Secondary amputation after lower extremity free-flap reconstruction

BACKGROUND

Microsurgical free-tissue transfer is often the definitive reconstructive option for lower extremity limb salvage. Despite an initial successful free-flap reconstruction, some patients ultimately undergo lower extremity amputation. The indications for secondary amputation include non- or malunion, infection, hardware failure, or chronic pain. This study aimed to identify the etiology and outcome of secondary amputation after lower extremity free-flap reconstruction.

METHODS

A retrospective cohort study was performed including patients who underwent lower extremity free-flap reconstruction from January 2002 to December 2020. Patients who underwent secondary amputation were identified. A survey based on the PROMIS® Pain Interference Scale and activities of daily living (ADLs) was then conducted to assess patient-reported outcomes. Fifteen (52%) patients who underwent amputation responded to the survey, with a median follow-up time of 4.4 years.

RESULTS

Of 410 patients who underwent lower extremity free-flap reconstruction, 40 (9.8%) patients underwent subsequent amputation. Of these, 10 patients had failed free-flap reconstruction and 30 patients had secondary amputation after an initially successful soft tissue coverage. The most common etiology for secondary amputation was infection (68%, n = 27). Eighty percent (n = 12) of survey respondents were able to use a prosthetic limb and ambulate.

CONCLUSIONS

The most common etiology of secondary amputation was infection. Most patients who ultimately underwent amputation were able to ambulate with a prosthetic, but the majority of patients reported chronic pain. This study could be used to guide potential free-flap candidates regarding the risks and outcomes of lower extremity free-flap reconstruction.

Rhinopharynx irrigations and mouthwash with dissolved mupirocin in treatment of MRSA throat colonization - proof-of-concept study

BACKGROUND

To prevent transmission of, and infection with, meticillin-resistant Staphylococcus aureus (MRSA), eradication treatment of colonized individuals is recommended. Throat colonization is a well-known risk factor for eradication failure. Staphylococcus aureus throat colonization is associated with colonization of the rhinopharynx, but in the currently recommended Danish MRSA eradication strategies, rhinopharynx colonization is not directly targeted. Rhinopharynx colonization could therefore be an important risk factor for prolonged MRSA throat carriage.

AIM

To determine whether irrigation and wash of the rhinopharynx and mouth with dissolved mupirocin is a feasible and potentially efficacious supplementary strategy against treatment-resistant MRSA throat carriage.

METHODS

The patient study was an open, non-blinded, trial including 20 treatment-resistant MRSA throat carriers. In the study, the patients received a supplementary treatment besides the standard treatment according to the Danish MRSA eradication strategy. The supplementary treatment consisted of rhinopharyngeal irrigation and mouth-gurgling twice a day for 14 days with a mupirocin ointment (22 g 2% ointment per litre of isotonic sterile saline solution) in a 37°C solution.

FINDINGS

Eighteen patients (90%) complied with the treatment protocol and none ex-perienced any major adverse events. Out of the 18 patients who finished the study per protocol, 15 (83%) and seven (39%) patients had negative MRSA sampling results one and six months after end of treatment, respectively.

CONCLUSION

This study demonstrates the feasibility and clinical potential of also targeting the rhinopharynx and oropharynx in non-systemic throat MRSA eradication strategies.

Genetic parameters for reproductive losses estimated from in-line milk progesterone profiles in Swedish dairy cattle

This study assessed the extent of reproductive losses and associated genetic parameters in dairy cattle, using in-line milk progesterone records for 14 Swedish herds collected by DeLaval's Herd Navigator. A total of 330,071 progesterone samples were linked to 10,219 inseminations (AI) from 5,238 lactations in 1,457 Swedish Red and 1,847 Swedish Holstein cows. Pregnancy loss traits were defined as early embryonic loss (1-24 d after AI), late embryonic loss (25-41 d after AI), fetal loss (42 d after AI until calving), and total pregnancy loss (from d 1 after AI until calving). The following classical fertility traits were also analyzed: interval from calving to first service, interval from calving to last service, interval between first and last service, calving interval, and number of inseminations per service period. Least squares means with standard error (LSM ± SE), heritabilities, and genetic correlations were estimated in a mixed linear model. Fixed effects included breed, parity (1, 2, ≥3), estrus cycle number when the AI took place, and a linear regression on 305-d milk yield. Herd by year and season of AI, cow, and permanent environmental effect were considered random effects. Extensive (approximately 45%) early embryonic loss was found, but with no difference between the breeds. Swedish Red was superior to Swedish Holstein in the remaining pregnancy loss traits with, respectively: late embryonic loss of 6.1 ± 1.2% compared with 13.3 ± 1.1%, fetal loss of 7.0 ± 1.2% compared with 12.3 ± 1.2%, and total pregnancy loss of 54.4 ± 1.4% compared with 60.6 ± 1.4%. Swedish Red also had shorter calving to first service and calving to last service than Swedish Holstein. Estimated heritability was 0.03, 0.06, and 0.02 for early embryonic, late embryonic, and total pregnancy loss, respectively. Milk yield was moderately genetically correlated with both early and late embryonic loss (0.52 and 0.39, respectively). The pregnancy loss traits were also correlated with several classical fertility traits (-0.46 to 0.92). In conclusion, Swedish Red cows had lower reproductive loss during late embryonic stage, fetal stage, and in total, and better fertility than Swedish Holstein cows. The heritability estimates for pregnancy loss traits were of the same order of magnitude as previously reported for classical fertility traits. These findings could be valuable in work to determine genetic variation in reproductive loss and its potential usefulness as an alternative fertility trait to be considered in genetic or genomic evaluations.

Genetic parameters of endocrine fertility traits based on in-line milk progesterone profiles in Swedish Red and Holstein dairy cows

Evaluating fertility traits based on endocrine progesterone profiles is becoming a promising option to improve dairy cow fertility. Several studies have been conducted on endocrine fertility traits, mainly in the Holstein breed. In this study, focusing also on the Swedish Red (SR) breed, genetic parameters were estimated for classical and endocrine fertility traits, the latter based on in-line milk progesterone records obtained for 14 Swedish herds using DeLaval Herd Navigator (DeLaval International, Tumba, Sweden). A total of 210,403 observations from 3,437 lactations of 1,107 SR and 1,538 Holstein cows were used. Mixed linear animal models were used for estimation of genetic parameters. Least squares means analysis showed that Holstein cows had a 2.5-d-shorter interval from calving to commencement of luteal activity (C-LA) and longer length of first inter-ovulatory interval (IOI) than SR cows. The highest mean interval for C-LA, IOI, and first luteal phase length (LPL) was observed in the fourth parity. The incidence of short (<18 d), normal, (18-24 d), and long (>24 d) IOI was 29.3, 40.7, and 30%, respectively. Genetic analysis indicated moderate heritability (h²) for C-LA (h² = 0.24), luteal activity during the first 60 d in milk (LA60, h² = 0.15), proportion of samples with luteal activity (PLA, h² = 0.13), and calving to first heat (CFH, h² = 0.18), and low heritability estimates for LPL (h² = 0.08) and IOI (h² = 0.03) in the combined data set for both breeds. Similar heritability estimates were obtained for each breed separately except for IOI and LPL in SR cows, for which heritability was estimated to be zero. Swedish Red cows had 0.01 to 0.06 higher heritability estimates for C-LA, LA60, and PLA than did Holstein cows. Calving interval had moderate heritability among the classical traits for Holstein and the combined data set, but h² was zero for SR. Commencement of luteal activity had a strong genetic correlation with LA60 (mean ± SE; -0.88 ± 0.06), PLA (-0.72 ± 0.11), and CFH (0.90 ± 0.04). Similarly, CFH had a strong genetic correlation with IOI (0.98 ± 0.20). Number of inseminations per series showed a weak genetic correlation with all endocrine traits except IOI. Overall, endocrine traits had higher heritability estimates than classical traits in both breeds, and may have a better potential to explain the actual reproductive status of dairy cows than classical traits. This might favor inclusion of some endocrine fertility traits-especially those related to commencement of luteal activity-as selection criteria and breeding goal traits if recording becomes more common in herds. Further studies on genetic and genomic evaluations for endocrine fertility traits may help to provide firm conclusions. A prerequisite is that the data from automatic devices be made available to recording and breeding organizations in the future and included in a central database.

