punjab, India. The concentration of fluoride in drinking water of different areas varied from 5.9 to 24.5 mg/L. Study group consisted of 705 patients in the age group between 20 and 60 years (mean age of 39.35±11.27) affected with osteodental fluorosis were compared with 300 age- and sex-matched controls (with mean age of 35.28±8.25 years). Biochemical data was analyzed by one-way analysis of variance (ANOVA) with post hoc Tukey-Kramer and Bonferroni multiple comparison tests. The relationship between hepatic enzymes was calculated by Pearson's correlation and linear regression. The results revealed significantly (P<0.001) higher concentration of serum fluoride in patients when compared to control. The mean activities of cyclic adenosine monophosphate (AMP), alkaline phosphatase (ALKP), acid phosphatase (ACP), aspartate aminotransaminase (AST), and alanine aminotransaminase (ALT) were significantly (P<0.05-0.001) elevated in patients from all fluoride areas. ANOVA with post hoc Turkey-Kramer and Bonferroni multiple comparison test demonstrated a significant (P<0.0001) variance in the activities of cAMP, ALKP, ACP, AST, and ALT in fluorotic patients, with elevation in water fluoride levels. Maximum elevation of 196.14% (ACP), 99.31% (cyclic adenosine monophosphate; cAMP), 72.08% (ALT), 60.14% (AST), and least 21.35% (ALKP) was recorded in patients exposed to 24.5 mg/L fluoride in drinking water. There was positive correlation between water fluoride, serum fluoride and AST (r=0.77, 0.91), ALT (r=0.82, 0.90), ALKP (r=0.88, 0.97), and ACP (r=0.74, 0.85). Pearson's correlation demonstrated highly significant (P<0.05) positive relationship between water fluoride and cAMP (regression equation: Y=0.9807×+22:081, =0.84; r=0.92, P<0.05). The increased levels of transaminases in fluorotic patients suggest alteration in liver functions. The level of alkaline and acid phosphatase was increased during fluoride intoxication which is also an early marker of hepatic cell damage because of its specificity and catalytic activity. The elevated levels of enzymes are reflective of bone disorders, which are characterized by increased osteoblastic activity. There levels increased several times if cellular damage occurs in the liver. The results suggest that fluoride exposure intensifies the activities of hepatic function enzymes in osteofluorosis.

Background: The problem of high fluoride concentration in groundwater resources has become one of the most important toxicological and geo-environmental issues in India. Excessive fluoride in drinking water causes dental and skeletal fluorosis, which is encountered in endemic proportions in several parts of the world. World Health Organization (WHO) guideline value and the permissible limit of fluoride as per Bureau of Indian Standard (BIS) is 1.5 mg/L. About 20 states of India, including 43 blocks of seven districts of West Bengal, were identified as endemic for fluorosis and about 66 million people in these regions are at risk of fluoride contamination. Studies showed that withdrawal of sources identified for fluoride often leads reduction of fluoride in the body fluids (re-testing urine and serum after a week or 10 days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days., Objective: To determine the prevalence of signs and symptoms of suspected dental, skeletal, and non-skeletal fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among participants taking water with fluoride concentration above the permissible limit, and to assess the changes in clinical manifestations of the above participants after they started consuming safe drinking water., Materials and Methods: A longitudinal intervention study was conducted in three villages in Rampurhat Block I of Birbhum district of West Bengal to assess the occurrence of various dental, skeletal, and non-skeletal manifestations of fluorosis, along with food habits, addictions, and use of fluoride containing toothpaste among the study population and the impact of taking safe water from the supplied domestic and community filters on these clinical manifestations. The impact was studied by follow-up examination of the participants for 5 months to determine the changes in clinical manifestations of the above participants after they started consuming safe drinking water from supplied domestic filters and community filter with fluoride concentration below the permissible limit. The data obtained were compared with the collected data from the baseline survey., Results: The prevalence of signs of dental, skeletal, and non-skeletal fluorosis was 66.7%, 4.8-23.8%, and 9.5-38.1%, respectively, among the study population. Withdrawal of source(s) identified for fluoride by providing domestic and community filters supplying safe water led to 9.6% decrease in manifestation of dental fluorosis, 2.4-14.3% decrease in various manifestations of skeletal fluorosis, and 7.1-21.5% decrease in various non-skeletal manifestations within 5 months. Following repeated motivation of participants during visit, there was also 9.7-38.1% decrease in the usage of fluoride containing toothpaste, and 9.8-45.3% and 7.3-11.9% decrease in the consumption of black lemon tea and tobacco, respectively, which are known sources of fluoride ingestion in our body and have an effect on the occurrence of various manifestations of fluorosis following drinking of safe water from domestic and community filters., Conclusion: Increased prevalence of dental, skeletal, and non-skeletal fluorosis was found among the study population. Withdrawal of source(s) identified for fluoride by supplying domestic and community filters, dietary restriction, and other nutritional interventions led to decrease in manifestation of the three types of fluorosis within 5 months.

