The Hunter-8 Scale Prehospital Triage Workflow for Identification of Large Vessel Occlusion and Brain Haemorrhage.

OBJECTIVE: The Hunter-8 prehospital stroke scale predicts large vessel occlusion in hyperacute ischemic stroke patients (LVO) at hospital admission. We wished to test its performance in the hands of paramedics as part of a prehospital triage algorithm. We aimed to determine (a) the proportion of patients identified by the Hunter-8 algorithm, receiving reperfusion therapies, (b) whether a call to stroke team improved this, and (c) performance for LVO detection using an expanded LVO definition. METHODS: A prehospital workflow combining pre-morbid functional status, time from symptom onset, and the Hunter-8 scale was implemented from July 2019. A telephone call to the stroke team was prompted for potential treatment candidates. Classic LVO was defined as a proximal middle cerebral artery (MCA-M1), terminal internal carotid artery, or tandem occlusion. Extended LVO added proximal MCA-M2 and basilar occlusions. RESULTS: From July 2019 to April 2021, there were 363 Hunter-8 activations, 320 analyzed: 181 (56.6%) had confirmed ischemic strokes, 13 (4.1%) transient ischemic attack, 91 (28.5%) stroke mimics, and 35 (10.9%) intracranial hemorrhage. Fifty-two patients (16.3%) received reperfusion therapies, 35 with Hunter-8 ≥ 8. The stroke doctor changed the final destination for 76 patients (23.7%), and five received reperfusion therapies. The AUCs for classic and extended LVO were 0.73 (95% CI 0.66-0.79) and 0.72 (95% CI 0.65-0.77), respectively. CONCLUSION: The Hunter-8 workflow resulted in 28.7% of confirmed ischemic stroke patients receiving reperfusion therapies, with no secondary transfers to the comprehensive stroke center. The role of communication with stroke team needs to be further explored.

Clinical outcomes to exercise training in type 1 diabetes: A systematic review and meta-analysis.

AIMS: To establish the relationship between exercise training and clinical outcomes in people with type I diabetes. METHODS: Studies were identified through a MEDLINE search strategy, Cochrane Controlled Trials Registry, CINAHL, SPORTDiscus and Science Citation Index. The search strategy included a mix of key concepts related to trials of exercise training in people with type 1 diabetes; glycaemic control. Searches were limited to prospective randomized or controlled trials of exercise training in humans with type 1 diabetes lasting 12  weeks or more. RESULTS: In exercised adults there were significant improvements in body mass Mean Difference (MD): -2.20 kg, 95% Confidence Interval (CI) -3.79-0.61, p = .007; body mass index (BMI) MD: -0.39 kg/m2, 95% CI -0.75-0.02, p = .04; Peak VO2 MD: 4.08 ml/kg/min, 95% CI -2.18-5.98, p < .0001; and, low-density lipoprotein cholesterol (LDL) MD: -0.21 mmol/L, 95% CI -0.33-0.08, p = .002. In exercised children there were significant improvements in insulin dose MD: -0.23 IU/kg, 95% CI -0.37-0.09, p = .002; waist circumference MD: -5.40 cm, 95% CI -8.45 to -2.35, p = .0005; LDL MD: -0.31 mmol/L, 95% CI -0.55 to -0.06, p = .02; and, triglycerides MD: -0.21 mmol/L, 95% CI -0.42 to -0.01, p = .04. There were no significant changes in glycosylated haemoglobin (HbA1C%), fasting blood glucose, resting heart rate, resting systolic blood pressure or high density lipoproteins in either group. CONCLUSIONS: Exercise training improves some markers of type 1 diabetes severity; particularly body mass, BMI, Peak VO2 and LDL in adults and insulin dose, waist circumference, LDL and triglycerides in children.

The effect of exercise training on clinical outcomes in patients with the metabolic syndrome: a systematic review and meta-analysis.

