Hasil untuk "Toxicology. Poisons"

Bingbu Li, Bingbu Li, Bingbu Li et al.

IntroductionDeltamethrin is a pyrethroid insecticide commonly used to kill animal parasites in aquaculture. However, increasing evidence suggests that deltamethrin affects the health of aquatic animals by causing tissue damage and even death.MethodsIn this study, the damage caused by deltamethrin to the gill and liver tissues, as well as its effects on oxidative stress and immune metabolism, were studied in Paralichthys olivaceus.ResultsWe observed a positive correlation between the residual levels of deltamethrin (Del) and the exposure concentrations, with the highest residue detected in the 0.28 μg/L concentration group (0.0684 mg/kg at 7 days). Then, we observed different degrees of damage to the gill and liver tissues of the Paralichthys olivaceus, including swelling, apical fusion, shedding of gill secondary lamellae, liver cell necrosis, and nuclear vacuolization, by observing tissue sections. Lysozyme enzyme activity increased, whereas catalase and alkaline phosphatase enzyme activities decreased. The liver transcriptome results of the control and high-concentration (0.28 μg/L) groups showed that there were 697 differentially expressed genes, including 390 upregulated and 307 downregulated genes. These differentially expressed genes were significantly enriched in oxidation-reduction, ferroptosis, steroid biosynthesis, and apoptosis pathways.DiscussionIn summary, we found that deltamethrin induces oxidative stress and metabolic disorders in P. olivaceus and leads to inflammation. However, the fish body resists such damage through a complex regulatory network. These experimental results provide a theoretical reference for the safe use of deltamethrin in P. olivaceus.

Tommaso Campani, Ginevra Manieri, Ilaria Caliani et al.

Agroecosystems provide habitats, food, and water for many pollinators and insects, but they are also heavily exposed to threats from the widespread use of pesticides and fertilizers. Managed honeybees and wild bees encounter pesticides in vineyards by collecting morning dew from vine leaves and accessing sugars from grapes, particularly during dry periods. This study assessed the toxicological effects of the commercial fungicide formulations Fantic FNCWG^® and Ramedit combi^®, both individually and in combination, on honeybees. Using a multi-biomarker approach, we evaluated neurotoxicity, metabolic disturbances, phase II detoxification processes, and immune system function. Our findings revealed that commercial fungicide mixtures with multiple active ingredients affect bees differently than single active compounds. Biomarker responses highlighted how these complex mixtures disrupt various enzymatic pathways; including immune function; altering critical enzyme kinetics involved in detoxification and potentially impairing essential bee functions. This study emphasizes the need for more comprehensive research into the sublethal effects of commercial pesticides, particularly those used in vineyards, which are understudied compared to pesticides used in orchards.

Enas M. ALzayadneh, Kamal A. ALHadidi, Ihab Alasasfeh et al.

Introduction: Acute accidental poisoning in children remains a significant public health issue and a predictable cause of morbidity around the world. To take preventive measures, it is necessary to identify the pattern of this problem. Objective: To determine the extent and characteristics of paediatric poisoning, an epidemiological investigation specific to each country is required. The goal of our research was to determine the current pattern of acute poisoning in children between (0−5) years old in Jordan. Methods: This retrospective study performs a descriptive analysis of the Jordan University Hospital’s National Poison Information Center (NPIC) database and describes the epidemiology of acute poisoning in children between (0−5) years old during a period of two years (2018–2019). Results: Paediatric poisoning (0−5) years old accounts for approximately 88% of poisoning cases in Jordan between 2018 and 2019.Out of 3531 paediatric poisoning cases, 44.9% of cases were in children between (2−3) years old, 63.4% of subjects were male. 40.9% of calls were from governmental hospitals. Most cases occurred at home (98.7%) and were unintentional (98.6%). Medication poisoning was the commonest among cases (71.0%). Besides, 89.4% were asymptomatic at the time of call, and Central Nervous System (CNS) symptoms being the most common (3.6%) among the symptomatic cases. Conclusions: Most cases of paediatric poisoning handled by the NPIC was due to medications. To prevent or minimize these cases, it is necessary to educate parents and other caregivers about proper medication storage and use, and in case of poisoning, urgent referral to health facilities is required.

Hui SHI, Guzhengyue ZHENG, Xing ZHAO et al.