Three hundred one-day-old avian broilers were divided into four equal groups of 75 animals that were fed for 42 days as follows: a control diet containing 23 mg fluorine (F)/kg and three high F diets containing 400, 800, and 1200 mg F/kg, respectively, for high F groups I, II, and III. The superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were greatly decreased, while the malondialdehyde (MDA) contents were markedly increased in high F groups II and III. At the same time, mitochondrial injury and expanded endocytoplasmic reticulum were obviously observed in high F groups II and III, and the fluoride contents both in spleen and serum were significantly increased in the three high F groups when compared with those of control group. The results showed that excess dietary F in the range of 800-1200 mg/kg caused obvious oxidative stress, which provided a possible pathway for the apoptosis of splenocytes in chickens.

Background: High fluoride ion (F(-)) levels are found in many surface and well waters. Drinking F(-)-contaminated water typically explains endemic skeletal fluorosis (SF). In some regions of Asia, however, poor quality "brick tea" also causes this disorder. The plant source of brick, black, green, orange pekoe, and oolong tea, Camellia sinensis, can contain substantial amounts of F(-). Exposure to 20 mg F(-) per day for 20 yr of adult life is expected to cause symptomatic SF. High F(-) levels stimulate osteoblasts and enhance bone apposition but substitute for OH(-) groups in hydroxyapatite crystals and thereby result in skeletal fragility and perhaps lead to secondary hyperparathyroidism. Beginning in 2005, we showed that daily consumption of 1-2 gallons of instant tea made from this plant can lead to SF., Aim: We describe a 48-yr-old American woman who developed SF from brewed tea., Patient and Methods: Our patient had elevated bone mineral density revealed by dual-energy x-ray absorptiometry (spine Z-score, +9.9), severe chronic bone and joint pain, and kyphosis after consuming 1-2 gallons of brewed orange pekoe tea daily for more than three decades. F(-) levels were high in her serum, urine, and clippings of fingernails and toenails, as well as in our reproduction of her beverage. Renal function was normal. She had vitamin D deficiency. Elevated serum PTH levels were unresponsive to adequate vitamin D supplementation. Pain resolved over several months when she stopped drinking tea and continued ergocalciferol., Conclusion: Our patient shows that SF can result from chronic consumption of large volumes of brewed tea.

Purpose: This study aims to examine the interactive effect of fluoride burden with calcitonin receptor (CTR) gene polymorphisms on the risk of fluoride (F) bone injury and provide the basis for determination of F bone injury risk factors., Methods: In this case-control study, a total of 119 cases and 126 controls were enrolled from 2 aluminum plants in Hubei province. F burden (UF) was measured by F ion-selective electrode method. The CTR gene polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Logistic regression analysis was used to estimate multivariate-adjusted odds ratios, 95% confidence intervals (CI)., Results: The odds of developing F bone injury for participants in the moderate F burden group versus the mild F burden group were 4.1 (95% CI: 1.9, 8.7); the heavy F burden group versus the mild F burden group were 14.1 (95% CI: 6.5, 30.6). The odds of developing F bone injury for participants with the TC & TT genotypes versus the CC genotype were 2.6 (95% CI: 1.4, 4.7). The interactions between TC & TT genotypes and moderate, heavy F burden were significant (OR = 14.4; OR = 40.3)., Conclusion: The interactive effect of F burden and CTR genotype was significant, which increased the F bone injury risk.