BACKGROUND: Purpose: to establish if exercise training improves clinical outcomes in people with metabolic syndrome (MetS). Registered with PROSPERO international prospective register of systematic reviews ( https://www.crd.york.ac.uk/PROSPERO/Identifier:CRD42017055491 ). DATA SOURCES: studies were identified through a MEDLINE search strategy (1985 to Jan 12, 2017), Cochrane controlled trials registry, CINAHL and SPORTDiscus. STUDY SELECTION: prospective randomized or controlled trials of exercise training in humans with metabolic syndrome, lasting 12 weeks or more. RESULTS: We included 16 studies with 23 intervention groups; 77,000 patient-hours of exercise training. In analyses of aerobic exercise studies versus control: body mass index was significantly reduced, mean difference (MD) -0.29 (kg m-2) (95% CI -0.44, -0.15, p < 0.0001); body mass was significantly reduced, MD -1.16 kg (95% CI -1.83, -0.48, p = 0.0008); waist circumference was significantly reduced MD -1.37 cm (95% CI -2.02, -0.71, p < 0.0001), peak VO2 was significantly improved MD 3.00 mL kg-1 min-1 (95% CI 1.92, 4.08, p < 0.000001); systolic blood pressure and diastolic blood pressure were significantly reduced, MD -2.54 mmHg (95% CI -4.34, -0.75, p = 0.006), and, MD -2.27 mmHg (95% CI -3.47, -1.06, p = 0.0002) respectively; fasting blood glucose was significantly reduced MD -0.16 mmol L-1 (95% CI -0.32, -0.01, p = 0.04); triglycerides were significantly reduced MD -0.21 mmol L-1 (95% CI -0.29, -0.13, p < 0.00001); and low density lipoprotein was significantly reduced MD -0.03 mmol L-1 (95% CI -0.05, -0.00, p = 0.02). In analyses of combined exercise versus control: waist circumference, MD -3.80 cm (95% CI -5.65, -1.95, p < 0.0001); peak VO2 MD 4.64 mL kg-1 min-1 (95% CI 2.42, 6.87, p < 0.0001); systolic blood pressure MD -3.79 mmHg (95% CI -6.18, -1.40, p = 0.002); and high density lipoprotein (HDL) MD 0.14 (95% CI 0.04, 0.25, p = 0.009) were all significantly improved. We found no significant differences between outcome measures between the two exercise interventions. CONCLUSIONS: Exercise training improves body composition, cardiovascular, and, metabolic outcomes in people with metabolic syndrome. For some outcome measures, isolated aerobic exercise appears optimal.

The effect of resistance training on clinical outcomes in heart failure: A systematic review and meta-analysis.

OBJECTIVES: To quantify the change in effect sizes, for selected clinical outcome measures, in people with heart failure, from resistance exercise, either in isolation, or in combination with aerobic training. BACKGROUND: Most exercise training data in heart failure, relates to aerobic exercise, we sought to provide current evidence for the benefits of resistance training in this population. METHODS: We conducted a MEDLINE search (1985 to May 1, 2016), for exercise based rehabilitation trials in heart failure, using search terms 'resistance training, combined training, left ventricular dysfunction, peak VO2, cardio-myopathy and systolic heart dysfunction'. RESULTS: The 27 included studies provided a total of 2321 participants, 1172 in an intervention and 1149 in either sedentary controls or aerobic exercise only groups, producing over 31,263 patient-hours of training. Mortality, hospitalization, resting blood pressure and Left ventricular fraction were all unchanged with resistance or combined aerobic and resistance training. Peak VO2 was improved in combined exercise vs. control MD of 1.43ml·kg(-1)·min(-1) (95% CI 0.63, 2.23, p=0.0004; and in resistance vs. control MD 3.99ml·kg(-1)·min(-1) (95% CI 1.47, 6.51, p=0.002). Quality of Life (MLwHFQ) was improved in combined vs. control MD -8.31 (95% CI -14.3, -2.33, p=0.006). Six-minute walk distance was improved combined exercise vs. control, MD 13.49m (95% CI 1.13, 25.84, p=0.03); and resistance vs. control MD 41.77m (95% CI 21.90, 61.64, p<0.0001): SMD 1.25 (95%CI 0.53, 1.98, p=0.0007). CONCLUSIONS: Resistance only or combined training improves peak VO2, quality of life and walking performance in heart failure patients.

