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Attention regarding perfluoroalkyl and polyfluoroalkyl substances (PFAS) has increased in recent years, due to recognition of widespread environmental presence, recognition of a chemical structure that confers resistance to degradation, and reported health concerns. Historical common exposure sources include food, drinking water, occupational circumstances, and products in commerce (e.g., carpeting, clothing, paper products). Early-2000's data showed perfluorooctanoic acid (PFOA) was present in blood samples from nearly all the U.S. general population (>99%). Alterations in industrial manufacturing processes, increased regulatory scrutiny, and advanced water treatment options have reduced the reported human body burden of PFAS in the U.S., including for PFOA. Human serum concentrations of PFOA, which do not identify the source(s) of exposure, have exhibited a substantial decrease (~63%) between the 1999-2000 and the 2013-2014 NHANES monitoring by the Centers for Disease Control and Prevention (CDC). With respect to both noncancer and potential cancer effects that may be associated with reported serum levels of PFOA, conclusions regarding an absence of effects, or insufficient information to suggest adverse effects, prevent a consistent conclusion about the occurrence and magnitude of human health effects. In the last several years, a number of state and federal agencies have developed health advisories or guideline values for drinking water exposure that are in the sub-ppb range. In 2016, a USEPA Health Advisory of 0.07 ppb was released, which stands in contrast to 2016 Health-based Values from Health Canada ranging from 0.2 ppb (PFOA) to 30 ppb, and a few other U.S. states with values even less than that of USEPA (e.g., MN, NJ, VT). Further work is necessary to distinguish in transparent fashion between drinking water levels that intentionally are set on a conservative basis to protect human health vs exposure levels that may be associated with tangible adverse effects. [ABSTRACT FROM AUTHOR]

This study examines experiences of living with chronic illness for haemodialysis patients. In order to understand these experiences the paper takes an existential-phenomenological approach. Interviews of seven participants (five males, two females) were collected in a haemodialysis clinic. Based upon the participants experiences three core themes emerged: (1) the challenges of living with chronic renal failure; (2) body changes and embodiment; (3) their illness experience and social relationships. The findings suggest that the illness experience of chronic renal failure is an on-going struggle to attain a sense of control. We suggest that where a sense of control is limited this can create a sense of powerlessness. Further, the illness experience was not solely restricted to the individual, but also affected wider social relationships. It is only through taking into account the context of patients experience of illness that clinicians/nurses can meaningfully draw on all aspects of evidence to reach integrated clinical judgement. [ABSTRACT FROM AUTHOR]

Antifouling paints may contain copper which prevents the attachment and growth of organisms on vessel hulls. In the study, estuarine copper concentrations and its dispersal are determined as well as whole-body copper burden of Mytilus edulis deployed at 8 sites in the estuary, following boat wash-down in Lymington estuary, United Kingdom. The copper concentrations half a meter away from a boat wash-down was quickly diluted within 4 h. But 24 h following a wash down, copper levels remained 10- to 20-fold elevated above the levels 30 m away from the source. Copper concentrations in the sediment half a meter from the point source were about 100-fold greater than within the marina but the marina sediment concentrations were still above the effect range low. Mortality of M. edulis was not observed, but copper body burden 24 h following a wash down event was up to tenfold elevated for 5 d before returning to normal within 21 d. [ABSTRACT FROM AUTHOR]