The formation of an ordered enamel organic extracellular matrix (EOECM) seems to be a crucial step for the proper formation of the enamel mineral phase. The ordered supramolecular structure of the EOECM in the secretory stage can be analyzed using polarizing microscopy, as it is strongly birefringent. Excessive fluoride (F) ingestion during tooth development can cause enamel fluorosis, leading to increased porosity in mature enamel. We analyzed the effects of F on the birefringence of the EOECM in the A/J, CBA, and DBA/2 strains of mice given 0, 11.25, and 45 ppm of fluoride in drinking water. In the CBA and DBA/2 strains, the 11.25 and 45 ppmF groups presented a significant decrease in optical retardation (OR) when compared with the respective 0 (CBA 11.25 ppmF p = 0.0056 and 45 ppmF p < 0.0001; DBA/2 11.25 and 45 ppmF p < 0.05). ORs in A/J 0 ppmF were significantly higher than in 45 (p < 0.0001). The enamel of the A/J strain was more severely affected by fluoride than it was in the other strains of mice and exhibited the lowest levels of fluoride in plasma, whereas its normal secretory enamel presented a significantly higher protein absorbance than it did in CBA and DBA mice (p = 0.0099 and p = 0.0025, respectively). The results showed that experimental fluorosis can alter the supramolecular organization of EOECM in the secretory stage of amelogenesis and that the susceptibility to dental fluorosis seems to be influenced by the inherent characteristics of the developing enamel.

Glucose intolerance in fluorosis areas and when fluoride is administered for the treatment of osteoporosis has been reported. Controlled fluoridation of drinking water is regarded as a safe and effective measure to control dental caries. However, the effect on glucose homeostasis was not studied so far. The aim of this study was to evaluate the effect of the intake of fluoridated water supply on glucose metabolism in rats with normal and deficient renal function. Male Sprague-Dawley rats were divided into eight groups of four rats. Renal insufficiency was induced in four groups (NX) which received drinking water containing 0, 1, 5, and 15 ppm F (NaF) for 60 days. Four groups with simulated surgery acted as controls. There were no differences in plasma glucose concentration after a glucose tolerance test between controls and NX rats and among rats with different intakes of fluoride. However, plasma insulin level increased as a function of fluoride concentration in drinking water, both in controls and in NX rats. It is concluded that the consumption of fluoridated water from water supply did not affect plasma glucose levels even in cases of animals with renal disease. However, a resistance to insulin action was demonstrated.

Teriparatide increases skeletal mass, bone turnover markers, and bone strength, but local effects on bone tissue may vary between skeletal sites. We used positron emission tomography (PET) to study (18)F-fluoride plasma clearance (K(i)) at the spine and standardized uptake values (SUVs) at the spine, pelvis, total hip, and femoral shaft in 18 postmenopausal women with osteoporosis. Subjects underwent a 1-hour dynamic scan of the lumbar spine and a 10-minute static scan of the pelvis and femurs at baseline and after 6 months of treatment with 20 µg/day teriparatide. Blood samples were taken to derive the arterial input function and lumbar spine K(i) values evaluated using a three-compartment model. SUVs were calculated for the spine, pelvis, total hip, and femoral shaft. After 6 months treatment with teriparatide, spine K(i) values increased by 24% (p = .0003), while other model parameters were unchanged except for the fraction of tracer going to bone mineral (k(3)/[k(2) + k(3)]), which increased by 23% (p = .0006). In contrast to K(i) , spine SUVs increased by only 3% (p = .84). The discrepancy between changes in K(i) and SUVs was explained by a 20% decrease in (18)F(-) plasma concentration. SUVs increased by 37% at the femoral shaft (p = .0019), 20% at the total hip (p = .032), and 11% at the pelvis (p = .070). Changes in bone turnover markers and BMD were consistent with previous trials. We conclude that the changes in bone formation rate during teriparatide treatment as measured by (18)F(-) PET differ at different skeletal sites, with larger increases in cortical bone than at trabecular sites., (Copyright © 2011 American Society for Bone and Mineral Research.)