Organophosphate and phthalate esters in settled dust from apartment buildings in Stockholm.

In this study, the occurrence of nine phthalate diesters (phthalates) and 14 organophosphorus flame retardants (PFRs) was investigated in 62 house dust samples collected from 19 buildings in Stockholm area during the year 2008. Eight phthalates were detected in almost all samples, with median concentrations ranging from 0.47 µg/g to 449 µg/g with di(2-ethylhexyl) phthalate being the most abundant compound. Twelve PFRs were detected with median concentrations ranging from 0.19 µg/g to 11 µg/g. Within this class of compounds, the most abundant were tris(2-chloroisopropyl) and tris(2-butoxyethyl) phosphate. Both classes of compounds were also measured in the air of the apartments, but no correlation between air and dust concentrations could be found. Based on these measurements, exposure, via house dust ingestion and air inhalation, was calculated for adults and toddlers, and compared to published limit values in order to estimate potential health risks. In an extreme exposure scenario for toddlers, di(2-ethylhexyl) phthalate, tris(2-chloroethyl) phosphate, tris(2-butoxyethyl) phosphate, and tributyl phosphate were close to the reference dose for chronic oral exposure or the tolerable daily intake. Standard Reference Material SRM 2585 was used as a quality control sample, and the levels of diisononyl and diisodecyl phthalates were determined in this material.

Organophosphate and phthalate esters in air and settled dust - a multi-location indoor study.

UNLABELLED: This paper reports the abundance in indoor air and dust of eleven organophosphate esters and six phthalate esters. Both groups of these semi-volatile compounds are widely incorporated as additives into plastic materials used in the indoor environment, thus contributing to indoor exposure to industrial chemicals. Thirty sampling sites representing three different indoor environments (private homes, day care centers, and workplaces) in the Stockholm area, Sweden, were selected to obtain representative concentration profiles in both ambient air and settled dust. Eight of the target organophosphate esters and all six phthalate esters were found in both air and dust samples at all locations. The phthalate esters were more abundant than the organophosphate esters, typically ten times higher total concentrations. Especially interesting were the high levels of tributoxyethyl phosphate in the day care centers, the relatively high levels of chlorinated organophosphate esters in the air of workplaces and the overall high levels of diethylhexyl phthalate in dust. The air concentration profiles of the phosphate esters differed significantly between the three indoor environments, whereas the concentration profiles of the phthalate esters as well as their total concentrations were similar. The correlation between concentrations found in air and in dust was found to be weak. PRACTICAL IMPLICATIONS: Organophosphate esters and phthalate esters are commonly used as additives in numerous building materials and consumer products. The use of these compounds is increasing, and phosphate and phthalate esters are to be regarded as ubiquitous contaminants in the indoor environment. These compounds comprise a number of different compounds that have been associated with biologic effects in animal studies as well as in humans. Thus, it is of concern to increase the knowledge about human exposure of these compounds because of their presence in indoor air. In this paper, thirty indoor environments have been surveyed with respect to seventeen of the most abundant of these compounds.

Large-volume programmed-temperature vaporiser injection for fast gas chromatography with electron capture and mass spectrometric detection of polybrominated diphenyl ethers.

A large volume injection fast-GC-MS method has been developed, optimized and evaluated for the determination of polybrominated diphenyl ethers, including the decabrominated diphenyl ether (BDE-209). The programmed-temperature vaporiser injection parameters, temperature programming of the GC oven, and the physical dimensions of the narrow bore GC column were investigated to find the optimal operating conditions for the analysis. Depending on parameter settings the yield of the PBDEs and particularly BDE-209, varies significantly. Volumes up to 125 microl were successfully injected and a fast GC separation was performed, with retention times as short as 6.4 min for the last eluting compound, BDE-209. In a pilot study an air sample, collected at an electronics dismantling facility, was analyzed. Low-resolution mass spectrometry in electron capture negative ion mode was used for detection. Nine BDE congeners, including BDE-209, were identified and quantified.

