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Background
Projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object.
Case presentation
A 36-year-...
Context in source publication
Context 1
... scanning acoustic microscope (AMS-50SI) developed by Honda Electronics (Toyohashi, Japan), whose schematic setup is shown in Fig. 3, was used in AI mode. It has a transducer with quartz lens, a pulser/receiver, an oscillo- scope, a computer, and a display monitor. An 80 MHz transducer is installed within the microscope, which gener- ates the signals and collects the reflected acoustic waves. Water is the coupling medium between the quartz lens and the substrate. ...
Citations
... Additionally, embedded fragments release metals in the circulatory system slowly and cause chronic toxicity due to heavy metals. However, the local effect and its influence on the metallic object have not been investigated (Bilen et al., 2018). Co-occurring of heavy metals from modern firearms without fragments, dense inert metal explosive or tungsten bomb were discovered to cause long-time unknown risks in Gaza war veterans' fragments free-wounds tissues because of their toxic, teratogenic, and cancerous effects on the human body (Griffiths, 2022). ...
... Embedded shrapnel from explosive devices and retained bullet fragments also can increase serum levels of toxic metals including Se [167]. Higher risk of ALS was found in naturally seleniferous US regions [168,169]. ...
Multiple studies indicate that United States veterans have an increased risk of developing amyotrophic lateral sclerosis (ALS) compared to civilians. However, the responsible etiological factors are unknown. In the general population, specific occupational (e.g. truck drivers, airline pilots) and environmental exposures (e.g. metals, pesticides) are associated with an increased ALS risk. As such, the increased prevalence of ALS in veterans strongly suggests that there are exposures experienced by military personnel that are disproportionate to civilians. During service, veterans may encounter numerous neurotoxic exposures (e.g. burn pits, engine exhaust, firing ranges). So far, however, there is a paucity of studies investigating environmental factors contributing to ALS in veterans and even fewer assessing their exposure using biomarkers. Herein, we discuss ALS pathogenesis in relation to a series of persistent neurotoxicants (often emitted as mixtures) including: chemical elements, nanoparticles and lipophilic toxicants such as dioxins, polycyclic aromatic hydrocarbons and polychlorinated biphenyls. We propose these toxicants should be directly measured in veteran central nervous system tissue, where they may have accumulated for decades. Specific toxicants (or mixtures thereof) may accelerate ALS development following a multistep hypothesis or act synergistically with other service-linked exposures (e.g. head trauma/concussions). Such possibilities could explain the lower age of onset observed in veterans compared to civilians. Identifying high-risk exposures within vulnerable populations is key to understanding ALS etiopathogenesis and is urgently needed to act upon modifiable risk factors for military personnel who deserve enhanced protection during their years of service, not only for their short-term, but also long-term health.
... Additionally, projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream [16]. Usually, metallic objects embedded into the soft tissue become encapsulated and do not release metals into the systemic circulation. ...
... Missiles close to the bone, [17], joints, and intervertebral disks are continuously bathed with synovial fluid, which eventually washes off lead from the bullets resulting in systemic toxicity [18,19]. Females are more vulnerable to this form of toxicity which can then lead to neuropathy [16,20]. ...
Penetrating injuries due to fragments energized by an explosive event are life/limb-threatening and are associated with poor clinical and functional outcomes. Penetrating injuries are commonly inflicted in attacks with explosive devices. The extremities, especially the leg, are the most commonly affected body areas, presenting a high risk of infection, slow recovery, and the threat of amputation. This report presents a case of a young factory worker who sustained an injury to the leg with a foreign body lodged near the neuro-vascular bundle.
A 44-year-old gentleman sustained a projectile injury while working in a stainless steel factory from the rula (steel rolling) machine with a foreign body getting lodged in the leg in March 2019. He was initially managed with wound care and didn't report any functional impairment. Gradually patient developed numbness and claudication symptoms of the foot over the next couple of years. He was subsequently operated on in 2021 for removal of the stainless steel foreign body encased in dystrophic calcification close to the tibial nerve and posterior tibial vessels. Interestingly the entry point of the foreign body was on the anterolateral aspect of the leg. The foreign body was removed using the postero-lateral approach to the tibia with careful dissection close to the neurovascular bundle. At a follow-up of 3 months, the patient is symptom-free with significant improvement of limb function.
The authors propose that the foreign body crossed the interosseous membrane to get lodged close to the posterior tibial neurovascular bundle. In such a scenario, the patient was extremely lucky to have survived an amputation or significant functional injury of the limb. Proper protective equipment is needed not only for the torso but also for extremities to protect industrial workers from such limb-threatening injuries. Moreover, primary care physicians should be sensitised for the proper management of such injuries.
... Blood Pb levels in Syrian and Iraqi refugees were also found to correlate with neuroplasticity index and worse self-reported mental health (Arnetz et al., 2020). In addition to central neurotoxic effects of Pb, it has been proposed that tissue Pb infiltration resulting from shotgun injury may possess toxicity to the peripheral neural system (Bilen et al., 2018). ...