Danish experience of meticillin-resistant Staphylococcus aureus eradication with emphasis on nose-throat colonization and supplementary systemic antibiotic treatment

This study aimed to evaluate the Danish Board of Health's guidance for treating the carriage of meticillin-resistant Staphylococcus aureus (MRSA), focusing on nose-throat carriage and use of supplementary systemic antibiotics. The results of MRSA eradication treatment among 358 patients were analysed, focusing on those with nose (N=58) or throat (N=183) MRSA colonization. The Danish guidance for MRSA treatment was found to be more successful in patients with nose colonization (66%) compared with throat colonization (41%), despite the fact that the cumulative eradication rates were equal after three treatment cycles (71% vs 73%). This study found that supplementation of colonization treatment with systemic antibiotics does not have a positive effect.

Characteristics of macrolide responders in persistent post-surgical rhinosinusitis

INTRODUCTION

The anti-inflammatory effects of long term low dose macrolide therapy have shown benefit in the management of diffuse panbronchiolitis. Dramatic responses to macrolide in the upper airway are seen but our understanding of the patient phenotype predisposing to macrolide response in chronic rhinosinusitis (CRS) is poor.

METHODS

A case control study was performed in a tertiary level rhinology practice of consecutive chronic rhinosinusitis patients placed on a 3-month low dose macrolide therapy after failing at least 3 months of corticosteroid irrigation therapy post-endoscopic sinus surgery. Patients were defined as a macrolide responder when having near normal endoscopy after a 3-month period of clarithromycin treatment. Patient characteristics of smoking, asthma, atopy status, revision surgery, symptom severity (SNOT-22) along with biomarkers from serum and tissue histopathology results were compared between groups.

RESULTS

Of twenty-eight consecutive macrolide treated patients, 19 responders were compared to 9 non-responders. The groups were similar in age, female gender, non-smoking, asthma, and atopy. Macrolide response was associated with a lack of tissue eosinophilia (more than 10/HPF) and lower serum eosinophilia. Neutrophil expression was similar in tissue and serum. Squamous metaplasia was overexpressed in non-responders.

CONCLUSION

Low tissue and serum eosinophilia, and absence of tissue squamous metaplasia may predict a CRS phenotype suitable to a trial of long-term macrolide therapy when surgery and topical therapy has failed.

Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty

BACKGROUND

Inferior turbinate procedures are applied to relieve medically refractory nasal obstruction. However, the nature of congestion differs between allergic(AR) and non-allergic rhinitis(NAR). This study compares surgical outcomes between AR and NAR patients.

METHODOLOGY

A case-control study of patients undergoing turbinate with or without septoplasty surgery for nasal obstruction was performed. Patient reported outcomes were: nasal obstruction, global nasal function(GNF), and sino-nasal outcome test(SNOT-22) with rhinitis, facial symptom, sleep and psychological sub-scores. Nasal peak inspiratory flow(NPIF) assessed nasal airflow. Measurements were obtained preoperatively and 3 months postoperatively.

RESULTS

190 patients were assessed. AR had worse obstruction and worse GNF. All outcomes improved post-surgery; nasal obstruction, GNF, SNOT-22, rhinitis-symptoms, facial-symptoms, sleep-function, psychological-function and NPIF. GNF improvement was greater in AR. NPIF improvement was similar between groups.

CONCLUSIONS

Both AR and NAR patients gained benefit from surgery to relieve nasal obstruction. AR patients demonstrate greater improvement in GNF score but allergy management may contribute to this.

Periostin as a marker of mucosal remodelling in chronic rhinosinusitis

BACKGROUND

Although extracellular matrix (ECM) proteins are associated with irreversible lower airway changes, the relationship with upper airway remodelling which occurs during chronic rhinosinusitis (CRS) is poorly understood. This study assessed the expression of ECM proteins periostin, fibulin-1, fibronectin and collagenIV in nasal mucosa of patients with and without histologic features of remodelling.

METHODS

A cross-sectional study of sinonasal mucosal biopsies taken from patients, undergoing surgery for CRS was performed, where patients were grouped according to remodelling, defined by basement membrane thickening (BMT over 7.5 micrometer) and subepithelial fibrosis. An overall view and three random fields of immunostained tissue sections that included epithelium, basement membrane and submucosa, were imaged using Zeiss Zen software. The area and intensity of positive staining were scored by two blinded observers, using a 12-point ordinal scale of weak to strong.

RESULTS

65 patients (47.6 +/- 13.4years, 44.6% female) were assessed. Patients were grouped as controls 26.2%, BMT/no fibrosis 38.5% or BMT and fibrosis 33.8%. Stronger grade of periostin expression was associated with remodelling changes and tissue eosinophilia over 10/HPF. Fibulin-1, fibronectin and collagenIV did not differ.

CONCLUSION

Periostin expression was associated with the presence of BMT, fibrosis and tissue eosinophilia and may identify patients undergoing remodelling changes.

Periostin as a marker of mucosal remodelling in chronic rhinosinusitis

BACKGROUND

Although extracellular matrix (ECM) proteins are associated with irreversible lower airway changes, the relationship with upper airway remodelling which occurs during chronic rhinosinusitis (CRS) is poorly understood. This study assessed the expression of ECM proteins periostin, fibulin-1, fibronectin and collagenIV in nasal mucosa of patients with and without histologic features of remodelling.

METHODS

A cross-sectional study of sinonasal mucosal biopsies taken from patients, undergoing surgery for CRS was performed, where patients were grouped according to remodelling, defined by basement membrane thickening (BMT over 7.5 micrometer) and subepithelial fibrosis. An overall view and three random fields of immunostained tissue sections that included epithelium, basement membrane and submucosa, were imaged using Zeiss Zen software. The area and intensity of positive staining were scored by two blinded observers, using a 12-point ordinal scale of weak to strong.

RESULTS

65 patients (47.6 +/- 13.4years, 44.6% female) were assessed. Patients were grouped as controls 26.2%, BMT/no fibrosis 38.5% or BMT and fibrosis 33.8%. Stronger grade of periostin expression was associated with remodelling changes and tissue eosinophilia over 10/HPF. Fibulin-1, fibronectin and collagenIV did not differ.

CONCLUSION

Periostin expression was associated with the presence of BMT, fibrosis and tissue eosinophilia and may identify patients undergoing remodelling changes.

The impact of bitter taste receptor genetics on culturable bacteria in chronic rhinosinusitis

BACKGROUND

Extra-oral bitter taste receptors have been associated with innate bacterial defence mechanisms. Genetic variation in T2R38 functionality has been shown to be associated with susceptibility to upper respiratory tract infections and chronic rhinosinusitis (CRS). We sought to independently assess the influence of bitter taste receptor genotype on the presence of culturable bacteria in the sinuses.

METHODOLOGY

A cross-sectional analysis of patients with CRS undergoing surgery was performed. Middle meatal nasal swabs were sent for microbiological evaluation at the time of the procedure. Mucosal biopsies were taken and sent for bitter taste receptor genotype analysis. Sequencing of 3 polymorphisms in the TAS2R38 gene was performed to identify genotypes as super-tasters (PAV/PAV), non-tasters (AVI/AVI) or heterozygous expression (PAV/AVI). The presence of culturable organisms and common pathogens were compared with bitter taste receptor genotypes.

RESULTS

25 patients (age 52.4 +/- 18.28 years, 51% female) were assessed. Super-tasters comprised 16% of the group, 24% were non-tasters and 48% had heterozygous expression. A cultured pathogen was grown in 48% of patients; 32% gram-positive, 20% gram-negative, 28% grew Staphylococcus aureus and 12% Pseudomonas aeruginosa. A non-taster genotype was predictive of colonised pathogens. Tissue eosinophilia (more than 10 HPF) was seen in 48%.