In environmental epidemiological research, extensive non-random environmental exposures and complex confounding biases pose significant challenges when attempting causal inference. In recent years, the introduction of causal inference methods into observational studies has provided a broader range of statistical tools for causal inference research in environmental epidemiology. The instrumental variable (IV) approach, as a causal inference technique for effectively controlling unmeasured confounding factors, has gradually found application in the field of environmental epidemiological research. This article reviewed the basic principles of IV and summarized the current research progress and limitations of applying IV for causal inference in environmental epidemiology. IV application in the field of environmental epidemiology is still in the initial stage. Rational use of IV and effective integration with other causal inference methods will become the focus of the development of causal inference in environmental epidemiology. The aim of this paper is to provide a methodological reference and basis for future studies involving causal inference to target population health effects of environmental exposures in China.

Peifang LIU, Bo SHEN, Xuyan XU et al.

BackgroundDentists are a high-risk population of work-related musculoskeletal disorders (WMSDs), where the body part with the highest prevalence is the neck. ObjectiveTo analyze potential influencing factors of neck pain among dentists, and explore a prediction model of neck pain in dentists. MethodsDentists from different hospitals in Fuzhou were selected as study subjects by stratified cluster sampling according to hospital characteristics (dental hospitals, general hospitals, and dental clinics). The basic information, presentation of WMSDs, and its influencing factors were investigated by using the Chinese version of Musculoskeletal Disorders Questionnaire and the Subjective Workload Assessment Technique. A total of 655 questionnaires were collected, of which 603 were valid, with an effective rate of 92.1%. Multiple logistic regression was used to analyze potential influencing factors of neck pain in dentists. A prediction model of neck pain of dentists was constructed by using neural network model, and the prediction efficiency of the model was evaluated. ResultsThe neck was the body part with the highest prevalence (43.8%, 264/603) of WMSDs among dentists. The results of multiple logistic regression analysis showed that female (OR=2.709, 95%CI: 1.852-3.962, P <0.001), working age of 10-<20 years (versus <10 years, OR=3.836, 95%CI: 2.471-5.957, P<0.001), keeping head up or down for a long time (OR=8.492, 95%CI: 2.203-32.731, P=0.002), holding head sideways for a long time (OR=2.210, 95%CI: 1.376-3.550, P<0.001), maintaining the same sitting spot for a long time (OR=4.336, 95%CI: 2.192-8.579, P<0.001), and psychological load value ≥70 (versus <40, OR=1.901, 95%CI: 1.038-3.480, P=0.037) increased the risk of neck pain in dentists. Sufficient operating space (OR=0.507, 95%CI: 0.302-0.850, P=0.010) and doing some exercise during work break (OR=0.670, 95%CI: 0.453-0.991, P=0.045) reduced the risk of reporting neck pain among dentists. A neural network prediction model of dentists' neck pain was constructed with 1 hidden layer and 6 hidden layer neurons. The percentage of correct prediction of training set was 89.6%, and the percentage of correct prediction of test set was 83.9%. The order of importance of the independent variables included in the model were working age, holding head sideways for a long time, psychological load, etc. The result of neural network model of neck pain among dentists showed that the area under the curve of receiver operator characteristic (ROC) was 0.940 (95%CI: 0.922-0.958, P<0.001). When the maximum diagnostic value was determined by the ROC curve, the sensitivity was 84.8%, the specificity was 91.2%, and the Youden Index was 0.760. ConclusionNeck pain of dentists is affected by many factors, such as individual factors (gender and working age), ergonomic factors (keeping various postures and operations for a long time, operating space, etc.), psychological factors (different levels of psychological load) and so on. The neural network model can be used as a prediction tool to explore the risk of reporting neck pain among dentists.

Youhua MO, Ting XU, Shidi MENG et al.

