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Abstract Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medi...
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... disturbances and elevated biomarkers of myocardial tissue damage are frequent in patients poisoned with carbon monoxide [17,21,22]. The symptoms depend on the amount of carboxyhemoglobin formed and the remaining hemoglobin available for oxygen transportation (Table 1) [23]. However, there is only a loose relation between carboxyhemoglobin levels and symptoms, and the whole clinical situation should be taken into account when assessing the patient [22]. ...Similar publications
Background: Dicobalt edetate and hydroxocobalamin are widely used to treat hydrogen cyanide poisoning. However, comparative and quantitative efficacy data are lacking. Although post-exposure treatment is typical, it may be possible to administer these antidotes before exposure to first attenders entering a known site of cyanide release, as suppleme...
Citations
... One of the menaces for public health, is the possible exposition to radiation or toxic related materials, as a consequence it is well known that, at a global level, strategical projects have emerged to act proactively in guaranteeing the availability of material and technological resources specifically designed to counteract foreseeable damages in exposed subjects, to minimize the long-term effects, as well as, if necessary, to provide a constant supply up to have controlled the risky situations [1,[11][12][13][14][15][16]. ...
... It has been reported that the harmful effects on human health by body loads of 137 Cs that have entered the body, inhaled, orally or through open wounds, can be either immediate and fatal, or manifest up to years after exposure as cases of cancer, and even as inherited disorders. Tl poisoning is usually caused by accidently or intentionally ingesting the non-radioactive form of this element [12,[20][21][22][23][24]. ...
... As the possibility of avoiding or mitigating the harmful effects on health in the long term with decorporation therapy is very limited, the term "urgent approach" arises, which consists of starting the treatment of all victims with suspected contamination as quickly as possible, until they have been formally excluded from said risk, by measuring the relevant contamination [12,14,21,24,25]. ...
Ferric hexacyanoferrate, Fe4 [Fe(CN)6]3 · xH2O, known as Prussian blue (PB), has proven its effectiveness as an antidote in cases of accidental poisoning or poisoning caused by radioactive materials such as cesium (Cs) and thallium (Tl); which due to their solubility in water, when absorbed by the human body, cause serious damage to vital organs. The local development of a drug with PB as an active ingredient arises as a response to the civil and military needs established within the Ministry's pharmacy request for national defense. This fact contemplates the circumstances related to public health protection in the nuclear, radiological, biological and chemical (NRBQ) of the emergency institutions in health and national security. In this paper and by using various analytical techniques, the characterization of the locally synthesized PB with pharmaceutical quality has been described, as a first step to predict its behavior in the preparation of a drug that contains it as an active ingredient.
The research findings demonstrate that locally synthesized PB is suitable for use in oral dosage forms, enabling the local development of drug formulations incorporating PB, thus being able to potentially become a main resource in the treatment of Cs and Tl poisoning in any accidental or intended of the population. This development opens up the possibility of creating drug formulations that incorporate PB at a local level, making it a potentially significant resource in the treatment of Cs and Tl poisoning. The ability to locally produce and utilize PB in oral dosage forms could be crucial in addressing cases of accidental or intentional exposure within the population. This advancement not only contributes to the scientific understanding of PB but also holds promising implications for practical applications in public health and emergency situations.
... According to official French guidelines, decorporation therapy should start within 2 h after radionuclide incorporation (ASN, 2008). Simulations have shown that there is a time window ranging from several hours to several days, depending on the radionuclide, the physicochemical properties of the compounds, and the invasion pathway, that should be used for optimum therapeutic efficacy (Rump et al., 2016(Rump et al., , 2017Yan et al., 2019). ...