An increasing body of literature has demonstrated that armed conflicts and military activity may contribute to environmental pollution with metals, although the existing data are inconsistent. Therefore, in this paper, we discuss potential sources of military-related metal emissions, environmental metal contamination, as well as routes of metal exposure and their health hazards in relation to military activities. Emission of metals into the environment upon military activity occurs from weapon residues containing high levels of particles containing lead (Pb; leaded ammunition), copper (Cu; unleaded), and depleted uranium (DU). As a consequence, military activity results in soil contamination with Pb and Cu, as well as other metals including Cd, Sb, Cr, Ni, Zn, with subsequent metal translocation to water, thus increasing the risk of human exposure. Biomonitoring studies have demonstrated increased accumulation of metals in plants, invertebrates, and vertebrate species (fish, birds, mammals). Correspondingly, military activity is associated with human metal exposure that results from inhalation or ingestion of released particles, as well as injuries with subsequent metal release from embedded fragments. It is also notable that local metal accumulation following military injury may occur even without detectable fragments. Nonetheless, data on health effects of military-related metal exposures have yet to be systematized. The existing data demonstrate adverse neurological, cardiovascular, and reproductive outcomes in exposed military personnel. Moreover, military-related metal exposures also result in adverse neurodevelopmental outcome in children living within adulterated territories. Experimental in vivo and in vitro studies also demonstrated toxic effects of specific metals as well as widely used metal alloys, although laboratory data report much wider spectrum of adverse effects as compared to epidemiological studies. Therefore, further epidemiological, biomonitoring and laboratory studies are required to better characterize military-related metal exposures and their underlying mechanisms of their adverse toxic effects.
... Micrometer-sized structures can be detected by micro-computed tomography (micro-CT), magnetic resonance imaging (MRI), micro-optical coherence tomography (micro-OCT), scanning electron microscopy (SEM) or positron emission tomography (PET) [8,10], however these techniques are either very expensive or require ionizing radiation. Dispersive x-ray spectroscopy (EDS) is a chemical characterization technique, which can be implemented in electron microscope systems [11]. It detects all elements ranging from beryllium (Be) to uranium (U) and their distribution within samples by the bombardment of the specimen surface with a focused electron beam. ...
... Microcalcification analysis within atherosclerotic plaques can be performed with SEM-EDS system, however, this would again be a very expensive method [12]. ICP-OES is an analytical technique in which chemical elements in samples can be determined and when combined with a suitable imaging modality, morphological and chemical information would be obtained simultaneously with a less expensive system [11]. ...
Calcium deposition within the atherosclerotic plaques is the precursor of cardiovascular complications. Therefore, determination of levels of minerals and trace elements in blood plays an important role in assigning the stage of atherosclerosis. In this study, determination of mineral and trace element levels in atherosclerotic patients is aimed. Mineral and trace element levels within serum samples of 12 atherosclerotic patients were evaluated by Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) and phosphorous (P), iron (Fe), magnesium (Mg) and calcium (Ca) levels were examined. Human carotid atherosclerotic plaque samples were previously screened by Scanning Acoustic Microscopy (SAM) and sound speed maps of the plaques showed higher sound speed values in the calcified regions, when compared to collagen-rich regions, indicating accumulation of calcium. Element analysis also showed increased Ca levels within serum samples. Therefore, it can be concluded that Ca deposition can be examined by ICP-OES and SAM, indicating that these techniques are confirmatory and may be combined to characterize atherosclerosis in the future.
Scanning electron microscopy (SEM) and energy dispersive X‐ray (EDX) are powerful tools to study the ultrastructure of numerous specimens and to determine their elemental composition, respectively. However, results have not yet been reported on their application to urine samples in routine clinical laboratory practice. Herein we investigate urine sediment by using SEM and EDX to detect and identify different urine components. A total of 206 urine samples from patients with and without urinary tract infections were analyzed using SEM and EDX. Microorganisms, crystals, epithelial cells, leukocytes, and erythrocytes were targeted in urine sediment samples. The identification of urine components was based on their morphology, size, contrast, and elemental composition. SEM‐analysis allowed us to identify and classify microorganisms in urine sediments into the categories of gram‐negative bacilli, cluster cocci, chain cocci, gram‐negative bacilli, gram‐positive bacilli, and yeasts. In addition, various types of epithelial cells such as renal, transitional, and squamous epithelial cells were found. Furthermore, leukocytes and erythrocytes were well identified, with the detection of various morphological forms of erythrocytes, such as dysmorphic and isomorphic erythrocytes. Using SEM–EDX analysis, calcium oxalate was the most frequently‐identified crystal (92.0%), with prominent peaks of C, O, and Ca elements, followed by struvite (6%), with peaks of Mg, P, O, and N. These preliminary data suggest that the two complementary SEM–EDX analyses can be used to detect and identify microorganisms and crystals in urine samples. Further studies are still needed to apply SEM–EDX to urine sediment analysis. SEM–EDX analyses provided comparative results with the routine results, with accurate identification, high resolution and deep focus compared to the routine urinalysis
SEM‐analysis allowed us to identify and classify microorganisms in urine sediments into the categories of gram‐negative bacilli, cluster cocci, chain cocci, gram‐negative bacilli, gram‐positive bacilli and yeasts.
SEM–EDX analysis enabled the accurate identification of crystals based on both morphology and elemental composition.