Fluoroacetate is a highly toxic species naturally found in plants and in commercial products (compound 1080) for population control of several undesirable animal species. However, it is non-selective and toxic to many other animals including humans, and thus its detection is very important for forensic purposes. This paper presents a sensitive and fast method for the determination of fluoroacetate in blood serum using capillary electrophoresis with capacitively coupled contactless conductivity detection. Serum blood samples were treated with ethanol to remove proteins. The samples were analyzed in BGE containing 15 mmol/L histidine and 30 mmol/L gluconic acid (pH 3.85). The calibration curve was linear up to 75 μmol/L (R² =0.9995 for N=12). The detection limit in the blood serum was 0.15 mg/kg, which is smaller than the lethal dose for humans and other animals. Fluoride, a metabolite of the fluoroacetate defluorination, could also be detected for levels greater than 20 μmol/L, when polybrene was used for reversion of the EOF. CTAB and didecyldimethylammonium bromide are not useful for this task because of the severe reduction of the fluoride level. However, no interference was observed for fluoroacetate., (Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: We describe a heart transplant patient with painful periostitis and exostoses who was receiving long-term therapy with voriconazole, which is a fluoride-containing medication. Elevated plasma and bone fluoride levels were identified. Discontinuation of voriconazole therapy led to improvement in pain and reduced fluoride and alkaline phosphatase levels., Methods: To determine whether voriconazole is a cause of fluoride excess, we measured plasma fluoride levels in 10 adult post-transplant patients who had received voriconazole for at least 6 months and 10 post-transplant patients who did not receive voriconazole. To assess the effect of renal insufficiency on fluoride levels in subjects receiving voriconazole, half were recruited on the basis of a serum creatinine level of ≥1.4 mg/dL on their most recent measurement, whereas the other 5 subjects receiving voriconazole had serum creatinine levels <1.4 mg/dL. All control subjects had serum creatinine levels of ≥1.4 mg/dL. Patients were excluded from the study if they received a fluorinated pharmaceutical other than voriconazole., Results: All subjects who received voriconazole had elevated plasma fluoride levels, and no subjects in the control group had elevated levels (14.32 μmol/L ± 6.41 vs 2.54 ± 0.67 μmol/L; P<.001). Renal function was not predictive of fluoride levels. Plasma fluoride levels remained significantly higher in the voriconazole group after adjusting for calcineurin inhibitor levels and doses. Half of the voriconazole group subjects had evidence of periostitis, including exostoses in 2 patients. Discontinuation of voriconazole therapy in patients with periostitis resulted in improvement of pain and a reduction in alkaline phosphatase and fluoride levels., Conclusions: Voriconazole is associated with painful periostitis, exostoses, and fluoride excess in post-transplant patients with long-term voriconazole use.

Perfluoroalkyl acid carboxylates and sulfonates (PFAAs) have many consumer and industrial applications. The persistence and widespread distribution of these compounds in humans have brought them under intense scrutiny. Limited pharmacokinetic data is available in humans; however, human data exists for two communities with drinking water contaminated by PFAAs. Also, there is toxicological and pharmacokinetic data for monkeys, which can be quite useful for cross-species extrapolation to humans. The goal of this research was to develop a physiologically-based pharmacokinetic (PBPK) model for PFOA and PFOS for monkeys and then scale this model to humans in order to describe available human drinking water data. The monkey model simulations were consistent with available PK data for monkeys. The monkey model was then extrapolated to the human and then used to successfully simulate the data collected from residents of two communities exposed to PFOA in drinking water. Human PFOS data is minimal; however, using the half-life estimated from occupational exposure, our model exhibits reasonable agreement with the available human serum PFOS data. It is envisioned that our PBPK model will be useful in supporting human health risk assessments for PFOA and PFOS by aiding in understanding of human pharmacokinetics.

