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Efficiency of advanced wastewater treatment technologies to reduce micropollutants which mediate dioxin-like toxicity was investigated. Technologies compared included ozonation, powdered activated carbon and granular activated carbon. In addition to chemical analyses in samples of effluents, surface waters, sediments, and fish, (1) dioxin-like potentials were measured in paired samples of effluents, surface waters, and sediments by use of an in vitro biotest (reporter gene assay) and (2) dioxin-like effects were investigated in exposed fish by use of in vivo activity of the mixed-function, monooxygenase enzyme, ethoxyresorufin O-deethylase (EROD) in liver. All advanced technologies studied, based on degradation or adsorption, significantly reduced dioxin-like potentials in samples and resulted in lesser EROD activity in livers of fish. Results of in vitro and in vivo biological responses were not clearly related to quantification of targeted analytes by use of instrumental analyses., (Copyright © 2016 Elsevier Inc. All rights reserved.)

A sensitive, multi-residue method using solid-phase extraction followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed to determine a representative group of 35 analytes, including corrosion inhibitors, pesticides and pharmaceuticals such as analgesic and anti-inflammatory drugs, five iodinated contrast media, β-blockers and some of their metabolites and transformation products in water samples. Few other methods are capable of determining such a broad range of contrast media together with other analytes. We studied the parameters affecting the extraction of the target analytes, including sorbent selection and extraction conditions, their chromatographic separation (mobile phase composition and column) and detection conditions using two ionisation sources: electrospray ionisation (ESI) and atmospheric pressure chemical ionisation (APCI). In order to correct matrix effects, a total of 20 surrogate/internal standards were used. ESI was found to have better sensitivity than APCI. Recoveries ranging from 79 to 134 % for tap water and 66 to 144 % for surface water were obtained. Intra-day precision, calculated as relative standard deviation, was below 34 % for tap water and below 21 % for surface water, groundwater and effluent wastewater. Method quantification limits (MQL) were in the low ng L(-1) range, except for the contrast agents iomeprol, amidotrizoic acid and iohexol (22, 25.5 and 17.9 ng L(-1), respectively). Finally, the method was applied to the analysis of 56 real water samples as part of the validation procedure. All of the compounds were detected in at least some of the water samples analysed. Graphical Abstract Multi-residue method for the determination of micropollutants including pharmaceuticals, iodinated contrast media and pesticides in waters by LC-MS/MS.

Nitrification and urease inhibitors (NUIs) decelerate the bacterial oxidation of nitrogen species by suppressing the activity of soil microorganisms. Thus, nitrogen losses can be limited and the efficiency of nitrogen fertilizers can be increased. After application NUI transfers to surface water may occur through leaching or surface run-off. In order to assess the occurrence of nitrification and urease inhibitors in the aquatic environment a multi-analyte high-performance liquid chromatography-mass spectrometry method was developed. 1H-1,2,4-Triazole and dicyandiamide (DCD) were detected for the first time in German surface waters. Only at a few sites 1H-1,2,4-triazole has been episodically detected with concentrations up to the μg L(-1)-range. DCD was ubiquitously present in German surface waters. An industrial site was identified as the point source of DCD being responsible for exceptionally high DCD concentrations of up to 7.2 mg L(-1) in close proximity to the point of discharge. Both compounds were also detected in at least one wastewater treatment plant effluent, but their concentrations in surface waters did not correlate with those of typical markers for domestic wastewater. Other NUIs were not detected in any of the samples. Laboratory-scale batch tests proved that 1H-1,2,4-triazole and DCD are not readily biodegradable, are not prone to hydrolysis and do not tend to adsorb onto soil particles. Ozonation and activated carbon filtration proved to be ineffective for their removal.

JAK2, MPL, and CALR mutations, which underlie essential thrombocythemia (ET) in most adults, are infrequent in children. Consequently, additional tests are needed to confirm pediatric ET diagnoses. We report a child with suspected ET and normal JAK2, MPL, and CALR analyses. Serum thrombopoietin (TPO) was markedly elevated, leading to analysis of the TPO gene, TPHO, which contains an upstream open reading frame (uORF) known to repress THPO translation. Sequencing revealed a de novo, germline stopgain mutation in the uORF, explaining the elevated TPO and thrombocytosis. This finding suggests that screening TPO levels and, if elevated, THPO 5' UTR sequencing could be diagnostic., (© 2016 Wiley Periodicals, Inc.)

Background: The purpose was to identify barriers including logistical and health belief correlates of late stage presentation of cervical cancer (CxCa) among medically underserved women presenting to a safety net health care system., Methods: Women presenting with newly diagnosed CxCa were asked to complete a detailed health belief survey that included questions about barriers to care and their knowledge of CxCa. All information was collected prior to initiating cancer treatment. Comparisons were made among women diagnosed at early stages of disease amendable to surgical treatment (≤IB1) and those diagnosed at a stage requiring local-regional or systemic/palliative treatment (≥IB2)., Results: Among the 138 women, 21.7% were diagnosed with ≤lB1 disease, while 78.3% were diagnosed with ≥IB2 disease. Late-stage diagnosis was associated with a greater number of emergency room (ER) visits (p<.001) and blood transfusions (p<.001) prior to diagnosis. Compared to 88% with ≤lB1 disease, only 53% of patients with ≥IB2 disease had a car (p=.003). Women with ≥IB2 disease were more likely to be without a primary care provider (75.0% vs. 42.3%, p=.001)., Conclusion: Access to transportation and lack of a regular primary care provider or a medical home are associated with late-stage of CxCa at diagnosis. Many medically underserved women continue to use the ER as their primary source of health care, and as a result their CxCa is diagnosed in advanced stages, with higher medical costs and lower chances of cure. The lack of Medicaid expansion in Texas may result in a worsening of this situation., (Copyright © 2015. Published by Elsevier Inc.)