CONCLUSION

Even in a small sample of patients with CRS, non-taster T2R38 genotype appears to predict the presence of culturable bacteria colonising the sinus cavity at the time of surgery for their condition. A genetic link to patients more likely to become infected is likely.

Association of gastro-oesophageal reflux and chronic rhinosinusitis: systematic review and meta-analysis

INTRODUCTION

Gastro-oesophageal reflux disease (GORD) has been implicated in the development of chronic rhinosinusitis (CRS). The association of GORD with CRS is systematically assessed from the medical literature.

METHODOLOGY

Embase and MEDLINE were searched using a comprehensive strategy limited to English language and Human subjects. Any study with original data on the experimental, diagnostic, treatment or prognostic association of CRS with GORD was included. Studies without a control group, case reports and review articles were excluded.

RESULTS

The search returned 958 records, with an additional 10 found from bibliographic lists; this produced 32 studies. The included studies (n=32) consisted of studies reporting pathogenic factors (n=20), epidemiological association (n=8), prognostic interactions (n=3), and a combination of these outcomes (n=1). Potential pathogenic roles for GORD in CRS were supported; CRS subjects had greater prevalence of intranasal Helicobacter pylori and acid reflux than subjects without CRS. CRS is more prevalent in GORD sufferers than those without GORD. Evidence is conflicting for GORD as a factor in CRS treatment failure.

CONCLUSION

The results support a significant association of GORD with CRS. Physicians should be cognizant of the potential for acid and non-acid reflux as a driving factor in CRS.

Reaction mechanism of dimethyl ether carbonylation to methyl acetate over mordenite – a combined DFT/experimental study

Dimethyl ether carbonylation to methyl acetate over mordenite was studied theoretically with density functional theory calculations and experimentally in a fixed bed flow reactor. A new reaction path to methyl acetate entirely in the 8 membered ring was discovered.

Household air pollution from wood burning in two reconstructed houses from the Danish Viking Age

During 13 winter weeks, an experimental archeology project was undertaken in two Danish reconstructed Viking Age houses with indoor open fireplaces. Volunteers inhabited the houses under living conditions similar to those of the Viking Age, including cooking and heating by wood fire. Carbon monoxide (CO) and particulate matter (PM2.5 ) were measured at varying distances to the fireplace. Near the fireplaces CO (mean) was 16 ppm. PM2.5 (mean) was 3.40 mg/m(3) , however, measured in one house only. The CO:PM mass ratio was found to increase from 6.4 to 22 when increasing the distance to the fire. Two persons carried CO sensors. Average personal exposure was 6.9 ppm, and from this, a personal PM2.5 exposure of 0.41 mg/m(3) was estimated. The levels found here were higher than reported from modern studies conducted in dwellings using biomass for cooking and heating. While this may be due to the Viking house design, the volunteer's lack of training in attending a fire maybe also played a role. Even so, when comparing to today's issues arising from the use of open fires, it must be assumed that also during the Viking Age, the exposure to woodsmoke was a contributing factor to health problems.

Organophosphorus pesticide degradation product in vitro metabolic stability and time-course uptake and elimination in rats following oral and intravenous dosing

Levels of urinary dialkylphosphates (DAPs) are currently used as a biomarker of human exposure to organophosphorus insecticides (OPs). It is known that OPs degrade on food commodities to DAPs at levels that approach or exceed those of the parent OP. However, little has been reported on the extent of DAP absorption, distribution, metabolism and excretion. The metabolic stability of O,O-dimethylphosphate (DMP) was assessed using pooled human and rat hepatic microsomes. Time-course samples were collected over 2 h and analyzed by LC-MS/MS. It was found that DMP was not metabolized by rat or pooled human hepatic microsomes. Male Sprague-Dawley rats were administered DMP at 20 mg kg(-1) via oral gavage and i.v. injection. Time-course plasma and urine samples were collected and analyzed by LC-MS/MS. DMP oral bioavailability was found to be 107 ± 39% and the amount of orally administered dose recovered in the urine was 30 ± 9.9% by 48 h. The in vitro metabolic stability, high bioavailability and extent of DMP urinary excretion following oral exposure in a rat model suggests that measurement of DMP as a biomarker of OP exposure may lead to overestimation of human exposure.

Evaluation of a radioimmunoassay and establishment of a reference interval for salivary cortisol in healthy subjects in Denmark

A commercial radioimmunoassay (RA) for salivary cortisol was evaluated using certified reference material in water and spiked to pooled saliva in the range 2.1-89.1 nmol/L. A variance component model for describing the effects of age, body mass index (BMI), diurnal variation, gender, days of sick leave during the past year, and smoking habits was established. Reference intervals for salivary cortisol in 120 healthy individuals performing their routine work were established according to the International Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry (IFCC). The method evaluation of the certified reference material in water did not show any bias of the method, i.e. recovery was 97% [CI: 94%; 100.9%]. LOD (detection limit) was 1.59 nmol/L. The ratio between analytical and within-subject variation (CVa/CVi) was 0.14, indicating that the method was adequate for measurement in healthy subjects. Reference intervals were estimated to be from 3.6 to 35.1 nmol/L for samples at the time of awakening (05.27-07.27), 7.6-39.4 nmol/L for peak level in saliva samples collected 20 min after awakening (05.47-07.47), and LOD 10.3 nmol/L for late afternoon samples (17.00-19.00). Reactivity (increase from awakening to 20 min after awakening) was estimated to be 82% [CI: -179; 345%] and recovery (decrease from 20 min after awakening to 18.00) to be 80% [CI: 51; 109%]. Eighteen percent of the subjects showed a decrease in cortisol in saliva from awakening to 20 min after awakening. Salivary cortisol was not affected by age, body mass index, gender, smoking habits or days of sick leave during the past year.

Reference intervals and variation for urinary epinephrine, norepinephrine and cortisol in healthy men and women in Denmark

Reference intervals for urinary epinephrine, norepinephrine and cortisol in 120 healthy individuals performing their routine work were established according to the International Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) for use in the risk assessment of exposure to occupational stress. Reference intervals were established for three different times of the day: in morning samples (05.45-07.15) the limit of detection (LOD) was 2.10 micromol epinephrine/mol creatinine (82 women) and 2.86 micromol epinephrine/mol creatinine (37 men), and the reference interval was 3.6-29.1 micromol norepinephrine/mol creatinine and 2.3-52.8 micromol cortisol/mol creatinine (119 women and men); in afternoon samples (15.30-18.30) the reference interval was 0.64-10.8 micromol epinephrine/mol creatinine (82 women), 1.20-11.2 micromol/epinephrine/mol creatinine (36 men), 11.0-54.1 micromol/ norepinephrine/mol creatinine and LOD was 42.4 micromol cortisol/mol creatinine (117 women and men); in evening samples (21.45-23.45) LOD was 8.66 micromol epinephrine/mol creatinine (81 women) and 7.99 micromol/epinephrine/mol creatinine (36 men), the reference interval was 11.0-54.1 micromol norepinephrine/mol creatinine, and LOD was 42.4 micromol cortisol/mol creatinine (117 women and men). A variance component model for describing the effects of age, body mass index (BMI), diurnal variation, gender, days of sick leave during past year and smoking habits was established. Women showed a higher morning value but excreted lower amounts of epinephrine during the day as compared to men. No gender differences could be demonstrated for the excretion of norepinephrine and cortisol. Excretion of epinephrine and norepinephrine increased with smoking and decreased with increased BMI. No effects were observed in the excretion of cortisol.

