Progression of diabetic retinopathy in women with pregestational diabetes during pregnancy and postpartum.

BACKGROUND: Diabetic retinopathy (DR) may worsen during pregnancy, but its course in the postpartum remains poorly understood. Understanding the natural history of DR during and after pregnancy can help determine when sight-threatening DR treatment should be administered. METHODS: A prospective longitudinal cohort study recruited pregnant women with pre-existing type 1 (T1D) or type 2 diabetes from two tertiary Diabetes Antenatal Clinics in Melbourne, Australia. Eye examination results in early pregnancy, late pregnancy, and up to 12-months postpartum were compared to determine DR changes. Two-field fundus photographs and optical coherence tomography scans were used to assess DR severity. RESULTS: Overall, 105 (61.4%) women had at least two eye examinations during the observation period. Mean age was 33.5 years (range 19-51); 54 women (51.4%) had T1D; 63% had HbA1c <7% in early pregnancy. DR progression rate was 23.8% (95% CI 16.4-32.6). Having T1D (RR 4.96, 95% CI 1.83-13.46), pre-existing DR in either eye (RR 4.54, 95% CI 2.39-8.61), and elevated systolic blood pressure (adjusted RR 2.49, 95% CI 1.10-5.66) were associated with increased risk of progression. Sight-threatening progression was observed in 9.5% of women. Among the 19 eyes with progression during pregnancy, 15 eyes remained stable, three eyes progressed, and only one eye regressed in the postpartum. CONCLUSIONS: Nearly 1 in 4 women had DR progression from conception through to 12-months postpartum; almost half of these developing sight-threatening disease. DR progression occurring during pregnancy was found to predominantly remain unchanged, or worsen, after delivery, with very few eyes spontaneously improving postpartum.

Contrast Increment and Decrement Processing in Individuals With and Without Diabetes.

Purpose: Animal models suggest that ON retinal ganglion cells (RGCs) may be more vulnerable to diabetic insult than OFF cells. Using three psychophysical tasks to infer the function of ON and OFF RGCs, we hypothesized that functional responses to contrast increments will be preferentially affected in early diabetes mellitus (DM) compared to contrast decrement responses. Methods: Fifty-two people with DM (type 1 or type 2) (mean age = 34.8 years, range = 18-60 years) and 48 age-matched controls (mean age = 35.4 years, range = 18-60 years) participated. Experiment 1 measured contrast sensitivity to increments and decrements at four visual field locations. Experiments 2 and 3 measured visual temporal processing using (i) a response time (RT) task, and (ii) a temporal order judgment task. Mean RT and accuracy were collected for experiment 2, whereas experiment 3 measured temporal thresholds. Results: For experiment 1, the DM group showed reduced increment and decrement contrast sensitivity (F (1, 97) = 4.04, P = 0.047) especially for the central location. For experiment 2, those with DM demonstrated slower RT and lower response accuracies to increments and decrements (increments: U = 780, P = 0.01, decrements: U = 749, P = 0.005). For experiment 3, performance was similar between groups (F (1, 91) = 2.52, P = 0.137). Conclusions: When assessed cross-sectionally, nonselective functional consequences of retinal neuron damage are present in early DM, particularly for foveal testing. Whether increment-decrement functional indices relate to diabetic retinopathy (DR) progression or poorer visual prognosis in DM requires further study.

Impact of Microplastics on the Ocular Surface.

Plastics are synthetic materials made from organic polymers that are ubiquitous in daily living and are especially important in the healthcare setting. However, recent advances have revealed the pervasive nature of microplastics, which are formed by degradation of existing plastic products. Although the impact on human health has yet to be fully characterised, there is increasing evidence that microplastics can trigger inflammatory damage, microbial dysbiosis, and oxidative stress in humans. Although there are limited studies investigating their effect on the ocular surface, studies of microplastics on other organs provide some insights. The prevalence of plastic waste has also triggered public outcry, culminating in the development of legislation aimed at reducing microplastics in commercial products. We present a review outlining the possible sources of microplastics leading to ocular exposure, and analyse the possible mechanisms of ocular surface damage. Finally, we examine the utility and consequences of current legislation surrounding microplastic regulation.