BackgroundThe severity of occupational injury in countries such as the United Kingdom, the United States, and Germany is usually analyzed using lost workdays, but in existing occupational injury surveillance research in China, the application of this index is rare. ObjectiveTo evaluate the application value of lost workdays in non-fatal occupational injury surveillance, and provide a reference for the construction of occupational injury surveillance index system. MethodsThe public data of European Statistics on Accidents at Work (ESAW) from 2010 to 2019 on non-fatal injury accidents in 27 member states of the European Union were used. Non-fatal occupational injury is defined as an injury event during occupational activities or at work resulting a victim's absence from work for ≥4 d. According to the European Statistics on Accidents at Work-Summary methodology, the lost workdays were divided into 8 categories (4-6 d, 7-13 d, 14-20 d, 21-30 d, 31-91 d, 92-182 d, 183 d and above, and unknown). Annual percentage change (APC) and the average annual percentage change (AAPC) were used to evaluate the overall trend changes in the incidence rate of non-fatal occupational injury accidents in different lost workdays from 2010 to 2019, and the non-fatal occupational injury accidents in key industries. The characteristics of the occurrence of non-fatal occupational injuries were analyzed in conjunction with the changes in non-fatal occupational injuries in different lost workdays in the industry. ResultsFrom 2010 to 2019, the overall incidence of non-fatal occupational injury accidents in the European Union showed a downward trend, and the AAPC was −1.0% (P<0.05). The accident rates of lost workdays of 4-6 d and 92-182 d showed an upward trend, and the AAPC were 7.9% and 5.8% respectively (P<0.05). The average annual accident rates of non-fatal occupational injuries (≥4 d) in Categories C (manufacturing industry), E (water supply, sewage treatment, waste management and remediation), and F (construction industry) showed a linear downward trend, and the AAPC were −3.0%, −2.5%, and −1.5%, respectively (P<0.05). However, among them, the rate of non-fatal occupational injury accidents with 92-182 d of lost workdays in the manufacturing industry showed a significant upward trend, with an AAPC of 3.7% (P<0.001). ConclusionUsing lost workdays combined with APC and AAPC by Join-point linear regression analysis can measure the severity and trend changes of non-fatal occupational injury accidents in different industries and different lost workdays. This indicator has an important practical significance in evaluating the effectiveness of occupational injury prevention and control strategies adopted by countries and enterprises.

Mostafa Soleimani Shadvar, Shirin Moradkhani

Background: Falcaria vulgaris and Echinophora platyloba, two members of Apiaceae family, are native flora of Iran and have numerous ethnobotanical applications. Objectives: The present study focuses on the chemical composition of the essential oils and the evaluation of the antioxidant capacity of F. vulgaris and E. platyloba growing in Hamadan province. Methods: Hydrodistillated essential oil from aerial parts of F. vulgaris and E. platyloba were obtained using clevenger apparatus. The chemical composition of the essential oils was determined using GC-MS analysis. Methanol extracts from aerial parts and seeds of F. vulgaris and E. platyloba were obtained by Soxhlet extractor. The antioxidant properties of the extracts were determined through use of several antioxidant assays (DPPH, FRAP, β-carotene-linoleic acid and iron-chelating test). Results: GC-MS analysis revealed that the major components of F. vulgaris essential oil were spathulenol, and palmitic acid. The main components of E. platyloba were γ-decalactone and (E)-sesquilavandulol. The extract from aerial parts of F. vulgaris consistently exhibited more antioxidative power than the rest of the extracts, followed by the extracts from aerial parts of E. platyloba. The results of DPPH, FRAP and β-carotene-linoleic tests were well correlated with each other, but they were somewhat different from the results of the iron-chelating test. Conclusion: The results of this research showed that F. vulgaris and E. platyloba contain significant antioxidant properties; therefore, their use in food and pharmaceutical industries as preservatives will be fruitful.

Sushweta Mahalanobish, Mousumi Kundu, Sumit Ghosh et al.

Recently, different natural bioactive compounds have been used as anticancer agents for their various therapeutic benefits and non-toxic nature to other organs. However, they have various restrictions in preclinical and clinical studies due to their non-targeting nature and insufficient bioavailability. As a result, a zinc oxide nanoparticle (ZnO) based drug delivery medium was constructed which has good bio-compatibility and bio-degradability. It also displays cancer cell-specific drug delivery in a targeted and controlled way. In the present study, phenylboronic acid (PBA) tagged ZnO nanoparticles (ZnO-PBA) was fabricated and in the next step, chrysin (a natural bio-active molecule) was loaded to it to form the nanoconjugate (ZnO-PBA-Chry). Different characterization techniques were used to confirm the successful fabrication of ZnO-PBA-Chry. PBA-tagging to the nanoparticle helps in targeted delivery of chrysin in lung cancer cells (A549) as PBA binds with sialic acid receptors which are over-expressed on the surface of A549 cells. As ZnO dissociates in acidic pH, it shows stimuli-responsive release of chrysin in tumor microenvironment. Application of ZnO-PBA-Chry nanohybrid in lung cancer cell line A549 caused oxidative stress mediated intrinsic cell death and cell cycle arrest. ZnO-PBA-Chry downregulated MMP-2 and VE-Cadherin, thereby inhibiting metastasis and the invasive property of A549 cells.

