Heavy metals in human hair and teeth

Biological samples were collected simultaneously with environmental quality investigations. Studies of metal levels in biological (hair and teeth) and environmental (soil and air) samples were performed in Zwardoń during 1991/1992. Zwardoń is a small mountain resort village, situated on the border pass of Zwardoń, in the close proximity of the southwestern border of Poland. Heavy metal levels in soil, air, and chemical metals forms in the soil were examined. Pearson’s product correlation in soil (for total concentration of heavy metals and each chemical form) in hair and in teeth was calculated to investigate bioavailability of heavy metals in human organism. We received essential correlations simultaneously between: Pb vs Mn in exchangeable form of metal in soil, in teeth and in soil (total); Cd vs Zn and Mn vs Co in organically bound form in soil and in teeth and soil (total); and Cu vs Zn in all investigated samples (teeth, hair, soil total, and organically bound form in soil); Mn vs Co and Cr vs Mn in residual form in soil, in teeth, and in soil (total) and between Co vs Ni for hair, soil (total), and residual form in soil.     

Essential trace and toxic element distribution in the scalp hair of Pakistani myocardial infarction patients and controls

The pathogenesis of heart disease has been associated with changes in the balance of certain trace elements. The aim of this study was to evaluate the Zn, Fe, Cu, Cr, Ni, Pb, and Cd contents in scalp hair samples of myocardial infarction (MCI) patients hospitalized in the cardiac ward of National Hospital in Hyderabad city (Pakistan). Scalp hair samples were collected from 193 patients (104 male, 89 female) of 3 age groups (46–60, 61–75, and 76–90 yr), for a comparative study, 200 normal, healthy subjects (103 male, 97 female) of the same age groups residing in the same city were selected. All metals in scalp hair samples were assessed by a flame/graphite furnace atomic absorption spectrophotometer, prior to microwave-assisted and conventional wet acid digestion methods. Results were calculated in micrograms per gram. The mean values of Fe and Zn of scalp hair samples of MCI patients were significantly reduced compared to the control subjects of both genders. The mean Fe concentrations in male patients were 19.42, 12.36, and 6.98 vs 30.69, 24.42, and 16.75 for the control patients in the three age groups (46–60, 61–75, and 76–90 yrs, respectively). The mean Zn concentration in male patients were 169.2, 149.4, and 107.7 μg/g vs 206.1, 188.0, and 154.4 μg/g for the control group (p<0.002, 0.004, and 0.001) in all three age groups, respectively. These differences were also observed in the female study groups. The mean values of Pb, Cd, and Ni were significantly high in patients compared to healthy subjects (mean Pb in male patients: 11.85, 12.89, and 14.52 those of female patients were 11.88, 12.73, and 14.21 vs the male controls patients (6.08, 7.56, and 8.56) and female controls (5.99, 7.41, and 8.25) for all three age groups, respectively. The concentration of Ni and Cd in the scalp hair samples of the heart patients of both sexes were significantly higher compared to the control; in the case of Ni the range of significant difference for males was found to be p<0.001–0.009 and for females to be p<0.0.002–0.007 and significantly high concentration of Cd were observed in hair samples of patients than in controls in the range for males (p<0.001–0.009) and in females (p<0.001–0.011). The Zn/Cu and Zn/Cd ratios in the scalp hair (p<0.01) of the diseased groups were significantly lower than that of the healthy groups. Deficiency of essential trace metals and high level of toxic metals might play a role in the development of heart disease in the subjects of this study. Toxic metals might also cause diminished absorption of essential elements.     

Analyses of toxic metals and essential minerals in the hair of arizona children with autism and associated conditions, and their mothers

The objective of this study ws to assess the levels of 39 toxic metals and essential minerals in hair samples of children with autism spectrum disorders and their mothers compared to controls. Inductively coupled plasma-mass spectrometry was used to analyze the elemental content of the hair of children with autism spectrum disorders (n=51), a subset of their mothers (n=29), neurotypical children (n=40), and a subset of their mothers (n=25). All participants were recruited from Arizona. Iodine levels were 45% lower in the children with autism (p=0.005). Autistic children with pica had a 38% lower level of chromium (p=0.002). Autistic children with low muscle tone had very low levels of potassium (−66%, p=0.01) and high zinc (31%, p=0.01). The mothers of young children with autism had especially low levels of lithium (56% lower, p=0.005), and the young children (ages 3–6 yr) with autism also had low lithium (−30% p=0.04). Low iodine levels are consistent with previous reports of abnormal thyroid function, which likely affected development of speech and cognitive skills. Low lithium in the mothers likely caused low levels of lithium in the young children, which could have affected their neurological and immunological development. Further investigations of iodine, lithium, and other elements are warranted.     