In order to evaluate surface water and the sediment quality of rivers connected to wastewater treatment plants (WWTPs) with different treatment technologies, fish embryo tests (FET) with Danio rerio were conducted using native water and sediment samples collected upstream and downstream of four WWTPs in Southern Germany. Two of these WWTPs are connected to the Schussen River, a tributary of Lake Constance, and use a sand filter with final water purification by flocculation. The two others are located on the rivers Schmiecha and Eyach in the area of the Swabian Alb and were equipped with a powdered activated carbon stage 20 years ago, which was originally aimed at reducing the release of stains from the textile industry. Several endpoints of embryo toxicity including mortality, malformations, reduced hatching rate, and heart rate were investigated at defined time points of embryonic development. Higher embryotoxic potentials were found in water and sediments collected downstream of the WWTPs equipped with sand filtration than in the sample obtained downstream of both WWTPs upgraded with a powdered activated carbon stage.

As an environmental contaminant of anthropogenic origin metformin is present in the high ng/L- up to the low μg/L-range in most surface waters. Residues of metformin may lead to the formation of disinfection by-products during chlorine disinfection, when these waters are used for drinking water production. Investigations on the underlying chemical processes occurring during treatment of metformin with sodium hypochlorite in aqueous medium led to the discovery of two hitherto unknown transformation products. Both substances were isolated and characterized by HPLC-DAD, GC-MS, HPLC-ESI-TOF, (1)H-NMR and single-crystal X-ray structure determination. The immediate major chlorination product is a cyclic dehydro-1,2,4-triazole-derivate of intense yellow color (Y; C4H6ClN5). It is a solid chlorimine of limited stability. Rapid formation was observed between 10 °C and 30 °C, as well as between pH 3 and pH 11, in both ultrapure and tap water, even at trace quantities of reactants (ng/L-range for metformin, mg/L-range for free chlorine). While Y is degraded within a few hours to days in the presence of light, elevated temperature, organic solvents and matrix constituents within tap water, a secondary degradation product was discovered, which is stable and colorless (C; C4H6ClN3). This chloroorganic nitrile has a low photolysis rate in ambient day light, while being resistant to heat and not readily degraded in the presence of organic solvents or in the tap water matrix. In addition, the formation of ammonia, dimethylamine and N,N-dimethylguanidine was verified by cation exchange chromatography., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

An increasing number of organic micropollutants (OMP) is detected in anthropogenically influenced water cycles. Source control and effective natural and technical barriers are essential to maintain a high quality of drinking water resources under these circumstances. Based on the literature and our own research this study proposes a limited number of OMP that can serve as indicator substances for the major sources of OMP, such as wastewater treatment plants, agriculture and surface runoff. Furthermore functional indicators are proposed that allow assessment of the proper function of natural and technical barriers in the aquatic environment, namely conventional municipal wastewater treatment, advanced treatment (ozonation, activated carbon), bank filtration and soil aquifer treatment as well as self-purification in surface water. These indicator substances include the artificial sweetener acesulfame, the anti-inflammatory drug ibuprofen, the anticonvulsant carbamazepine, the corrosion inhibitor benzotriazole and the herbicide mecoprop among others. The chemical indicator substances are intended to support comparisons between watersheds and technical and natural processes independent of specific water cycles and to reduce efforts and costs of chemical analyses without losing essential information., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Discharge of substances like pesticides, pharmaceuticals, flame retardants, and chelating agents in surface waters has increased over the last decades due to the rising numbers of chemicals used by humans and because many WWTPs do not eliminate these substances entirely. The study, results of which are presented here, focused on associations of (1) concentrations of micropollutants in wastewater treatment plant (WWTP) effluents, surface waters, sediments, and tissues of fishes; (2) results of laboratory biotests indicating potentials for effects in these samples and (3) effects either in feral chub (Leuciscus cephalus) from two German rivers (Schussen, Argen) or in brown trout (Salmo trutta f. fario) and rainbow trout (Oncorhynchus mykiss) exposed in bypass systems to streamwater of these rivers or in cages directly in the rivers. The Schussen and Argen Rivers flow into Lake Constance. The Schussen River is polluted by a great number of chemicals, while the Argen River is less influenced by micropollutants. Pesticides, chelating agents, flame retardants, pharmaceuticals, heavy metals, polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs) were detected in effluents of a WWTP discharging to the Schussen as well as in surface water, and/or fishes from downstream of the WWTP. Results obtained by biotests conducted in the laboratory (genotoxicity, dioxin-like toxicity, and embryotoxicity) were linked to effects in feral fish collected in the vicinity of the WWTP or in fishes exposed in cages or at the bypass systems downstream of the WWTP. Dioxin-like effect potentials detected by reporter gene assays were associated with activation of CYP1A1 enzymes in fishes which are inducible by dioxin-like chemicals. Abundances of several PCBs in tissues of fishes from cages and bypass systems were not associated with these effects but other factors can influence EROD activity. Genotoxic potentials obtained by in vitro tests were associated with the presence of micronuclei in erythrocytes of chub from the river. Chemicals potentially responsible for effects on DNA were identified. Embryotoxic effects on zebrafish (Danio rerio), investigated in the laboratory, were associated with embryotoxic effects in trout exposed in streamwater bypass systems at the two rivers. In general, responses at all levels of organization were more pronounced in samples from the Schussen than in those from the Argen. These results are consistent with the magnitudes of chemical pollution in these two streams. Plausibility chains to establish causality between exposures and effects and to predict effects in biota in the river from studies in the laboratory are discussed., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Combined sewer systems collect surface runoff as well as wastewater of industrial and domestic origin. During periods of heavy rainfall the capacity of the sewer system is exceeded and the overflow is discharged into receiving waters without any treatment. Consequently, combined sewer overflow (CSO) is considered as a major source of water pollution. This study investigates the effectiveness of a retention soil filter (RSF) for the removal of micropollutants as well as facultative pathogenic and antibiotic resistant bacteria from CSO. The removal of organic group parameters like total organic carbon was excellent and the removal efficiency for micropollutants of the RSF and the wastewater treatment plant (WWTP), which treats wastewater of the same origin during dry and normal weather conditions, was comparable. Compounds of high environmental concern like estrogens or certain pharmaceuticals, e.g. diclofenac, were completely eliminated or removed to a high degree during RSF passage. RSF treatment also reduced the number of E. coli, enterococci and staphylococci by 2.7, 2.2 and 2.4 log-units (median values), respectively. Obviously, some Staphylococcus species can better adapt to the conditions of the RSF than others as a shift of the abundance of the different species was observed when comparing the diversity of staphylococci obtained from the RSF influent and effluent. RSF treatment also decreased the absolute number of antibiotic resistant bacteria. The percentage of antibiotic resistant E. coli and staphylococci isolates also decreased during passage of the RSF, whereas the percentage of resistant enterococci did not change. For E. coli ampicillin and for enterococci and staphylococci erythromycin determined the antibiotic resistance level. The results demonstrate that RSFs can be considered as an adequate treatment option for CSO. The performance for the removal of micropollutants is comparable with a medium sized WWTP with conventional activated sludge treatment. The number of facultative pathogenic and antibiotic resistant bacteria was considerably decreased during RSF passage. However, as RSF effluents still contained antibiotic resistance genes and traces of micropollutants; receiving waters may still be at risk from negative environmental impacts.