Yong-Soon Kim, Ka-Young Park, Eun-Sang Cho

1-Propanol is a colorless volatile liquid at room temperature and is an important industrial alcohol. Workers are potentially exposed to it through inhalation during industrial activities, including manufacturing, sampling, filling, and mixing processes, as well as during cleaning, maintenance, and repair. Consequently, further information and/or testing for inhalation-related toxicological data is required to assess occupational risk. In this study, 80 (40 male and 40 female) F344 rats were exposed to 1-propanol vapors for 13 weeks (6 h a day, 5 days per week) at target concentrations of 0, 500, 1,600, and 5200 ppm in a whole-body inhalation chamber system. Clinical signs, mean body weight changes, food consumption, hematology, blood biochemistry, necropsy, organ weight, and histopathological findings were observed. The exposure concentrations in chambers were 501.30 ± 9.54 ppm, 1605.43 ± 66.55 ppm, and 5202.19 ± 102.74 ppm for the low, middle, and high dose groups, respectively. No changes related to 1-propanol were observed, including histopathological findings, except for mean body weight changes. The significant decrease in mean body weight at a high dose was not considered to be an adverse effect. Based on these results, the no observed adverse effect concentration of 1-propanol was estimated to be 5202.19 ppm.

Henry A. Spiller, Hannah L. Hays, Marcel J. Casavant

AbstractWe reevaluate the treatment of mercury poisoning, incorporating recent advances in understanding of mercury toxicity and the mercury:selenium interaction. This review focuses on: 1) the role, limitations and benefits of chelation (Unithiol, succimer and N-Acetylcysteine); 2) the role of selenium supplementation; and 3) how the different forms of mercury are impacted by use of chelation and selenium. Unithiol and succimer produce increases in urinary excretion of mercury and to a lesser degree blood and total body mercury. The primary role of N-acetylcysteine is increasing renal mercury excretion, similar to the thiol-chelators. Additional unique features of acetylcysteine include increased efflux of methylmercury from the brain, and reduced oxidative stress via increased glutathione production. The role of selenium includes: 1) restoration of selenoprotein activity, 2) protection against mitochondrial injury and DNA damage, 3) demethylation of methylmercury, 4) sequestering of mercury via Hg:Se complexes, and 5) redistribution of Hg inside organisms. Selenium may increase blood Hg, via a “sink” effect, causing a redistribution of mercury away from the brain. A combined approach for mercury poisoning treatment was developed focusing on restoration of selenoprotein function, reduction of oxidative stress and increased mercury elimination.

Stacey E. Anderson, Rachel Baur, Michael Kashon et al.

Occupational immune diseases are a serious public health burden and are often a result of exposure to low molecular weight (LMW) chemicals. The complete immunological mechanisms driving these responses are not fully understood which has made the classification of chemical allergens difficult. Antimicrobials are a large group of immunologically-diverse LMW agents. In these studies, mice were dermally exposed to representative antimicrobial chemicals (sensitizers: didecyldimethylammonium chloride (DDAC), ortho-phthalaldehyde (OPA), irritants: benzal-konium chloride (BAC), and adjuvant: triclosan (TCS)) and the mRNA expression of cytokines and cellular mediators was evaluated using real-time qPCR in various tissues over a 7-days period. All antimicrobials caused increases in the mRNA expression of the danger signals Tslp (skin), and S100a8 (skin, blood, lung). Expression of the TH2 cytokine Il4 peaked at different timepoints for the chemicals based on exposure duration. Unique expression profiles were identified for OPA (Il10 in lymph node, Il4 and Il13 in lung) and TCS (Tlr4 in skin). Additionally, all chemicals except OPA induced decreased expression of the cellular adhesion molecule Ecad. Overall, the results from these studies suggest that unique gene expression profiles are implicated following dermal exposure to various antimicrobial agents, warranting the need for additional studies. In order to advance the development of preventative and therapeutic strategies to combat immunological disease, underlying mechanisms of antimicrobial-induced immunomodulation must be fully understood. This understanding will aid in the development of more effective methods to screen for chemical toxicity, and may potentially lead to more effective treatment strategies for those suffering from immune diseases.