Estimation of Toxic Metals in Scalp Hair Samples of Chronic Kidney Patients

The determination of toxic metals (TMs) in the biological samples of human beings is an important clinical screening procedure. The aim of this work is to determine total content of TMs, aluminum (Al), cadmium (Cd), nickel (Ni), and lead (Pb) in scalp hair samples of chronic kidney male patients (CKPs) on maintenance hemodialysis, during the period of 2005–2007. The study included 115 CKPs (all smokers) and 150 controls or referents [82 (nonsmokers) and 68 (smokers)]. Both controls and patients (males) were of the same age group (ranged 25–55 years), socioeconomic status, localities, and dietary habits. The scalp hair samples were analyzed by electrothermal atomic absorption spectrometer, prior to microwave-induced acid digestion. The accuracy of the total Al, Cd, Ni, and Pb measurements was tested by simultaneously analyzing certified reference material (human hair NCS ZC81002). No significant differences were observed between the analytical results and the certified values (paired t test at p > 0.05). The levels of TMs in scalp hair samples of patients were found to be higher as compared to control nonsmoker and smokers. Moreover, the study shows that levels of Al, Cd, Ni, and Pb in scalp hair samples may be useful to evaluate the impact of cigarette smoking in kidney failure patients.     

Status of Selected Heavy Metal Distribution in Scalp Hair of Traffic Control Personnel Exposed to Vehicular Emissions

Scalp hair samples of traffic control personnel (n = 71, ages between 25 to 45 years) were analyzed for 11 selected metals by using an Inductively Coupled Argon Plasma Atomic Emission (ICP-AE) technique using nitric acid–perchloric acid based wet digestion method. The observed order of mean concentrations (μ g/g, dry weight) of the metals, in washed hair samples, was: Ca > Mg > Zn > Fe > Pb > Cu > Ni > Mn > Cr > Cd > Co, with corresponding metal levels at 1042.2, 182.4, 169.7, 13.6, 12.4, 11.1, 2.7, 1.9, 1.9, 0.8, and 0.7 μ g/g, respectively. Most of the unwashed samples exhibited 10–15% higher metal levels compared with those in washed samples. A positive metal-to-metal correlation (p < 0.01) was observed for the metal pairs: Ca-Mg (r = 0.737), Pb-Cr (r = 0.441), and Cu-Zn (0.385). Principal Component Analysis (PCA) extracted 6 factors as metals origin using varimax normalized rotation commutatively representing more than 76% of the total variance. Cluster Analysis (CA) showed five strong clusters of selected metals in the hair of the subjects: Age-Exposure, Ca-Mg, Cd-Fe-Mn, Pb-Cr, and Cu-Zn. The results of the current study were compared with those for two other occupationally exposed groups, metal arc welders and autodrivers, using published literature values. The traffic controllers in our study generally, with the exception of Cu, exhibited lower levels of metals in hair samples than did autodrivers and arc welders.     

Characterization and Distribution of the Selected Metals in the Scalp Hair of Cancer Patients in Comparison with Normal Donors

Eighteen metals were estimated in the scalp hair samples from cancer patients (n = 111) and normal donors (n = 113). Nitric acid–perchloric acid wet digestion procedure was used for the quantification of the selected metals by flame atomic absorption spectrophotometry. In the scalp hair of cancer patients, highest average levels were found for Ca (861 μg/g), followed by Na (672 μg/g), Zn (411 μg/g), Mg (348 μg/g), Fe (154 μg/g), Sr (129 μg/g), and K (116 μg/g), whereas in comparison, the dominant metals in the scalp hair of normal donors were Ca (568 μg/g), Zn (177 μg/g), Mg (154 μg/g), Fe (110 μg/g), and Na (103 μg/g). The concentrations of Ca, Cd, Co, Cr, Fe, K, Mg, Mn, Na, Ni, Pb, Sb, Sr, and Zn were notably higher in the hair of cancer patients as compared with normal donors, which may lead to a number of physiological disorders. Strong positive correlations were found in Mn–Pb (0.83), Cd–Cr (0.82), Cd–Li (0.57), Fe–Pb (0.56), and Fe–Mn (0.55) in the hair of cancer patients whereas Na–Cd, Li–Cr, Li–Co, Co–Cd, Li–Cd, Na–Co, Na–Li, Ca–Mg and Na–Cr exhibited strong relationships (r > 0.50) in the hair of normal donors. Principal Component Analysis (PCA) of the data revealed seven PCs, both for cancer patients and normal donors, but with significantly different loadings. Cluster Analysis (CA) was also used to support the PCA results. The study evidenced significantly different pattern of metal distribution in the hair of cancer patients in comparison with normal donors. The role of trace metals in carcinogenesis was also discussed.     