Seasonal and biological variation of urinary epinephrine, norepinephrine, and cortisol in healthy women

BACKGROUND

There is a significant circadian and seasonal periodicity in various endocrine functions. The present study describes the within-day and seasonal fluctuation for urinary catecholamines and cortisol and estimates the within- (CV(i)) and between-subject (CV(g)) coefficients of variation for healthy women undertaking their routine work. In addition, index of individuality (I(i)) and power calculations were derived.

METHODS

Eleven healthy females undertaking their routine life-style at work participated in the study. Each subject collected six samples during 24 h 15 days over a year, giving a total number of 990 samples. Using a random effect analysis of variance, we estimated CV(g) and total within-subject variation (CV(ti)), i.e. combined within-subject and analytical variation, from logarithmically transformed data. Analytical variation was subtracted from CV(ti) to give CV(i). CV(i) was estimated from samples collected monthly during 1 year (CV(iy)), weekly during 1 month (CV(im)), and six to eight times/day (CV(id)).

RESULTS

A seasonal variation was demonstrated for excretion of epinephrine, norepinephrine, and cortisol standardized with creatinine. Concentrations of urinary epinephrine were higher during June and July compared to the rest of the year, whereas concentrations of urinary cortisol were higher during December and January compared to the rest of the year. Excretion of norepinephrine was lower during working hours and higher during hours off work for June and July compared to the rest of the year. There was a high within- and between-subject variation, which could not be explained by menstrual cycle, behavioral, emotional, or cognitive stress reactions.

CONCLUSIONS

Despite high biological variation a reasonably low sample size, e.g. 10-50 individuals, is adequate for practical applicability, i.e. studying differences above 150%. The present study recommends to include the sampling time in the statistical evaluation of data and to be aware of the changes in diurnal variations over seasons. When single measurements are to be evaluated, reference intervals are recommended.

Urinary concentrations of trichloroacetic acid in Danish workers exposed to trichloroethylene, 1947-1985

BACKGROUND

Since 1947, the National Labour Inspection Service in Denmark has relied upon urinary measurements of trichloroacetic acid (TCA) in surveys of the occupational exposure to trichloroethylene (TCE).

METHODS

We examined the paper files relating to 2397 TCA measurements to extract information about the year, the company, the work process and the worker. We used multiple regression models to analyze the effects of various factors on the urinary concentration of TCA.

RESULTS

The regression analyses showed that (1) a four-fold decrease in TCA concentrations occurred from 1947 to 1985; (2) the highest concentrations were observed in the iron and metal, chemical, and dry cleaning industries; (3) TCA levels were two times higher among men compared with women in the iron and metal and dry cleaning industries; (4) TCA concentrations were higher among younger compared with older workers; and (5) persons working in an area in which TCE was used, but not working with TCE themselves, also showed urinary TCA levels indicative of exposure.

CONCLUSIONS

Calendar year, type of industry, degree of contact with TCE, sex and age were predictors of TCA concentration in the urine of Danish workers.

Reference interval and subject variation in excretion of urinary metabolites of nicotine from non-smoking healthy subjects in Denmark

BACKGROUND

Passive smoking has been found to be a respiratory health hazard in humans. The present study describes the calculation of a reference interval for urinary nicotine metabolites calculated as cotinine equivalents on the basis of 72 non-smokers exposed to tobacco smoke less than 25% of the day.

METHODS

Twenty subjects (passive smokers) exposed to tobacco smoke more than 25% of the day (subjectively assessed) and 32 smokers were used to validate the estimated reference interval. Urine samples were collected three times during the day approximately at 06.30, 17.00 and 22.45 h.

RESULTS

Within-subject variation was found to be 89.4, 72.6, and 79.2% and between-subject variation was found to be 64.5, 64.2, and 36.1%. No gender difference could be demonstrated. In general all subjects showed increased concentrations in the afternoon and evening samples compared to the morning samples. Parametric reference interval for excretion of nicotine metabolites in urine from non-smokers was established according to International Union of Pure and Applied Chemistry (IUPAC) and International Federation for Clinical Chemistry (IFCC) for use of risk assessment of exposure to tobacco smoke. The reference interval for urinary cotinine was estimated to be 1.1-90.0 micromol/mol creatinine in morning samples from non-smokers. An intercomparison between the radioimmunoassay (RIA) method used for determination of nicotine metabolites and a gas chromatography-mass spectrometry (GC-MS) method for determination of cotinine was carried out on 27 samples from non-smokers and smokers. Results obtained from the RIA method showed 2.84 [confidence interval (CI): 2.50; 3.18] times higher results compared to the GC-MS method. A linear correlation between the two methods was demonstrated (rho=0.96).

CONCLUSION

The RIA method is rapid and adequate for clinical use in the assessment of exposure to tobacco smoke, i.e. ratio between CV(a)/CV(ti) was<0.50.

Cancer incidence among Danish workers exposed to trichloroethylene

Human evidence regarding the carcinogenicity of the animal carcinogen trichloroethylene (TCE) is limited. We evaluated cancer occurrence among 803 Danish workers exposed to TCE, using historical files of individual air and urinary measurements of TCE-exposure. The standardized incidence ratio (SIR) for cancer overall was close to unity for both men and women who were exposed to TCE. Men had significantly elevated SIRs for non-Hodgkin's lymphoma (SIR = 3.5; n = 8) and cancer of the esophagus (SIR = 4.2; n = 6). Among women, the SIR for cervical cancer was significantly increased (SIR = 3.8; n = 4). No clear dose-response relationship appeared for any of these cancers. We found no increased risk for kidney cancer. In summary, we found no overall increase in cancer risk among TCE-exposed workers in Denmark. For those cancer sites where excesses were noted, the small numbers of observed cases and the lack of dose-related effects hinder etiological conclusions.

Pharmacokinetics and pharmacodynamics of antiulcer agents in llama

Plasma concentration time curves following intravenous (i.v.) administration of 1.5 mg/kg of ranitidine, 0.2 mg/kg, 0.4 mg/kg and 0.8 mg/kg of omeprazole, respectively, were analysed in six llamas. Plasma profiles after i.v. administration of both drugs showed plasma concentrations declining in a biexponential manner with a rapid distribution phase. Pharmacokinetics parameters after ranitidine administration to six llamas showed a mean elimination half-life of 1.53 +/- 0.26 h. The mean volume of distribution (Vdss) in llamas was 1.77 +/- 0.31 L/kg, and mean body clearance in llamas was 0.778 +/- 0.109 L/kg/h. Ranitidine produced only a small transitory (<1 h) decline in acid production when administered i.v. at a dose of 1.5 mg/kg. Omeprazole showed dose-dependent nonlinear pharmacokinetics. The mean half-life of 0.2 mg/kg i.v. omeprazole was shorter than that of 0.4 and 0.8 mg/kg i.v. omeprazole, i.e. 0.61, 0.72 and 1.07 h, respectively. The area under the curve (AUC) and mean residence time (MRT) increased with increasing dose, while clearance decreased as dose increased. The decline in acid production following 0.2 mg/kg i.v. omeprazole was highly variable and did not produce a clinically useful suppression of third compartment acid production. In contrast, both 0.4 mg/kg and 0.8 mg/kg omeprazole i.v. administration significantly reduced third compartment acid production. The reduction in acid production following 0.8 mg/kg omeprazole was not significantly greater than the reduction observed following 0.4 mg/kg dosage. Misoprostol (10 microg/kg) was administered i.v. in an absolute alcohol solution. Two animals collapsed following drug administration. While the side-effects could have been produced by either misoprostol or the alcohol vehicle, the clinical changes were more consistent with an adverse drug reaction. Unfortunately, the limitation of UV detection did not provide the sensitivity needed to quantify the amount of misoprostol in llama plasma, and the pharmacokinetics could not be evaluated.