Identification of novel polyfluoroalkyl substances in surface water runoff from a chemical stockpile fire.

In 2018, over 30,000 L of fluorine-free firefighting foam was used to extinguish an industrial warehouse fire of uncharacterized chemical and industrial waste. Contaminated firewater and runoff were discharged to an adjacent freshwater creek in Melbourne, Australia. In this study, we applied nontarget analysis using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QToF-MS) to 15 surface water samples to investigate the presence of legacy, novel and emerging per-and polyfluoroalkyl substances (PFAS). We identified six novel and emerging fluorotelomer-based fluorosurfactants in the Australian environment for the first time, including: fluorotelomer sulfonamido betaines (FTABs or FTSA-PrB), fluorotelomer thioether amido sulfonic acids (FTSASs), and fluorotelomer sulfonyl amido sulfonic acids (FTSAS-So). Legacy PFAS including C6-C8 perfluoroalkyl sulfonic acids, C4-C10 perfluoroalkyl carboxylic acids, and perfluoro-4-ethylcyclohexanesulfonate were also detected in surface water. Of note, we report the first environmental detection of ethyl 2-ethenyl-2-fluoro-1-(trifluoromethyl) cyclopropane-1-carboxylate. Analysis of several Class B certified fluorine-free foam formulations allowed for use in Australia revealed that there was no detectable PFAS. Patterns in the homologue profiles of fluorotelomers detected in surface water are consistent with environments impacted by fluorinated aqueous film-forming foams. These results provide strong evidence that firewater runoff of stockpiled fluorinated firefighting foam was the dominant source of detectable PFAS to the surrounding environment.

Prevalence of diabetic retinopathy in women with pregestational diabetes during pregnancy and the postpartum.

BACKGROUND: Diabetic retinopathy (DR) may be affected by pregnancy. The majority of prevalence data regarding DR in pregnancy predate the advent of contemporary guidelines for diabetes management during pregnancy. This study reports DR prevalence and associated risk factors in women with pregestational diabetes during pregnancy and the postpartum in Australia. METHODS: A total of 172 pregnant women with type 1 (T1DM) or type 2 diabetes diagnosed pre-pregnancy were prospectively recruited from two obstetrics hospitals in Melbourne (November 2017-March 2020). Eye examinations were scheduled in each trimester, at 3-, 6-, and 12-months postpartum. DR severity was graded from two-field fundus photographs by an independent grader utilising the Airlie House Classification. Sight-threatening DR (STDR) was defined as the presence of diabetic macular oedema or proliferative DR. RESULTS: Overall, 146 (84.9%) women had at least one eye examination during pregnancy. The mean age was 33.8 years (range 19-51), median diabetes duration was 7.0 years (IQR 3.0-17.0), 71 women (48.6%) had T1DM. DR and STDR prevalence during pregnancy per 100 eyes was 24.3 (95% CI 19.7-29.6) and 9.0 (95% CI 6.1-12.9); while prevalence in the postpartum was 22.2 (95% CI 16.5-29.3) and 10.0 (95% CI 5.4-17.9), respectively. T1DM, longer diabetes duration, higher HbA1c in early pregnancy, and pre-existing nephropathy were significant risk factors. CONCLUSIONS: The prevalence of DR in pregnant women was similar to the non-pregnant diabetic population in Australia. One in nine participants had STDR during pregnancy and the postpartum, highlighting the need to optimise DR management guidelines in pregnancy given the significant risk of vision loss.

Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Women With Preexisting Diabetes: A Systematic Review and Meta-analysis.