Early fallout is defined as the fallback to the earth’s surface of radioactive particles shortly after a nuclear detonation (often arbitrarily defined within 24 h). At the difference of wide spreading global fallout, early fallout mainly consists of larger particles that are often visible. The initial mixture is rich in short- and very short-lived radionuclides associated with a very high initial activity that decreases rapidly (in 7 h, the dose rate is reduced by 90%). The main danger of early fallout results from external irradiation by highly penetrating gamma-radiation that may cause acute radiation sickness. Only in the case of the thyroid, internal irradiation by the incorporation of radioiodine may prevail. The bombings of Hiroshima and Nagasaki are examples of airbursts with many fatalities by prompt effects (blast, burns, and initial ionizing radiations), but they produced little fallout. The nuclear test code-named Castle Bravo on the Marshall Islands (1954) did not have casualties by its blast, thermal or initial radiation effects, but the inhabitants of the nearby islands and the crew of a Japanese fisherboat (Lucky Dragon) were affected by large amounts of fallout. For the inhabitants of the Rongelap Atoll, the average dose from external irradiation was assessed at 1.6 Gy. From a clinical point of view, based on hematological data using the METREPOL classification system, the acute radiation syndrome can be categorized as mild (H1). Blood transfusions were not required, and antibiotics were not administered for prophylaxis or therapy of infections related to irradiation. The equivalent dose received by the thyroid resulted mainly from internal irradiation with 7.6 Gy. The major late effects were thyroid abnormalities, including thyroid failure, nodules, and malignant tumors. The 23 Japanese crewmen seem to have been irradiated by higher doses (2.9 Gy). Compared to the hematological data of the Rongelap victims, the evolution pattern over time is quite similar. Still, the absolute values of the cell counts are lower, and on average, the acute radiation syndrome can be categorized as rather moderate (H2). Considering the individual cases, data show a large interindividual variability, and the clinical severity category ranges from “no alterations” (H0) to severe (H3). Victims were treated with repeated blood transfusions and antibiotics. Several of them developed jaundice, and one of them died six months after the incident showing symptoms compatible with subacute liver failure. A radiochemical organ analysis revealed that only the bones were clearly contaminated with fission products. In the 1990s, many surviving crewmen were diagnosed with hepatitis C, incurred probably from blood transfusions that were often contaminated at the time, and died from hepatocellular carcinomas. Thyroid dysfunctions were not reported. The Castle Bravo case permits to study the health hazards resulting from early fallout independently from the prompt effects of a nuclear detonation. The prevailing external irradiation was confirmed, except for the thyroid with a higher dose resulting from radioiodine incorporation mainly caused by ingestion. As shown for the Japanese fishermen, the risks incurred by medical treatments must be carefully weighed against the benefits of the therapeutic intervention. The cause of death of the only short-term fatality is not fully elucidated, but is consistent with liver failure due to transfusion hepatitis rather than radiation effects.
... Vitamin B 12 , also known as cobalamin, is a watersoluble vitamin. As an important bioactive substance in vivo, Vitamin B 12 exists in many forms in vivo. ...
... It plays an indispensable role in DNA synthesis, methylation, and maintaining genomic stability, and acts as a cofactor in a variety of biochemical processes. Vitamin B 12 accelerates the proliferation of granulation tissue and the regeneration of epithelial cells. It can also repair and regenerate damaged skin epithelial cells and vascular endothelial cells and nourish and promote the repair of damaged nerve sheaths. ...
... In addition, Vitamin B 12 ointment has excellent analgesic and antipruritic effects, and can effectively relieve skin pain. [10][11][12] Mini fragrant pigs are unique to China and have a skin morphology and tissue structure that strongly resembles that of humans. Importantly, the pig skin responds to radiation in a similar manner to human skin, both in terms of time-and dose-dependence. ...
Radiodermatitis is an inevitable side effect of radiotherapy in cancer treatment and there is currently no consensus on effective drugs for treating the condition. Vitamin B12 is known to be effective for repairing and regenerating damaged skin. However, there are few studies on the use of Vitamin B12 for treating radiodermatitis. This study explored the therapeutic efficacy and mechanism of action of Vitamin B12 ointment on radiodermatitis. A porcine model of grade IV radiodermatitis was established. The ointment was applied for 12 weeks after which histological staining, transmission electron microscopy, RT‐qPCR, western blotting, and gene sequencing were performed for the evaluation of specific indicators in skin samples. After 12 weeks of observation, the Vitamin B12 treatment was found to have significantly alleviated radiodermatitis. The treatment also significantly reduced the expression levels of NF‐κB, COX‐2, IL‐6, and TGF‐β in the skin samples. The pathways involved in the effects of the treatment were identified by analysing gene expression. In conclusion, Vitamin B12 ointment was found to be highly effective for treating radiodermatitis, with strong anti‐radiation, anti‐inflammatory, and anti‐fibrosis effects. It is thus a promising drug candidate for the treatment of severe radiodermatitis.
... The use of inhaled corticosteroids ensures the highest dose deposition in the airway, thus decreasing side effects and ameliorating pulmonary fibrosis [293]. Nevertheless, systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany [294] and there is no evidence of a significant longterm benefit based on the use of corticosteroids. ...
Atomic and radiological crises can be caused by accidents, military activities, terrorist assaults involving atomic installations, the explosion of nuclear devices, or the utilization of concealed radiation exposure devices. Direct damage is caused when radiation interacts directly with cellular components. Indirect effects are mainly caused by the generation of reactive oxygen species due to radiolysis of water molecules. Acute and persistent oxidative stress associates to radiation-induced biological damages. Biological impacts of atomic radiation exposure can be deterministic (in a period range a posteriori of the event and because of destructive tissue/organ harm) or stochastic (irregular, for example cell mutation related pathologies and heritable infections). Potential countermeasures according to a specific scenario require considering basic issues, e.g., the type of radiation, people directly affected and first responders, range of doses received and whether the exposure or contamination has affected the total body or is partial. This review focuses on available medical countermeasures (radioprotectors, radiomitigators, radionuclide scavengers), biodosimetry (biological and biophysical techniques that can be quantitatively correlated with the magnitude of the radiation dose received), and strategies to implement the response to an accidental radiation exposure. In the case of large-scale atomic or radiological events, the most ideal choice for triage, dose assessment and victim classification, is the utilization of global biodosimetry networks, in combination with the automation of strategies based on modular platforms.