Repeated exposures to cobalt or chromate on the hands of patients with hand eczema and contact allergy to that metal

The present study aimed at evaluating the effects of daily repeated exposures to low cobalt or chromate concentrations on the hands of patients with hand eczema and cobalt or chromate allergy. For 2 weeks, the patients immersed a finger for 10 min daily into the appropriate metal salt solution in water. During the 1st week, this was a 10 or 50 mg/l cobalt concentration or a 10 mg/l chromate concentration, and, during the 2nd week, a 100 or 200 mg/l cobalt concentration or a 100 mg/l chromate concentration. This regimen elicited a flare of hand eczema only in the chromate-exposed chromate-sensitive patients. During the exposure period, accumulation of cobalt or chromate in the nail was demonstrated. Standardization of chemical methods of quantification of skin exposure to allergens, combined with experimental exposure studies in patients with specific contact allergy, will increase the possibility of providing evidence-based medicine in the area of allergic contact dermatitis in the future.

Nickel-induced cytokine production from mononuclear cells in nickel-sensitive individuals and controls. Cytokine profiles in nickel-sensitive individuals with nickel allergy-related hand eczema before and after nickel challenge

Exposure to nickel is a major cause of allergic contact dermatitis which is considered to be an inflammatory response induced by antigen-specific T cells. Here we describe the in vitro analysis of the nickel-specific T-cell-derived cytokine response of peripheral blood mononuclear cells from 35 nickel-allergic and 30 non-nickel-allergic individuals. Peripheral blood mononuclear cells were stimulated with 10(-4) and 10(-5) mol/l NiSO4 for 6 days and then additionally with ionomycin and phorbol myristate acetate for 24 h. Culture supernatants were analysed for interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha) by quantitative ELISA. The analysis showed that the synthesis of IL-4 and IL-5 but not of IFN-gamma or TNF-alpha was significantly higher in the nickel-allergic individuals. The finding of preferential synthesis of Th2 cytokines was somewhat of a surprise, since previous studies have suggested a Th1 response in nickel-mediated allergic contact dermatitis. Subsequently, the nickel-allergic individuals were randomized to experimental exposure to nickel or vehicle in a double-blind design. A daily 10-min exposure of one finger to 10 ppm nickel solution for 1 week followed by 100 ppm for an additional week evoked a clinical response of hand eczema in the nickel-exposed group. Blood samples were drawn on days 7 and 14 after the start of this exposure to occupationally relevant concentrations of nickel. No statistically significant differences were observed in the nickel-induced in vitro cytokine response during the exposure period. Our results indicate the possibility that IL-4 and IL-5 are involved in the pathogenesis of nickel-mediated contact dermatitis.

Seasonal and biological variation of blood concentrations of total cholesterol, dehydroepiandrosterone sulfate, hemoglobin A(1c), IgA, prolactin, and free testosterone in healthy women

BACKGROUND

Concentrations of physiological response variables fluctuate over time. The present study describes within-day and seasonal fluctuations for total cholesterol, dehydroepiandrosterone sulfate (DHEA-S), hemoglobin A(1c) (HbA(1c)), IgA, prolactin, and free testosterone in blood, and estimates within- (CV(i)) and between-subject (CV(g)) CVs for healthy women. In addition, the index of individuality, prediction intervals, and power calculations were derived.

METHODS

A total of 21 healthy female subjects participated in the study. Using a random effects analysis of variance, we estimated CV(g) and total within-subject variation (CV(ti)), i.e., the combined within-subject and analytical variation, from logarithmically transformed data. Analytical variation was subtracted from CV(ti) to give CV(i). CV(i) was estimated from samples taken monthly during 1 year (CV(iy)), weekly during 1 month (CV(im)), and six times within 1 day (CV(id)).

RESULTS

A cyclic seasonal variation was demonstrated for total cholesterol, DHEA-S, HbA(1c), prolactin, and free testosterone. Within-day variation was shown for prolactin and free testosterone. The overall mean values for the group and the variability (CV(iy) and CV(g)) were: 5.1 mmol/L, 13% [corrected], and 12% [corrected] for total cholesterol; 6.6 micromol/L, 20% [corrected], and 49% [corrected] for DHEA-S; 30% [corrected], 7.0% [corrected], and 7.5% [corrected] for HbA(1c)/hemoglobin(total); 2.1 g/L, 5.9%, and 13% for IgA; 136 mIU/L, 58% [corrected], and 63% [corrected] for prolactin; and 5.4 pmol/L, 55% [corrected], and 68% [corrected] for free testosterone.

CONCLUSIONS

Collecting samples at specific hours of the day or times of the year may reduce high biological variation. Alternatively, the number of individuals may be increased and a paired study design chosen to obtain adequate statistical power.

Effects of repeated skin exposure to low nickel concentrations: a model for allergic contact dermatitis to nickel on the hands

We studied the effects of repeated daily exposure to low nickel concentrations on the hands of patients with hand eczema and nickel allergy. The concentrations used were chosen to represent the range of trace to moderate occupational nickel exposure. The study was double-blinded and placebo controlled. Patients immersed a finger for 10 min daily into a 10-p.p.m. nickel concentration in water for the first week, and during the second week into a 100-p.p.m. nickel concentration. This regimen significantly increased (P = 0.05) local vesicle formation and blood flow (P = 0.03) as compared with a group of patients who immersed a finger into water. The nickel concentrations used also provoked significant inflammatory skin changes on sodium lauryl sulphate (SLS)-treated forearm skin of the patients, whereas inflammatory skin changes were not observed in healthy volunteers without hand eczema and nickel allergy, either on normal or on SLS-treated forearm skin. The present study strongly suggests that the changes observed were specific to nickel exposure. Standardized methods to assess trace to moderate nickel exposure on the hands, and the associated effects in nickel-sensitized subjects, are needed.

Nickel concentrations in serum and urine of patients with nickel eczema

This study is a part of the Biological Risk Assessment of Human Metal Sensitisation (BRAHMS) project with the aim of elucidating clinical and physiological effects of repeated exposures to low concentrations of metal allergens. Nickel allergic individuals (n = 35) with hand eczema and healthy controls (n = 30) were included in the study. Both groups had similar levels of nickel in urine, while the level of nickel in serum was significantly lower in nickel allergic individuals compared to controls. Nickel allergic individuals had a significantly lower intake of nickel-rich food items (chocolate, nuts, beans, porridge oats). Serum nickel levels correlated with intake of these foods, suggesting that the difference in serum nickel levels was caused by differences in dietary nickel intake.

Evaluation of a whole cell, p57- vaccine against Renibacterium salmoninarum

A whole cell Renibacterium salmoninarum vaccine was developed using 37 degrees C heat treated cells that were subsequently formalin fixed; this treatment reduced bacterial hydrophobicity and cell associated p57. Coho salmon Oncorhynchus kisutch were immunized with the p57- vaccine by either a combination of intraperitoneal (i.p.) and intramuscular (i.m.) injections or per os. In the first experiment, i.p./i.m. vaccination of coho salmon with p57- cells in Freund's Incomplete Adjuvant (FIA) conferred a statistically significant increase in mean time to death after the salmon were i.p. challenged with 4.1 x 10(6) colony forming units (cfu) of R. salmoninarum. There was no significant difference in response between fish immunized with R. salmoninarum cell surface extract in FIA and those immunized with extracellular protein (ECP) concentrated from culture supernatant in FIA. The i.p. challenge dose resulted in complete mortality of all fish by Day 43. In a second experiment, fish were orally vaccinated with p57- R. salmoninarum cells encased in a pH protected, enteric-coated antigen microsphere (ECAM). Fish were bath challenged with 4.2 x 10(6) cfu ml-1 on Day 0 and sampled at time points of 0 (pre-challenge), 50, 90, or 150 d immersion challenge. Vaccine efficacy was determined by monitoring the elaboration of p57 in the kidneys of vaccinated and control fish. Fish vaccinated orally demonstrated a significantly lower concentration of p57 (p < 0.01) at Day 150 post challenge compared to fish receiving ECAMs alone. Fish receiving p57 cells without ECAM coating also showed a significantly lower p57 level (p < 0.03) versus control. In contrast, fish injected intraperitoneally with the p57- cells or fish fed p57+ R. salmoninarum cells in ECAMs demonstrated no significant difference (p > 0.05) versus controls. In summary, these studies suggest the preliminary efficacy of 37 degrees C treatment of R. salmoninarum cells as an oral bacterial kidney disease vaccine.