Importance: Diabetic retinopathy (DR) may be worsened by pregnancy in pregnant women with preexisting type 1 diabetes (T1D) or type 2 diabetes (T2D). Conflicting findings from previous studies have resulted in inconsistencies in guidelines regarding DR management in pregnancy. Global estimates of DR prevalence and progression in pregnancy are therefore required to provide clearer information about the overall true burden of DR in this population. Objective: To estimate the prevalence of DR and its progression rate in pregnant women with preexisting T1D or T2D diagnosed before pregnancy. Data Sources: For this systematic review and meta-analysis, conducted from November 27, 2018, to June 29, 2021, a systematic literature search was conducted in MEDLINE/Ovid, Embase/Ovid, and Scopus databases to identify English-language articles that were published from inception through October 2020. Study Selection: Observational studies that reported on DR and its changes in pregnant women with preexisting T1D and T2D. Data Extraction and Synthesis: Two independent reviewers extracted relevant data from each included study. Data were pooled using a random-effects model with the Freeman-Tukey double arcsine transformation. This study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Main Outcomes and Measures: Prevalence of any DR, proliferative DR (PDR), and DR progression rates. Results: A total of 18 observational studies involving 1464 pregnant women with T1D and 262 pregnant women with T2D were included in the analysis. The pooled prevalence of any DR and PDR in early pregnancy was 52.3 (95% CI, 41.9-62.6) and 6.1 (95% CI, 3.1-9.8) per 100 pregnancies, respectively. The pooled progression rate per 100 pregnancies for new DR development was 15.0 (95% CI, 9.9-20.8), worsened nonproliferative DR was 31.0 (95% CI, 23.2-39.2), progression from nonproliferative DR to PDR was 6.3 (95% CI, 3.3-10.0), and worsened PDR was 37.0 (95% CI, 21.2-54.0). DR progression rates per 100 pregnancies were similar between the T1D and T2D groups, except for the development of new DR (T1D groups: 15.8; 95% CI, 10.5-21.9; T2D groups: 9.0; 95% CI, 4.9-14.8). A global trend toward a lower DR progression rate was observed after the 1989 St Vincent Declaration. Conclusions and Relevance: Results of this systematic review and meta-analysis suggest that women with T1D and T2D had a similar risk of DR progression during pregnancy. Despite improvements in the management of diabetes and diabetes during pregnancy, DR prevalence and progression in pregnant women with diabetes remains higher than the nonpregnant population with diabetes, highlighting the need to improve DR management in pregnancy.

PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A CASE OF HIGH-FLOW DIRECT CAROTID CAVERNOUS FISTULA.

PURPOSE: To report a case of paracentral acute middle maculopathy in a patient with high-flow carotid cavernous fistula. METHODS: A case report of a 53-year-old male patient who sustained an iatrogenic high-flow carotid cavernous fistula and secondary paracentral acute middle maculopathy. RESULTS: At review 1-week postembolization of the carotid cavernous fistula, there was no significant improvement in visual acuity, tests of optic nerve function, external ophthalmoplegia, and ptosis. Spectral domain optical coherence tomography was performed, which revealed hyperreflectivity of the parafoveal plexiform layers of the right eye with ill-defined margins straddling the inner nuclear layer. CONCLUSION: We suggest that spectral domain optical coherence tomography be performed in cases of high-flow direct carotid cavernous fistula where the best-corrected visual acuity is reduced out of keeping with other ophthalmic manifestations.

The histone acetyltransferase HBO1 promotes efficient tip cell sprouting during angiogenesis.

Blood vessel growth and remodelling are essential during embryonic development and disease pathogenesis. The diversity of endothelial cells (ECs) is transcriptionally evident and ECs undergo dynamic changes in gene expression during vessel growth and remodelling. Here, we investigated the role of the histone acetyltransferase HBO1 (KAT7), which is important for activating genes during development and for histone H3 lysine 14 acetylation (H3K14ac). Loss of HBO1 and H3K14ac impaired developmental sprouting angiogenesis and reduced pathological EC overgrowth in the retinal endothelium. Single-cell RNA sequencing of retinal ECs revealed an increased abundance of tip cells in Hbo1-deficient retinas, which led to EC overcrowding in the retinal sprouting front and prevented efficient tip cell migration. We found that H3K14ac was highly abundant in the endothelial genome in both intra- and intergenic regions, suggesting that HBO1 acts as a genome organiser that promotes efficient tip cell behaviour necessary for sprouting angiogenesis. This article has an associated 'The people behind the papers' interview.

