Chronic Toxoplasma gondii Infection Modulates Hearing Ability across the Adult Life Span

While several studies have shown associations between hearing disorders and congenital toxoplasmosis, the present study investigated the impact of chronic, latent Toxoplasma gondii (T. gondii) infection on hearing loss. We used a regression analysis to explore whether latent T. gondii infection modulates changes in hearing thresholds over an age range from 20 to 70 years. We analyzed audiometric data of 162 T. gondii IgG-positive and 430 T. gondii-negative participants, collected in the Dortmund Vital Study (DVS, ClinicalTrials.gov Identifier: NCT05155397), a prospective study on healthy cognitive aging. The regression analysis indicated that latent toxoplasmosis was associated with an accelerated development in hearing loss over the observed age range. Hearing loss was less frequent in IgG-positive than in IgG-negative participants up to the age of about 40 for a low (0.125-1 kHz)-frequency range. For high (2-8 kHz) frequencies, this pattern reversed for ages above 65 years. We discuss these findings on hearing function in the context of a recently proposed model, suggesting that latent toxoplasmosis can differentially affect brain functions across a lifespan.

Early expansion of activated adaptive but also exhausted NK cells during acute severe SARS-CoV-2 infection

The analysis of immunological parameters during the course of a SARS-CoV-2 infection is of great importance, both to identify diagnostic markers for the risk of a severe course of COVID-19, and to better understand the role of the immune system during the infection. By using multicolor flow cytometry we compared the phenotype of Natural Killer (NK) cells from hospitalized COVID-19 patients during early SARS-CoV-2 infection with samples from recovered and SARS-CoV-2 naïve subjects. Unsupervised high-dimensional analysis of 28-color flow cytometric data revealed a strong enrichment of NKG2C expressing NK cells in response to the acute viral infection. In addition, we found an overrepresentation of highly activated NK cell subsets with an exhausted phenotype. Moreover, our data show long-lasting phenotypic changes within the NK cell compartment that did not completely reverse up to 2 months after recovery. This demonstrates that NK cells are involved in the early innate immune response against SARS-CoV-2.

From Immunosenescence to Aging Types-Establishing Reference Intervals for Immune Age Biomarkers by Centile Estimation

Immunological aging type definition requires establishing reference intervals from the distribution of immunosenescence biomarkers conditional on age. For 1605 individuals (18-97 years), we determined the comprehensive immune age index IMMAX from flow-cytometry-based blood cell sub-populations and identified age-specific centiles by fitting generalized additive models for location, scale, and shape. The centiles were uncorrelated with age and facilitated the categorization of individuals as immunologically slow or fast aging types. Using its 50th percentile as a reference, we rescaled the IMMAX to equivalent years of life (EYOL) and computed the immunological age gap as the difference between EYOL and chronological age. Applied to preliminary baseline and follow-up measurements from 53 participants of the Dortmund Vital Study (Clinical-Trials.gov Identifier: NCT05155397), the averaged changes in the IMMAX and EYOL conformed to the 5-year follow-up period, whereas no significant changes occurred concerning IMMAX centiles and age gap. This suggested that the participants immunologically adapted to aging and kept their relative positions within the cohort. Sex was non-significant. Methodical comparisons indicated that future confirmatory analyses with the completed follow-up examinations could rely on percentile curves estimated by simple linear quantile regression, while the selection of the immunosenescence biomarker will greatly influence the outcome, with IMMAX representing the preferable choice.

Temperature-Humidity-Dependent Wind Effects on Physiological Heat Strain of Moderately Exercising Individuals Reproduced by the Universal Thermal Climate Index (UTCI)

Increasing wind speed alleviates physiological heat strain; however, health policies have advised against using ventilators or fans under heat wave conditions with air temperatures above the typical skin temperature of 35 °C. Recent research, mostly with sedentary participants, suggests mitigating the effects of wind at even higher temperatures, depending on the humidity level. Our study aimed at exploring and quantifying whether such results are transferable to moderate exercise levels, and whether the Universal Thermal Climate Index (UTCI) reproduces those effects. We measured heart rates, core and skin temperatures, and sweat rates in 198 laboratory experiments completed by five young, semi-nude, heat-acclimated, moderately exercising males walking the treadmill at 4 km/h on the level for three hours under widely varying temperature-humidity combinations and two wind conditions. We quantified the cooling effect of increasing the wind speed from 0.3 to 2 m/s by fitting generalized additive models predicting the physiological heat stress responses depending on ambient temperature, humidity, and wind speed. We then compared the observed wind effects to the assessment performed by the UTCI. Increasing the wind speed lowered the physiological heat strain for air temperatures below 35 °C, but also for higher temperatures with humidity levels above 2 kPa water vapor pressure concerning heart rate and core temperature, and 3 kPa concerning skin temperature and sweat rate, respectively. The UTCI assessment of wind effects correlated positively with the observed changes in physiological responses, showing the closest agreement (r = 0.9) for skin temperature and sweat rate, where wind is known for elevating the relevant convective and evaporative heat transfer. These results demonstrate the potential of the UTCI for adequately assessing sustainable strategies for heat stress mitigation involving fans or ventilators, depending on temperature and humidity, for moderately exercising individuals.

A modelling framework for local thermal comfort assessment related to bicycle helmet use

Thermal discomfort due to accumulated sweat increasing head skin wettedness may contribute to low wearing rates of bicycle helmets. Using curated data on human head sweating and helmet thermal properties, a modelling framework for the thermal comfort assessment of bicycle helmet use is proposed. Local sweat rates (LSR) at the head were predicted as the ratio to the gross sweat rate (GSR) of the whole body or by sudomotor sensitivity (SUD), the change in LSR per change in body core temperature (Δt_re). Combining those local models with Δt_re and GSR output from thermoregulation models, we simulated head sweating depending on the characteristics of the thermal environment, clothing, activity, and exposure duration. Local thermal comfort thresholds for head skin wettedness were derived in relation to thermal properties of bicycle helmets. The modelling framework was supplemented by regression equations predicting the wind-related reductions in thermal insulation and evaporative resistance of the headgear and boundary air layer, respectively. Comparing the predictions of local models coupled with different thermoregulation models to LSR measured at the frontal, lateral and medial head under bicycle helmet use revealed a large spread in LSR predictions predominantly determined by the local models and the considered head region. SUD tended to overestimate frontal LSR but performed better for lateral and medial head regions, whereas predictions by LSR/GSR ratios were lower and agreed better with measured frontal LSR. However, even for the best models root mean squared prediction errors exceeded experimental SD by 18-30%. From the high correlation (R > 0.9) of skin wettedness comfort thresholds with local sweating sensitivity reported for different body regions, we derived a threshold value of 0.37 for head skin wettedness. We illustrate the application of the modelling framework using a commuter-cycling scenario, and discuss its potential as well as the needs for further research.