Selenium concentration in blood and hair of holstein dairy cows

Four-hundred Holstein cows in 40 dairy farms in north Greece were included in this study, and blood (n=400), black hair (n=400), white hair (n=40), and feed (n=40) samples were obtained. Although the feeding regime in these farms was similar, the selenium content of feeds was variable. The Se content of concentrate feeds was 0.104±0.086 mg/kg dry matter (DM), and of silage, it was 0.025±0.018 mg/kg. A significantly positive correlation was found between the Se concentration in black hair and the Se concentration in blood (r ²=0.610, p<0.001), the Se concentration in white hair and the Se concentration in blood (r ²=0.770, p<0.001), and the Se concentration in white hair and the Se concentration in black hair (r ²=0.921, p<0.001). The Se concentration in white hair was significantly smaller than that in black hair (p<0.001).     

Lead, copper, zinc, and magnesium content in hair of children and young people with some neurological diseases

The lead, copper, zinc, and magnesium levels of scalp hair taken from 153 children aged 1–15 yr and young people (16–18 yr) with selected neurological disorders (hyperexcibility, loss of consciousness, and epileptiform convulsions of an unknown origin, etc.), were measured using the atomic absorption spectrometry method and then compared with a control group of healthy children (n=108). The research indicated significantly reduced mean levels of magnesium in the hair of children suffering from selected neurological diseases (in children aged 11–15 yr of age, above 30%; up to 5 yr of age, nearly 30%; the differences were statistically significant at p<0.05) and slightly decreased mean levels of copper (differences statistically significant at p<0.05, particularly in the 11 to 15-yr category). Differences in zinc levels in hair were inconsiderable (not statistically significant in any age groups). The lead level in the hair of the above-mentioned group of children was exceeded in relation to the control group (a statistically significant difference at p<0.05 for the total group). A more than twofold decrease in the mean value of the Mg/Pb ratio (and a nearly 30% decrease in the value of the Mg/Zn ratio) in the hair of children suffering from neurological diseases suggests that the high toxicity of lead accompanying, among other things, magnesium deficiencies might be a cause of the observed disorders in children.     

Copper,Chromium, Manganese,Iron, Nickel,and Zinc Levels in Biological Samples of Diabetes Mellitus Patients

There is accumulating evidence that the metabolism of several trace elements is altered in diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progress of this disease. The aim of present study was to compare the level of essential trace elements, chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), and zinc (Zn) in biological samples (whole blood, urine, and scalp hair) of patients who have diabetes mellitus type 2 (n = 257), with those of nondiabetic control subjects (n = 166), age ranged (45–75) of both genders. The element concentrations were measured by means of an atomic absorption spectrophotometer after microwave-induced acid digestion. The validity and accuracy was checked by conventional wet-acid-digestion method and using certified reference materials. The overall recoveries of all elements were found in the range of (97.60–99.49%) of certified values. The results of this study showed that the mean values of Zn, Mn, and Cr were significantly reduced in blood and scalp-hair samples of diabetic patients as compared to control subjects of both genders (p < 0.001). The urinary levels of these elements were found to be higher in the diabetic patients than in the age-matched healthy controls. In contrast, high mean values of Cu and Fe were detected in scalp hair and blood from patients versus the nondiabetic subjects, but the differences found in blood samples was not significant (p < 0.05). These results are consistent with those obtained in other studies, confirming that deficiency and efficiency of some essential trace metals may play a role in the development of diabetes mellitus.     