Contemporary biological markers assess present, or very recent, exposure to fluoride: fluoride concentrations in blood, bone surface, saliva, milk, sweat and urine have been considered. A number of studies relating fluoride concentration in plasma to fluoride dose have been published, but at present there are insufficient data on plasma fluoride concentrations across various age groups to determine the 'usual' concentrations. Although bone contains 99% of the body burden of fluoride, attention has focused on the bone surface as a potential marker of contemporary fluoride exposure. From rather limited data, the ratio surface-to-interior concentration of fluoride may be preferred to whole bone fluoride concentration. Fluoride concentrations in the parotid and submandibular/sublingual ductal saliva follow the plasma fluoride concentration, although at a lower concentration. At present, there are insufficient data to establish a normal range of fluoride concentrations in ductal saliva as a basis for recommending saliva as a marker of fluoride exposure. Sweat and human milk are unsuitable as markers of fluoride exposure. A proportion of ingested fluoride is excreted in urine. Plots of daily urinary fluoride excretion against total daily fluoride intake suggest that daily urinary fluoride excretion is suitable for predicting fluoride intake for groups of people, but not for individuals. While fluoride concentrations in plasma, saliva and urine have some ability to predict fluoride exposure, present data are insufficient to recommend utilizing fluoride concentrations in these body fluids as biomarkers of contemporary fluoride exposure for individuals. Daily fluoride excretion in urine can be considered a useful biomarker of contemporary fluoride exposure for groups of people, and normal values have been published., (Copyright © 2011 S. Karger AG, Basel.)

Although so many studies exist on effect of fluoride on hematological parameters in experimental animals, a few studies have been conducted to investigate the effects of chronic fluorosis on hematological parameters in humans' subjects with endemic fluorosis. So we aimed to determine the hematological parameters in patients with endemic fluorosis. The study group consisted of 60 patients with endemic fluorosis (27 females, 33 males, and mean age 33.4 ± 9.6 years). An age-, gender-, and body mass index-matched control group was composed of 34 healthy volunteers (11 females, 23 males with a mean age 32.6 ± 5.6 years). Urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (0.42 ± 0.09 vs 1.92 ± 0.14 mg/l, respectively; P < 0.001). There were no statistically significant differences between the fluorosis group and control group with respect to hematological parameters (complete blood count and ferritin). We concluded that chronic fluorosis has no effect on hematological parameters in patients with endemic fluorosis.

