Biomonitoring of exposure to chemical warfare agents: a review.

In this report an overview of the methods currently available for detection of exposure to a number of chemical warfare agents (CWA), i.e., sulfur mustard, lewisite and nerve agents, is presented. Such methods can be applied for various purposes, e.g., diagnosis and dosimetry of exposure of casualties, confirmation of nonexposure, verification of nonadherence to the Chemical Weapons Convention, health surveillance, and forensic purposes. The methods are either based on mass spectrometric or immunochemical analysis of CWA adducts with DNA or proteins or based on mass spectrometric analysis of urine or plasma metabolites that result from hydrolysis and/or glutathione conjugation. Several of the methods have been successfully applied to actual cases.

Comparison of multicultural literature in three health professions: physical therapy, nursing & social work.

All health professions' education programs are mandated by their accrediting agencies to include diversity and multicultural content within their curricula. This article reviews literature from the three professions of nursing, social work, and physical therapy that indicates that they accomplish this at different places on the continuum of curricular integration and transformation as identified by Banks. An examination of the complexity of each profession's standards, and a comparison of the depth of cultural competency within each profession is included. Even with the more 'experienced' professions of social work and nursing, there appear to continue to be inconsistencies in the structuring and teaching of multicultural content.

Rapid screening procedures for the hydrolysis products of chemical warfare agents using positive and negative ion liquid chromatography-mass spectrometry with atmospheric pressure chemical ionisation.

Qualitative screening procedures have been developed for the rapid detection and identification of the hydrolysis products of chemical warfare agents in aqueous samples and extracts, using liquid chromatography-mass spectrometry with positive and negative atmospheric pressure chemical ionisation (APCI). Previously reported screening procedures, which used positive APCI or electrospray ionisation (ESI), were modified by using LC conditions that allowed acquisition of positive and negative ion mass spectra. APCI was generally found to be more robust than ESI, probably due to variable adduct ion formation with ESI, depending on the condition of the sample and the system. Negative APCI provided selective detection of acidic analytes and allowed facile differentiation of alkyl alkylphosphonic acids from isomeric dialkyl alkylphosphonates. The combination of positive and negative APCI, using a C18 column and water-methanol mobile phase modified with ammonium formate, provides a rapid screening procedure for chemical warfare agent degradation products, with limits of detectability in the range 10-100 ng/ml. In the case of proficiency test samples, where analyte concentrations are in the range 1-10 ppm, introduction of the sample by infusion may provide an even faster preliminary screening procedure.

The interaction of sarin and soman with plasma proteins: the identification of a novel phosphonylation site.

Incubation of both sarin and soman with human plasma has shown that binding occurs to a tyrosine residue. Similar binding occurs when sarin and soman are incubated with human serum albumin. This binding may provide an important biological marker, which retains full structural information concerning the identity of the agent, in cases of allegations of chemical warfare use.

Alternating antineutrophil cytoplasmic antibody specificity: drug-induced vasculitis in a patient with Wegener's granulomatosis.

We describe a patient who presented with Wegener's granulomatosis associated with antineutrophil cytoplasmic antibodies (ANCA) directed against proteinase 3 (PR3) with a cytoplasmic immunofluorescence pattern (cANCA), whose ANCA type changed to antimyeloperoxidase antibodies with a perinuclear immunofluorescence pattern (pANCA) when treated with propylthiouracil, and changed back to anti-PR3 antibodies with cANCA after the medication was discontinued. The patient developed flares of vasculitis symptoms associated with rises in either type of ANCA. Tests for antimyeloperoxidase ANCA were repeatedly negative before the drug was started, strongly implicating the drug as the cause of the episode. This case demonstrates that patients with idiopathic ANCA-positive vasculitis may quickly develop a superimposed drug-associated ANCA-positive vasculitis. Iatrogenic vasculitis should be suspected when a patient with idiopathic vasculitis with one type of ANCA develops the other type of ANCA.

Biological fate of sulphur mustard: identification of valine and histidine adducts in haemoglobin from casualties of sulphur mustard poisoning.