Accurate cervical intra-epithelial neoplasia (CIN) lesion grading is needed for effective patient management. We applied computer-assisted scanning and analytic approaches to immuno-stained CIN lesion sections to more accurately delineate disease states and decipher cell proliferation impacts from HPV and smoking within individual epithelial layers. A patient cohort undergoing cervical screening was identified (n = 196) and biopsies of varying disease grades and with intact basement membranes and epithelial layers were obtained (n = 261). Specimens were sectioned, stained (Mib1), and scanned using a high-resolution imaging system. We achieved semi-automated delineation of proliferation status and epithelial cell layers using Otsu segmentation, manual image review, Voronoi tessellation, and immuno-staining. Data were interrogated against known status for HPV infection, smoking, and disease grade. We observed increased cell proliferation and decreased epithelial thickness with increased disease grade (when analyzing the epithelium at full thickness). Analysis within individual cell layers showed a ≥50% increase in cell proliferation for CIN2 vs. CIN1 lesions in higher epithelial layers (with minimal differences seen in basal/parabasal layers). Higher rates of proliferation for HPV-positive vs. -negative cases were seen in epithelial layers beyond the basal/parabasal layers in normal and CIN1 tissues. Comparing smokers vs. non-smokers, we observed increased cell proliferation in parabasal (low and high grade lesions) and basal layers (high grade only). In sum, we report CIN grade-specific differences in cell proliferation within individual epithelial layers. We also show HPV and smoking impacts on cell layer-specific proliferation. Our findings yield insight into CIN progression biology and demonstrate that rigorous, semi-automated imaging of histopathological specimens may be applied to improve disease grading accuracy.

Many studies about endocrine pollution in the aquatic environment reveal changes in the reproduction system of biota. We analysed endocrine activities in two rivers in Southern Germany using three approaches: (1) chemical analyses, (2) in vitro bioassays, and (3) in vivo investigations in fish and snails. Chemical analyses were based on gas chromatography coupled with mass spectrometry. For in vitro analyses of endocrine potentials in water, sediment, and waste water samples, we used the E-screen assay (human breast cancer cells MCF-7) and reporter gene assays (human cell line HeLa-9903 and MDA-kb2). In addition, we performed reproduction tests with the freshwater mudsnail Potamopyrgus antipodarum to analyse water and sediment samples. We exposed juvenile brown trout (Salmo trutta f. fario) to water downstream of a wastewater outfall (Schussen River) or to water from a reference site (Argen River) to investigate the vitellogenin production. Furthermore, two feral fish species, chub (Leuciscus cephalus) and spirlin (Alburnoides bipunctatus), were caught in both rivers to determine their gonadal maturity and the gonadosomatic index. Chemical analyses provided only little information about endocrine active substances, whereas the in vitro assays revealed endocrine potentials in most of the samples. In addition to endocrine potentials, we also observed toxic potentials (E-screen/reproduction test) in waste water samples, which could interfere with and camouflage endocrine effects. The results of our in vivo tests were mostly in line with the results of the in vitro assays and revealed a consistent reproduction-disrupting (reproduction tests) and an occasional endocrine action (vitellogenin levels) in both investigated rivers, with more pronounced effects for the Schussen river (e.g. a lower gonadosomatic index). We were able to show that biological in vitro assays for endocrine potentials in natural stream water reasonably reflect reproduction and endocrine disruption observed in snails and field-exposed fish, respectively.

The transformation of the artificial sweetener acesulfame by direct photolysis was investigated at various pH values, in different water types and at various concentration levels. Main photodegradation products of acesulfame were elucidated and analyzed both in laboratory experiments and in a full-scale waterworks using UV treatment for disinfection purposes. The degradation of acesulfame was found to be independent of the pH (range 5-11) and followed pseudo first order kinetics in a concentration range between 1 μg∙L(-1) and 10 mg∙L(-1). Calculated rate constants were in the range between 5.4·10(-3)s(-1) and 7.4·10(-3)s(-1). The main photodegradation products of acesulfame were separated by ion exchange chromatography and high performance liquid chromatography and were identified as hydroxylated acesulfame and iso-acesulfame by high resolution mass spectrometry and fragmentation experiments. In the case of iso-acesulfame an intramolecular rearrangement is assumed as the transformation product has a higher polarity and different product ions after MS fragmentation compared to acesulfame. Minor transformation products were identified as amidosulfonic acid and sulfate by comparison with analytical standards. The transformation pathway was found to be transferable to drinking water production as the identified transformation products were also detected to a similar extent in fortified tap water. In a Swiss full-scale waterworks acesulfame concentrations were reduced by approximately 30% and one of the main UV transformation products could be qualitatively detected., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Neurodevelopmental outcomes after the Norwood procedure for single right ventricular lesions are worse than those in the normal population. It would be valuable to identify which patients at the time of Norwood discharge are at greatest risk for neurodevelopmental impairment later in childhood. As such, this study sought to construct and validate a model to predict poor neurodevelopmental outcome using variables readily available to the clinician. Using data from the 14 month neurodevelopmental outcome of the Single-Ventricle Reconstruction (SVR) trial, a classification and regression tree (CART) analysis model was developed to predict severe neurodevelopmental impairment, defined as a Psychomotor Development Index (PDI) score lower than 70 on the Bayley Scales of Infant Development-II. The model then was validated using data from subjects enrolled in the Infant Single Ventricle (ISV) trial. The PDI scores were lower than 70 for 138 (44 %) of 313 subjects. Predictors of a PDI lower than 70 were post-Norwood intensive care unit (ICU) stay longer than 46 days, genetic syndrome or other anomalies, birth weight less than 2.7 kg, additional cardiac surgical procedures, and use of five or more medications at hospital discharge. Using these risk factors, the CART model correctly identified 75 % of SVR subjects with a PDI lower than 70. When the CART model was applied to 70 subjects from the ISV trial, the correct classification rate was 67 %. This model of variables from the Norwood hospitalization can help to identify infants at risk for neurodevelopmental impairment. However, given the overall high prevalence of neurodevelopmental impairment and the fact that nearly one third of severely affected children would not have been identified by these risk factors, close surveillance and assessment for early intervention services are warranted for all infants after the Norwood procedure.