Introduction: Mercury has long been prohibited for use in skin-lightening agents, but such products are still widely available in many parts of the world. Objective: To evaluate the characteristics of subjects with nephrotic syndrome caused by exposures to skin-lightening products containing mercury and the impact of treatments with chelation agents and/or steroids on the time to achieve remission of proteinuria and normal urine mercury concentrations. Methods: We searched Medline and Embase (1971–31 March 2019), Google Scholar (2001–March 2019) and WanFang Data (1999–March 2019), using mercury, mercury poisoning, cosmetics, skin-lightening and nephrotic syndrome as search terms. Affected subjects must have had nephrotic range proteinuria and a renal biopsy performed. The searches revealed 46 citations, but 32 were excluded because of a doubtful history, incomplete data collection, more than one source of mercury exposures, non-nephrotic proteinuria, treatments by herbal medicines and duplicate articles. The 14 remaining reports describing 30 cases formed the basis of this review. Incidence and geographical origins: There was an obvious increase in the number of reports with more complete information from Asia (n = 13) and Europe (n = 1) during 2002–2006 (n = 3) and 2010–2017 (n = 11), involving 3 subjects in 2002–2006 and 27 subjects in 2010–2017. Characteristics of subjects: All 30 subjects were Asian females, mostly aged 18–52 years (median 34 years). Nephrotic syndrome occurred 1–60 months (median 5 months) after exposures to mercury. The proteinuria was heavy (urinary protein excretion 3.2–20.7 g/day, median 5.7 g/day). Other features of mercury toxicity were generally absent. Blood mercury concentrations were normal in 6 subjects and 1.1–10.9 times (median 3.5 times) the upper limit of normal in 14 subjects. Urine mercury concentrations were much higher in 24 subjects, at 1.2–94.6 times (median 9.8 times) the upper limit of normal. Renal biopsy typically revealed minimal change disease (67%) or membranous nephropathy (23%). Etiological importance of mercury: Several clinical observations strongly support the etiological importance of mercury, including a positive relationship between body mercury burden (24-h urine mercury excretion) and severity of proteinuria, the parallel (often proportional) reductions in body mercury burden and proteinuria after cessation of exposures and initiation of chelation therapy and the risk of persistent proteinuria in subjects not treated with chelating agents. Natural history and impact of specific treatments: Spontaneous recovery (within 1.5 months) of mercury-induced nephrotic syndrome was rare. Twenty-three subjects were treated with chelating agents (n = 7) or chelating agents plus steroids (n = 16). There was relatively clear information on the time to remission of proteinuria (urine protein <150 mg/day) in nine subjects following chelation therapy (n = 5) or chelation therapy plus steroids (n = 4) (median 2 months, range 1–9 months). In comparison, the time to remission was longer in three subjects not treated with chelation therapy (≥12 months). There were fewer reports with relatively clear information on the time to achieve normal urine mercury concentrations (<35 nmol/day, <50 nmol/L or <5.0 nmol/mmol creatinine). In four subjects with treatment by chelating agents (n = 1) or chelating agents plus steroids (n = 3), this took 9–16 months (mean ∼11 months). The adjunctive role of steroids in mercury-induced nephrotic syndrome was unclear. Conclusions: Repeated exposures to inorganic mercury in skin-lightening cosmetic products typically cause minimal change disease or membranous nephropathy, resulting in nephrotic syndrome. Apart from cessation of product use, chelation therapy is clearly indicated, in view of the etiological importance of mercury and the presence of increased body burden with target organ damage. The optimal dosages and treatment strategies for unithiol (2,3-dimercapto-1-propanesulfonic acid) and succimer (dimercaptosuccinic acid) have yet to be determined. [ABSTRACT FROM AUTHOR]

For many years, the sculpin has been utilized as a sentinel monitoring species for anthropogenic impacts on the marine environment. To further develop its potential as a screening model body burden of several trace elements, including cadmium (Cd), copper (Cu), mercury (Hg), lead (Pb) and selenium (Se), were investigated. In addition, histopathology in shorthorn sculpins (Myoxocephalus scorpius; n = 20) and fourhorn sculpins (Myoxocephalus quadricornis; n = 10) were examined at three sites around the Scoresby Sound settlement in Central East Greenland. Fourhorn sculpins caught at the most distant site from the settlement, contained significantly higher hepatic Cu and Cd concentrations as well as significantly elevated gill Pb levels compared to the shorthorn sculpins collected at two other sites closer to the settlement. Histological examinations showed that fish with significantly higher concentrations of hepatic Cd and Se exhibited greater nuclear alterations, interstitial hyperplasia/hypertrophy, interstitial mononuclear infiltrations and granulomas. Further, fish with higher Cd and Cu gill tissue levels displayed a significantly higher number of cytoplasmic alterations and lamellar epithelium lifting, hypertrophic and hyperplastic epithelium along with mucus cell hyperplasia. While the presence of liver lesions were not species or sex-specific, the presence of gill lesions decreased in the order female fourhorn sculpins > female shorthorn sculpins > male fourhorn sculpins > male shorthorn sculpins. Hepatic Hg concentrations exceeded known lowest observable effect doses (LOED) for fish (0.1–0.5 μg g−1 ww) in 27% of fish, while liver Cd residues in 80% exceeded LOED (0.42–1.8 μg g−1 ww). Based upon these results, data suggest that using the sculpin as a valuable sentinel fish species histopathology may serve as a reliable tool for assessing marine ecosystem exposure to trace metals. However, confounding physiological and ecological factors also need to be considered. [ABSTRACT FROM AUTHOR]