Mass spectrometric characteristics of decabromodiphenyl ether and the application of isotopic dilution in the electron capture negative ionization mode for the analysis of polybrominated diphenyl ethers.

The mass spectrometric properties of (12)C-and (13)C-labeled decabromodiphenyl ether (BDE-209) in the low-resolution mass spectrometry electron capture negative ionization mode (ECNI-MS) is described in detail and are compared with those of polybrominated diphenyl ethers (PBDEs) with a lower degree of bromination. The mass spectrometric properties of BDE-209 make it possible to apply (13)C-labeled BDE-209 as an internal surrogate standard for the determination of BDE-209 by isotopic dilution. A combination of the [Br](-) and [C(6)Br(5)O](-) fragment ions is proposed for the detection with ECNI-MS in the selected ion monitoring mode to increase selectivity, sensitivity and accuracy in the determination of decabromodiphenyl ether together with other polybrominated diphenyl ethers. The importance of optimizing the instrument parameters to obtain optimal response from the mass spectrometer in the analysis of PBDEs is discussed in detail.

Acupuncture for the treatment of vulvar vestibulitis: a pilot study.

BACKGROUND: The study was conducted to obtain a preliminary indication of the effectiveness of acupuncture in the treatment of vulvar vestibulitis but also to obtain information how well the women tolerate the treatment. METHODS: Fourteen young women with vulvar vestibulitis according to Friedrich's criteria were enrolled in the study and 13 fulfilled the acupuncture treatment a total of 10 times. For evaluation quality of life (QOL) assessments were made before starting the treatment and then at one week and at three months after it was completed. RESULTS: The treatment was well tolerated and the QOL measurements were all significantly higher after both the last acupuncture and three months later, compared to before the treatment was started. CONCLUSION: The results seem promising, but a larger controlled randomized study should be carried out before the treatment can be recommended for use in clinical practice.

Flame retardants in indoor air at an electronics recycling plant and at other work environments.

Air samples from a plant engaged in recycling electronics goods, a factory assembling printed circuit boards, a computer repair facility, offices equipped with computers, and outdoor air have been analyzed with respect to their content of brominated hydrocarbon and phosphate ester flame retardants. Polybrominated diphenyl ethers, polybrominated biphenyls, 1,2-bis(2,4,6-tribromophenoxy)-ethane, tetrabromobisphenol A, and organophosphate esters were all detected in the indoor air samples, with the highest concentrations being detected in air from the recycling plant. In air from the dismantling hall at the recycling plant the average concentrations of decabromodiphenyl ether, tetrabromobisphenol A, and triphenyl phosphate were 38, 55, and 58 pmol/m3, respectively. Significantly higher levels of all of these additives were present in air in the vicinity of the shredder at the dismantling plant. This is the first time that 1,2-bis(2,4,6-tribromophenoxy)-ethane and several arylated phosphate esters are reported to be contaminants of air in occupational settings. At all of the other sites investigated, low levels of flame retardants were detected in the indoor air. Flame retardants associated with airborne particles, present at elevated levels, pose a potential health hazard to the exposed workers.

CYP1A1 and GSTM1 polymorphisms affect urinary 1-hydroxypyrene levels after PAH exposure.