Metformin, an antidiabetic drug with one of the highest consumption rates of all pharmaceuticals worldwide, is biologically degraded to guanylurea in wastewater treatment plants. Due to high metformin influent concentrations of up to 100 μg/L and its high but incomplete degradation both compounds are released in considerable amounts of up to several tens of μg/L into recipient rivers. This is the first systematic study on their environmental fate and the effectiveness of treatment techniques applied in waterworks to remove metformin and guanylurea from surface water influenced raw waters. The concentrations in surface waters depend strongly on the respective wastewater burden of rivers and creeks and are typically in the range of about 1 μg/L for metformin and several μg/L for guanylurea but can reach elevated average concentrations of more than 3 and 20 μg/L, respectively. Treatment techniques applied in waterworks were investigated by an extended monitoring program in three facilities and accompanied by laboratory-scale batch tests. Flocculation and activated carbon filtration proved to be ineffective for removal of metformin and guanylurea. During ozonation and chlorination experiments with waterworks-relevant ozone and chlorine doses they were partly transformed to yet unknown compounds. The effectiveness of the treatment steps under investigation can be ordered chlorination > ozonation > activated carbon filtration > flocculation. However, most effective for removal of both compounds at the three full-scale waterworks studied proved to be an underground passage (riverbank filtration or artificial groundwater recharge). A biological degradation is most likely as sorption can be neglected. This is based on laboratory batch tests conducted with three different soil materials according to OECD guideline 106. Since such treatment steps were implemented in all three drinking water treatment plants, even traces of metformin and its metabolite guanylurea could not be detected at the end of the treatment trains. Both can only be expected in finished drinking water if surface influenced raw water is used by direct abstraction without underground passage., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: In the Single Ventricle Reconstruction trial, infants undergoing the Norwood procedure were randomly allocated to undergo a right ventricle-to-pulmonary artery shunt or a modified Blalock-Taussig shunt. Apart from shunt type, subjects received the local standard of care. We evaluated variation in perioperative care during the Norwood hospitalization across 14 trial sites., Methods: Data on preoperative, operative, and postoperative variables for 546 enrolled subjects who underwent the Norwood procedure were collected prospectively on standardized case report forms, and variation across the centers was described., Results: Gestational age, birth weight, and proportion with hypoplastic left heart syndrome were similar across sites. In contrast, all recorded variables related to preoperative care varied across centers, including fetal diagnosis (range, 55%-85%), preoperative intubation (range, 29%-91%), and enteral feeding. Perioperative and operative factors were also variable across sites, including median total support time (range, 74-189 minutes) and other perfusion variables, arch reconstruction technique, intraoperative medication use, and use of modified ultrafiltration (range, 48%-100%). Additional variation across centers was seen in variables related to postoperative care, including proportion with an open sternum (range, 35%-100%), median intensive care unit stay (range, 9-44 days), type of feeding at discharge, and enrollment in a home monitoring program (range, 1%-100%; 5 sites did not have a program). Overall, in-hospital death or transplant occurred in 18% (range across sites, 7%-39%)., Conclusions: Perioperative care during the Norwood hospitalization varies across centers. Further analysis evaluating the underlying causes and relationship of this variation to outcome is needed to inform future studies and quality improvement efforts., (Copyright © 2012 The American Association for Thoracic Surgery. All rights reserved.)

A new hybrid organic-inorganic chromophore based on ferrocene was synthesized. In addition to a detailed synthesis description the article describes complex quantum chemical and experimental (UV-VIS and electrochemical) studies of the redox and chromophore characteristics. The properties studied include the diffusion coefficient as well as solvatochromic effects in solvents differing in polarity, namely dichloromethane, propylene carbonate and acetonitrile. The experimental results are discussed within a framework of theoretical description at the DFT and TDDFT (6-31G(df,p)) levels of theory, with the PCM solvation model. Accuracy of B3LYP and BLYP functionals in reproducing orbital energy levels and optical transitions of the title molecule is briefly discussed., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Cross-sectional studies have suggested a role for activation of adaptive immunity in smokers with emphysema, but the clinical application of these findings has not been explored. Here we examined the utility of detecting autoreactive T cells as a screening tool for emphysema in an at-risk population of smokers. We followed 156 former and current (ever)-smokers for 2 years to assess whether peripheral blood CD4 T cell cytokine responses to lung elastin fragments (EFs) could discriminate between those with and without emphysema, and to evaluate the relevance of autoreactive T cells to predict changes during follow-up in lung physiological parameters. Volunteers underwent baseline complete phenotypic assessment with pulmonary function tests, quantitative chest CT, yearly 6-min walk distance (6MWD) testing, and annual measurement of CD4 T cell cytokine responses to EFs. The areas under the receiver operating characteristic curve to predict emphysema for interferon gamma (IFN-γ), and interleukin 6 (IL-6) responses to EFs were 0.81 (95% CI of 0.74-0.88) and 0.79 (95% CI of 0.72-0.86) respectively. We developed a dual cytokine enzyme-linked immunocell spot assay, the γ-6 Spot, using CD4 T cell IFN-γ and IL-6 responses and found that it discriminated emphysema with 90% sensitivity. After adjusting for potential confounders, the presence of autoreactive T cells was predictive of a decrease in 6MWD over 2 years (decline in 6MWD, -19 m per fold change in IFN-γ; P = 0.026, and -26 m per fold change in IL-6; P = 0.003). In support of the human association studies, we cloned CD4 T cells with characteristic T helper (Th)1 and Th17 responses to EFs in the peripheral blood of ever-smokers with emphysema, confirming antigenicity of lung elastin in this population. These findings collectively suggest that the EF-specific autoreactive CD4 T cell assay, γ-6 Spot, could provide a non-invasive diagnostic tool with potential application to large-scale screening to discriminate emphysema in ever-smokers, and predict early relevant physiological outcomes in those at risk.