1. Analytical methods were developed for the detection of N-terminal valine and histidine adducts in haemoglobin alkylated with sulphur mustard. 2. N-(2-hydroxyethylthioethyl)-N-terminal valine was selectively cleaved from globin with the Edman reagent pentafluorophenyl isothiocyanate. The resulting thiohydantoin derivative was analysed by high resolution gc-ms using negative ion chemical ionization. An alternative procedure, involving acid hydrolysis of globin to its constituent amino acids and conversion of the adduct to its di-TBDMS derivative, was less sensitive. 3. N-(2-hydroxyethylthioethyl)histidine was analysed, after acid hydrolysis of globin, as its fluorenylmethyloxycarbonyl derivative by lc-ms-ms using electrospray ionisation and selected reaction monitoring. 4. N-(2-hydroxyethylthioethyl)valine and (2-hydroxyethylthioethyl)histidine were detected in globin isolated from a rat treated percutaneously with sulphur mustard, and in globin from five blood samples collected from human casualties of sulphur mustard poisoning. The adducts are proposed as biological markers of sulphur mustard poisoning. in addition to urinary metabolites and DNA adducts.

Biological fate of sulphur mustard: in vitro alkylation of human haemoglobin by sulphur mustard.

1. Human blood was incubated in vitro with a 1:1 mixture of [35S,12C4]- and [13C4]-sulphur mustard. Alkylated globin, containing the 2-hydroxyethylthioethyl (HETE) moiety, was isolated from the blood incubate following lysis of the erythrocytes and acidification with HCl in isopropanol. 2. The alkylated globin was hydrolysed with Pronase E to give a digest containing alkylated amino acids and alkylated dipeptides. A number of these were partially purified by hplc and identified by gc-ms and lc-ms. 3. The alkylated globin was hydrolysed with trypsin to give a digest containing alkylated peptides. Ten of these were partially purified by hplc, tentatively identified by lc-electrospray mass spectrometry, and the sequences and sites of alkylation determined using lc-electrospray tandem mass spectrometry. 4. (2-Hydroxyethylthioethyl)glutathione was also shown to be present in the pronase and trypsin digests of alkylated globin. 5. N-terminal valine, on both the alpha and beta chains, and histidine residues were identified as the key sites of interaction for targeting as biological markers of sulphur mustard poisoning.

Improved methodology for the detection and quantitation of urinary metabolites of sulphur mustard using gas chromatography-tandem mass spectrometry.

Gas chromatography-tandem mass spectrometry (GC-MS-MS) with selected-reaction monitoring was applied to the analysis of urinary metabolites of sulphur mustard, derived from the beta-lyase pathway and from hydrolysis. In the case of beta-lyase metabolites, a limit of detection of 0.1 ng/ml was obtained, compared to 2-5 ng/ml using single stage GC-MS with selected-ion monitoring. GC-MS-MS methodology was less useful when applied to the analysis of thiodiglycol bis(pentafluorobenzoate) using negative-ion chemical ionisation although selected-reaction chromatograms were cleaner than selected-ion chromatograms. The advantage of using GC-MS-MS was demonstrated by the detection of low levels of beta-lyase metabolites in the urine of casualties who had been exposed to sulphur mustard.

Biological fate of sulphur mustard, 1,1'-thiobis(2-chloroethane): identification of beta-lyase metabolites and hydrolysis products in human urine.

1. Samples of urine from two human subjects accidentally exposed to sulphur mustard were analysed for metabolites derived from hydrolysis (thiodiglycol, thiodiglycol sulphoxide), conjugation with glutathione (1,1'-sulphonylbis [2-S-(N-acetylcysteinyl)ethane]) and from further metabolism of glutathione conjugates by the beta-lyase pathway (1,1-sulphonylbis[2-(methylsulphinyl)ethane], 1-methylsulphinyl-2-[2-(methylthio)ethylsulphonyl]ethane). 2. Thiodiglycol sulphoxide was excreted in much higher concentrations than thiodiglycol, as was observed previously in rat exposed to sulphur mustard. However, the use of thiodiglycol sulphoxide as a biological marker for sulphur mustard poisoning is limited by its presence at low concentrations in normal human urine. 3. beta-lyase metabolites were detected at concentrations comparable with those of thiodiglycol sulphoxide. No background levels of beta-lyase metabolites have been detected in normal human urine, and they are proposed as unequivocal diagnostic and forensic indicators of sulphur mustard poisoning in man.

Application of gas chromatography-mass spectrometry and gas chromatography-tandem mass spectrometry to the analysis of chemical warfare samples, found to contain residues of the nerve agent sarin, sulphur mustard and their degradation products.