Certain human biotransformation enzymes have been implicated in the formation and scavenging of the ultimate reactive metabolites, the diolepoxides, from polycyclic aromatic hydrocarbons (PAHs). In the present study, performed on aluminum smelter workers, we have analyzed airborne PAH, the pyrene metabolite 1-hydroxypyrene (1-OHP) in urine, and genotypes for biotransformation enzymes involved in PAH metabolism. The aim was to evaluate the correlation between external exposure and biomarkers of exposure and to investigate to what extent genetic polymorphism in metabolic enzymes can explain interindividual variation in urinary 1-OHP levels. DNA was prepared from blood samples from 98 potroom workers and 55 controls and altogether eight polymorphisms in the CYP1A1, mEH, GSTM1, GSTP1 and GSTT1 genes were analyzed. The 1-OHP excretion was found to correlate significantly (P 100-fold) and univariate and multivariate regression analyses were used to find the variables that could determine differences in excretion. The variation could, to some degree, be explained by differences in exposure to airborne particulate-associated PAHs, the use of personal respiratory protection devices, smoking habits and genetic polymorphisms in the cytochrome P450 1A1, GSTM1 and GSTT1 enzymes. The part of the variance that could be explained by differences in biotransformation genotypes seemed to be of the same order of magnitude as the variance explained by differences in exposure. In the control group as well as in the occupationally exposed group, the highest 1-OHP levels were observed in individuals carrying the CYP1A1 Ile/Val genotype who were also of the GSTM1 null genotype. The results show that urinary 1-OHP is a sensitive indicator of recent human exposure to PAHs and that it may also to some extent reflect the interindividual variation in susceptibility to PAHs.

Exposure to polycyclic aromatic hydrocarbons and genotoxic effects on nonsmoking Swedish road pavement workers.

OBJECTIVES: The objective of this study was to investigate exposure to polycyclic aromatic hydrocarbons (PAH) from asphalt fumes among Swedish road pavement workers and determine whether any effects could be detected with genotoxic tests. METHODS: The study included 28 nonsmoking road pavers and 30 nonsmoking referents. The concentration of PAH was determined in the breathing zone of the road pavers. 1-Hydroxypyrene was analyzed before and after shifts of asphalt work and during the afternoon for referents. Sister chromatid exchanges (SCE) and micronuclei (MN) were determined in peripheral lymphocytes. RESULTS: Several 3- or 4-ring PAH were found, and the analysis indicated that they occurred in bitumen fumes rather than in traffic fumes. The average total concentration of PAH was 2.3 (range 0.2-23.8) microg/m3. The concentration of 1-hydroxypyrene in urine was higher for the road pavers than for the referents, but there was no significant difference between the pre- and postshift values of the road pavers. The road pavers had no significant increase in SCE or MN. CONCLUSIONS: The study showed that Swedish road pavers have an increased exposure to PAH from bitumen fumes, but no genotoxic effects could be detected by SCE or MN tests.

Genotoxic exposures of potroom workers.

OBJECTIVES: Potroom workers in aluminum reduction plants have increased risks for bladder and lung cancer due to exposure from polycyclic aromatic hydrocarbons (PAH). In this study correlations between measures of the external, internal, and biological effective dose have been studied for PAH. METHODS: Venous blood samples were obtained from 98 male potroom workers and 55 unexposed male blue-collar workers, for the analysis of aromatic adducts to DNA (deoxyribonucleic acid) in lymphocytes, using the 32P-postlabeling technique. 1-Hydroxypyrene in urine was analyzed with high-pressure liquid chromatography. Personal sampling of both particulate and gas phase PAH was performed during a full workday for the potroom workers and for 5 referents. Individual PAH congeners were determined with liquid chromatographic-mass spectrometric and gas chromatographic-mass spectrometric techniques. RESULTS: The respiratory-zone airborne level of the sum of 22 particulate (median 13.2 micro/m3) and the 7 gas phase PAH-congeners (median 16.3 microg/m3) among the potroom workers was a hundred times higher than among the referents. The urinary concentration of 1-hydroxypyrene before work was 30 times higher for the potroom workers (median 3.43 micromol/mol creatinine) than for the referents. Most airborne PAH congeners correlated with the excretion of 1-hydroxypyrene in urine. The frequency of aromatic DNA adducts did not, however, differ between the potroom workers and the referents, and no correlation was found for 1-hydroxypyrene in urine. CONCLUSIONS: Despite an obvious occupational exposure to PAH, no increase in aromatic DNA adducts in lymphocytes was found among the potroom workers.

Polychlorinated biphenyls in blood plasma among Swedish female fish consumers in relation to low birth weight.