An overview is given of existing trace analytical methods for the determination of seven popular artificial sweeteners [acesulfame (ACE), aspartame, cyclamate (CYC), neotame, neohesperidine dihydrochalcone, saccharin (SAC), and sucralose (SUC)] from aqueous environmental samples. Liquid chromatography-electrospray ionization tandem mass spectrometry and liquid chromatography-electrospray ionization high-resolution mass spectrometry are the methods most widely applied, either directly or after solid-phase extraction. Limits of detection and limits of quantification down to the low nanogram per liter range can be achieved. ACE, CYC, SAC, and SUC were detected in wastewater treatment plants in high microgram per liter concentrations. Per capita loads of individual sweeteners can vary within a wide range depending on their use in different countries. Whereas CYC and SAC are usually degraded by more than 90% during wastewater treatment, ACE and SUC pass through wastewater treatment plants mainly unchanged. This suggests their use as virtually perfect markers for the study of the impact of wastewater on source waters and drinking waters. In finished water of drinking water treatment plants using surface-water-influenced source water, ACE and SUC were detected in concentrations up to 7 and 2.4 μg/L, respectively. ACE was identified as a precursor of oxidation byproducts during ozonation, resulting in an aldehyde intermediate and acetic acid. Although the concentrations of ACE and SUC are among the highest measured for anthropogenic trace pollutants found in surface water, groundwater, and drinking water, the levels are at least three orders of magnitude lower than organoleptic threshold values. However, ecotoxicology studies are scarce and have focused on SUC. Thus, further research is needed both on identification of transformation products and on the ecotoxicological impact of artificial sweeteners and their transformation products.

Purpose: The two artificial sweeteners cyclamate (CYC) and acesulfame (ACE) have been detected in wastewater and drinking water treatment plants. As in both facilities ozonation might be applied, it is important to find out if undesired oxidation products (OPs) are formed., Methods: For the separation and detection of the OPs, several analytical techniques, including nuclear magnetic resonance experiments, were applied. In order to distinguish between direct ozone reaction and a radical mechanism, experiments were carried out at different pH values with and without scavenging OH radicals. Kinetic experiments were used for confirmation that the OPs are formed during short ozone contact time applied in waterworks. Samples from a waterworks using bank filtrate as raw water were analyzed in order to prove that the identified OPs are formed in real and full-scale ozone applications., Results: In the case of CYC, oxidation mainly occurs at the carbon atom, where the sulfonamide moiety is bound to the cyclohexyl ring. Consequently, amidosulfonic acid and cyclohexanone are formed as main OPs of CYC. When ozone reacts at another carbon atom of the ring a keto moiety is introduced into the CYC molecule. Acetic acid and the product ACE OP170, an anionic compound with m/z=170 and an aldehyde hydrate moiety, were identified as the main OPs for ACE. The observed reaction products suggest an ozone reaction according to the Criegee mechanism due to the presence of a C=C double bond. ACE OP170 was also detected after the ozonation unit of a full-scale drinking water treatment plant which uses surface water-influenced bank filtrate as raw water., Conclusions: Acesulfame can be expected to be found in anthropogenic-influenced raw water used for drinking water production. However, when ACE OP170 is formed during ozonation, it is not expected to cause any problem for drinking water suppliers, because the primary findings suggest its removal in subsequent treatment steps, such as activated carbon filters.

Six trace contaminants (acesulfame (ACE), sucralose (SUC), carbamazepine (CBZ), diatrizoic acid (DTA), 1H-benzotriazole (BTZ) and its 4-methyl analogue (4-TTri)) were traced from wastewater treatment plants (WWTPs) to receiving waters and further to riverbank filtration (RBF) wells to evaluate their prediction power as potential wastewater markers. Furthermore, the persistence of some compounds was investigated in advanced wastewater treatment by soil aquifer treatment (SAT). During wastewater treatment in four conventional activated sludge WWTPs ACE, SUC, and CBZ showed a pronounced stability expressed by stable concentration ratios in influent (in) and effluent (out) (ACE/CBZ: in45, out40; SUC/CBZ: in1.8, out1.7; and ACE/SUC: in24, out24). In a fifth WWTP, additional treatment with powdered activated carbon led to a strong elimination of CBZ, BTZ, and 4-TTri of about 80% and consequently to a distinctive shift of their ratios with unaffected compounds. Data from a seven month monitoring program at seven sampling locations at the rivers Rhine and Main in Germany revealed the best concentration correlation for ACE and CBZ (r(2) = 0.94) and also a good correlation of ACE and CBZ concentrations to BTZ and 4-TTri levels (r(2) = 0.66 to 0.82). The comparison of ratios at different sampling sites allowed for the identification of a CBZ point source. Furthermore, in Switzerland a higher consumption of SUC compared to Germany can be assumed, as a steadily increasing ACE/SUC ratio along the river Rhine was observed. In RBF wells a good correlation (r(2) = 0.85) was again observed for ACE and CBZ. Both also showed the highest stability at a prolonged residence time in the subsurface of a SAT field. In the most peripheral wells ACE and CBZ were still detected with mean values higher than 36 µg L(-1) and 1.3 µg L(-1), respectively. Although SUC concentrations in wastewater used for SAT decreased by more than 80% from about 18 µg L(-1) to 2.1 µg L(-1) and 3.5 µg L(-1) in these outlying wells, the compound was still adequate to indicate a wastewater impact in a qualitative way.