An overview of optometrists' diabetic retinopathy practice patterns - a cross-sectional survey.

PURPOSE: Contemporary eye care increasingly recommends the use of advanced retinal imaging technology. Anecdotal evidence suggests that this equipment is widely available in primary eye care settings; however, knowledge regarding how optometrists use this equipment in the context of diabetic retinopathy (DR) is limited. This study aimed to obtain a current overview of optometrists' clinical practice behaviours in the detection, screening, diagnosis and management of patients with diabetes. METHODS: A cross-sectional survey was designed to evaluate optometrists' self-reported clinical practice patterns and perceptions, as well as the availability and impact of retinal imaging equipment specific to DR and diabetic macular oedema (DMO) on optometrists' clinical practice. The survey invited participation from all optometrists practising in Australia. RESULTS: One hundred and sixty-seven optometrists participated. Optometrists' self-reported confidence in assessing DR and DMO was high. Optometrists' referral patterns considered the severity of DR and DMO before initiating referral to secondary ophthalmology care. Nearly all optometrists (98.8%) indicated that they had some form of retinal imaging equipment available to them in clinical practice. An optical coherence tomography (OCT) device was available to 75.5% of optometrists. A significant association between having an OCT device in the practice and higher self-reported confidence levels in the assessment of DMO was found. CONCLUSIONS: Many optometrists are well equipped with sophisticated retinal imaging technology for the provision of high-quality eye care. Enhancing optometric training and education programmes can maximise the community benefit of access to this equipment and improve delivery of eye care in the community.

Blocking endothelial apoptosis revascularizes the retina in a model of ischemic retinopathy.

Aberrant, neovascular retinal blood vessel growth is a vision-threatening complication in ischemic retinal diseases. It is driven by retinal hypoxia frequently caused by capillary nonperfusion and endothelial cell (EC) loss. We investigated the role of EC apoptosis in this process using a mouse model of ischemic retinopathy, in which vessel closure and EC apoptosis cause capillary regression and retinal ischemia followed by neovascularization. Protecting ECs from apoptosis in this model did not prevent capillary closure or retinal ischemia. Nonetheless, it prevented the clearance of ECs from closed capillaries, delaying vessel regression and allowing ECs to persist in clusters throughout the ischemic zone. In response to hypoxia, these preserved ECs underwent a vessel sprouting response and rapidly reassembled into a functional vascular network. This alleviated retinal hypoxia, preventing subsequent pathogenic neovascularization. Vessel reassembly was not limited by VEGFA neutralization, suggesting it was not dependent on the excess VEGFA produced by the ischemic retina. Neutralization of ANG2 did not prevent vessel reassembly, but did impair subsequent angiogenic expansion of the reassembled vessels. Blockade of EC apoptosis may promote ischemic tissue revascularization by preserving ECs within ischemic tissue that retain the capacity to reassemble a functional network and rapidly restore blood supply.

A Case of Glaucoma in Hereditary Spherocytosis.

PURPOSE: To report a case of glaucoma and the inherited red cell membranopathy hereditary spherocytosis diagnosed simultaneously in 2 individuals in a family. PATIENT: A 66-year-old man with normal pressure glaucoma and hereditary spherocytosis. RESULTS: This patient presented with a branch retinal vein occlusion, and normal tension glaucoma that was incidentally detected. Further history revealed that the patient's maternal grandmother also had hereditary spherocytosis and glaucoma. CONCLUSIONS: We hypothesize that glaucoma and hereditary spherocytosis may be associated. Hereditary spherocytosis may be a potential risk factor for glaucoma by causing impaired blood supply to the optic nerve.