Calibrating a Comprehensive Immune Age Metric to Analyze the Cross Sectional Age-Related Decline in Cardiorespiratory Fitness

Cardiorespiratory fitness (CRF) is essential for sustained work ability in good health, but declines with aging, as does the functionality of the immune system, the latter process commonly referred to as immunosenescence. This study aimed to compare the capacity of immunosenescence biomarkers with chronological age for predicting low CRF in a cross-sectional sample recruited from the regional working population. CRF was determined by submaximal bicycle ergometer testing in a cross-sectional sample of 597 volunteers aged 20-70 years from the 'Dortmund Vital Study' (DVS, ClinicalTrials.gov Identifier: NCT05155397). Low CRF was scored if the ergometer test was not completed due to medical reasons or if the power output projected to a heart rate of 130 bpm divided by body mass was below sex-specific reference values of 1.25 W/kg for females and 1.5 W/kg for males, respectively. In addition to established biomarkers of immunosenescence, we calibrated a comprehensive metric of immune age to our data and compared its predictive capacity for low CRF to chronological age, while adjusting our analysis for the influence of sex, obesity, and the level of regular physical activity, by applying univariate and multiple logistic regression. While obesity, low physical activity, chronological and immune age were all associated with increased probability for low CRF in univariate analyses, multiple logistic regression revealed that obesity and physical activity together with immune age, but not chronological age, were statistically significant predictors of low CRF outcome. Sex was non-significant due to the applied sex-specific reference values. These results demonstrate that biological age assessed by our immunological metric can outperform chronological age as a predictor for CRF and indicate a potential role for immunosenescence in explaining the inter-individual variability of the age-related decline in cardiorespiratory fitness.

Indicators to assess physiological heat strain – Part 1: Systematic review

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this first paper of the series, we conducted a systematic review (registration: INPLASY202090088) to identify all TSIs and provide reliable information regarding their use (funded by EU Horizon 2020; HEAT-SHIELD). Eight databases (PubMed, Agricultural and Environmental Science Collection, Web of Science, Scopus, Embase, Russian Science Citation Index, MEDLINE, and Google Scholar) were searched from database inception to 15 April 2020. No restrictions on language or study design were applied. Of the 879 publications identified, 232 records were considered for further analysis. This search identified 340 instruments and indicators developed between 200 BC and 2019 AD. Of these, 153 are nomograms, instruments, and/or require detailed non-meteorological information, while 187 can be mathematically calculated utilizing only meteorological data. Of these meteorology-based TSIs, 127 were developed for people who are physically active, and 61 of those are eligible for use in occupational settings. Information regarding the equation, operating range, interpretation categories, required input data, as well as a free software to calculate all 187 meteorology-based TSIs is provided. The information presented in this systematic review should be adopted by those interested in performing on-site monitoring and/or big data analytics for climate services to ensure appropriate use of the meteorology-based TSIs. Studies two and three in this series of companion papers present guidance on the application and validation of these TSIs, to guide end users of these indicators for more effective use.

Indicators to assess physiological heat strain – Part 2: Delphi exercise

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this second paper of the series, we identified the criteria to consider when adopting a TSI to protect individuals who work in the heat, and we weighed their relative importance using a Delphi exercise with 20 experts. Two Delphi iterations were adequate to reach consensus within the expert panel (Cronbach's α = 0.86) for a set of 17 criteria with varying weights that should be considered when adopting a TSI to protect individuals who work in the heat. These criteria considered physiological parameters such as core/skin/mean body temperature, heart rate, and hydration status, as well as practicality, cost effectiveness, and health guidance issues. The 17 criteria were distributed across three occupational health-and-safety pillars: (i) contribution to improving occupational health (55% of total importance), (ii) mitigation of worker physiological strain (35.5% of total importance), and (iii) cost-effectiveness (9.5% of total importance). Three criteria [(i) relationship of a TSI with core temperature, (ii) having categories indicating the level of heat stress experienced by workers, and (iii) using its heat stress categories to provide recommendations for occupational safety and health] were considered significantly more important when selecting a TSI for protecting individuals who work in the heat, accumulating 37.2 percentage points. These 17 criteria allow the validation and comparison of TSIs that presently exist as well as those that may be developed in the coming years.

Neutralizing antibody responses 300 days after SARS-CoV-2 infection and induction of high antibody titers after vaccination

Neutralizing antibodies against SARS‐CoV‐2 are important to protect against infection and/or disease. Using an assay to detect antibodies directed against the receptor binding domain (RBD) of SARS‐CoV‐2 Spike, we identified individuals with SARS‐CoV‐2 infection after an outbreak at a local health institution. All but one COVID‐19 patient developed detectable anti‐RBD antibodies and 77% had virus neutralizing antibody titers of >1:25. Antibody levels declined slightly over time. However, we still detected virus neutralizing antibody titers in 64% of the COVID‐19 patients at >300 days after infection, demonstrating durability of neutralizing antibody levels after infection. Importantly, full COVID‐19 vaccination of these individuals resulted in higher antibody titers compared to fully vaccinated individuals in the absence of prior infection. These data demonstrate long‐lived antibody‐mediated immunity after SARS‐CoV‐2 infection, and a clear benefit of two vaccine doses for recovered individuals.

Sex differences in temperature-related all-cause mortality in the Netherlands

PURPOSE

Over the last few decades, a global increase in both cold and heat extremes has been observed with significant impacts on human mortality. Although it is well-identified that older individuals (> 65 years) are most prone to temperature-related mortality, there is no consensus on the effect of sex. The current study investigated if sex differences in temperature-related mortality exist in the Netherlands.