Objective: To observe certain changes of oxidation, anti-oxidation and vascular function indexes of Application of New Zealand rabbit exposed by high-fluoride., Methods: 20 male New Zealand rabbits were randomly divided into control group, drunk deionized water and feed basic diet. High-fat group, drunk deionized water and feed basic diet plus 0.5% cholesterol and 7% egg yolk powder high fat diet. High-fluorine group, drunk high-fluoride water (ion-100 mg/L) and feed basic diet. High-fluoride and high-fat group, drunk high-fluoride water (ion-100 mg/L) and feed basic diet plus 0.5% cholesterol and 7% egg yolk powder high fat diet. The experimental periods were 6 months. Blood samples were collected to determine the fluorine concentration in plasma, in the third and sixth month before experiment. In the sixth month of the experiment, blood, heart and liver samples were gathered to make homogenate, and detect superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities and malondialdehyde (MDA) contents by biochemical method. The 6-keto-prostate F1alpha (6-keto-PGF1alpha), thromboxane B2 (TXB2) and endothelin-1(ET-1) contents were detected by radioimmunoassay. Nitric oxide synthase (NOS), inducible NOS (iNOS), and endothelial NOS (eNOS) were detected by biochemical method. Leukocyte iNOS-mRNA and eNOS-mRNA contents were detected by situ hybridization., Results: In the third and sixth month of experiment, serum fluorides were elevated in rabbits who drunk high-fluorine water, activities of SOD and GSH-Px in blood, liver and heart were decreased (P < 0.01, P < 0.05), while the myocardial MDA contents increased (P < 0.05), 6-keto-PGF1alpha contents in plasma decreased (P < 0.01), TXB2 and ET-1 levels increased (P < 0.01, P < 0.05), total NOS activities in serum decreased (P < 0.05), total NOS activities in liver and iNOS activities in heart and liver increased (P < 0.05). Expression of iNOS-mRNA in leukocyte increased, expression of eNOS-mRNA decreased (P < 0.05) in rabbits who drunk high-fluorine in the sixth month. Factorial analysis of variance, serum, liver and myocardial SOD activities and serum MDA contents, plasma ET-1 contents and serum iNOS activities, liver total NOS activities showed that high-fluorine and high-fat enhanced interactive (P < 0.01 P < 0.05) ., Conclusion: High-fluoride could inhibit antioxidant enzymes, impair vascular endothelial function, body NO metabolism disorder. High fluoride and high-fat could have a certain synergy in this process.

Osteogenesis imperfecta (OI) is a clinically and genetically heterogeneous disease due primarily to mutations in the type I procollagen genes, COL1A1 and COL1A2, causing bone deformity and numerous lifetime fractures. OI murine (oim) model mice carry a mutation in the col1a2 gene causing aberrant production of homotrimeric type I collagen [α1(I)(3)], leading to bone fragility and glomerular accumulation of type I collagen. Previous studies demonstrated that heterozygous (+/oim) and homozygous (oim/oim) mice have elevated tibiae fluoride concentrations but reduced femoral biomechanics. However, it is unclear whether these 2 variables are causally related, because impaired renal function could reduce urinary fluoride excretion, thus elevating bone fluoride concentrations regardless of disease status. Our goal in this study was to determine whether dietary fluoride restriction would improve femoral biomechanics in oim mice. Wild-type, +/oim, and oim/oim mice were fed a control (5 mg/kg fluoride) or fluoride-restricted diet (0 mg/kg fluoride) for ∼13 wk, at which time plasma and femora were analyzed for fluoride concentrations and bone biomechanical properties. In wild-type, +/oim, and oim/oim mice, dietary fluoride restriction reduced femoral fluoride burden by 54-74%, respectively (P < 0.05), without affecting glomerular collagen deposition. Oim/oim mice fed the fluoride-restricted diet had reduced material tensile strength (P < 0.05) compared with oim/oim mice fed the control diet. However, dietary fluoride restriction did not affect stiffness or whole bone femoral breaking strength, regardless of genotype. These data suggest that oim mice have reduced bone strength due to homotrimeric type I collagen, independent of bone fluoride content.

Coal-combustion-type fluorosis has only been reported in China and its pathogenesis has not been fully understood. Fluoride causes chronic toxic effects and selenium modulates cellular activities through signal transduction in human cells. The present study enrolled three groups of subjects with well-defined serum and urine fluoride and hair selenium: high fluoride+high selenium group, high fluoride group and normal control group. The expressions of p38, NF-kB p65, caspase-3 and p53 genes at both protein and mRNA levels in peripheral blood mononuclear cells (PBMCs) were determined by Western blotting and quantitative real-time RT-PCR, respectively. The results showed that the expressions of p38, NF-kB p65, and caspase-3 protein in high fluoride group were higher than those in the other two groups. The mRNA level of NF-kB p65 and caspase-3 was significantly higher in high fluoride+high selenium group than control and lower than high fluoride group. The mRNA and protein level of p53 was significantly higher in high fluoride+high selenium group than that in other two groups. These results suggest that selenium may influence the protein and gene expression associated with p38 signal transduction pathway and up-regulate p53 expression in PBMCs from patients with coal-combustion-type fluorosis., (Copyright 2010 Elsevier GmbH. All rights reserved.)

