Tetracyclines (TCs), used as human and veterinary medicines, are the most widely used antibiotics. More than 75% of TCs are excreted in an active form and released into the environment through human ...and animal urine and feces, causing adverse effects on the ecological system and human health. Few articles review the environmental occurrence and behaviors of TCs, as well as their risks and toxicities. Here, we comprehensively summarized the recent advances on the following important issues: (1) Environmental occurrence of TCs. TCs are used globally and their occurrence in the aquatic environment has been documented, including surface water, groundwater, drinking water, wastewater, sediment, and sludge. (2) Environmental behaviors of TCs, particularly the fate of TCs in wastewater treatment plants (WWTPs). Most WWTPs cannot effectively remove TCs from wastewater, so alternative methods for efficient removal of TCs need to be developed. The latest degradation methods of TCs are summarized, including adsorption, photocatalytic, photochemical and electrochemical, and biological degradations. (3) Toxicities and possible risks of TCs. The toxicological data of TCs indicate that several TCs are more toxic to algae than fish and daphnia. Risk assessments based on individual compound exposure indicate that the risks arising from the current concentrations of TCs in the aquatic environment cannot be ignored.
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•Occurrence, fate, toxicity and risk of typical TCs in the aquatic environment were summarized.•Huge amount of TCs are used and > 75% released in active form to the aquatic environment.•TCs can be degraded and mineralized by alternative advanced oxidation processes in WWTPs.•TCs are more toxic to algae than daphnia and fish, generally in the order TC > CTC > OTC.•Currently TCs exhibit non-negligible risks to aquatic ecosystem and organisms.
Ecological risk assessment of metals (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) in surface sediments from 31 small craft harbours (SCHs) in Nova Scotia, Canada was conducted using multiple risk assessment ...approaches. Approaches used were contamination factor, pollution load index, geoaccumulation index, potential ecological risk factor for individual metals, comprehensive potential ecological risk index, mean probable effect level quotient and mean effects range median quotient. Results indicated most SCHs exhibited low ecological risk from sediment metal concentrations, except for two harbours. Metal contamination was highest in Canso Harbour, followed by Clarks Harbour. SCH sediments were only slightly contaminated with low probability of pollution according to mean probable effect level and mean effects range median quotients. However, pollution load and geoaccumulation indexes indicated Cd and Hg had the highest metal contamination across SCH sediments. Cadmium and Hg had the highest potential ecological risk, respectively compared to other metals.
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•Risk assessment of metals in small craft harbour (SCH) sediments was conducted.•Multiple ecological risk assessment approaches were assessed in 31 SCHs in Nova Scotia.•SCHs sediments had 9–10% probability of toxicity and categorized as slightly toxic.•Potential ecological risk of Cd was higher than other metals.•Canso and Clarks Harbour exhibited highest ecological risk compared to other SCHs.
1. Predictions of the identities and ecological impacts of invasive alien species are critical for risk assessment, but presently we lack universal and standardized metrics that reliably predict the ...likelihood and degree of impact of such invaders (i.e. measurable changes in populations of affected species). This need is especially pressing for emerging and potential future invaders that have no invasion history. Such a metric would also ideally apply across diverse taxonomic and trophic groups. 2. We derive a new metric of invader ecological impact that blends: (i) the classic Functional Response (FR; consumer per capita effect) and Numerical Response (NR; consumer population response) approaches to determining consumer impact, that is, the Total Response (TR = FR × NR), with; (ii) the Tarker-Lonsdale equation' for invader impact, where Impact = Range × Abundance × Effect (per capita effect), into; (iii) a new metric, Relative Impact Potential (RIP), where RIP = FR × Abundance. The RIP metric is an invader/native ratio, where values > 1 predict that invader ecological impact will occur, and increasing values above 1 indicate increasing impact. In addition, the invader/invader RIP ratio allows comparisons of the ecological impacts of different invaders. 3. Across a diverse range of trophic and taxonomic groups, including predators, herbivores, animals and plants (22 invader/native systems with 47 individual comparisons), high-impact invaders were significantly associated with higher FRs compared to native trophic analogues. However, the RIP metric substantially improves this association, with 100% predictive power of high-impact invaders. 4. Further, RIP scores were significantly and positively correlated with two independent ecological impact scores for invaders, allowing prediction of the degree of impact of invasive alien species with the RIP metric. Finally, invader/invader RIP scores were also successful in identifying and associating with higher impacting invasive alien species. 5. Synthesis and applications. The Relative Impact Potential metric combines the per capita effects of invaders with their abundances, relative to trophically analogous natives, and is successful in predicting the likelihood and degree of ecological impact caused by invasive alien species. As the metric constitutes readily measurable features of individuals, populations and species across abiotic and biotic context-dependencies, even emerging and potential future invasive alien species can be assessed. The Relative Impact Potential metric can be rapidly utilized by scientists and practitioners and could inform policy and management of invasive alien species across diverse taxonomic and trophic groups.