METHODS

Twenty-three-year ambient temperature data of the Netherlands were combined with daily mortality data which were subdivided into sex and three age classes (< 65 years, 65-80 years,  ≥ 80 years). Distributed lag non-linear models were used to analyze the effect of ambient temperature on mortality and determine sex differences in mortality attributable to the cold and heat, which is defined as mean daily temperatures below and above the Minimum Mortality Temperature, respectively.

RESULTS

Attributable fractions in the heat were higher in females, especially in the oldest group under extreme heat (≥ 97.5th percentile), whilst no sex differences were found in the cold. Cold- and heat-related mortality was most prominent in the oldest age group (≥ 80 years) and to a smaller extent in the age group between 65-80 years. In the age group < 65 years temperature-related mortality was only significant for males in the heat.

CONCLUSION

Mortality in the Netherlands represents the typical V- or hockey-stick shaped curve with a higher daily mortality in the cold and heat than at milder temperatures in both males and females, especially in the age group ≥ 80 years. Heat-related mortality was higher in females than in males, especially in the oldest age group (≥ 80 years) under extreme heat, whilst in the cold no sex differences were found. The underlying cause may be of physiological or behavioral nature, but more research is necessary.

Impact of biometeorological conditions and air pollution on influenza-like illnesses incidence in Warsaw

In order to assess the influence of atmospheric conditions and particulate matter (PM) on the seasonally varying incidence of influenza-like illnesses (ILI) in the capital of Poland-Warsaw, we analysed time series of ILI reported for the about 1.75 million residents in total and for different age groups in 288 approximately weekly periods, covering 6 years 2013-2018. Using Poisson regression, we predicted ILI by the Universal Thermal Climate Index (UTCI) as biometeorological indicator, and by PM2.5 and PM10, respectively, as air quality measures accounting for lagged effects spanning up to 3 weeks. Excess ILI incidence after adjusting for seasonal and annual trends was calculated by fitting generalized additive models. ILI morbidity increased with rising PM concentrations, for both PM2.5 and PM10, and with cooler atmospheric conditions as indicated by decreasing UTCI. While the PM effect focused on the actual reporting period, the atmospheric influence exhibited a more evenly distributed lagged effect pattern over the considered 3-week period. Though ILI incidence adjusted for population size significantly declined with age, age did not significantly modify the effect sizes of both PM and UTCI. These findings contribute to better understanding environmental conditionings of influenza seasonality in a temperate climate. This will be beneficial to forecasting future dynamics of ILI and to planning clinical and public health resources under climate change scenarios.

Results of the Optimune trial: A randomized controlled trial evaluating a novel Internet intervention for breast cancer survivors

INTRODUCTION

After the acute treatment phase, breast cancer patients often experience low quality of life and impaired mental health, which could potentially be improved by offering cognitive behavioural therapy (CBT) and addressing exercise and dietary habits. However, CBT and other behavioural interventions are rarely available beyond the acute treatment phase. Internet-based interventions could bridge such treatment gaps, given their flexibility and scalability. In this randomized controlled trial (RCT), we investigated the effects of such an intervention ("Optimune") over three months.

METHODS

This RCT included 363 female breast cancer survivors (age range = 30-70), recruited from the community, who had completed the active treatment phase. Inclusion criteria were: breast cancer diagnosis less than 5 years ago and acute treatment completion at least 1 month ago. Participants were randomly assigned to (1) an intervention group (n = 181), in which they received care as usual (CAU) plus 12-month access to Optimune immediately after randomization, or (2) a control group (n = 182), in which they received CAU and Optimune after a delay of 3 months. Primary endpoints were quality of life (QoL), physical activity, and dietary habits at three months. We hypothesized that intervention group participants would report better QoL, more physical activity, and improved dietary habits after 3 months.

RESULTS

Intention-to-treat (ITT) analyses revealed significant effects on QoL (d = 0.27, 95% CI: 0.07-0.48) and dietary habits (d = 0.36, 95% CI: 0.15-0.56), but the effect on physical exercise was not significant (d = 0.30; 95% CI: 0.10-0.51).

DISCUSSION

These findings suggest the effectiveness of Optimune, a new CBT-based Internet intervention for breast cancer survivors, in facilitating improvements in quality of life and dietary habits. Efforts to disseminate this intervention more broadly may be warranted.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03643640. Registered August 23rd 2018, https://clinicaltrials.gov/ct2/show/NCT03643640.

Low self-reported stress despite immune-physiological changes in paramedics during rescue operations

Despite the high stress levels, paramedics seem to ignore or even negate the stress. This can be detrimental and lead to stress-related diseases. Therefore, we investigated the divergence between physiological and psychological stress responses of paramedics. Participants were 16 paramedics and 17 white-collar workers. We assessed psychological stress parameters, cortisol awakening response (CAR), and quantified immune parameters. In paramedics, electrocardiogram (ECG) was measured during one complete 24-hour shift. Our results revealed that CAR was higher in paramedics compared to controls. An alteration of immune parameters was observed even during days of free time. Also, ECG recordings showed acute stress in paramedics during rescue situations. Questionnaires revealed that rescue-service specific stressors affect psychological outcomes. However, paramedics reported significantly less mental stress and higher levels of depersonalization than controls. Taken together, our results suggest higher stress in paramedics compared to controls. However, paramedics negate their daily stress. Our findings underline therefore the importance to develop stress-management interventions for paramedics including sensitization for their stress reactions.

Analysis of Natural Killer cell functions in patients with hereditary hemochromatosis

Hereditary hemochromatosis (HH) is an autosomal-recessive disorder of the iron metabolism. Patients are typically affected by dysregulated iron levels, which can lead to iron accumulation within essential organs, such as liver, heart and pancreas. Furthermore, many HH patients are also afflicted by several immune defects and increased occurrence of autoimmune diseases that are linked to human homeostatic iron regulator protein (HFE) in the immune response. Here we examined immune cell phenotype and function in 21 HH patients compared to 21 healthy controls with a focus on Natural Killer (NK) cells. We observed increased basal and stimulated production of pro-inflammatory cytokines such as IL-1β or IL-18 in HH patients compared to healthy controls. However, we did not find major changes in the phenotype, the amount or the cytotoxic function of NK cells in HH patients. Instead, our data show a general decrease in the total number of granulocytes in HH patients (2774 ± 958 per μl versus 3457 ± 1122 per μl in healthy controls). These data demonstrate that NK cells of HH patients are not significantly affected and that the patients' treatment by regular phlebotomy is sufficient to avoid systemic iron overload and its consequences to the immune system.