... In the case of combination injuries (blast injury + irradiation and/or radioactive contamination), it should be noted that mechanical trauma can cause an immediately life-threatening situation (e.g., tension pneumothorax), whereas acute radiation sickness develops with a latency ranging from days to weeks. Therefore, as in every medical emergency, the principle "treat first what kills first" applies [33,43]. The preservation of the vital functions always has first priority and initial triage and treatment decisions must be done using the general rules of trauma care [33]. ...
In the case of a terrorist attack by a “dirty bomb”, blast injuries, external irradiation and the incorporation of radioactivity are to be expected. Departing from information about the radiological attack scenario with cesium-137 in the U.S. National Scenario Planning Guide, we estimated the radiological doses absorbed. Similar calculations were performed for a smaller plume size and a detonation in a subway. For conditions as described in the U.S. scenario, the committed effective dose amounted to a maximum of 848 mSv, even for very unfavorable conditions. Red bone marrow equivalent doses are insufficient to induce acute radiation sickness (ARS). In the case of a smaller plume size, the ARS threshold may be exceeded in some cases. In a subway bombing, doses are much higher and the occurrence of ARS should be expected. The health hazards from a dirty bomb attack will depend on the location and the explosive device. The derived Haddon matrix indicates that preparing for such an event includes education of all the medical staff about radiation effects, the time lines of radiation damages and the treatment priorities. Further determinants of the outcome include rapid evacuation even from difficult locations, the availability of a specific triage tool to rapidly identify victims at risk for ARS, the availability of an antidote stockpile and dedicated hospital beds to treat seriously irradiated victims.
... From a medical point of view, victims of a dirty bomb attack may suffer blast injuries with mechanical trauma due to fragments and burns. These injuries may be life threatening and according to the principle "treat first what kills first" should be treated with first priority [13,14]. External irradiation may occur, but the analysis of many hypothetical scenarios suggests that the radiological doses absorbed by most victims would not be sufficient to cause acute radiation sickness, at least in the case of an area denial bomb attack with cesium-137. ...
Background
In radiological emergencies with radionuclide incorporation, decorporation treatment is particularly effective if started early. Treating all people potentially contaminated (“urgent treatment”) may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses.
Methods
The committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix, we departed from a large-scale scenario (60,000 victims) and based on purchase prices of antidotes and screening equipment in Germany, we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life.
Results
Monitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment, an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The cost-effectiveness of preparedness for a “dirty bomb” attack is less than for common health care, but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector.
Conclusion
To achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed, the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for “dirty bomb” attacks is an issue of principle that must be dealt with by political leaders.
... Whole lung lavage (WLL), formerly known as bronchoalveolar lavage, is performed via double-lumen endotracheal intubation under general anesthesia; it is used to treat lung diseases by lavage, removing inhaled dust, inflammatory cells, cytokines, immune reaction products, and foreign substances from the lungs (Lacin 2016;Lu et al. 2017). At present, it is also the primary method used to remove radionuclides from the respiratory system (Gay et al. 2017), particularly in cases of insoluble radionuclide inhalation and high-dose exposure (Yan et al. 2019). However, opinions differ regarding when WLL should be initiated to achieve the best results and promote excretion. ...
Purpose
This study compared the effect of whole lung lavage (WLL) at different time-points early after exposure of the respiratory system to insoluble radioactive particles.
Materials and methods
Forty adult beagles were randomized into a control group and the 3-h, 8-h, 24-h, and 48-h lavage groups (n = 8). A canine model of acute lung injury was established by spraying a depleted uranium (DU) suspension using a superfine fiber bronchoscope, at a dose of 20 mg/kg. The lavage groups were subjected to WLL at 3 h, 8 h, 24 h, and 48 h post-DU exposure, while the control group received no treatment after exposure. Measurement of U in serum was performed using inductively coupled plasma mass spectrometry; measurements in the lavage fluid and left lung tissue were performed using inductively coupled plasma atomic emission spectrometry. The color of the lavage fluid was analyzed using colorimetry, and shadow changes in the lung were observed using chest computed tomography (CT).