This study aimed to evaluate clinical outcomes including hemodynamics, right ventricle (RV) function, and tricuspid valve (TV) function in patients with hypoplastic left heart syndrome (HLHS) at midterm after completion of staged palliation based on the source of pulmonary blood flow provided at stage 1. The records of all patients with HLHS who completed Fontan palliation between 2001 and 2007 were retrospectively reviewed. The outcome variables were RV dysfunction, TV, and neo-atrioventricular (neo-AV) regurgitation (from latest echocardiogram), cardiac index (CI), pulmonary vascular resistance (PVR), pulmonary artery pressure (PAp), and right ventricular end-diastolic pressure (RVEDp) (from latest catheterization). Clinical status was obtained from medical records and by contact with the referring cardiologist if necessary. Of 118 patients undergoing a Fontan for HLHS, 116 had a fenestrated lateral tunnel and 2 had an extracardiac conduit. At the time of stage 1 palliation, 36 patients had a right ventricle-to-pulmonary artery (RV-PA) conduit, and 82 patients had a modified Blalock-Taussig shunt (mBTS). All the patients except one who died of sepsis on extracorporeal membrane oxygenation (ECMO) survived the Fontan operation and were discharged home. At a mean follow-up post-Fontan period of 28.4 months (range, 0.16-95.3 months), three patients had died (2 on the transplantation list and 1 from pulmonary vein stenosis), and one patient had the Fontan circulation taken down. No patient had a heart transplantation. A follow-up echocardiogram was performed for 115 patients (after a mean of 15.6 months for RV-PA and 32.1 months for BTS), and 66 patients underwent a post-Fontan catheterization (after a mean of 15.8 months for RV-PA and 29.3 months for BTS). The hemodynamic results for RV-PA conduit versus BTS were a CI of 3.4 ± 0.8 versus 3.4 ± 1.2, a PVR of 1.8 ± 0.7 versus 1.7 ± 0.8, a PAp of 14.3 ± 3.1 versus 14.2 ± 4.5, and an RVEDp of 7.1 ± 3.3 versus 8.9 ± 5.3. No statistically significant differences were found between shunt types regarding survival or degree of RV dysfunction or in terms of neo-AV regurgitation, CI, PVR, PAp, RVEDp, or rhythm problems. Patients in the BTS group required more tricuspid valvuloplasties and had more tricuspid regurgitation at follow-up evaluation. The patients in the RV-PA group had more PA interventions. In conclusion, the contemporary results after Fontan palliation for HLHS were excellent. At the midterm follow-up evaluation, outcomes and hemodynamic data were similar between shunt types. However, the patients in the BTS group exhibited more tricuspid regurgitation, and the patients in the RV-PA group had increased pulmonary artery interventions.

Objective: Chronic pancreatitis (CP) is a predisposing disease for pancreatic carcinoma (PC), however, precise molecular mechanisms of cancer development in the background of CP are ill defined., Methods: A total of 443 laser-microdissected pancreatic intraepithelial neoplasias (PanINs), acinar-ductal metaplasia (ADM), and normal ducts from 21 patients with CP were analyzed for loss of heterozygosity (LOH) and immunohistochemical protein expression of p53, p16, and DPC4. Pancreatic intraepithelial neoplasias were analyzed for mutations in p53, p16, and Ki-ras genes by ABI sequencing. Aneuploidy was determined by fluorescence in situ hybridization with probes for chromosomes 3, 7, 8, and 17., Results: Loss of heterozygosity rate in PanIN-1 and ADM was between 1.7% (p53) and 5.8% (p16). In PanIN-3, p53 protein overexpression and loss of expression for p16 and DPC4 protein were seen. Heterozygous mutations of p53 and p16 without LOH were found in PanIN-1A and ADM, whereas homozygous mutations were found in PanIN-3. Aneuploidy increased from PanIN-1A to PanIN-3. Ki-ras mutations were discovered first in PanIN-1., Conclusions: Heterozygous mutations of p53- and p16 genes together with chromosomal instability occur early in CP and are clonally expanded, but final inactivation mostly by LOH happens later in pancreatic carcinogenesis. Determination of aneuploidy in pancreatic juice may be of value for early detection and risk assessment in patients with long-standing CP.

Due to incomplete removal of artificial sweeteners in wastewater treatment plants some of these compounds end up in receiving surface waters, which are used for drinking water production. The sum of removal efficiency of single treatment steps in multi-barrier treatment systems affects the concentrations of these compounds in the provided drinking water. This is the first systematic study revealing the effectiveness of single treatment steps in laboratory experiments and in waterworks. Six full-scale waterworks using surface water influenced raw water were sampled up to ten times to study the fate of acesulfame, saccharin, cyclamate and sucralose. For the most important treatment technologies the results were confirmed by laboratory batch experiments. Saccharin and cyclamate proved to play a minor role for drinking water treatment plants as they were eliminated by nearly 100% in all waterworks with biologically active treatment units like river bank filtration (RBF) or artificial groundwater recharge. Acesulfame and sucralose were not biodegraded during RBF and their suitability as wastewater tracers under aerobic conditions was confirmed. Sucralose proved to be persistent against ozone and its transformation was < 20% in lab and field investigations. Remaining traces were completely removed by subsequent granular activated carbon (GAC) filters. Acesulfame readily reacts with ozone (pseudo first-order rate constant k = 1.3 x 10(-3) s(-1) at 1 mg L(-1) ozone concentration). However, the applied ozone concentrations and contact times under typical waterworks conditions only led to an incomplete removal (18-60%) in the ozonation step. Acesulfame was efficiently removed by subsequent GAC filters with a low throughput of less than 30 m(3) kg(-1), but removal strongly depended on the GAC preload. Thus, acesulfame was detected up to 0.76 microg L(-1) in finished water., (2010 Elsevier Ltd. All rights reserved.)

Purpose: Glioblastoma (GBM) is the most common and aggressive type of glioma and has the poorest survival. However, a small percentage of patients with GBM survive well beyond the established median. Therefore, identifying the genetic variants that influence this small number of unusually long-term survivors may provide important insight into tumor biology and treatment., Patients and Methods: Among 590 patients with primary GBM, we evaluated associations of survival with the 100 top-ranking glioma susceptibility single nucleotide polymorphisms from our previous genome-wide association study using Cox regression models. We also compared differences in genetic variation between short-term survivors (STS; or= 36 months), and explored classification and regression tree analysis for survival data. We tested results using two independent series totaling 543 GBMs., Results: We identified LIG4 rs7325927 and BTBD2 rs11670188 as predictors of STS in GBM and CCDC26 rs10464870 and rs891835, HMGA2 rs1563834, and RTEL1 rs2297440 as predictors of LTS. Further survival tree analysis revealed that patients >or= 50 years old with LIG4 rs7325927 (V) had the worst survival (median survival time, 1.2 years) and exhibited the highest risk of death (hazard ratio, 17.53; 95% CI, 4.27 to 71.97) compared with younger patients with combined RTEL1 rs2297440 (V) and HMGA2 rs1563834 (V) genotypes (median survival time, 7.8 years)., Conclusion: Polymorphisms in the LIG4, BTBD2, HMGA2, and RTEL1 genes, which are involved in the double-strand break repair pathway, are associated with GBM survival.