Long Term Adaptation to Heat Stress: Shifts in the Minimum Mortality Temperature in the Netherlands

It is essentially unknown how humans adapt or will adapt to heat stress caused by climate change over a long-term interval. A possible indicator of adaptation may be the minimum mortality temperature (MMT), which is defined as the mean daily temperature at which the lowest mortality occurs. Another possible indicator may be the heat sensitivity, i.e., the percentage change in mortality per 1°C above the MMT threshold, or heat attributable fraction (AF), i.e., the percentage relative excess mortality above MMT. We estimated MMT and heat sensitivity/AF over a period of 23 years for older adults (≥65 years) in the Netherlands using three commonly used methods. These methods are segmented Poisson regression (SEG), constrained segmented distributed lag models (CSDL), and distributed lag non-linear models (DLNM). The mean ambient temperature increased by 0.03°C/year over the 23 year period. The calculated mean MMT over the 23-year period differed considerably between methods [16.4 ± 1.2°C (SE) (SEG), 18.9 ± 0.5°C (CSDL), and 15.3 ± 0.4°C DLNM]. MMT increased during the observed period according to CSDL (0.11 ± 0.05°C/year) and DLNM (0.15 ± 0.02°C/year), but not with SEG. The heat sensitivity, however, decreased for the latter method (0.06%/°C/year) and did not change for CSDL. Heat AF was calculated for the DLNM method and decreased with 0.07%/year. Based on these results we conclude that the susceptibility of humans to heat decreases over time, regardless which method was used, because human adaptation is shown by either an increase in MMT (CSDL and DLNM) or a decrease in heat sensitivity for unchanged MMT (SEG). Future studies should focus on what factors (e.g., physiological, behavioral, technological, or infrastructural adaptations) influence human adaptation the most, so it can be promoted through adaptation policies. Furthermore, future studies should keep in mind that the employed method influences the calculated MMT, which hampers comparability between studies.

Quantitative analysis of human NK cell reactivity using latex beads coated with defined amounts of antibodies

Natural Killer (NK) cell responses are regulated by a variety of different surface receptors. While we can determine the overall positive or negative effect of a given receptor on NK cell functions, investigating NK cell regulation in a quantitative way is challenging. To quantitatively investigate individual receptors for their effect on NK cell activation, we chose to functionalize latex beads that have approximately the same size as lymphocytes with defined amounts of specific antibodies directed against distinct activating receptors. This enabled us to investigate NK cell reactivity in a defined, clean, and controllable system. Only CD16 and NKp30 could activate the degranulation of resting human NK cells. CD16, NKG2D, NKp30, NKp44, and NKp46 were able to activate cultured NK cells. NK cell activation resulted in the induction of polyfunctional cells that degranulated and produced IFN-γ and MIP-1β. Interestingly, polyfunctional NK cells were only induced by triggering ITAM-coupled receptors. NKp44 showed a very sensitive response pattern, where a small increase in receptor stimulation caused maximal NK cell activity. In contrast, stimulation of 2B4 induced very little NK cell degranulation, while providing sufficient signal for NK cell adhesion. Our data demonstrate that activating receptors differ in their effectiveness to stimulate NK cells.

Heat Acclimation Does Not Modify Q 10 and Thermal Cardiac Reactivity

Heat acclimation (HA) is an essential modifier of physiological strain when working or exercising in the heat. It is unknown whether HA influences the increase of energy expenditure (Q ₁₀ effect) or heart rate (thermal cardiac reactivity TCR) due to increased body temperature. Therefore, we studied these effects using a heat strain database of climatic chamber experiments performed by five semi-nude young males in either non-acclimated or acclimated state. Measured oxygen consumption rate (VO₂), heart rate (HR), and rectal temperature (T _re) averaged over the third hour of exposure were obtained from 273 trials in total. While workload (walking 4 km/h on level) was constant, heat stress conditions varied widely with air temperature 25-55°C, vapor pressure 0.5-5.3 kPa, and air velocity 0.3-2 m/s. HA was induced by repeated heat exposures over a minimum of 3 weeks. Non-acclimated experiments took place in wintertime with a maximum of two exposures per week. The influence of T _re and HA on VO₂ and HR was analyzed separately with mixed model ANCOVA. Rising T _re significantly (p < 0.01) increased both VO₂ (by about 7% per degree increase of T _re) and HR (by 39-41 bpm per degree T _re); neither slope nor intercept depended significantly on HA (p > 0.4). The effects of T _re in this study agree with former outcomes for VO₂ (7%/°C increase corresponding to Q ₁₀ = 2) and for HR (TCR of 33 bpm/°C in ISO 9886). Our results indicate that both relations are independent of HA with implications for heat stress assessment at workplaces and for modeling heat balance.

Accuracy of metabolic rate estimates from heart rate under heat stress-an empirical validation study concerning ISO 8996

The standard ISO 8996 provides methods for the determination of metabolic rate from measured oxygen consumption (M_VO2), as well as simplified estimation algorithms based on heart rate (M_HR). We quantified the accuracy of these methods by comparing M_HR with M_VO2 measured in 373 climatic chamber experiments under different workloads and widely varying heat stress conditions. While our results confirmed the 5% accuracy level for M_VO2, M_HR considerably overestimatedM_VO2 due to the rise in core temperature concomitantly increasing heart rate by approximately 30 bpm/°C resulting in an overall error of 43%. After individually correcting for this bias the accuracy was 10-15% as stipulated by the standard. Thus, methods correcting for the thermal component of heart rate, e.g. by introducing intermittent resting periods of sufficient length of at least five min when investigating heat stress at workplaces, should become a mandatory element in the ongoing revision of the relevant standards.