Speciation measurements by HPLC-HGAAS of dimethylarsinic acid and arsenobetaine in three candidate lyophilized urine reference materials

Speciation measurements of dimethylarsinic acid (DMA) and arsenobetaine (AsB) in three candidate lyophilized urine reference materials are described. The measurements were based on cation-exchange liquid chromatography coupled to hydride generation atomic absorption spectrometry with on-line digestion of the organic. As species by alkaline persulfate solution aided by ultraviolet radiation. Arsenic concentrations as DMA were significantly different in the three samples. The mean values for the three samples were 4.1 +/- 0.3, 55.3 +/- 1.2 and 134.1 +/- 1.5 micrograms l-1, respectively. No significant differences in AsB concentrations were observed among the three samples. The mean As concentrations as AsB in the three samples were 17.4 +/- 0.4, 17.7 +/- 0.2 and 17.5 +/- 0.3 micrograms l-1, respectively. By off-line digestion of the urine samples, total As concentrations in the three materials were also obtained. The mean values were 23.4 +/- 0.3, 76.6 +/- 1.6 and 151.3 +/- 1.8 micrograms l-1, respectively. These results correlated well with the results obtained by neutron activation analysis in our laboratory (r = 0.999; p < 0.0001).

Inductively coupled plasma mass spectrometric determination of molybdenum in urine from a Danish population

Molybdenum creatinine levels in urine were measured in 128 Danish inhabitants by ICP-MS in order to establish reference intervals of molybdenum in urine for the Danish population as a part of the EURO-TERVIHT project (Trace Element Reference Values in Human Tissues). The Mo concentration was determined using the isotopes 95Mo and 98Mo. The values measured based on 98Mo were about 2% lower than those calculated using 95Mo, a negligible difference in the context of reference values. The limit of detection was 0.2 microgram l-1, the precision was 8.6% and the recovery of added NIST 1643c certified reference material was 94%. The distribution of the data, with and without correction for creatinine concentration, was long-normal. The mean concentration measured was 42.5 micrograms l-1, (3.89 micrograms Mo mmol-1 creatinine) using 95Mo and 41.5 micrograms l-1 (3.81 micrograms Mo mmol-1 creatinine) using 98Mo, with the 95% parametric reference intervals 10.0-124.0 micrograms l-1 (0.89-11.50 micrograms Mo mmol-1 creatinine) and 9.6-122.6 micrograms l-1 (0.84-11.47 micrograms Mo mmol-1 creatinine), respectively. The difference between men and women reached the level of significance only after the values were corrected for the creatinine concentration. There was no influence of age on the Mo concentration. Specific effects of different food and beverage intakes could not be demonstrated, with the exception of a positive correlation between butter consumption and Mo concentration.

Trends in quality assurance of metal determination in clinical chemistry

A summary is given of the main strategies that can be used to obtain high quality results in the determination of metals in clinical chemistry. The trends in quality assurance of metal analyses are discussed.

A DANREF certified reference material for chromate in cement

Two candidate reference materials for chromate in cement were produced in the DANREF network and certified in an interlaboratory study. Fifteen laboratories participated in the interlaboratory study and six different analytical methods were used. The certified values were estimated as the consensus mean of laboratory mean values (outliers excluded). Only results from laboratories using methods relying on chromate speciation were accepted. The certified values (+/- 95% confidence limits) were 0.678 (+/- 0.075) mg CrVI kg-1 dry cement for the low level and 6.04 (+/- 0.28) mg CrVI kg-1 dry cement for the high level. Methods based on total chromium determination gave on average results that were 6.5% higher (both levels). However, the difference between speciation and non-speciation results was significant at the high concentration level only.

Toxic trace element reference levels in blood and urine: influence of gender and lifestyle factors

This study is part of the EURO-TERVIHT project (Trace Element Reference Values in Human Tissues) which aims at establishing reference intervals for trace elements in blood, urine and other human tissues. In this study reference intervals (0.05-0.95 fractiles) were estimated for lead in blood (105-529 nmol/l for men, 80-340 nmol/l for women), manganese in blood (100-271 nmol/l) and arsenic in urine (36-541 nmol/l for men, 21-475 nmol/l for women). Upper reference limits (0.95 fractile) were established for chromium in urine (13 nmol/l), nickel in urine (52 nmol/l) and cobalt in urine (23 nmol/l for men, 31 nmol/l for women). The reference group was a Danish subpopulation (n = 189), age 40-70 years. The influence of gender, age, health status parameters, nutrition and various lifestyle factors was investigated. Urinary arsenic and blood lead levels were found to be higher for men than for women. Arsenic levels also increased with age up to 60 years, and then decreased. Alcohol intake lead to increased arsenic levels in urine as well as blood lead levels. Urinary nickel levels were higher in persons frequently eating porridge and porridge oats.

Identifying denial in stroke patients

The purpose of this study was to test the reliability of an experimental assessment tool for identifying and differentiating between psychodynamic and neurogenic denial in stroke patients. A one-page criterion referenced denial assessment tool was used by interdisciplinary rater teams to evaluate patients with either right or left hemisphere insults. High interrater reliability was obtained. Assessment data indicated that right-CVA patients had higher psychodynamic and neurogenic denial scores than left-CVA patients. Higher psychodynamic denial scores were also observed in the second month post-stroke. The experimental denial assessment tool proved to be a practical way for identifying and differentiating psychodynamic and neurogenic forms of denial. This tool can provide a means for ongoing assessment to support precise nursing diagnoses and promote effective patient-focused care planning throughout the rehabilitation process.

Cryopreservation of channel catfish spermatozoa: Effect of cryoprotectant, straw size, and formulation of extender

Various aspects of the cryopreservation of spermatozoa of channel catfish (Ictalurus punctatus ) were studied in relation to spermatozoa motility. The objectives were to evaluate 1) the efficacy of 5, 10 and 15% of methanol or n,n-dimethyl acetamide (DMA) as cryoprotectants; 2) the acute toxicity of 5, 10 and 15% methanol or DMA; 3) the use of 0.5-ml vs. 0.25-ml straws; 4) the efficacy of 5, 10 and 15% of methanol in Hanks' balanced salt solution (HBSS) or HBSS without glucose, and 5) the use of HBSS with or without 5% methanol. We found that use of 5% methanol as a cryoprotectant resulted in significantly higher post-thaw motility (P = 0.0001) than did 5, 10 or 15% DMA. The use of 5% of either cryoprotectant resulted in significantly higher post-thaw motility (P = 0.0001) than did 10 or 15% of the cryoprotectants. Samples containing 10 or 15% DMA had significantly lower motility (P = 0.0001) after 30 min exposure than did samples containing 5, 10 or 15% methanol. The use of 0.25-ml straws resulted in significantly higher post-thaw motility (P = 0.0001) than that of 0.5-ml straws. No difference was found in post-thaw motility between HBSS with and without glucose as the extenders. Cryopreservation in HBSS without addition of cryoprotectant resulted in post-thaw motility values of about 1%.