Ulltrastructural and trace metal studies on radiographers’ hair and nails

Scalp hair and fingernail samples of 42 medical radiographers and 42 nonradiographers (control) with matching age groups and food habits were collected for this study. Trace metal estimation by atomic absorption spectrometry (AAS) has indicated a significant increase (P < 0.001) in Zn, Cu, and Cd contents in the radiographers’ hair and nails. Scanning electron microscopy (SEM) reveled structural changes in the hair and nails of radiographers. Significant alterations in the Zn and Cd contents along with extensive structural damage in the hair and nails probably indicate that low-dose Χ-radiation imposes stress on these radiation workers.     

Cadmium, copper and zinc in tissues of deceased copper smelter workers

Workers at a copper and lead smelter in northern Sweden have a multifactorial exposure to a number of heavy metals. The concentrations of cadmium, copper and zinc in liver, lung, kidney and brain tissues have been determined by atomic absorption spectrometry in 32 deceased long-term exposed male lead smelter workers, and compared with those of 10 male controls. Furthermore, copper and zinc levels in hair and nails were determined by energy-dispersive X-ray fluorescence.

The highest cadmium concentrations among both workers and controls were observed in kidney, followed in order by liver, lung and brain. The levels in kidney, liver and lung were all significantly higher in the workers than in the controls (p < 0.03). Among the workers relatively strong positive correlations (p < 0.03) were observed between cadmium concentrations in liver and lung, liver and kidney, liver and brain, and lung and brain. In the exposed workers a positive correlation was observed between cadmium and zinc concentrations in the kidney (r_s = 0.38; p = 0.034). This is probably mainly due to the protein metallothionein, which is stored in the kidney, binding equimolar amounts of these two metals.

The highest concentrations of copper were found in hair and nails among both workers and controls, followed in order by liver, brain, kidney and lung. The tissue concentrations of copper in brain, lung and kidney were all significantly higher among the smelter workers than in the controls (p ≤ 0.036). Copper levels in lung and age at time of death were positively correlated among the exposed workers (r_s = 0.39; p = 0.029). In the same group, positive correlations between copper and zinc concentrations in kidney (r_s = 0.45; p = 0.009) and nails (r_s = 0.68; p < 0.001) were also observed, reflecting possible biological interactions between these two metals.

Among both workers and controls, the highest zinc concentrations were found in hair, followed in order by nails, liver, kidney, brain and lung. Significantly higher tissue concentrations among the workers as compared with the reference group were noted in kidney, liver and brain (p ≤ 0.033).

Neither copper nor zinc concentrations in hair and nails seemed to provide a useful measure of the trace element status of the smelter workers.     

Level of Trace Elements (Copper,Zinc, Magnesium and Selenium) and Toxic Elements (Lead and Mercury) in the Hair and Nail of Children with Autism

Autism is a multi-factorial pathology observed in children with altered levels of essential and elevated levels of toxic elements. There are also studies reporting a decrease in nutritional trace elements in the hair and nail of autistic children with healthy controls; moreover, bioelements have been shown to play an important role in the central nervous system. Therefore, the purpose of the present study was to assess the levels of trace elements like copper (Cu), zinc (Zn), magnesium (Mg), and selenium (Se) and toxic elements like mercury (Hg), and lead (Pb) in the hair and nail samples of autistic children and to evaluate whether the level of these elements could be correlated with the severity of autism. The subjects of the study were 45 autistic children with different grades of severity (low (LFA), medium (MFA), and high (HFA) functioning autism) according to Childhood Autism Rating Scale, n = 15 children in each group and 50 healthy children (age and sex matched). The boys and girls ratio involved in this study was 4:1, and they were 4-12 years of age. The study observed a valid indication of Cu body burden in the autistic children. The children with different grades of autism showed high significance (p < 0.001) in the level of copper in their hair and nail samples when compared to healthy controls. The level of Cu in the autistic children could be correlated with their degree of severity (more the Cu burden severe is autism). The study showed a significant elevation (p < 0.001) in the levels of toxic metals Pb and Hg in both hair and nail samples of autistic children when compared to healthy control group. The elevation was much pronounced in LFA group subjects when compared among autistic groups MFA and HFA. The levels of trace elements Mg and Se were significantly decreased (p < 0.001) in autistic children when compared to control. The trace element Zn showed significant variation in both hair and nails of LFA group children when compared to control group and other study groups. The significant elevation in the concentration of Cu, Pb, and Hg and significant decrease in the concentration of Mg and Se observed in the hair and nail samples of autistic subjects could be well correlated with their degrees of severity.     