Estimated work ability in warm outdoor environments depends on the chosen heat stress assessment metric

With a view to occupational effects of climate change, we performed a simulation study on the influence of different heat stress assessment metrics on estimated workability (WA) of labour in warm outdoor environments. Whole-day shifts with varying workloads were simulated using as input meteorological records for the hottest month from four cities with prevailing hot (Dallas, New Delhi) or warm-humid conditions (Managua, Osaka), respectively. In addition, we considered the effects of adaptive strategies like shielding against solar radiation and different work-rest schedules assuming an acclimated person wearing light work clothes (0.6 clo). We assessed WA according to Wet Bulb Globe Temperature (WBGT) by means of an empirical relation of worker performance from field studies (Hothaps), and as allowed work hours using safety threshold limits proposed by the corresponding standards. Using the physiological models Predicted Heat Strain (PHS) and Universal Thermal Climate Index (UTCI)-Fiala, we calculated WA as the percentage of working hours with body core temperature and cumulated sweat loss below standard limits (38 °C and 7.5% of body weight, respectively) recommended by ISO 7933 and below conservative (38 °C; 3%) and liberal (38.2 °C; 7.5%) limits in comparison. ANOVA results showed that the different metrics, workload, time of day and climate type determined the largest part of WA variance. WBGT-based metrics were highly correlated and indicated slightly more constrained WA for moderate workload, but were less restrictive with high workload and for afternoon work hours compared to PHS and UTCI-Fiala. Though PHS showed unrealistic dynamic responses to rest from work compared to UTCI-Fiala, differences in WA assessed by the physiological models largely depended on the applied limit criteria. In conclusion, our study showed that the choice of the heat stress assessment metric impacts notably on the estimated WA. Whereas PHS and UTCI-Fiala can account for cumulative physiological strain imposed by extended work hours when working heavily under high heat stress, the current WBGT standards do not include this. Advanced thermophysiological models might help developing alternatives, where not only modelling details but also the choice of physiological limit criteria will require attention. There is also an urgent need for suitable empirical data relating workplace heat exposure to workability.

Executive control, ERP and pro-inflammatory activity in emotionally exhausted middle-aged employees. Comparison between subclinical burnout and mild to moderate depression

Burnout is a syndrome occurring mainly in individuals with long-term stressful work. The main complaints are emotional exhaustion and reduced performance. Burnout also largely overlaps with depression. Both are characterized by increased incidence of infections due to dysregulation of the immune system, overexpression of pro-inflammatory cytokines and cognitive deficits, particularly related to executive functions. To distinguish between burnout and depression already at the pre-clinical stage, the present double-blinded study compared immunological and cognitive parameters in seventy-six employees from emotionally demanding occupations who were post-hoc subdivided into two groups scoring low (EE-) and high (EE+) in emotional exhaustion and low (DE-) and high (DE+) in depression. Immunological parameters were measured from blood samples. Executive functions were studied by analyzing event-related brain potentials (ERPs) and performance during a task switching paradigm. Psychosocial job parameters were measured with standardized questionnaires. Burnout and mild to moderate depression largely overlapped. However, several subjects showed burnout without depressive symptoms. Higher levels of the pro-inflammatory cytokines IL-6 and IL-12 were correlated with burnout severity and depressive symptoms in male individuals. In the switch task a trend for lower performance in the EE+ vs. EE- group and no difference between DE+ and DE- groups were found. In the ERPs, however, differences were observed which distinguished between subclinical burnout and depression: the terminal contingent negative variation (CNV), indicating preparatory activity and the P3b, related to allocation of cognitive resources were generally reduced in EE+ vs. EE-, whereas no differences were found in the DE+ vs. DE- groups. The frontal P3a was selectively reduced in switch trials in the EE+ vs. EE- group and showed only a trend in DE+ vs. DE-, indicating impairment of executive control in subclinical burnout. Taken together, the results unveil specific immunological changes and declines in brain functions in employees with subclinical burnout that are not apparent in persons with moderate depression. Hence, the combination of immunological, behavioral and ERP methods renders a promising method for distinguishing both syndromes and for improving an early diagnosis of burnout before a clinical stage is reached.

Calculation of Clothing Insulation by Serial and Parallel Methods: Effects on Clothing Choice by IREQ and Thermal Responses in the Cold

Cold protective clothing was studied in 2 European Union projects. The objectives were (a) to examine different insulation calculation methods as measured on a manikin (serial or parallel), for the prediction of cold stress (IREQ); (b) to consider the effects of cold protective clothing on metabolic rate; (c) to evaluate the movement and wind correction of clothing insulation values. Tests were carried out on 8 subjects. The results showed the possibility of incorporating the effect of increases in metabolic rate values due to thick cold protective clothing into the IREQ model. Using the higher thermal insulation value from the serial method in the IREQ prediction, would lead to unacceptable cooling of the users. Thus, only the parallel insulation calculation method in EN 342:2004 should be used. The wind and motion correction equation (No. 2) gave realistic values for total resultant insulation; dynamic testing according to EN 342:2004 may be omitted.

Evaporative cooling: effective latent heat of evaporation in relation to evaporation distance from the skin

Calculation of evaporative heat loss is essential to heat balance calculations. Despite recognition that the value for latent heat of evaporation, used in these calculations, may not always reflect the real cooling benefit to the body, only limited quantitative data on this is available, which has found little use in recent literature. In this experiment a thermal manikin, (MTNW, Seattle, WA) was used to determine the effective cooling power of moisture evaporation. The manikin measures both heat loss and mass loss independently, allowing a direct calculation of an effective latent heat of evaporation (λeff). The location of the evaporation was varied: from the skin or from the underwear or from the outerwear. Outerwear of different permeabilities was used, and different numbers of layers were used. Tests took place in 20°C, 0.5 m/s at different humidities and were performed both dry and with a wet layer, allowing the breakdown of heat loss in dry and evaporative components. For evaporation from the skin, λeff is close to the theoretical value (2,430 J/g) but starts to drop when more clothing is worn, e.g., by 11% for underwear and permeable coverall. When evaporation is from the underwear, λeff reduction is 28% wearing a permeable outer. When evaporation is from the outermost layer only, the reduction exceeds 62% (no base layer), increasing toward 80% with more layers between skin and wet outerwear. In semi- and impermeable outerwear, the added effect of condensation in the clothing opposes this effect. A general formula for the calculation of λeff was developed.