Critical evaluation and review of cadmium concentrations in blood for use in occupational health according to the TRACY protocol

Cadmium in blood (B-Cd) may be used to assess recent exposure to cadmium in the working or general environment. In a paper published elsewhere pooled reference values using meta-analysis of B-Cd values in general-population studies were calculated. In the present study tentative references intervals were described which can be used for comparison with data from occupationally exposed groups or individuals. The selection of studies was done according to criteria as published by the international project TRACY. For this purpose, 800 publications covering the period 1983-1992 were reviewed on their suitability for establishing tentative reference intervals. From these 800 publications, four finally met the selection criteria. Most important criteria for selection were the check for contamination during sampling of the blood, the storage and pretreatment procedures, and the existence of internal and external quality control programs. Also, stratifications into sex, smoking habits and occupation were important selection criteria. It turned out that for non-smoking white-collar workers in the age range of 19-65 years, B-Cd values were below 0.8 micrograms/l for most areas. All other groups within this age group, e.g., white collar workers in Japan, blue-collar workers, and smokers tend to have higher B-Cd values in these sequences. Blue-collar workers not clearly exposed to Cd have higher values than white-collar workers, indicating still some minor exposure. It is not clear if this small exposure has an occupational or lifestyle (e.g., diet) origin. Geographical regions also show an influence on B-Cd levels, e.g., values in Japan are higher than elsewhere. This influence may be due to differences in diet. The conclusion will be that reference values for B-Cd in fact are area-dependent.

The disposition of five therapeutically important antimicrobial agents in llamas

The disposition of five therapeutic antimicrobial agents was studied in llamas (Lama glama) following intravenous bolus administration. Six llamas were each given ampicillin, tobramycin, trimethoprim, sulfamethoxazole, enrofloxacin and ceftiofur at a dose of 12 mg/kg, 1 mg/kg, 3 mg/kg, 15 mg/kg, 5 mg/kg, and 2.2 mg/kg of body weight, respectively, with a wash out period of at least 3 days between treatments. Plasma concentrations of these antimicrobial agents over 12 h following i.v. bolus dosing were determined by reverse phase HPLC. Disposition of the five antimicrobial agents was described by a two compartment open model with elimination from the central compartment, and also by non-compartmental methods. From compartmental analysis, the elimination rate constant, half-life, and apparent volume of distribution in the central compartment were determined. Statistical moment theory was used to determine noncompartmental pharmacokinetic parameters of mean residence time, clearance, and volume of distribution at steady state. Based on the disposition parameters determined, and stated assumptions of likely effective minimum inhibitory concentrations (MIC) a dose and dosing interval for each of five antimicrobial agents were suggested as 6 mg/kg every 12 h for ampicillin; 4 mg/kg once a day or 0.75 mg/kg every 8 h for tobramycin; 3.0 mg/kg/15 mg/kg every 12 h for trimethoprim/sulfamethoxazole; 5 mg/kg every 12 h for enrofloxacin; and 2.2 mg/kg every 12 h for ceftiofur sodium for llamas. Steady-state peak and trough plasma concentrations were also predicted for the drugs in this study for llamas.

Sample collection guidelines for trace elements in blood and urine. IUPAC Commission of Toxicology

This paper presents an organized system for element-specific sample collection and handling of human blood (whole blood, serum or plasma, packed cells or erythrocytes) and urine also indicating a proper definition of the subject and sample. Harmonized procedures for collection, preparation, analysis and quality control are suggested. The aim is to assist scientists worldwide to produce comparable data which will be useful on a regional, national and international scale. The guidelines are directed to the elements aluminium, arsenic, cadmium, chromium, cobalt, copper, lead, lithium, manganese, mercury, nickel, selenium and zinc. These include the most important elements measured for their occupational or clinical significance, and serve as examples of principles that will guide development of methods for other elements in the future.

Blood lead in the general population in Poland

Lead concentration in venous blood (Pb-B) was investigated in 1122 inhabitants (including 555 children under 10 years of age) of five Polish towns with no large industrial lead emitters (group I) and in 1246 persons (707 children under 10 years of age) living in the vicinity of zinc and copper mills (group II). The samples were analysed using electrothermal atomic absorption spectrometry (ETAAS) and the performing laboratory participated in the external quality control scheme during the study period (1992-1994). In group I the mean geometric Pb-B concentrations ranged from 23.8 to 48.3 micrograms/l in females, from 42.5 to 76.8 micrograms/l in males and from 29.9 to 62.5 micrograms/l in children. In group II, the mean geometric Pb-B concentrations were significantly higher and ranged from 49.4 to 105 micrograms/l in females, from 98.5 to 149 micrograms/l in males and from 73.7 to 114 micrograms/l in children, the values decreasing as the distance from the source of emission increased. Cigarette smoking was found to bring about a significant increase in Pb-B levels for both males and females. A significant correlation was noted between Pb-B concentrations in mothers and children. The ratio between child and maternal Pb-B concentrations amounted to approximately 1.0 for group I and to about 0.5 for group II. These findings indicate the necessity of undertaking preventive activities over the lead-contaminated areas. However, the lead hazard in Poland seems to be associated with point sources of emission and hence does not concern the whole population.

Geltape method for measurement of work related surface contamination with cobalt containing dust: correlation between surface contamination and airborne exposure

OBJECTIVES

The geltape method is a new method for optical measurement of total amount of dust on surfaces. The objectives were to study the potential applicability of this method to measurements of work related cobalt exposure during painting of plates with cobalt dye.

METHODS

Consecutive series of work related geltape prints were taken from surfaces inside and outside the ventilation cabins of two plate painters during two full working days. The amount of dust picked up by the geltapes was measured optically with a field monitor. Also, personal air samples were collected on filters at the different work processes. In the laboratory the contents of cobalt on the geltape prints and the filters were measured with inductive coupled plasma atomic emission spectroscopy.

RESULTS

The key results were: (a) when the geltape prints were taken from surfaces inside the cabins the optically measured area of the geltapes covered with total dust (area (%)) correlated well with the chemically measured amount of cobalt present on the geltapes. Linear correlation coefficient (R2) was 0.91 for geltape prints taken on the floor and 0.94 for prints taken on the ceiling; (b) the cumulative airborne cobalt exposure, calculated from data on work related exposure by personal sampling, correlated with the area (%) of geltape prints taken from the ceiling of the cabin (R2 = 0.98); (c) the geltape method could be used to distinguish both between work processes with different levels of cobalt exposure, and between plate painters subjected to significant differences in airborne cobalt exposure.

CONCLUSION

The geltape method could produce measures of the work related exposures as well as whole day exposure for cobalt. The geltape results correlated with measurements of personal airborne cobalt exposure. In this industry the profile of exposure is well-defined in time, and it seems reasonable to apply this fast and low cost method in routine exposure surveillance to obtain a more detailed description of the exposure than can be obtained by the use of airborne measurements only.

Human exposure to toxic metals: factors influencing interpretation of biomonitoring results

An important approach to assessment of risk from environmental and occupational exposures is biomonitoring which provides an estimate of the total dose absorbed and gives indirect access to determination of target site concentrations. It is also a tool for assessing residual exposure, when respiratory protection is used. The interest in biological effects from toxic metals has increased during the last decades, as large amounts of metals have been released into industrial areas, and it is estimated that approximately 150,000 Danish workers are exposed to various metals. Since biomonitoring results play an important role in decision-making regarding great health and economic impact, understanding the factors influencing validity of such data is essential. In the present survey, the toxic elements arsenic, cadmium, chromium, cobalt, lead and nickel are used as examples to illustrate the disturbing factors in the interpretation of biomonitoring results. The aim of collecting samples is to obtain a small and representative sample of subjects or of a subpopulation being investigated for specific purposes, e.g. the pollution at Mundelstrup, where arsenic exposure of inhabitants and workers engaged in removing contaminated soil was monitored. As exposures vary over time and between subjects, it should be recognized that sampling as well as analytical variations contribute both to bias and random errors. Also biomonitoring data are a function of demographic, lifestyle and geographic factors. Therefore, stratified sampling designs are of the utmost importance. Half-lives play an important role. For short half-lives below 10 h, no decision can be made on long-term exposure if only one urine sample has been taken. For arsenic, cobalt, chromium and nickel in urine measured at the end of a workweek (t1/2: 20-100 h), 2-3 samples should be taken to monitor a single worker, and the results should be interpreted from the average of the results. For groups of workers, it is recommended that results from at least 5-10 workers be used to obtain a useful group mean value. In general, pharmacokinetics modelling contributes to information on sampling time and sampling size. Intake of cobalt in mineral tablets containing soluble cobalt compounds was a factor with a large influence on blood and urinary levels. Age and gender influence the blood and urine concentrations of arsenic, cadmium, cobalt and lead, e.g. B-Pb in females is 20-30% lower than B-Pb in males.(ABSTRACT TRUNCATED AT 400 WORDS)