Hair trace elements in kidney dialysis patients by INAA

INAA was used to determine selected trace elements—Ca, Al, P, and S—in 104 cleaned scalp hair samples from kidney dialysis patients (n=54) and healthy controls (n=50) in order to explore any differences in these elements that might be related to prolonged dialysis and/or associated medication in comparison with blood serum levels of Al and P measured in the same clinic at the time of hair sampling. After correction for P (and Si) interference in Al content, it was observed that there were no significant differences (at 95% confidence level) in hair Al and Ca, which had been expected, whereas while there were definite increases in P and S. Multivariant factor analysis applied to the same data set, however, showed some multiple correlations among four variables: serum Al, duration of dialysis, medication, and hair Al.     

Advantages of the Use of Deciduous Teeth,Hair, and Blood Analysis for Lead and Cadmium Bio-Monitoring in Children. A Study of 6-Year-Old Children from Krakow (Poland)

The population of about 300 6-year-old preschool children was studied for lead (Pb) and cadmium (Cd) in deciduous teeth, scalp hair, and capillary blood. Zinc (Zn) content in hair was also measured due to its possible interferences with the elements studied. The Pb and Cd contents were measured by graphite furnace atomic absorption spectrometry with Zeeman background correction, and Zn, by flame method. Metal levels found were comparable to those in European countries. Positive correlations between Pb and Cd in the same and different tissues were widespread (r = 0.23–0.68). A positive correlation was found between Pb in teeth and blood (r = 0.65, p < 0.001). Pb blood threshold 100 μg L⁻¹ referred to 2.6 μg g⁻¹ Pb in teeth. Predictability of this Pb teeth limit was 14% vs. 5% for Pb blood. Strong negative correlation was found between hair Pb and Zn (r = −0.68, p < 0.001). Enhanced Cd and Zn levels in hair were associated with the household drinking water hardness. The associations with some other environmental and behavioral factors were also presented and discussed. The results proved the advantage of analysis of primary teeth for Pb exposure screening of preschool children.     

Zinc,copper, selenium,and glutathione peroxidase in blood of 11-yr-old dunedin,New Zealand children

Blood was obtained from 564 11-yr-old children who had participated since birth in a multidisciplinary health and development study. Serum zinc concentration did not differ between the boys and the girls (mean±SD: 91=17 μg/100 mL,n=453). Five-6% of serum zinc values were low; although there was a weak correlation with height, none of the boys with low values were below the 10th percentile for height for this group. Serum copper concentration (112±24 μg/100 mL,n=454) was unrelated to sex, height, weight, body mass index, socioeconomic status (SES), or iron status. Blood selenium concentration (49±10 ng/mL,n=564) was lower than previously reported for Dunedin children; it was higher in children in the lower SES categories. The data represent normal values for healthy, 11-yr-old NZ children.     

The exposure level of heavy metals at four different locations near Gan-Ning-Meng reaches of the Yellow River,China

Hair, water, and sediment samples (n = 69, 27, and 24, respectively) were collected at four locations (P1–P4) along the Yellow River Gan-Ning-Meng (GNM) reaches, China. Total elemental contents of Cd, Cr, Cu, Fe, Mn, Pb, and Zn were determined using inductively coupled plasma mass spectroscopy (ICP-MS) to investigate their distribution and exposure levels in the different media. Results showed that trace metals had widely spatial variability in water and hair samples. There were the highest levels of mean concentrations of Cd, Cu, Fe, Mn, Pb, and Zn (geometric mean, GM = 0.22, 17, 65, 3.0, 4.9, and 170 μg/g, respectively) in residents' hairs living at P2. Most of the hair donors in this study showed high concentrations of Cr when compared with the literature. Differences could be distinguished for Mn (p = 0.001) and Fe (p = 0.001) with gender, and for Cr (p = 0.021), Zn (p = 0.003), and Pb (p = 0.035) with age, respectively. The pollution assessments revealed an unpolluted degree in filtered water and a moderately polluted degree for Cd in sediments at P1–P4. Correlation analysis showed significant correlations between hair and sediment samples for Cr and Mn. This paper provides basic and useful information in facing public and environmental health challenges in the GNM sections of the Yellow River.     