The uncertainty of UTCI due to uncertainties in the determination of radiation fluxes derived from numerical weather prediction and regional climate model simulations

In this study we examine the determination accuracy of both the mean radiant temperature (Tmrt) and the Universal Thermal Climate Index (UTCI) within the scope of numerical weather prediction (NWP), and global (GCM) and regional (RCM) climate model simulations. First, Tmrt is determined and the so-called UTCI-Fiala model is then used for the calculation of UTCI. Taking into account the uncertainties of NWP model (among others the HIgh Resolution Limited Area Model HIRLAM) output (temperature, downwelling short-wave and long-wave radiation) stated in the literature, we simulate and discuss the uncertainties of Tmrt and UTCI at three stations in different climatic regions of Europe. The results show that highest negative (positive) differences to reference cases (under assumed clear-sky conditions) of up to -21°C (9°C) for Tmrt and up to -6°C (3.5°C) for UTCI occur in summer (winter) due to cloudiness. In a second step, the uncertainties of RCM simulations are analyzed: three RCMs, namely ALADIN (Aire Limitée Adaptation dynamique Développement InterNational), RegCM (REGional Climate Model) and REMO (REgional MOdel) are nested into GCMs and used for the prediction of temperature and radiation fluxes in order to estimate Tmrt and UTCI. The inter-comparison of RCM output for the three selected locations shows that biases between 0.0 and ±17.7°C (between 0.0 and ±13.3°C) for Tmrt (UTCI), and RMSE between ±0.5 and ±17.8°C (between ±0.8 and ±13.4°C) for Tmrt (UTCI) may be expected. In general the study shows that uncertainties of UTCI, due to uncertainties arising from calculations of radiation fluxes (based on NWP models) required for the prediction of Tmrt, are well below ±2°C for clear-sky cases. However, significant higher uncertainties in UTCI of up to ±6°C are found, especially when prediction of cloudiness is wrong.

The Universal Thermal Climate Index UTCI compared to ergonomics standards for assessing the thermal environment

The growing need for valid assessment procedures of the outdoor thermal environment in the fields of public weather services, public health systems, urban planning, tourism & recreation and climate impact research raised the idea to develop the Universal Thermal Climate Index UTCI based on the most recent scientific progress both in thermo-physiology and in heat exchange theory. Following extensive validation of accessible models of human thermoregulation, the advanced multi-node 'Fiala' model was selected to form the basis of UTCI. This model was coupled with an adaptive clothing model which considers clothing habits by the general urban population and behavioral changes in clothing insulation related to actual environmental temperature. UTCI was developed conceptually as an equivalent temperature. Thus, for any combination of air temperature, wind, radiation, and humidity, UTCI is defined as the air temperature in the reference condition which would elicit the same dynamic response of the physiological model. This review analyses the sensitivity of UTCI to humidity and radiation in the heat and to wind in the cold and compares the results with observational studies and internationally standardized assessment procedures. The capabilities, restrictions and potential future extensions of UTCI are discussed.

Deriving the operational procedure for the Universal Thermal Climate Index (UTCI)

The Universal Thermal Climate Index (UTCI) aimed for a one-dimensional quantity adequately reflecting the human physiological reaction to the multi-dimensionally defined actual outdoor thermal environment. The human reaction was simulated by the UTCI-Fiala multi-node model of human thermoregulation, which was integrated with an adaptive clothing model. Following the concept of an equivalent temperature, UTCI for a given combination of wind speed, radiation, humidity and air temperature was defined as the air temperature of the reference environment, which according to the model produces an equivalent dynamic physiological response. Operationalising this concept involved (1) the definition of a reference environment with 50% relative humidity (but vapour pressure capped at 20 hPa), with calm air and radiant temperature equalling air temperature and (2) the development of a one-dimensional representation of the multivariate model output at different exposure times. The latter was achieved by principal component analyses showing that the linear combination of 7 parameters of thermophysiological strain (core, mean and facial skin temperatures, sweat production, skin wettedness, skin blood flow, shivering) after 30 and 120 min exposure time accounted for two-thirds of the total variation in the multi-dimensional dynamic physiological response. The operational procedure was completed by a scale categorising UTCI equivalent temperature values in terms of thermal stress, and by providing simplified routines for fast but sufficiently accurate calculation, which included look-up tables of pre-calculated UTCI values for a grid of all relevant combinations of climate parameters and polynomial regression equations predicting UTCI over the same grid. The analyses of the sensitivity of UTCI to humidity, radiation and wind speed showed plausible reactions in the heat as well as in the cold, and indicate that UTCI may in this regard be universally useable in the major areas of research and application in human biometeorology.

UTCI-Fiala multi-node model of human heat transfer and temperature regulation

The UTCI-Fiala mathematical model of human temperature regulation forms the basis of the new Universal Thermal Climate Index (UTC). Following extensive validation tests, adaptations and extensions, such as the inclusion of an adaptive clothing model, the model was used to predict human temperature and regulatory responses for combinations of the prevailing outdoor climate conditions. This paper provides an overview of the underlying algorithms and methods that constitute the multi-node dynamic UTCI-Fiala model of human thermal physiology and comfort. Treated topics include modelling heat and mass transfer within the body, numerical techniques, modelling environmental heat exchanges, thermoregulatory reactions of the central nervous system, and perceptual responses. Other contributions of this special issue describe the validation of the UTCI-Fiala model against measured data and the development of the adaptive clothing model for outdoor climates.

Predicting urban outdoor thermal comfort by the Universal Thermal Climate Index UTCI--a case study in Southern Brazil

Recognising that modifications to the physical attributes of urban space are able to promote improved thermal outdoor conditions and thus positively influence the use of open spaces, a survey to define optimal thermal comfort ranges for passers-by in pedestrian streets was conducted in Curitiba, Brazil. We applied general additive models to study the impact of temperature, humidity, and wind, as well as long-wave and short-wave radiant heat fluxes as summarised by the recently developed Universal Thermal Climate Index (UTCI) on the choice of clothing insulation by fitting LOESS smoothers to observations from 944 males and 710 females aged from 13 to 91 years. We further analysed votes of thermal sensation compared to predictions of UTCI. The results showed that females chose less insulating clothing in warm conditions compared to males and that observed values of clothing insulation depended on temperature, but also on season and potentially on solar radiation. The overall pattern of clothing choice was well reflected by UTCI, which also provided for good predictions of thermal sensation votes depending on the meteorological conditions. Analysing subgroups indicated that the goodness-of-fit of the UTCI was independent of gender and age, and with only limited influence of season and body composition as assessed by body mass index. This suggests that UTCI can serve as a suitable planning tool for urban thermal comfort in sub-tropical regions.