Results
The lavage groups showed similarly increasing trends for serum U levels from DU exposure to 3 and 7 days after exposure; however, these values were significantly lower than those in the control group (P < 0.01). The U content in the lavage fluid was significantly higher in the 3-h group than in the 8-h, 24-h, and 48-h groups (P < 0.01), while that in the 8-h group was markedly higher than those in the 24-h and 48-h groups (P < 0.05). The average clearance rate of DU in the lungs varied in the range of 0.63‒7.06%. The U content in the left lung tissue of each lavage group was significantly lower than that in the control group (P < 0.01), while the content in the 8-h, 24-h, and 48-h groups was significantly higher than that in the 3-h group (P < 0.05). The colorimetric score of the lavage fluid in the 3-h group was significantly lower than those in the 8-h, 24-h, and 48-h groups (P < 0.05). Chest CT showed different degrees of consolidation and ground glass shadow changes in all groups. The score of the left lung shadow volume in the 3-h group was significantly lower than in the control, 8-h, 24-h, and 48-h groups (P < 0.01), while the score in the 8-h group was significantly higher than those in the 48-h and control groups (P < 0.05).
Conclusions
The best effect of WLL after exposure of the respiratory system to insoluble radioactive particles was achieved at 3 h, followed by 8 h; there was no difference in the effectiveness of lung lavage at 24 h and 48 h.
... Cerium oxidation states during processing. The cerium oxidation states during key steps in the separation were confirmed using cerium L 3 -edge X-ray absorption spectroscopy (XAS), which represents the most diagnostic analytical technique available for differentiating Ce III from Ce IV (Fig. 3) [12][13][14][15][16] . To characterize progression of the cerium oxidation state through the separation procedure, macroscopic amounts of Ce III (~0.7 mg) were oxidized and fixed to the anion-exchange resin (AG MP-1) and the column was washed (as described above). ...
... The first chelator, DTPA ( Fig. 1), provided a perfect testbed for 134 Ce III proof-of-concept experiments. Although this DTPA ligand does bind +4 metals, it is a well-established binder of f-block metals in the +3 oxidation state, with similar thermodynamic stability for corresponding M III and M IV complexes [13][14][15][16][17] . The second chelator was 3,4,3-LI(1,2-HOPO) (Fig. 1), a multidentate ligand that is exceptionally suited for binding +4 metals 18,19 , with reported thermodynamic stability constants from M IV complexes being 25 orders of magnitude higher than those from analogous M III complexes 18,20 . ...
Developing targeted α-therapies has the potential to transform how diseases are treated. In these interventions, targeting vectors are labelled with α-emitting radioisotopes that deliver destructive radiation discretely to diseased cells while simultaneously sparing the surrounding healthy tissue. Widespread implementation requires advances in non-invasive imaging technologies that rapidly assay therapeutics. Towards this end, positron emission tomography (PET) imaging has emerged as one of the most informative diagnostic techniques. Unfortunately, many promising α-emitting isotopes such as 225Ac and 227Th are incompatible with PET imaging. Here we overcame this obstacle by developing large-scale (Ci-scale) production and purification methods for 134Ce. Subsequent radiolabelling and in vivo PET imaging experiments in a small animal model demonstrated that 134Ce (and its 134La daughter) could be used as a PET imaging candidate for 225AcIII (with reduced 134CeIII) or 227ThIV (with oxidized 134CeIV). Evaluating these data alongside X-ray absorption spectroscopy results demonstrated how success relied on rigorously controlling the CeIII/CeIV redox couple.
Diagnosis of carbon monoxide (CO) poisoning is challenging, as it is generally based on a history of present illness leading to clinical suspicion. CO is a tasteless, odorless, and colorless gas that has become known as the “silent killer.” CO poisoning affects approximately 50,000 people in the United States each year and presents with wide range of nonspecific symptoms. Patients often do not know that they are being exposed to CO gas; it is therefore important to ask pertinent questions when taking a patient's history. Treatment consists of oxygen therapy. If a diagnosis is not made and treatment is not administered promptly, complications may occur.
The Radiation Emergency Assistance Center/Training Site or REAC/TS is a United States Department of Energy (DOE) emergency response asset and part of the National Nuclear Security Administration's (NNSA) Nuclear Emergency Support Team (NEST). REAC/TS started in 1976 to provide support to the US DOE and is under the Oak Ridge Institute for Science and Education (ORISE) and operated for the US DOE by Oak Ridge Associated Universities, a consortium of 125+ universities to further science and developing future scientists. As part of the support for the US DOE, REAC/TS is on call 24 hours a day, seven days a week for any radiological/nuclear (R/N) injuries or illnesses in the US and throughout the world. REAC/TS was one of the initial eight World Health Organization (WHO) Collaborating Centers, throughout the world, established in 1980 for radiation emergency management and subsequent member of WHO's Radiation Emergency Management Preparedness and Assistance Network (REMPAN). This article will discuss the REAC/TS experience with more recent internal contamination cases and discuss the many gaps existing in assessing and managing cases of internal contamination.