The fate of beta blockers (atenolol, acebutolol, bisoprolol, celiprolol, metoprolol, nadolol, pindolol, propranolol, and sotalol) was studied in surface water-sediment systems. A new analytical method was developed to determine the beta blockers in sediments by LC-ESI-tandem MS detection. The relative recoveries in sediments ranged from 89 +/- 7% (acebutolol) to 102 +/- 3% (nadolol) using deuterated surrogate standards. Beta blockers were present with concentrations up to 86 ng/g (bisoprolol) in the sediments of small German streams containing an elevated percentage of treated wastewater. Biotransformation studies and sorption isotherms of the beta blockers were performed with two natural river sediments ("Burgen", "Dausenau") differing in organic carbon content and particle size distribution. Biotransformation of beta blockers in the surface water-sediment systems exhibited a low to high persistence with 90% disappearance (DT(90)) ranging from 0.4-10 d (pindolol, atenolol) to >100 d (sotalol, propranolol or celiprolol). For sorption studies neither NaN(3) addition nor autoclavation led to a complete mass balance of the beta blockers, probably due to biotransformation. Isotherms at 6 h (apparent equilibrium, measuring aqueous and sediment phase) fitted by the Freundlich equation show that sorption of all beta blockers to the Burgen sediment were linear or close to it (i.e., n-values between 0.93 and 1.13), while in the Dausenau sediment the sorptions were slightly non linear (i.e., n-values 0.77-0.91). In river water the sorbed fraction is negligible in comparison to the dissolved fraction. Nevertheless, beta blockers can be detected with concentrations up to 86 ng/g (bisoprolol) in sediments of small streams containing more than 50% treated wastewater.

In this study, different approaches were used to assess and overcome the severe effects of interference from the sample matrix from different types of sludges and wastewater on the analysis of nine beta-blockers and the beta sympathomimetic clenbuterol. The partitioning of the target compounds into sludge was investigated in wastewater treatment plants (WWTPs) in both Canada and Germany to evaluate whether this is an important mechanism for removal from sewage. Due to ion suppression in the electro spray interface, absolute recoveries were for certain compounds even lower than 20%. By using surrogate standards, acceptable relative recoveries of >75% were achieved for WWTP influents and effluents and for sludges. These matrix effects underline the need to use appropriate surrogate standards to aid in analyte quantitation. Using the developed methods, beta-blockers were detected at concentrations up to 2 microg/L in WWTP effluents, with metoprolol, sotalol, and atenolol present as the dominant compounds. Removal rates within WWTPs were highly inconsistent and ranged from 1-69%. Propranolol showed the greatest degree of partitioning into sludge with solid/water partition coefficients of one order of magnitude higher than those for all other compounds. However, even for propranolol, sorption did not contribute significantly to the overall elimination in WWTPs. It is likely that the removal of beta-blockers during waste water treatment can be attributed primarily to microbial biodegradation.

The antidiabetic drug metformin is among the pharmaceuticals with the highest production numbers world-wide. This paper presents first data on the occurrence of metformin in sewage and surface waters in Germany. Analysis of metformin is based on pre-concentration of the analyte onto a polymeric solid-phase material and subsequent determination by liquid chromatography and tandem mass spectrometry. Applying the method to sewage and surface waters, recoveries >90% and limits of detection of 10 ng L(-1) could be achieved by pre-concentration of a sample volume of only 10 mL. Measurements in sewage and surface waters showed an almost ubiquitous presence of metformin in the aquatic environment. The measured concentration levels in sewage treatment plant influents correlate nicely to the prescription numbers for metformin in Germany. During sewage treatment a significant reduction of metformin concentrations was observed which seems to be mainly due to microbial degradation. Despite this significant elimination during sewage treatment, metformin was found in all river waters under investigation. Concentration levels depend on the sewage fraction of the receiving waters and for most rivers are in the range of several 100 ng L(-1), i.e. in the same order of magnitude or even higher than for other relevant pharmaceutical residues.

A method for the simultaneous determination of seven commonly used artificial sweeteners in water is presented. The analytes were extracted by solid phase extraction using Bakerbond SDB 1 cartridges at pH 3 and analyzed by liquid chromatography electrospray ionization tandem mass spectrometry in negative ionization mode. Ionization was enhanced by post-column addition of the alkaline modifier Tris(hydroxymethyl)amino methane. Except for aspartame and neohesperidin dihydrochalcone, recoveries were higher than 75% in potable water with comparable results for surface water. Matrix effects due to reduced extraction yields in undiluted waste water were negligible for aspartame and neotame but considerable for the other compounds. The widespread distribution of acesulfame, saccharin, cyclamate, and sucralose in the aquatic environment could be proven. Concentrations in two influents of German sewage treatment plants (STPs) were up to 190 microg/L for cyclamate, about 40 microg/L for acesulfame and saccharin, and less than 1 microg/L for sucralose. Removal in the STPs was limited for acesulfame and sucralose and >94% for saccharin and cyclamate. The persistence of some artificial sweeteners during soil aquifer treatment was demonstrated and confirmed their environmental relevance. The use of sucralose and acesulfame as tracers for anthropogenic contamination is conceivable. In German surface waters, acesulfame was the predominant artificial sweetener with concentrations exceeding 2 microg/L. Other sweeteners were detected up to several hundred nanograms per liter in the order saccharin approximately cyclamate > sucralose.