Investigating the distribution of polybrominated diphenyl ethers through an Australian wastewater treatment plant.

The aim of this study was to quantify the amount of polybrominated diphenyl ethers (PBDEs) released into the environment (biosolids, effluent) from a conventional Australian activated sludge treatment wastewater treatment plant (WWTP). The concentration of PBDE congeners was measured at various treatment stages and included four aqueous samples (raw, primary, secondary and tertiary effluents) and three sludges (primary, secondary and lime stabilized biosolids), collected at three sampling events over the course of the experiment (29 days). Semi-permeable membrane devices (SPMDs) were also installed for the duration of the experiment, the first time that SPMDs have been used to measure PBDEs in a WWTP. Over 99% of the PBDEs entering the WWTP were removed through the treatment processes, principally by sedimentation. The main congeners detected were BDE 47, 99 and 209, which are characteristic of the two major commercial formulations viz penta-BDE and deca-BDE. All the PBDE congeners measured were highly correlated with each other, suggesting a similar origin. In this case, the PBDEs are thought to be from domestic sources since domestic wastewater is the main contribution to the in-flow (approximately 95%). The mean concentration of SigmaPBDEs in chemically stabilized sewage sludge (biosolids) was 300microg kg(-1) dry weight. It is calculated that 2.3+/-0.3kg of PBDEs are disposed of each year with biosolids generated from the WWTP. If all Australian sewage sludge is contaminated to at least this concentration then at least 110kg of PBDEs are associated with Australian sewage sludge annually. Less than 10g are released annually into the environment via ocean outfall and field irrigation; this level of contamination is unlikely to pose risk to humans or the environment. The environmental release of treated effluent and biosolids is not considered a large source of PBDE environmental emissions compared to the quantities used annually in Australia.

Assessment of polybrominated diphenyl ethers (PBDEs) in samples collected from indoor environments in South East Queensland, Australia.

Polybrominated diphenyl ethers (PBDEs) are compounds that are used as flame retardants. Human exposure is suggested to be via food, dust and air. An assessment of PBDE exposure via indoor environments using samples of air, dust and surface wipes from eight sites in South East Queensland, Australia was conducted. For indoor air, SigmaPBDEs ranged from 0.5-179 pg/m(3) for homes and 15-487 pg/m(3) for offices. In dust, SigmaPBDEs ranged from 87-733 ng/g dust and 583-3070 ng/g dust in homes and offices, respectively. PBDEs were detected on 9 out of 10 surfaces sampled and ranged from non-detectable to 5985 pg/cm(2). Overall, the congener profiles for air and dust were dominated by BDE-209. This study demonstrated that PBDEs are ubiquitous in the indoor environments of selected buildings in South East Queensland and suggest the need for detailed assessment of PBDE concentrations using more sites to further investigate the factors influencing PBDE exposure in Australia.

Using SPMDs to monitor water column concentrations of PCDDs, PCDFs and dioxin-like PCBs in Port Jackson (Sydney Harbour), Australia.

Semipermeable membrane devices (SPMDs) were deployed on two occasions throughout Sydney Harbour, Australia, along a 25 km transect. They were used to measure spatial and temporal variation in the available concentrations of 7 polychlorinated dibenzo-p-dioxins (PCDDs) and 10 polychlorinated dibenzofurans (PCDFs) and 12 dioxin-like polychlorinated biphenyls (PCBs) in the water column. The relative percent difference (%RPD) among spatially replicated cages (within 0.13-0.41 km) ranged from less than 8% to greater than 66% across all congeners and was greater for WHO(05)-TEQ(DFP) (average=36%), PCDFs (average=34%) and PCDDs (average=33%) than PCBs (average=23%). Total PCDD (SigmaPCDDs) concentrations ranged between 2.7 and 84 pg L(-1), SigmaPCDF concentrations ranged from 0.15 to 7.2 pg L(-1), SigmaPCB concentrations ranged between 21 and 540 pg L(-1) and WHO(05)-TEQ(DFP) ranged from 0.069 to 1.85 pg L(-1). Highest concentrations were measured in SPMDs deployed in Homebush Bay and concentrations generally declined with distance from Homebush Bay. SPMDs detected changes in congener profiles downstream with OCDD, 2,3,7,8-TCDF and PCBs 189, 157, 167, and 126 increasing in proportion with distance from Homebush Bay. There was a large increase in the daily accumulation of the analytes from winter to summer resulting in an average 3.9-fold increase in the predicted concentration at one site with matched SPMDs.