Background
Because hospital‐acquired venous thromboembolism (VTE) represents a frequent cause of preventable deaths in medical inpatients, identifying at‐risk patients requiring thromboprophylaxis is ...critical. We aimed to externally assess the Caprini, IMPROVE, and Padua VTE risk scores and to compare their performance to advanced age as a stand‐alone predictor.
Methods
We performed a retrospective analysis of patients prospectively enrolled in the PREVENU trial. Patients aged 40 years and older, hospitalized for at least 2 days on a medical ward were consecutively enrolled and followed for 3 months. Critical ill patients were not recruited. Patients diagnosed with VTE within 48 hours from admission, or receiving full dose anticoagulant treatment or who underwent surgery were excluded. All suspected VTE and deaths occurring during the 3‐month follow‐up were adjudicated by an independent committee. The three scores were retrospectively assessed. Body mass index, needed for the Padua and Caprini scores, was missing in 44% of patients.
Results
Among 14 910 eligible patients, 14 660 were evaluable, of which 1.8% experienced symptomatic VTE or sudden unexplained death during the 3‐month follow‐up. The area under the receiver operating characteristic curves (AUC) were 0.60 (95% confidence interval CI 0.57‐0.63), 0.63 (95% CI 0.60‐0.66) and 0.64 (95% CI 0.61‐0.67) for Caprini, IMPROVE, and Padua scores, respectively. None of these scores performed significantly better than advanced age as a single predictor (AUC 0.61, 95% CI 0.58‐0.64).
Conclusion
In our study, Caprini, IMPROVE, and Padua VTE risk scores have poor discriminative ability to identify not critically ill medical inpatients at risk of VTE, and do not perform better than a risk evaluation based on patient's age alone.
Management of long-term immunosuppression following liver transplantation (LT) remains empirical. Surveillance liver biopsies in combination with transcriptional profiling could overcome this ...challenge by identifying recipients with active alloimmune-mediated liver damage despite normal liver tests, but this approach lacks applicability. Our aim was to investigate the utility of non-invasive tools for the stratification of stable long-term survivors of LT, according to their immunological risk and need for immunosuppression.
We conducted a cross-sectional multicentre study of 190 adult LT recipients assessed to determine their eligibility to participate in an immunosuppression withdrawal trial. Patients had stable liver allograft function and had been transplanted for non-autoimmune non-replicative viral liver disease >3 years before inclusion. We performed histological, immunogenetic and serological studies and measured the intrahepatic transcript levels of an 11-gene classifier highly specific for T cell-mediated rejection (TCMR).
In this cohort, 35.8% of patients harboured clinically silent fibro-inflammatory liver lesions (13.7% had mild damage and 22.1% had moderate-to-severe damage). The severity of liver allograft damage was positively associated with TCMR-related transcripts, class II donor-specific antibodies (DSAs), ALT, AST, and liver stiffness measurement (LSM), and negatively correlated with serum creatinine and tacrolimus trough levels. Liver biopsies were stratified according to their TCMR transcript levels using a cut-off derived from biopsies with clinically significant TCMR. Two multivariable prediction models, integrating ALT+LSM or ALT+class II DSAs, had a high discriminative capacity for classifying patients with or without alloimmune damage. The latter model performed well in an independent cohort of 156 liver biopsies obtained from paediatric liver recipients with similar inclusion/exclusion criteria.
ALT, class II DSAs and LSM are valuable tools to non-invasively identify stable LT recipients without significant underlying alloimmunity who could benefit from minimisation of immunosuppression.
A large proportion of liver transplant patients with normal liver tests have inflammatory liver lesions, which in 17% of cases are molecularly indistinguishable from those seen at the time of rejection. ALT, class II donor-specific antibodies and liver stiffness are useful in identifying patients with this form of subclinical rejection. We propose these markers as a useful tool to help clinicians determine if the immunosuppression administered is adequate.