Fatemeh Alimahdi, Nader Shahrokhi, Mohammad Khaksari Hadad et al.

Background: The levels of IL-13, IL-4, IL-1B, TNF-α and IL-10 alter in the colon of people with ulcerative colitis. previous studies, it was found that shilajit (asphaltum) was effective in the improvement of ulcerative colitis.we guessed that the shilajit has been able to improve the ulcerative colitis by affecting the amount of cytokines. Objective: The aim of the present study was to investigate the effects of shilajit on IL-13, IL-4, IL-1B, TNF-α and IL-10 in ulcerative colitis. Methods: In this experimental study, 49 white male rats were randomly divided into 7 groups including sham groups, ulcerative colitis, Gavage vehicle, Gavage shilajit, sulfasalazine, Intra Anal Vehicle, Intra Anal shilajit. To produce ulcerative colitis 2 cc acetic acid (4%) was prescribed intra-rectal. 4 days after the induction of colitis, it was given 4 days: shilajit 250 mg / kg was used as a gavage or intra anal. Sulfasalazine was dosed at 250 mg / kg in the form of gavage. Results: The Gavage shilajit group increased IL-10, IL-4and decreased IL-1β, TNF-α compared to Gavage vehicle group. Shilajit has been able to close the levels of IL-4, IL-13, IL-10, TNF-α to normal values of the sham group. Conclusion: Considering that the weight ratio of intestinal rat to the body of rat in the shilajit groups was lower than that of the sulfasalazine group, it can be shown that shilajit has been able to more reduce inflammation by making a more suitable change in cytokines in comparison with sulfasalazine.

Chen-Wei Liu, Tzu-Lin Lee, Yu-Chen Chen et al.

Abstract Background Epidemiological studies have shown that ambient air pollution is closely associated with increased respiratory inflammation and decreased lung function. Particulate matters (PMs) are major components of air pollution that damages lung cells. However, the mechanisms remain to be elucidated. This study examines the effects of PMs on intercellular adhesion molecule-1 (ICAM-1) expression and the related mechanisms in vitro and in vivo. Result The cytotoxicity, reactive oxygen species (ROS) generation, and monocyte adherence to A549 cells were more severely affected by treatment with O-PMs (organic solvent-extractable fraction of SRM1649b) than with W-PMs (water-soluble fraction of SRM1649b). We observed a significant increase in ICAM-1 expression by O-PMs, but not W-PMs. O-PMs also induced the phosphorylation of AKT, p65, and STAT3. Pretreating A549 cells with N-acetyl cysteine (NAC), an antioxidant, attenuated O-PMs-induced ROS generation, the phosphorylation of the mentioned kinases, and the expression of ICAM-1. Furthermore, an AKT inhibitor (LY294002), NF-κB inhibitor (BAY11–7082), and STAT3 inhibitor (Stattic) significantly down-regulated O-PMs-induced ICAM-1 expression as well as the adhesion of U937 cells to epithelial cells. Interleukin-6 (IL-6) was the most significantly changed cytokine in O-PMs-treated A549 cells according to the analysis of the cytokine antibody array. The IL-6 receptor inhibitor tocilizumab (TCZ) and small interfering RNA for IL-6 significantly reduced ICAM-1 secretion and expression as well as the reduction of the AKT, p65, and STAT3 phosphorylation in O-PMs-treated A549 cells. In addition, the intratracheal instillation of PMs significantly increased the levels of the ICAM-1 and IL-6 in lung tissues and plasma in WT mice, but not in IL-6 knockout mice. Pre-administration of NAC attenuated those PMs-induced adverse effects in WT mice. Furthermore, patients with chronic obstructive pulmonary disease (COPD) had higher plasma levels of ICAM-1 and IL-6 compared to healthy subjects. Conclusion These results suggest that PMs increase ICAM-1 expression in pulmonary epithelial cells in vitro and in vivo through the IL-6/AKT/STAT3/NF-κB signaling pathway.

Jian Lv, Ruidan Bai, Li Wang et al.