Stability and competitiveness of interviral recombinant RNAs derived from a chimeric cucumovirus.

We previously described interviral recombinant RNAs derived from a chimeric virus having RNAs 1 and 2 of cucumber mosaic virus (CMV) with RNA 3 from the related tomato aspermy virus (TAV) and the 2b gene from either TAV or another strain of CMV. Here, we show that these interviral recombinant RNAs 3 were stable in the infected plants and could co-exist with their wild-type parental viral RNAs in the same plants, but their de novo generations were inhibited in the presence of the wild-type parental viral RNAs. The recombinant viral genomes did not prevent the replication of other viral RNAs or vice versa, but one of the interviral recombinant viruses induced different symptoms in Physalis floridana from those induced by the parental chimeric virus without the interviral RNA 3 recombinant. Factors such as the nature of the 2b gene and/or the presence or absence of competing wild-type parental RNAs influenced the generation of the recombinant RNAs described. Our data provide additional mechanistic insight into generation, stabilization and competition of recombinant viral RNA in infected host plants.

Determination of polybrominated biphenyls in Tasmanian devils (Sarcophilus harrisii) by gas chromatography coupled to electron capture negative ion tandem mass spectrometry or electron ionization high-resolution mass spectrometry.

Two gas chromatography/mass spectrometry (GC/MS) methods for the determination of polybrominated biphenyls (PBBs) by isotope dilution analysis (IDA) using (13)C(12)-PBB 153 in the presence of polybrominated diphenyl ethers (PBDEs) were compared. Recovery of (13)C(12)-PBB 153 which was added to the extracted lipids before sample purification was commenced ranged from 88-117% (mean value 98.2 +/- 8.9%). Nevertheless, IDA analysis of PBBs using (13)C(12)-labelled congeners is limited by the potential co-elution of PBBs with polybrominated diphenyl ethers (PBDEs). The pair PBB 153 and BDE 154 was inspected since M(+) and [M-2Br](+) ions of (13)C(12)-PBB 153 and BDE 154 were only separated by 4 u. Gas chromatography/electron ionization high-resolution mass spectrometry with selected ion monitoring (GC/EI-HRMS-SIM) was suitable when m/z 475.7449 and m/z 477.7429 were used for (13)C(12)-PBB 153 because they are below the monoisotopic peak of the [M-2Br](+) fragment ion of hexaBDEs at m/z 479.7. Gas chromatography/electron capture negative ion tandem mass spectrometry selected reaction monitoring (GC/ECNI-MS/MS-SRM) measurements could be applied because (13)C(12)-PBB 153 and BDE 154 were separated by GC on a 25-m Factor Four CP-Sil 8MS column.Comparative measurements with GC/EI-HRMS-SIM and GC/ECNI-MSMS-SRM were carried out with samples of Tasmanian devils from Tasmania (Australia), an endangered species due to a virus epidemy which has already proved fatal for half of the population. Both techniques verified concentrations of PBB 153 in the range 0.3-11 ng/g lipids with excellent agreement of the levels in all but two samples. The PBB residue pattern demonstrated that PBB pollution originated from the previous discharge with technical hexabromobiphenyl which is dominated by PBB 153. Other congeners such as PBB 132 and PBB 138 were detected in the Tasmanian devils but the proportions relative to PBB 153 were lower than in the technical product. Samples of healthy and affected Tasmanian devils showed no significant difference in the PBB pollution level. The PBB concentrations in the Tasmanian devils were significantly below those causing toxic effects. On the other hand, PBB concentrations were one level or even higher than PBDEs.

