Decontamination and Reuse of N95 Masks: A Narrative Review.

BACKGROUND: The COVID-19 pandemic has presented an unprecedented strain on healthcare supplies. Currently there is a global shortage of personal protective equipment (PPE), especially N95 masks. In order to safeguard healthcare personnel in this critical time and to mitigate shortages of N95 respirators, reuse of N95 respirators has to be considered. METHODS: Using PubMed and Science Direct, a literature search was conducted to find and synthesize relevant literature on decontamination of N95 respirators for their subsequent reuse. Peer-reviewed publications related to methods of decontamination from January 2007 to April 2020 in the English language are included in this narrative review. Bibliographies of articles for relevant literature were also scrutinized. Findings. A total of 19 studies are included in this narrative review. The appraised methods include ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), ethylene oxide (EtO), hydrogen peroxide vapor (HPV), microwave steam bags (MSB), microwave-generated steam (MGS), dry microwave oven irradiation, hydrogen peroxide gas plasma (HPGP), dry heat, liquid hydrogen peroxide, and bleach and alcohol. CONCLUSION: In light of the COVID-19 pandemic, reuse of N95 respirators, although suboptimal, can be considered. Evidence reveals that UVGI, MHI, and HPV are amongst the safest and efficacious methods for decontamination of N95 masks. More research is needed to establish the safety and effectiveness of MGS, MSB, dry heat, EtO, liquid hydrogen peroxide, and HPGP. Alcohol, microwave irradiation, and bleach are not recommended because they damage N95 respirators.

Prevalence of SDHB, SDHC, and SDHD germline mutations in clinic patients with head and neck paragangliomas.

BACKGROUND: Paragangliomas are rare and highly heritable tumours of neuroectodermal origin that often develop in the head and neck region. Germline mutations in the mitochondrial complex II genes, SDHB, SDHC, and SDHD, cause hereditary paraganglioma (PGL). METHODS: We assessed the frequency of SDHB, SDHC, and SDHD gene mutations by PCR amplification and sequencing in a set of head and neck paraganglioma patients who were previously managed in two otolaryngology clinics in the USA. RESULTS: Fifty-five subjects were grouped into 10 families and 37 non-familial cases. Five of the non-familial cases had multiple tumours. Germline SDHD mutations were identified in five of 10 (50%) familial and two of 37 ( approximately 5%) non-familial cases. R38X, P81L, H102L, Q109X, and L128fsX134 mutations were identified in the familial cases and P81L was identified in the non-familial cases. Both non-familial cases had multiple tumours. P81L and R38X mutations have previously been reported in other PGL families and P81L was suggested as a founder mutation. Allelic analyses of different chromosomes carrying these mutations did not show common disease haplotypes, strongly suggesting that R38X and P81L are potentially recurrent mutations. Germline SDHB mutations were identified in two of 10 (20%) familial and one of 33 ( approximately 3%) non-familial cases. P131R and M71fsX80 were identified in the familial cases and Q59X was identified in the one non-familial case. The non-familial case had a solitary tumour. No mutations could be identified in the SDHC gene in the remaining four families and 20 sporadic cases. CONCLUSIONS: Mutations in SDHD are the leading cause of head and neck paragangliomas in this clinic patient series. SDHD and SDHB mutations account for 70% of familial cases and approximately 8% of non-familial cases. These results also suggest that the commonness of the SDHD P81L mutation in North America is the result of both a founder effect and recurrent mutations.

Germ line insertion of mtDNA at the breakpoint junction of a reciprocal constitutional translocation.

Constitutional chromosomal translocations are relatively common causes of human morbidity, yet the DNA double-strand break (DSB) repair mechanisms that generate them are incompletely understood. We cloned, sequenced and analyzed the breakpoint junctions of a familial constitutional reciprocal translocation t(9;11)(p24;q23). Within the 10-kb region flanking the breakpoints, chromosome 11 had 25% repeat elements, whereas chromosome 9 had 98% repeats, 95% of which were L1-type LINE elements. The breakpoints occurred within an L1-type repeat element at 9p24 and at the 3'-end of an Alu sequence at 11q23. At the breakpoint junction of derivative chromosome 9, we discovered an unusually large 41-bp insertion, which showed 100% identity to 12S mitochondrial DNA (mtDNA) between nucleotides 896 and 936 of the mtDNA sequence. Analysis of the human genome failed to show the preexistence of the inserted sequence at normal chromosomes 9 and 11 breakpoint junctions or elsewhere in the genome, strongly suggesting that the insertion was derived from human mtDNA and captured into the junction during the DSB repair process. To our knowledge, these findings represent the first observation of spontaneous germ line insertion of modern human mtDNA sequences and suggest that DSB repair may play a role in inter-organellar gene transfer in vivo. Our findings also provide evidence for a previously unrecognized insertional mechanism in human, by which non-mobile extra-chromosomal fragments can be inserted into the genome at DSB repair junctions.

Female exposure to high G: effects of simulated combat sorties on cerebral and arterial O2 saturation.

BACKGROUND: One of the key factors in maintaining optimal cognitive performance in the high-G environment is the adequate delivery of oxygen to the cerebral tissue. As eye-level blood pressure is compromised at 22 mmHg x G(-1), perfusion to the peripheral cerebral tissues (cerebral cortex) may not be adequate to support the mental demands of flight. This study measured the effect of closed-loop flight simulations (3 min) on cerebral oxygen saturation changes (rSO2), arterial oxygen saturation (SAO2), and heart rate (HR), in both rested (8 h of rest) and sleepless (24 h without sleep) conditions. METHODS: Subjects (16; 8 males and 8 females) were subjected to G-exposures via closed-loop flight simulations in a series of four 3-min sorties flown by subjects on the Dynamic Environment Simulator (centrifuge) in either a rested or a sleepless state. Prior to the centrifuge flight, subjects were instrumented with sensors for measurement of arterial oxygen saturation (SAO2) and regional cerebral tissue oxygenation (rSO2). Subjects wore the standard flight suit, boots, CSU-13B/P anti-G suit, and the COMBAT EDGE positive-pressure breathing for G-protection system. RESULTS: Significant changes in cerebral and arterial oxygen saturation were observed within groups when comparing pretest baselines and minimum values during the test and pre- and post-G rSO2, SAO2, and HR in both the rested and sleepless state, (p # 0.01), respectively, for each group. Comparisons between groups showed women to have significantly smaller regional cerebral cortex oxygen decreases than men (p # 0.01). No significant changes in SAO2, however, were observed between groups. Both men and women showed a slow recovery of rSO2 values to the prebaseline levels. CONCLUSIONS: Sleeplessness had no effect on the rSO2, SAO2, and HR compared with the rested condition. During acceleration, regional cerebral tissue oxygen decreased 13% in men compared with 9% in women. The recovery of cerebral tissue oxygen levels to prebaseline values was retarded somewhat when compared with the recovery response of arterial oxygen saturation.