Erratum: Interactions Between Cadmium and Zinc in the Biological Samples of Pakistani Smokers and Nonsmokers Cardiovascular Disease Patients

The pathogenesis of some cardiovascular diseases (CVDs) has been altered with changes in the balance of certain trace and toxic elements. The aim of the present study was to assess the role of zinc (Zn) and cadmium (Cd) in smoker and nonsmoker male CVD patients (n = 457) of two age groups (31–45) and (46–60). The both elements were determined in biological samples (scalp hair, blood, and urine) of CVD patients and healthy referents for comparison purpose. The concentrations of Zn and Cd were measured by atomic absorption spectrophotometer prior to microwave-assisted acid digestion. It was observed that the mean values of Cd were significantly higher in the biological samples of smokers CVD as compared to nonsmoker CVD patients, while the level of Zn was lower in both smoker and nonsmoker patients. The concentrations of Zn in whole blood and scalp hair samples were lower in CVD patients as compared to referents (p > 0.001). Results showed significant changes of levels of Cd and Zn in blood and scalp hair samples of CVD patients when compared with healthy referents, while reverse in the case of urine samples. It was observed that low Zn levels were associated with both smoker and nonsmoker CVD patients, while increased cadmium accumulation was observed in smoker patients as compared to nonsmoker patients (p > 0.025).     

Determination of total arsenic concentrations in nails by inductively coupled plasma mass spectrometry

The analysis of trace elements in biological samples will extend our understanding of the impact that environmental exposure to these elements has on human health. Measuring arsenic content in nails has proven useful in studies evaluating the chronic body burden of arsenic. In this study, we developed methodology with inductively coupled plasma-mass spectrometry (ICP-MS) for the determination of total arsenic in nails. We assessed the utility of the washing procedures for removing surface contamination. Four types of preanalysis treatments (water bath, sonication, water bath plus sonication, and control) after sample decomposition by nitric acid were compared to evaluate the digestion efficiencies. In addition, we studied the stability of the solution over 1 wk and the effect of acidity on the arsenic signal. Arsenic content in the digested solution was analyzed by using Ar-N₂ plasma with Te as the internal standard. The results suggest that washing once with 1% Triton Χ-100 for 20 min for cleaning nail samples prior to ICP-MS analysis is satisfactory. Repeated measurement analysis of variance revealed that there was no significant difference among the various sample preparation techniques. Moreover, the measurements were reproducible within 1 wk, and acidity seemed to have no substantial influence on the arsenic signal. A limit of detection (on the basis of three times the standard deviation of the blank measurement) of 7 ng As/g toenail was achieved with this system, and arsenic recoveries from reference materials (human hair and nails) were in good agreement (95–106% recovery) with the certified/reference values of the standard reference materials. ICP-MS offers high accuracy and precision, as well as highthroughput capacity in the analysis of total arsenic in nail samples.     

Effects of temperature and doxorubicin exposure on keratinocyte damage in vitro

Cancer chemotherapy treatment often leads to hair loss, which may be prevented by cooling the scalp during drug administration. The current hypothesis for the hair preservative effect of scalp cooling is that cooling of the scalp skin reduces blood flow (perfusion) and chemical reaction rates. Reduced perfusion leads to less drugs available for uptake, whereas the reduced temperature decreases uptake of and damage by chemotherapy. Altogether, less damage is exerted to the hair cells, and the hair is preserved. However, the two mechanisms in the hypothesis have not been quantified yet. To quantify the effect of reduced drug damage caused by falling temperatures, we investigated the effect of local drug concentration and local tissue temperature on hair cell damage using in vitro experiments on keratinocytes. Cells were exposed for 4 h to a wide range of doxorubicin concentrations. During exposure, cells were kept at different temperatures. Cell viability was determined after 3 d using a viability test. Control samples were used to establish a concentration–viability curve. Results show that cell survival is significantly higher in cooled cells (T < 22° C) than in non-cooled cells (T = 37° C), but no significant differences are visible between T = 10° C and T = 22° C. Based on this result and previous work, we can conclude that there is an optimal temperature in scalp cooling. Further cooling will only result in unnecessary discomfort for the patient and should therefore be avoided.