The UTCI-clothing model

The Universal Thermal Climate Index (UTCI) was conceived as a thermal index covering the whole climate range from heat to cold. This would be impossible without considering clothing as the interface between the person (here, the physiological model of thermoregulation) and the environment. It was decided to develop a clothing model for this application in which the following three factors were considered: (1) typical dressing behaviour in different temperatures, as observed in the field, resulting in a model of the distribution of clothing over the different body segments in relation to the ambient temperature, (2) the changes in clothing insulation and vapour resistance caused by wind and body movement, and (3) the change in wind speed in relation to the height above ground. The outcome was a clothing model that defines in detail the effective clothing insulation and vapour resistance for each of the thermo-physiological model's body segments over a wide range of climatic conditions. This paper details this model's conception and documents its definitions.

Physiological responses to temperature and humidity compared to the assessment by UTCI, WGBT and PHS

In COST Action 730, a multi-segmental thermophysiological model was used to describe physiological strain reactions for different climatic conditions in order to develop a 'Universal Thermal Climate Index' (UTCI). UTCI predictions for warm climates were compared with empirical data from the laboratory tests. The comparison was performed by means of equivalence lines within a psychrometric chart so that the combined influence of air temperature and humidity on physiological strain may be assessed. Within a reasonable regime of air temperatures and relative humidities (RH), the differences between simulated and measured values were as follows: for rectal temperatures below 0.3°C, for skin temperatures below 1.5°C, for sweat rates below 200 g/h and for heart rates (estimated from relative cardiac output) below 30 min(-1). This characterises the validity of the model with respect to the description of the influence of heat and humidity on physiological strain. The same comparison to physiological data was also conducted for the equivalent temperature calculated for UTCI. In order to compare UTCI with other thermal indices used in occupational health, the physiological data have also been compared to equivalence lines of WBGT (Wet Bulb Globe Temperature) and PHS (Predicted Heat Strain) indices.

Autonomic arousals related to traffic noise during sleep

AIM

To analyze the heart rate (HR) response to traffic noise during sleep and the influence of acoustic parameters, time of night, and momentary sleep stage on these responses.

PARTICIPANTS

Twelve women and 12 men (19-28 years).

MEASUREMENTS AND RESULTS

The participants slept in the laboratory for 4 consecutive nights in each of 3 consecutive weeks and were exposed to aircraft, road, or rail traffic noise with weekly permutations. The 4 nights of each week consisted of a random sequence of a quiet night (32 dBA) and 3 nights during which aircraft, rail traffic, or road traffic noises occurred with maximum levels of 45-77 dBA. The polysomnogram and the electrocardiogram were recorded during all nights. In case of awakenings, the HR alterations consisted of monophasic elevations for >1 min, with mean maximum HR elevations of 30 bpm. Though obviously triggered by the noise events, the awakenings per se rather than the acoustical parameters determined the extent and pattern of the response. Without awakenings, HR responses were biphasic and consisted of initial accelerations with maximum HR elevations of about 9 bpm followed by decelerations below the baseline. These alterations were clearly influenced by the acoustic parameters (traffic mode, maximum level, rate of rise) as well as by the momentary sleep stage.

CONCLUSIONS

Cardiac responses did not habituate to traffic noise within the night and may therefore play a key role in promoting traffic noise induced cardiovascular disease. If so, these consequences are more likely for responses accompanied by awakenings than for situations without awakenings.

Non-evaporative effects of a wet mid layer on heat transfer through protective clothing

In order to assess the non-evaporative components of the reduced thermal insulation of wet clothing, experiments were performed with a manikin and with human subjects in which two layers of underwear separated by an impermeable barrier were worn under an impermeable overgarment at 20 degrees C, 80% RH and 0.5 ms(-1) air velocity. By comparing manikin measurements with dry and wetted mid underwear layer, the increase in heat loss caused by a wet layer kept away from the skin was determined, which turned out to be small (5-6 W m(-2)), irrespective of the inner underwear layer being dry or wetted, and was only one third of the evaporative heat loss calculated from weight change, i.e. evaporative cooling efficiency was far below unity. In the experiments with eight males, each subject participated in two sessions with the mid underwear layer either dry or wetted, where they stood still for the first 30 min and then performed treadmill work for 60 min. Reduced heat strain due to lower insulation with the wetted mid layer was observed with decreased microclimate and skin temperatures, lowered sweat loss and cardiac strain. Accordingly, total clothing insulation calculated over the walking period from heat balance equations was reduced by 0.02 m(2) degrees C W(-1) (16%), while for the standing period the same decrease in insulation, representing 9% reduction only showed up after allowing for the lower evaporative cooling efficiency in the calculations. As evaporation to the environment and inside the clothing was restricted, the observed small alterations may be attributed to the wet mid layer's increased conductivity, which, however, appears to be of minor importance compared to the evaporative effects in the assessment of the thermal properties of wet clothing.

Apparent latent heat of evaporation from clothing: attenuation and "heat pipe" effects

Investigating claims that a clothed person's mass loss does not always represent their evaporative heat loss (EVAP), a thermal manikin study was performed measuring heat balance components in more detail than human studies would permit. Using clothing with different levels of vapor permeability and measuring heat losses from skin controlled at 34 degrees C in ambient temperatures of 10, 20, and 34 degrees C with constant vapor pressure (1 kPa), additional heat losses from wet skin compared with dry skin were analyzed. EVAP based on mass loss (E(mass)) measurement and direct measurement of the extra heat loss by the manikin due to wet skin (E(app)) were compared. A clear discrepancy was observed. E(mass) overestimated E(app) in warm environments, and both under and overestimations were observed in cool environments, depending on the clothing vapor permeability. At 34 degrees C, apparent latent heat (lambda(app)) of pure evaporative cooling was lower than the physical value (lambda; 2,430 J/g) and reduced with increasing vapor resistance up to 45%. At lower temperatures, lambda(app) increases due to additional skin heat loss via evaporation of moisture that condenses inside the clothing, analogous to a heat pipe. For impermeable clothing, lambda(app) even exceeds lambda by four times that value at 10 degrees C. These findings demonstrate that the traditional way of calculating evaporative heat loss of a clothed person can lead to substantial errors, especially for clothing with low permeability, which can be positive or negative, depending on the climate and clothing type. The model presented explains human subject data on EVAP that previously seemed contradictive.