Oxidative damage to cellular components such as lipids and cell membranes by free radicals and other reactive oxygen species is believed to be associated with the development of degenerative diseases. Fluoride intoxication is associated with oxidative stress and altered anti-oxidant defense mechanism. So the present study was extended to investigate black berry anti-oxidant capacity towards superoxide anion radicals, hydroxyl radicals and nitrite in different organs of fluoride-intoxicated rats. The data indicated that sodium fluoride (10.3mg/kg bw) administration induced oxidative stress as evidenced by elevated levels of lipid peroxidation and nitric oxide in red blood cells, kidney, testis and brain tissues. Moreover, significantly decreased glutathione level, total anti-oxidant capacity and superoxide dismutase activity were observed in the examined tissues. On the other hand, the induced oxidative stress and the alterations in anti-oxidant system were normalized by the oral administration of black berry juice (1.6g/kg bw). Therefore it can be concluded that black berry administration could minimize the toxic effects of fluoride indicating its free radical-scavenging and potent anti-oxidant activities., (Published by Elsevier Ltd.)

Background: There have been no studies in which fasting serum ionic fluoride (SIF) concentrations in a general population were investigated despite the fact that SIF has various activities in humans., Methods: A total of 332 healthy subjects (167 men and 165 women aged 40 to 69years) were selected from residents of 2 towns in Iwate Prefecture, Japan using sex-specific and age-specific stratified random sampling methods. Overnight fasting blood samples were collected from all subjects. Serum levels of creatinine, bone alkaline phosphatase and urinary deoxypyridinoline levels were determined in one laboratory. SIF concentrations were measured using highly sensitive methods. Estimated glomerular filtration rate (eGFR) was calculated using serum creatinine level, age and sex., Results: Mean SIF concentrations were 0.495mumol/l in men and 0.457mumol/l in women. SIF concentrations were independently related to eGFR in both sexes and to menopause status in women. SIF concentrations in women were significantly higher in the post-menopausal group than in the pre-menopausal group., Conclusion: SIF concentrations in middle-aged healthy subjects were increased with an age-related degeneration in renal function. SIF concentrations in post-menopausal women arise from the increased fluoride release from bone after menopause. Age is not related to SIF concentrations., (Copyright 2009 Elsevier B.V. All rights reserved.)

Background: Living donor liver transplantation (LDLT) patients run the risk of developing acute kidney injury (AKI) and subsequent chronic kidney disease, affecting morbidity and mortality. Sevoflurane has anti-inflammation properties, and renal ischemia/reperfusion under sevoflurane anesthesia resulted in drastic improvements in renal function. Extrahepatic metabolism of sevoflurane has been reported in patients undergoing liver transplantation, and might lead to nephrotoxicity. However, whether sevoflurane anesthesia is safe with regard to renal function in small-size liver transplantation needs further investigation. As neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of AKI, we looked at the renal effects of sevoflurane in a rat liver transplantation model using small-for-size grafts to investigate the changes of NGAL level and kidney histology., Methods: Sixty male Sprague-Dawley rats were randomly divided into 2 groups after 50% size liver transplantation. Rats were anesthetized with chloral hydrate or with sevoflurane and subjected to liver transplantation. Twelve rats in each group were used for the survival study and 6 rats were used for the hemodynamic study. Six rats in each group were sacrificed 2 or 24 h after reperfusion. We harvested kidneys and serum for further analysis, including histological and functional parameters; TNF-α, IL-6 and NGAL immunoassay; expressions of myeloperoxidase (MPO) activity; and NF-κB in renal tissues., Results: Rats in the sevoflurane group had significantly lower Scr 24 h after reperfusion compared with those in the chloral hydrate group. Rats in the sevoflurane group demonstrated significantly reduced NGAL concentrations compared with rats in the chloral hydrate group 2 h after reperfusion. Epithelial necrosis in the chloral hydrate group (3.2 ± 0.8) was greater than that in the sevoflurane group (1.5 ± 1.1; p < 0.05). Sevoflurane anesthesia resulted in significantly lower plasma TNF-α and IL-6 concentrations and reduced MPO concentrations 2 h after reperfusion (p < 0.05). NF-κB protein levels 2 h after reperfusion increased by at least 110% in the chloral hydrate group relative to the sevoflurane group 2 h after reperfusion (p < 0.05). However, the urine inorganic fluoride concentrations increased significantly (p < 0.001) 2 h after reperfusion in the sevoflurane group (6.1 ± 1.5 μmol·l⁻¹) compared with the chloral hydrate group., Conclusions: Sevoflurane anesthesia can attenuate renal injury and modulate inflammatory cascades in small-size liver transplantation using rat models., (Copyright © 2010 S. Karger AG, Basel.)