Polybrominated diphenyl ethers and polybrominated biphenyls in Australian sewage sludge.

This paper presents a brief review of the international scientific literature of polybrominated diphenyl ethers (PBDEs) and polybrominated biphenyls (PBBs) in sewage sludge and a survey of these compounds in sewage sludge from 16 Australian wastewater treatment plants (WWTPs). The SigmaPBDE mean concentration in the Australian study was 1137microgkg(-1) dry weight (d.w.) (s.d. 1116) and ranged between 5 and 4 230microgkg(-1)d.w. The urban mean of 1308microgkg(-1) (s.d. 1320) and the rural mean of 911microgkg(-1) (s.d. 831) are not statistically different and are similar to levels in European sludges. Principal components analysis was performed on the data set and revealed that 76% of the data variation could be explained by two components that corresponded to overall concentration of the pentaBDE and the decaBDE commercial formulations. An analysis of variance was performed comparing PBDEs levels at three WWTPs over the years 2005 and 2006, finding differences between treatment plants (BDE-47) but no significant difference in PBDE levels in the years 2005 and 2006. Low levels of BB-153 were detected in all samples of this survey (n=16); mean 0.6microgkg(-1)d.w. (s.d. 0.5). This compound has rarely been reported in any other study of sewage sludges undertaken outside Australia. This work highlights the need for a risk assessment of PBDEs in sewage sludge when used for land application, taking into account typical levels found in Australian sludges and soils.

Dioxin- and POP-contaminated sites--contemporary and future relevance and challenges: overview on background, aims and scope of the series.