Abstract Background An increasing number of studies are investigating the effects of Chinese medicine on hepatic fibrosis, but only few studies have examined the anti-fibrogenic properties of Artesunate (ART). The aim of the present study was to explore the anti-fibrotic effects of ART on LX-2 cells, the human HSC cell line, and to determine potential molecular mechanisms via the focal adhesion kinase (FAK)/ protein kinase B (Akt)/ β-catenin pathway. Methods LX-2 cells were stimulated with different concentration of ART (0, 12.5, 25 and 50 μg/ml) for 12, 24, 48 or 72 h, their proliferation was analyzed using the Cell Counting Kit-8 (CCK-8) assay. LX-2 cells were treated with different doses of ART (0, 12.5, 25 and 50 μg/ml) for 24 h, their apoptosis was measured using flow cytometry, the levels of mRNAs encoding collagen I or α-smooth muscle actin (α-SMA) were determined using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and the levels of key proteins in the FAK/Akt/β-catenin signaling pathway were assessed by western blotting. Specific inhibitors of FAK were added to the LX-2 cells cultures to explore the potential signaling. Results Exposing LX-2 cells to ART efficiently inhibited their proliferation, significantly promoted early apoptosis in a dose-dependent manner, and markedly downregulated the mRNA expression of α-SMA and collagen I. In addition, ART, similar to FAK inhibitor PF562271 significantly inhibited the FAK/Akt/β-catenin signaling pathway by reducing the levels of phosphorylated FAK, Akt and GSK-3β. Conclusions Our present study shows that ART could regulate the proliferation, apoptosis and activation of LX-2. Meanwhile, the anti-fibrogenic mechanisms of ART was correlated with FAK/Akt/β-catenin pathway. Future research should verify and extend these findings, as well as explore other molecules and therefore serve as useful therapeutic targets.

K. Engebretsen, Kathleen M Kaczmarek, Jenifer L Morgan et al.

G. Guzzi, C. L. La Porta

C. Botha, Heleen Coetser, L. Labuschagne et al.

During a six-year period (from January 2009 to December 2014), specimens collected from 344 cases of suspected organophosphorus and carbamate pesticide poisonings in wildlife, including birds, were submitted to the Toxicology Laboratory (ARC-OVI) for analysis. A positive diagnosis was made in 135 (39%) of these cases. The majority of cases were from birds, which included Cape vultures (Gyps coprotheres) and African white-backed vultures (Gyps africanus) and bateleur eagles (Terathopius ecaudatus). In one incident 49 vultures were killed when a farmer intentionally laced carcasses with carbofuran in an attempt to control jackal predation. There were 22 incidents of poisoning in helmeted guineafowl (Numida meleagris). On nine different occasions blue cranes (Anthropoides paradiseus) were poisoned, in one incident 14 birds were reported to have been killed. Over the period of investigation, there were 20 cases of poisoning involving mammalian species, the majority being vervet monkeys (Chlorocebus pygerythrus). The carbamate pesticides were responsible for 57 incidents of poisoning. Aldicarb, carbofuran and methomyl were detected in 26, 18 and 12 cases respectively. The majority of organophosphorus pesticide poisonings were caused by diazinon (n = 19), monocrotophos (n = 13) and methamidophos (n = 10).

T. Gawlikowski, M. Romek, L. Satora

P. Chai, K. Babu, E. Boyer

S. Gosselin, M. Morris, Andrea Miller-Nesbitt et al.

Abstract Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendations are inconsistent. To assist clinicians in decision-making, the American Academy of Clinical Toxicology created a workgroup composed of international experts from various clinical specialties, which includes representatives of major clinical toxicology associations. Rigorous methodology using the Appraisal of Guidelines for Research and Evaluation or AGREE II instrument was developed to provide a framework for the systematic reviews for this project and to formulate evidence-based recommendations on the use of ILE in poisoning. Systematic reviews on the efficacy of ILE in local anesthetic toxicity and non-local anesthetic poisonings as well as adverse effects of ILE are planned. A comprehensive review of lipid analytical interferences and a survey of ILE costs will be developed. The evidence will be appraised using the GRADE system. A thorough and transparent process for consensus statements will be performed to provide recommendations, using a modified Delphi method with two rounds of voting. This process will allow for the production of useful practice recommendations for this therapy.