The authors examined the hypothesized association between the body burden of polychlorinated biphenyls (PCB) in women and the risk of low birth weight for their infants. In Sweden, a main exposure route for PCBs and other persistent organochlorine compounds is through the consumption of fatty fish from the Baltic Sea (on the Swedish east coast). A previous comparison between a cohort of consumers of large quantities of fish from the Swedish east coast and a reference population, together with a following analysis based on questionnaire data from a case-control study within the east coast cohort, supported the hypothesized association. In 1995, blood samples were collected from the wives and ex-wives of fishermen from the Swedish east coast (n = 192) who had given birth during the period 1973-1991. Cases (n = 57), i.e., infants with low birth weight (1,500-2,750 g), were matched with controls (n = 135; birth weight, 3,250-4,500 g) on gender, parity, and calendar year of birth. The concentration of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in plasma was analyzed; it has been suggested that CB-153 is a relevant biomarker of exposure to PCBs. The concentration of CB-153 in the plasma of mothers during the year of childbirth was "estimated" using some alternative plausible kinetic models. For two alternative estimated exposure datasets, which were focused on separately, an increase in the risk of a low birth weight was observed at a CB-153 concentration of 300 and 400 ng/g lipid weight, respectively (adjusted odds ratios of 2.1 (95% confidence interval (CI) 1.0-4.7) and 2.3 (95% CI 0.9-5.9)). The present results strengthen the findings reported previously for this study population.

The impact of age, lactation and dietary habits on PCB in plasma in Swedish women.

The mean concentration of the chlorinated biphenyl 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in plasma from 192 fishermen's wives from the Swedish east coast was on a fresh weight basis 960 (range 80-4300) pg/g and lipid adjusted 160 (range 20-780) ng/g lipid. The concentration of CB-153 in plasma was significantly influenced by age, total lactation time and place of living during childhood and adolescence (fishing village vs. other place). The residential variable probably reflects early life consumption of fish from the Baltic Sea (at the Swedish east coast) contaminated with persistent organochlorine compounds.

Monitoring of polychlorinated biphenyls in human blood plasma: methodological developments and influence of age, lactation, and fish consumption.

Human plasma samples from 50 wives of fishermen have been analyzed with respect to PCBs. The non-ortho-substituted PCB congeners CB-126 and CB-169 were determined by mass spectrometry in negative ion chemical ionization mode, which demonstrated a limit of detection of 30 fg. The recoveries of the internal standards used for determination of ortho-substituted CBs were approximately 95%. Two methods, one gravimetric and the other based on enzymatic determinations of triglycerides, cholesterol and phospholipids, were compared for the determination of total amount of lipids in the plasma samples; the correlation coefficient was 0.82 and the slope 0.98. For practical reasons, enzymatic determinations are recommended for further use. The total, lipid-adjusted concentrations of PCBs in plasma were influenced by age, total lactation time and consumption of fatty fish from the Baltic Sea.

Lactate concentration differences in plasma, whole blood, capillary finger blood and erythrocytes during submaximal graded exercise in humans.

The aim of the study was to investigate the distribution of lactate in plasma, whole blood, erythrocytes, and capillary finger blood, before and during submaximal exercise. Ten healthy male subjects performed submaximal graded cycle ergometer exercise for 20-25 min. Venous blood samples and capillary finger blood samples were taken before exercise and every 5th min during exercise for lactate determination. The plasma lactate concentration was significantly higher (P less than 0.001, approximately 50%) than in the erythrocytes. This difference was not altered by the venous blood lactate concentration or exercise intensity. A significant difference (P less than 0.01) in lactate concentration was also found between capillary whole blood and venous whole blood. It was concluded that direct comparisons between lactate in capillary finger blood, venous whole blood and plasma could not be made.

Polycyclic aromatic compounds in curing smoke.

The curing smoke, generated by the smouldering of alder chips, from a commercial food smoking plant was investigated with respect to polynuclear aromatic compounds (PAC). Samples were taken from inside the ovens and in the working zone immediately outside them. Analysis showed that considerable amounts of methyl phenanthrenes were present in the smoke as a major part of the PAC content.