BACKGROUND, AIM AND SCOPE: Once they have been generated, polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) and other persistent organic pollutants (POPs) can persist in soils and sediments and in waste repositories for periods extending from decades to centuries. In 1994, the US EPA concluded that contaminated sites and other reservoirs are likely to become the major source of contemporary pollution problems with these substances. With this in mind, this article is the first in a new series in ESPR under the title 'Case Studies on Dioxin and POP Contaminated Sites--Contemporary and Future Relevance and Challenges', which will address this important issue. The series will document various experiences from sites contaminated with PCDD/F and other POPs. This article provides an overview of the content of the articles comprising the series. In addition, it provides a review of the subject in its own right and identifies the key issues arising from dioxin/POP-contaminated sites. Additionally, it highlights the important conclusions that can be drawn from these examples. The key aim of this article and of the series as a whole is to provide a comprehensive overview of the types of PCDD/F contaminated sites that exist as a result of historical activities. It details the various processes whereby these sites became contaminated and attempts to evaluate their contemporary relevance as sources of PCDD/Fs and other POPs. It also details the various strategies used to assess these historical legacies of contamination and the concepts developed, or which are under development, to effect their remediation. MAIN FEATURES: Special sessions on 'Contaminated sites--Cases, remediation, risk and policy' were held at the DIOXIN conferences in 2006 and 2007, and this theme will be continued at DIOXIN 2008 to be held in Birmingham. Selected cases from the approximately 70 contributions made to these sessions, together with some additional invited case studies are outlined together with the key issues they raise. By evaluating these cases and adding details of experiences published in the current literature, an overview will be given of the different features and challenges of dioxin and POP-contaminated sites. RESULTS: This article provides a systematic categorisation of types of PCDD/F and POP-contaminated sites. These are categorised according to the chemical or manufacturing process, which generated the PCDD/Fs or POPs and also includes the use and disposal aspects of the product life cycle in question. The highest historical PCDD/F and dioxin-like polychlorinated biphenyl (PCB) contamination burdens have arisen as a result of the production of chlorine and of chlorinated organic chemicals. In particular, the production of chlorinated pesticides, PCBs and the related contaminated waste streams are identified being responsible for historical releases of toxic equivalents (TEQs) at a scale of many tonnes. Along with such releases, major PCDD/F contaminated sites have been created through the application or improper disposal of contaminated pesticides, PCBs and other organochlorine chemicals, as well through the recycling of wastes and their attempted destruction. In some extreme examples, PCDD/F contaminated sites have also resulted from thermal processes such as waste incinerators, secondary metal industries or from the recycling or deposition of specific waste (e.g. electronic waste or car shredder wastes), which often contain chlorinated or brominated organic chemicals. The examples of PCDD/F and dioxin-like PCB contamination of fish in European rivers or the impact of contaminated sites upon fishing grounds and upon other food resources demonstrate the relevance of these historical problems to current and future human generations. Many of the recent food contamination problems that have emerged in Europe and elsewhere demonstrate how PCDD/F and dioxin like PCBs from historical sources can directly contaminate human and animal feedstuffs and indeed highlight their considerable contemporary relevance in this respect. Accordingly, some key experiences and lessons learnt regarding the production, use, disposal and remediation of POPs from the contaminated sites are summarised. DISCUSSION: An important criterion for evaluating the significance and risks of PCDD/Fs and other POPs at contaminated sites is their present or future potential for mobility. This, in turn, determines to a large degree their propensity for off-site transport and environmental accessibility. The detailed evaluation of contaminated site cases reveals different site-specific factors, which influence the varied pathways through which poor water-soluble POPs can be mobilised. Co-contaminants with greater water solubility are also typically present at such sites. Hence, pumping of groundwater (pump and treat) is often required in addition to attempting to physically secure a site. At an increasing number of contaminated sites, securing measures are failing after relatively short time spans compared to the time horizon, which applies to persistent organic pollutant contamination. Due to the immense costs and challenges associated with remediation of contaminated sites 'monitored natural attenuation' is increasingly gaining purchase as a conceptual remediation approach. However, these concepts may well prove limited in their practical application to contaminated sites containing persistent organic pollutants and other key pollutants like heavy metals. CONCLUSIONS: It is inevitable, therefore, that dioxin/POP-contaminated sites will remain of contemporary and future relevance. They will continue to represent an environmental issue for future generations to address. The securing and/or remediation of dioxin/POP-contaminated sites is very costly, generally in the order of tens or hundreds of millions of dollars. Secured landfills and secured production sites need to be considered as constructions not made for 'eternity' but built for a finite time scale. Accordingly, they will need to be controlled, supervised and potentially repaired/renewed. Furthermore, the leachates and groundwater impacted by these sites will require ongoing monitoring and potential further remediation. These activities result in high maintenance costs, which are accrued for decades or centuries and should, therefore, be compared to the fully sustainable option of complete remediation. The contaminated site case studies highlight that, while extensive policies and established funds for remediation exist in most of the industrialised western countries, even these relatively well-regulated and wealthy countries face significant challenges in the implementation of a remediation strategy. This highlights the fact that ultimately only the prevention of contaminated sites represents a sustainable solution for the future and that the Polluter Pays Principle needs to be applied in a comprehensive way to current problems and those which may emerge in the future. RECOMMENDATIONS AND PERSPECTIVES: With the continuing shift of industrial activities in developing and transition economies, which often have poor regulation (and weak self-regulation of industries), additional global challenges regarding POPs and other contaminated sites may be expected. In this respect, a comprehensive application of the "polluter pays principle" in these countries will also be a key to facilitate the clean-up of contaminated areas and the prevention of future contaminated sites. The threats and challenges of contaminated sites and the high costs of securing/remediating the problems highlight the need for a comprehensive approach based upon integrated pollution prevention and control. If applied to all polluting (and potentially polluting) industrial sectors around the globe, such an approach will prove to be both the cheapest and most sustainable way to underpin the development of industries in developing and transition economies.