Samples of clothing, grave debris, soil and munition fragments, collected from the Kurdish village of Birjinni, were analysed by GC-MS with selected ion monitoring (SIM) for traces of chemical warfare agents and their degradation products. Positive analyses were confirmed, where possible, by full scan mass spectra, or at low concentrations by additional GC-MS-SIM analysis using chemical ionisation, by higher resolution GC-MS-SIM, and by GC-tandem mass spectrometry using multiple reaction monitoring. Sulphur mustard and/or thiodiglycol were detected in six soil samples; isopropyl methylphosphonic acid and methylphosphonic acid, the hydrolysis products of the nerve agent sarin, were detected in six different soil samples. Trace amounts of intact sarin were detected on a painted metal fragment associated with one of these soil samples. The results demonstrate the application of different GC-MS and GC-MS-MS techniques to the unequivocal identification of chemical warfare agent residues in the environment at concentrations ranging from low ppb to ppm (w/w). They also provide the first documented unequivocal identification of nerve agent residues in environmental samples collected after a chemical attack.

Metabolism of thiodiglycol (2,2'-thiobis-ethanol): isolation and identification of urinary metabolites following intraperitoneal administration to rat.

1. The metabolism of thiodiglycol, 2,2'-thiobis-ethanol, was investigated following i.p. administration to rat. 2. Approximately 90% of the administered dose was excreted in the 0-24-h urine. Four metabolites were isolated by h.p.l.c. and identified by mass spectrometry. Structural assignments were confirmed by comparison with authentic synthetic standards. 3. Thiodiglycol sulphoxide was the major metabolite accounting for approximately > or = 90% of the excreted radioactivity following i.p. injection of 13C4, 35S-thiodiglycol. Thiodiglycol sulphone, S-(2-hydroxyethylthio)acetic acid and S-(2-hydroxy-ethylsulphinyl)acetic acid were identified as minor metabolites. 4. Analysis for thiodiglycol by GC-MS indicated approximately 0.5-1% of the applied dose was excreted unmetabolized.

Consuming aspartame with and without taste: differential effects on appetite and food intake of young adult males.

Despite some reports that aspartame (APM)-sweetened beverages may increase subjective appetite, previously we demonstrated that drinking 280 ml of an APM-sweetened soft drink (170 mg APM) had no effect on appetite, and 560 ml of the same soft drink (340 mg APM) reduced appetite. The present study examined this appetite reduction to determine its cause. Eighteen normal weight young adult males received five treatments (beverage preloads) at 1100 h in a randomized order, one per week: 280 ml of carbonated mineral water (CMW) (control), 560 ml of CMW, 280 ml of CMW with 340 mg of encapsulated APM, 280 ml of CMW sweetened with 340 mg APM, 560 ml of an APM-sweetened soft drink (340 mg APM). Subjective hunger and food appeal were measured from 0930 a.m. to 1230 h, and food intake from a buffet lunch offered at 1205 h was measured. Treatment had no effect on food intake or macronutrient selection. Both 560 ml of CMW or soft drink suppressed appetite, although 280 ml of APM-sweetened mineral water significantly increased subjective appetite relative to the control. Encapsulated APM had no effect on appetite. Therefore, appetite reduction following consumption of an APM-sweetened drink is likely due to drink volume and not the APM content. In addition, consuming APM-sweetened CMW produces a short-term increase in subjective appetite.

Pneumocandins from Zalerion arboricola. IV. Biological evaluation of natural and semisynthetic pneumocandins for activity against Pneumocystis carinii and Candida species.

A series of lipopeptide compounds co-produced during the fermentation of pneumocandin A0 (L-671,329) and related semisynthetic compounds were evaluated in vivo against Pneumocystis carinii pneumonia and systemic candidiasis. In addition, they were tested in vitro against a panel of pathogenic Candida species and in a Candida membrane 1,3-beta-D-glucan synthesis assay. The results of these studies demonstrate that pneumocandin A0 and pneumocandin B0 (L-688,786) are the most potent compounds when considering both antipneumocystis and anticandida activity. Other compounds in the series are selectively more potent against P. carinii or Candida albicans suggesting a diverging structure-activity relationship. Evaluation of these compounds for their ability to inhibit C. albicans 1,3-beta-D-glucan synthesis in vitro demonstrates that they inhibit this process. A positive correlation between 1,3-beta-D-glucan synthesis inhibition and in vitro antifungal activity was also demonstrated for some of the pneumocandins.

Biological fate of sulphur mustard, 1,1'-thiobis(2-chloroethane): isolation and identification of urinary metabolites following intraperitoneal administration to rat.