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•22% of stable liver recipients harbour moderate-to-severe subclinical immune allograft damage.•Subclinical damage is linked to allograft immunogenicity and degree of immunosuppression.•Recipients with active underlying alloimmunity can be identified using non-invasive markers.
IMPORTANCE: An estimated 1.2 million persons in the US currently have HIV, and more than 760 000 persons have died of complications related to HIV since the first cases were reported in 1981. ...Although treatable, HIV is not curable and has significant health consequences. Therefore, effective strategies to prevent HIV are an important public health and clinical priority. OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of preexposure prophylaxis with antiretroviral therapy for the prevention of HIV acquisition, and the diagnostic accuracy of risk assessment tools to identify persons at increased risk of HIV acquisition. POPULATION: Adolescents and adults who do not have HIV and are at increased risk of HIV. EVIDENCE ASSESSMENT: The USPSTF concludes with high certainty that there is a substantial net benefit from the use of effective antiretroviral therapy to reduce the risk of acquisition of HIV in persons at increased risk of acquiring HIV. RECOMMENDATION: The USPSTF recommends that clinicians prescribe preexposure prophylaxis using effective antiretroviral therapy to persons at increased risk of HIV acquisition to decrease the risk of acquiring HIV. (A recommendation)
Summary Background The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed ...to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. Methods We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov , number NCT01164371. Findings During 5·2 years median follow-up, we recorded 83 098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90–114 mm Hg and diastolic blood pressure of 60–74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 95% CI 1·32–1·58), subarachnoid haemorrhage (1·43 1·25–1·63), and stable angina (1·41 1·36–1·46), and weakest for abdominal aortic aneurysm (1·08 1·00–1·17). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 95% CI 0·86–0·98) and strongest for peripheral arterial disease (1·23 1·20–1·27). People with hypertension (blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9–63·8) compared with 46·1% (45·5–46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8–5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years. Interpretation The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them. Funding Medical Research Council, National Institute for Health Research, and Wellcome Trust.
•We firstly reviewed the occurrence data of PPCPs in aquatic environment in China.•PPCP levels were lower than or comparable to those reported in other countries.•PPCP pollution was related to ...megacities with high density of population.•Six PPCPs were identified as priority in waters in China.•Research needs and regulatory issues were discussed based on the reviewed studies.
Pharmaceuticals and personal care products (PPCPs) have been detected as contaminants of emerging concern ubiquitously in the aquatic environment in China and worldwide. A clear picture of PPCP contamination in the Chinese aquatic environment is needed to gain insight for both research and regulatory needs (e.g. monitoring, control and management). The occurrence data of 112 PPCPs in waters and sediments in China has been reviewed. In most cases, the detected concentration of these PPCPs in waters and sediments were at ng/L and ng/g levels, which were lower than or comparable to those reported worldwide. A screening level risk assessment (SLERA) identified six priority PPCPs in surface waters, namely erythromycin, roxithromycin, diclofenac, ibuprofen, salicylic acid and sulfamethoxazole. The results of SLERA also revealed that the hot spots for PPCP pollution were those river waters affected by the megacities with high density of population, such as Beijing, Tianjin, Guangzhou and Shanghai. Limitations of current researches and implications for future research in China were discussed. Some regulatory issues were also addressed.
Next-Generation Risk Assessment (NGRA) aims to implement New Approach Methodologies (NAMs) into risk assessment and to rely on new in vivo testing in animals only as a last resort. However, various ...technical and regulatory hurdles impede their regulatory implementation. Assumptions about the public's expectations could act as barriers to the acceptance of NAMs. This study aimed at investigating public views of animal testing and potential alternatives, namely in vitro and in silico testing. An online survey was conducted (N = 965). The results suggest that people make trade-offs, as they experience negative affect regarding in vivo testing, which partly might explain their openness regarding certain alternatives. In vitro tests were attributed the highest ability to determine harmful effects of chemicals for different endpoints, followed by in vivo and in silico tests. Our results further showed that many people accept chemicals to be only tested with alternatives, with highest acceptance for household consumer products, food contact material or building materials and less accepting for medicines and foods. This article addresses potential challenges that might arise from public perceptions and thus, contributes to the bottom-up initiatives to overcome the hurdles to the implementation of NAMs in regulatory risk assessment.
•Acceptability of in vivo testing was low, but highest for medicine and food.•In vitro tests elicited the highest expected ability to determine harmful effects.•Testing substances with alternatives to in vivo tests did not elicit public concern.•People apply affect and trust heuristics when confronted with different tests.
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