Objectives: This study evaluated the variability and time resource utilization of bedside 3-dimensional echocardiographic left ventricular volume analysis (3D-LVVA) in congenital heart disease (CHD). Background. There are currently limited data on the resource utilization and variability of 3D-LVVA in the CHD., Methods: Four reviewers of varying experience levels were timed performing 15 on-scanner 3D-LVVAs. Inter- and intraobserver variability for left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF) was evaluated., Results: Median age was 12.7 years (0.6-33 years). Diagnoses were: normal (n = 4), cardiomyopathy (n = 4), ventricular septal defect (n = 2), and atrioventricular canal, tricuspid atresia, bicuspid aortic valve, left ventricular hypertrophy, and heart transplant (n = 1 each). For interobserver variability, intraclass correlation coefficients (ICCs) for all possible combinations of reviewers were: LVEDV, 0.991-0.999 (P < .01); LVESV, 0.98-0.99 (P < .01); LVEF, 0.95-0.98 (P < .01). Bland-Altman plot mean differences (+/-2SD) were: LVEDV, -3 +/- 14%; LVESV, -5.4 +/- 21.4%; LVEF, 1.2 +/- 14.7%. Interobserver variability of LVESV was not dependent on ventricular volumes (P = .25; r(2) = 0.01) or heart rate (P = .43; r(2) = 0.003). For intraobserver variability, ICCs for 2 reviewers were LVEDV, 0.99, 0.99 (P < .01); LVESV, 0.99, 0.99 (P < .01); and LVEF, 0.94, 0.94 (P < .01), respectively. Bland-Altman plot mean differences (+/-2SD) were: LVEDV, -1 +/- 9.2%; LVESV, 0 +/- 19.6%; LVEF, -2.2 +/- 24%., Conclusion: Reviewers with varying experience levels can accomplish 3D-LVVA at the bedside with acceptable inter- and intraobserver reproducibility, providing the rationale for integrating 3D-LVVA into the care of CHD patients.

Background: Right ventricular endomyocardial biopsy is the gold standard for detecting active myocardial inflammation in cardiomyopathy as well as rejection after cardiac transplantation. This procedure has historically required the exclusive use of fluoroscopic guidance to guide catheter, sheath, and bioptome manipulation. The current study evaluates the feasibility and utility of real-time transthoracic three-dimensional echocardiography (3DE) to guide right ventricular endomyocardial biopsies in children., Methods: From July 2003 to April 2004, we utilized real-time 3DE in 28 consecutive cardiac catheterizations in children aged 18 months to 16 years who were undergoing endomyocardial biopsy. A commercially available 3DE scanner (Philips Sonos 7500) equipped with a 2-4 MHz 3D matrix array transthoracic probe was utilized in all cases., Results: A total of 123 endomyocardial biopsy samples were obtained in nine patients (BSA 0.85 m(2)+/- 0.33 m(2)). Of these 123 samples, 99 (80%) were obtained with the use of real-time transthoracic 3DE. There were no complications, including no new tricuspid valve leaflet flail or pericardial effusion. 3DE proved to be a reliable noninvasive modality to properly direct the bioptome to the desired site of biopsy within the right ventricle. As familiarity with this technique increased, the need for fluoroscopic guidance of bioptome manipulation in the right ventricle was minimized., Conclusions: The use of real-time transthoracic 3DE in endomyocardial right ventricular biopsies in children is both feasible and safe. Further study to determine the impact of real-time 3DE guidance on fluoroscopy and case times for endomyocardial biopsies is warranted.

Nesiritide (Natrecor, Scios Inc), human B-type natriuretic peptide, has hemodynamic effects that may be beneficial in pediatric patients after cardiac surgery. Experience with nesiritide and pediatrics is limited. The purpose of this study was to evaluate perioperative effects and safety of nesiritide in pediatric cardiothoracic surgery. Seventeen patients with congenital heart disease undergoing cardiac surgery were given a loading dose (1 microg/kg) while on cardiopulmonary bypass (constant flow) followed by continuous infusion for 24 hours (0.01 microg/kg/min x 6 hours, then 0.02 microg/kg/min x 18 hours). A 7% decrease in mean blood pressure was seen following nesiritide loading dose on cardiopulmonary bypass. No patient required intervention for hypotension while receiving nesiritide load or infusion. Nesiritide load during surgery and continuous infusion after cardiac surgery in pediatric patients resulted in no significant hemodynamic compromise.

Over the past several decades, knowledge of the biology and epidemiology of human papillomavirus (HPV) infection has increased tremendously. However, there are still many unanswered questions concerning the interaction of the virus with its host. The virus has been identified as a necessary causal agent for cervical squamous neoplasia and has been linked to the development of neoplasia in several other mucosal sites. The viral oncogenes E6 and E7 are the major players in the virus' scheme to evade the immune system and use the host cell replication machinery to survive. Many risk factors for infection with HPV have been identified; however, the focus now centers on identifying risk factors for persistence of the infection as it is likely that transient infections play a very small role in the overall development of clinical disease. Prevention measures to date have centered around screening programs, mostly for cervical cancer, including the perfection of screening techniques and inclusion of molecular testing for HPV into screening regimens. The development of prophylactic and therapeutic vaccines has also increased as primary prevention measures appear to have the best hope for long-term effects on cancer incidence.

Purpose: The prevalence of infective endocarditis (IE) among children with Staphylococcus aureus bacteremia (SAB) is unknown. The objective of this study was to determine prospectively the prevalence of IE among pediatric patients with SAB in a large tertiary care center., Methods: Between July 1998 and June 2001, all children who developed SAB whose parent/guardian signed informed consent underwent echocardiography. Clinical and follow-up results were collected prospectively. Endocarditis was classified according to the modified Duke criteria., Results: Fifty-one children developed SAB during the study interval. Definite (6 patients [11.8%]) or possible (4 patients [7.8%]) IE was present in 10 of 51 (20%) children with SAB. Most children (73%) developed bacteremia as a consequence of an infected intravascular device. Children with underlying congenital heart disease had a significantly higher prevalence of definite or possible IE, compared with those with structurally normal hearts (53% vs 3%). All patients with definite IE had multiple positive blood cultures. Mortality was high among patients with and without IE (40% vs 12%)., Conclusions: In this study, the prevalence of definite IE among children with SAB was approximately 12% and was frequently associated with congenital heart disease and multiple positive blood cultures. The mortality for children with SAB and definite or possible S aureus IE is high.