Considering that blood fluoride concentration varies according to fluoride exposure and that dental fluorosis is related to the amount of enamel formed under a given fluoride dose, the present study investigated whether the fluorosis produced by an oscillating chronic fluoride dose would be similar to that caused by exposure to a constant dose, representing the mean of the oscillation during a given time. Rats received during 78 days water with fluoride concentrations of 0, 12.5, 25 or 37.5 microg F/mL, or oscillating concentrations of 12.5 and 37.5 microg F/mL every 72 h (mean exposure=25 microg F/mL). The concentrations of fluoride in the plasma, femur and incisors of the rats were determined at the end of the experimental period. Also, the enamel dental fluorosis index was determined in the incisors using a quantitative method developed by our research group named Dental Fluorosis by Image Analysis (DFIA). Fluoride concentrations in plasma, femur and teeth, and DFIA increased linearly for constant fluoride concentrations in water (p<0.0001, r values=0.87-0.98). The results of the oscillating group and the groups receiving 25 microg F/mL did not differ significantly (p>0.05). The findings of this study suggest that in animals chronically exposed to symmetrically oscillating fluoride doses, the resulting dental fluorosis reflects the metabolic effect of the mean of the oscillating doses.

A/J and 129P3/J mouse strains have different susceptibilities to dental fluorosis, due to their genetic backgrounds. This study tested whether these differences are due to variations in water intake and/or F metabolism. A/J (susceptible to dental fluorosis) and 129P3/J mice (resistant) received drinking water containing 0, 10, or 50 ppm F. Weekly F intake, excretion and retention, and terminal plasma and femur F levels were determined. Dental fluorosis was evaluated clinically and by quantitative fluorescence (QF). Data were tested by two-way ANOVA. Although F intakes by the strains were similar, excretion by A/J mice was significantly higher due to greater urinary F excretion, which resulted in lower plasma and femur F levels. Compared with 129P3/J mice given 50 ppm F, significantly higher QF scores were recorded for A/J mice. In conclusion, these strains differ with respect to several features of F metabolism, and amelogenesis in the 129P3/J strain seems to be unaffected by high F exposure.

Intake of excess amounts of fluoride during tooth development cause enamel fluorosis, a developmental disturbance that makes enamel more porous. In mild fluorosis, there are white opaque striations across the enamel surface, whereas in more severe cases, the porous regions increase in size, with enamel pitting, and secondary discoloration of the enamel surface. The effects of fluoride on enamel formation suggest that fluoride affects the enamel-forming cells, the ameloblasts. Studies investigating the effects of fluoride on ameloblasts and the mechanisms of fluorosis are based on in vitro cultures as well as animal models. The use of these model systems requires a biologically relevant fluoride dose, and must be carefully interpreted in relation to human tooth formation. Based on these studies, we propose that fluoride can directly affect the ameloblasts, particularly at high fluoride levels, while at lower fluoride levels, the ameloblasts may respond to local effects of fluoride on the mineralizing matrix. A new working model is presented, focused on the assumption that fluoride increases the rate of mineral formation, resulting in a greater release of protons into the forming enamel matrix.