Estimation of reference values for urinary 1-hydroxypyrene and alpha-naphthol in Danish workers

In order to assess environmentally and occupationally related exposures to PAH compounds it is essential to have reference or normal values in human body fluids. The establishment of reliable reference intervals is an absolute pre-requisite in determining relationships between internal PAH exposure in humans and health effects in occupationally exposed workers. In this context the estimation of the biological level of PAH metabolites in urine from reference populations has become increasingly important in the field of environmental and occupational toxicology. The present study describes the calculation of tentative reference values for urinary 1-hydroxypyrene on the basis of two reference populations and for urinary alpha-naphthol on the basis of one reference population in accordance with IFCC recommendations. The study subjects were 115 healthy male workers occupationally exposed to PAH at low levels and 121 reference subjects non-occupationally exposed to PAH. Tentative reference values for urinary 1-hydroxypyrene were estimated. In addition, 236 healthy male workers were used to estimate tentative reference values for urinary alpha-naphthol. The reference populations were described by distribution free one-sided tolerance intervals. The 95% one-sided tolerance limit calculated for 1-hydroxypyrene in urine was 0.053 mumol/mol creatinine for non-occupationally exposed individuals and 0.169 mumol/mol creatinine for low level PAH exposed workers, with the coverage interval (95 +/- 4.5) percent at a probability of 0.95. Thus, the probability was 0.975 that the tolerance interval included at least 90.5% of the distribution. In addition, the probability was 0.025 that the tolerance interval included > 99.5% of the population. The tolerance interval for alpha-naphthol in urine was 5.665 mumol/mol creatinine with the coverage interval (95 +/- 4.5) percent at a probability of 0.95.

Assessment of long-term styrene exposure: a comparative study of a logbook method and biological monitoring

In a recent joint European research project "Biomonitoring of human populations exposed to genotoxic environmental chemicals: biomonitoring of styrene exposed individuals", a logbook method for assessment of long-term styrene exposure was applied in two Danish factories manufacturing glass fibre-reinforced polyester. The method was based on work process identification, assignment of work process concentrations and logbook keeping. Measures of exposure calculated by this method were compared with results from simultaneous measurements of styrene in blood and the metabolites mandelic acid and phenylglyoxylic acid in urine. Correlations were comparable with those obtained by use of personal samplers as published in the literature. Styrene in blood, however, only correlated with logbook concentrations at the time of sampling. Exposures were moderate to low. Mean personal 8-h time-weighted average concentration (8hTWAC) was 76 mg/m3 styrene (SD 54 mg/m3, range 2-230 mg/m3). The Danish 8hTWAC threshold limit value for styrene in air, 105 mg/m3 (25 ppm), was exceeded on 17% of personal days. The summed urinary metabolites, mandelic acid and phenylglyoxylic acid, had a mean personal value of 138 mg/g creatinine (SD 84 mg/g creatinine) on the day of sampling. Blood styrene mean value was 129 micrograms/l (SD 74 micrograms/l, range 66-358 micrograms/l). It is concluded that the logbook method offers a technique for testing whether measurements are performed on representative days and may be recommended as a tool supplementary to biological monitoring in the assessment of long-term exposure.

A 1982-1992 surveillance programme on Danish pottery painters. Biological levels and health effects following exposure to soluble or insoluble cobalt compounds in cobalt blue dyes

This paper provides a short overview of cobalt-related diseases with particular reference to the potential carcinogenicity of cobalt compounds, and a review of a 10-year surveillance programme on plate painters exposed to cobalt in two Danish porcelain factories. Clinical experience and epidemiological studies have demonstrated that cobalt exposure may lead to severely impaired lung function, i.e. hard metal lung disease and occupational cobalt-related asthma, contact dermatitis and cardiovascular effects. However, the evidence for the carcinogenicity of cobalt and cobalt compounds is considered inadequate (IARC, 1991). Most frequently, exposure to cobalt occurs simultaneously with exposure to other elements known to pose a health risk, (e.g. nickel, arsenic, chromium, tungsten). The importance of cobalt as sole causal agent in hard metal lung diseases, cardiomyopathy and cancer are still a matter of controversy. In the two Danish porcelain factories, cobalt blue underglaze dyes have been used since 1888. In contrast to the exposure experience of hard metal factories, the exposure of plate painters occurs with only low trace levels of other potentially harmful compounds such as the carcinogenic metals nickel, arsenic and chromium. Consequently, the nearly-pure cobalt exposure makes the plate painters an attractive group for studies on the health effects of cobalt. During the period 1982-1992 the surveillance programme showed a profound reduction in the urine level of cobalt (Co-U) from 100-fold to 10-fold above the median level of the unexposed control subjects. In the same period, the airborne cobalt exposure declined from 1356 nmol/m3 to 454 nmol/m3, the Danish occupational exposure limit being 845 nmol/m3. In 1982, when the cobalt exposure was above the occupational exposure limit, the plate painters showed a chronic impaired lung function. The obstructive effects may be similar to some of the effects observed in hard metal workers. In 1988, a study on the effect of cobalt exposure at low levels revealed no inhibitory effects on thyroid function, but the ratio between T4 and T3 increased, indicating that low cobalt exposure may have an impact on the metabolism of thyroid hormones. Parallel studies were conducted on the metabolism and excretion of cobalt. The gastrointestinal uptake of soluble CoCl was considerably higher than the uptake of insoluble cobalt(II) oxide. In addition, it was demonstrated that ingestion of controlled amounts of the soluble cobalt compound resulted in significantly higher concentrations of cobalt in urine and blood (Co-B) from females compared with males (P < 0.01). Future studies will involve epidemiology and genotoxicity to evaluate the previous and present cancer risk, and detailed process-related exposure assessment studies to select the methods most reliable for surveillance of low-dose cobalt exposure.

Correlation between work process-related exposure to polycyclic aromatic hydrocarbons and urinary levels of alpha-naphthol, beta-naphthylamine and 1-hydroxypyrene in iron foundry workers

In two Danish iron foundries the concentration of polycyclic aromatic hydrocarbons (PAH) in 24 personal air samples of workers employed in selected processes, i.e. melters, melted iron transporters, casters, machine molders, hand molders, shake-out workers and finishing workers, were measured and correlated to levels of 1-hydroxypyrene, alpha-naphthol and beta-naphthylamine in the urine of exposed workers. The highest total airborne PAH concentrations (sum of 15 selected PAH compounds: 9.6-11.2 micrograms/m3) were associated with casting, machine molding, and shake-out. The highest concentrations of the sum of six selected airborne carcinogenic PAH compounds were found for melting, casting and machine and hand molding. As seen in other working environments involving low-level PAH exposure, the content of naphthalene was high, in general exceeding 85% of the total content of PAH compounds. The present study demonstrates that 1-hydroxypyrene is a useful and direct biomarker of low-dose occupational exposure to PAH compounds. Molding and casting had the highest pyrene levels in iron foundries. Furthermore, the data shows that levels of beta-naphthylamine in urine are significantly elevated in iron foundry workers. Hand molders, finishing workers and truck drivers tended to have the highest levels. Concerning alpha-naphthol the highest concentrations were measured in urine from casters and shake-out workers. With regard to epidemiologic studies demonstrating that molders and casters have a higher risk of lung cancer, the present study suggests that the elevated risk may be due to exposure to carcinogenic PAH compounds in iron foundries, particularly in some high-risk work processes, e.g. casting and molding. In addition, the present study suggests that biological monitoring of 1-hydroxypyrene and beta-naphthylamine may be used to estimate the individual exposure, which seems to be correlated with exposure during individual work processes.