1. The metabolism of sulphur mustard, 1,1'-thiobis(2-chloroethane), in vivo was investigated following i.p. administration to rat. 2. Approx. 60% of dose was excreted in the 24 h urine. Many metabolites were present; nine have been isolated by h.p.l.c. and characterized by mass spectrometry. Structural assignments were confirmed by comparison with authentic synthetic standards. 3. Some metabolites result from initial hydrolysis of the sulphur mustard, but the majority are formed by conjugation with glutathione. These are further metabolized to N-acetylcysteine conjugates, or to methylthio/methylysulphinyl derivatives by a pathway probably involving beta-lyase, accompanied by oxidation of the mustard sulphur atom to sulphoxide or sulphone. 4. Thiodiglycol sulphoxide, 1,1'-sulphonylbis[2-S(N-acetylcysteinyl)ethane] and 1,1'-sulphonylbis[2-methylsulphinyl)ethane] or 1-methylsulphinyl-2-[2-(methylthio ethylsulphonyl]ethane were the most prevalent metabolites resulting from the three major pathways. Metabolic pathways for the formation of the excretion products are proposed.

Oral hypoglycemic agents. Pyrimido[1,2-a]indoles and related compounds.

A series of pyrimido[1,2-a]indoles were synthesized and studied for their hypoglycemic activity following oral administration at a standard dose of 100 mg/kg to fed rats. The effect of 10-alkoxyalkyl, 10-alkyl, 10-aryl, and 3,3-dialkyl substitution on the activity of 10-hydroxypyrimido[1,2-a]indoles was investigated. Relative potencies of a number of the most active compounds were defined by three-point dose-response studies. The most potent compounds were those with either 3,3-dimethyl substituents, compounds 21, 22, and 38, or 3,3-spirocyclohexane substituents, compounds 39 and 49. 10-Aminopyrimido[1,2-a]indoles were in general less active than the 10-hydroxy analogues, and potency was further decreased by derivatizing the 10-amino group. The most potent 10-amino derivatives were 57 and 58.

Biological fate of sulfur mustard, 1,1'-thiobis(2-chloroethane). Urinary excretion profiles of hydrolysis products and beta-lyase metabolites of sulfur mustard after cutaneous application in rats.

The urinary excretion profiles of some metabolites of sulfur mustard were determined by gas chromatography/mass spectrometry after cutaneous application of sulfur mustard in rats. Excretion profiles of the individual metabolites thiodiglycol and thiodiglycol sulfoxide, derived from the hydrolysis of sulfur mustard, were determined in different groups of three rats. Concentrations of thiodiglycol detected increased up to 10 fold after treatment of the urine with hydrochloric acid, presumably because of the excretion of acid-labile esters of thiodiglycol. Free thiodiglycol, free plus esterified thiodiglycol, and thiodiglycol sulfoxide excreted over 8 days accounted for less than 0.3%, 1-1.5%, and 3.4-4.3%, respectively, of the applied dose of sulfur mustard. In a further study, a modified analytical method was applied to determine these hydrolysis products and their acid-labile esters as the single analyte thiodiglycol, after treatment with acidic titanium trichloride. The excretion profile of the combined hydrolysis products was compared with the excretion profile of a different group of metabolites of sulfur mustard derived from the glutathione/beta-lyase pathway. These were also reduced to a common analyte, 1,1'-sulfonylbis-[2-(methylthio)ethane], after similar treatment with titanium trichloride. Urinary excretion of hydrolysis products determined in 4 rats over 8 days accounted for 3.7-13.6% of an applied cutaneous dose of sulfur mustard. Urinary excretion of beta-lyase metabolites accounted for 2.5-5.3% of the applied dose in the same group of rats. The excretion of beta-lyase products showed a much sharper decline than was observed for the hydrolysis products of sulfur mustard.

Transection of the stria terminalis without damage to the medial amygdala does not alter behavioural sodium regulation in rats.

Damage to the medial region of the amygdala has been shown to impair mineralocorticoid-induced sodium appetite, while leaving intact sodium appetite induced through sodium depletion. This effect may result from the interruption of the flow of information through the stria terminalis (ST), a neural pathway linking the medial amygdala with the ventral forebrain. We determined the effect of transecting the ST of the rat, at a point remote from the medial amygdala, on sodium appetite induced with the administration of mineralocorticoids and with the natriuretic furosemide. Similar to control and amygdala lesioned rats, rats with ST knife-cuts displayed a normal sodium appetite following treatment with furosemide. However, unlike medial amygdala lesions, transection of the ST alone did not block mineralocorticoid-induced sodium appetite. Therefore, the inability of mineralocorticoids to induce a salt appetite in medial amygdala lesioned rats does not result from damage to the stria terminalis.