Vibration induced low back disorders--comparison of the vibration evaluation according to ISO 2631 with a force-related evaluation

Long-term vibration stress can contribute to degenerative changes in the joints of the human body, especially in the lumbar spine. An important factor in the development of these diseases is given by the forces transmitted in the joints. Because the forces can hardly be measured a biomechanical model was developed which simulates the human body in the standing and the sitting posture. The vibration properties of the model were adapted to the transfer function provided in the standards and the literature. With the model the compressive forces at the driving point of the body, in the leg joints, and in two motion segments of the spine were simulated under a vertical pseudo random vibration. Transfer functions between the accelerations of the ground or of the seat and the forces were computed. Furthermore, based on the transfer function between seat acceleration and compressive force in the spinal motion segment L3-L4 weighting factors were derived. By means of these factors characteristic vibration values were computed for 57 realistic vibration spectra measured on 17 machines and vehicles. The consideration of the forces resulted in a stronger weighting of low-frequency vibrations compared to the weighted acceleration as suggested by ISO 2631-1. In order to enable an assessment of the health risk a force-related guidance value was derived which amounts to 0.81 ms(-2) (rms).

Do Birth Variable Data Predict Melatonin Production in 8- to 9-Year-Old Children? Analysis of Excreted 6-Sulfatoxymelatonin

HYPOTHESES

A cross-sectional study on urinary excretion of 6-sulfatoxymelatonin (aMT.6S) in young adults suggests a relation between melatonin production and body size at birth. As individual melatonin production remains stable during childhood and adolescence, this melatonin-birth size relation should also exist in children.

METHODS

Daily urinary output of aMT.6S of 147 healthy white children (78 boys, 69 girls), 8 or 9 years of age, was quantified by ELISA and related to birth variable data.

RESULTS

Contrary to expectation, aMT.6S output was not related to the ponderal index at birth but a moderate positive association with body mass index at the age of 8-9 years was seen.

CONCLUSION

This study in children contradicts previous findings in adults. As no obvious reason can be identified for this discrepancy, further research (particularly a longitudinal study) is recommended to clarify whether birth variable data may predict melatonin production in certain circumstances during or after puberty.

Association of cytochrome P450 2E1 polymorphisms and head and neck squamous cell cancer

The development of head and neck squamous cell cancer (HNSCC) is known to be strongly associated with tobacco use. One of the main enzymes for bioactivation of tobacco-related substances is the cytochrome 450 (CYP)2E1, of which different genetic variants are described. Analyzing a correlation between certain neoplasia and alteration of the CYP2E1 gene, most studies focus on the polymorphisms -1053C>T and 7632T>A, but recently another polymorphism, named -71G>T, with enhanced transcriptional activity, has been identified. In the current case-control study we investigate the putative association of the mentioned CYP2E1 polymorphisms on the risk of HNSCC. Comparing 312 German individuals with HNSCC to 299 controls we found a significantly enhanced risk for the development of that neoplasia in smoking carriers of -71G>T heterozygosity, while in -1053C>T and 7632T>A polymorphisms a corresponding correlation was absent. Since a coincidence of an aberrant p53 gene and CYP2E1 mutations has been described, we choose a subgroup of 140 patients with HNSCC for analyzing an association of mutations in these two genes. However, no such association could be found in either of the mentioned polymorphisms. Further studies have to focus on the -71G>T polymorphism and its possible linkage to cancers, in which smoking is a known risk-factor, as well as its functional relevance concerning the bioactivation of tobacco-related substances.

Excretion of 6-hydroxymelatonin sulfate (6-OHMS) in siblings during childhood and adolescence

The analysis was performed to support the assumption that in inter-individual variations melatonin production is determined genetically. Sixty-six siblings from 31 families (27 girls, 39 boys, 3-18 years) contributed to this study with 3 to 15 urine samples collected once a year over 24 h. The samples were stored at -20 degrees C and analyzed for the daily output of the melatonin metabolite 6-hydroxymelatonin sulfate (6-OHMS) by an enzyme-linked immunosorbent assay (ELISA). The results indicate that 6-OHMS excretion was significantly correlated in siblings (r = 0.37, p = 0.01), suggesting a possible genetic background of melatonin production. However, prospective studies controlling also lifestyle factors such as diet are required to further confirm the hypothesis.

Evaluation of performance and load in simulated rescue tasks for a novel design SCBA: effect of weight, volume and weight distribution

A self-contained breathing apparatus (SCBA) with an innovative rucksack shape that provides a better distribution of its weight over the middle and lower parts of the back (device C: 6l, 13.7 kg) was compared with two conventional SCBA which differed from each other in volume and weight (A: 6l, 15 kg, B: 6.8l, 11.7 kg). Twelve fire-fighters (27-49 yr) performed three exercises while using the three SCBA in a systematically permuted sequence. The exercises consisted of simulated rescue work under natural climatic conditions in a dwelling on the second floor and several typical elements of severe fire-fighting actions. Duration, heart rate, breathing frequency, rectal temperature, and sweat loss were recorded. Perceived exertion was rated and the carrying features of the SCBA were subjectively evaluated. The exercise was executed faster with the rucksack device, heart rates were then lower and the carrying features were evaluated as better. Thus, the weight of the SCBA was shown to be less important than its distribution.

Melatonin production during childhood and adolescence: a longitudinal study on the excretion of urinary 6-hydroxymelatonin sulfate

Cross-sectional data on urinary 6-hydroxymelatonin sulfate (6-OHMS) excretion in children suggest a constant melatonin secretion during growth. The present longitudinal study concerned, accordingly, the intra-individual stability of melatonin production during childhood and adolescence. Urine samples collected during a longitudinal investigation of healthy white children and adolescents were analyzed. Forty-six boys and 38 girls were chosen for the present study. They had passed 3-15 annual examinations between their 3rd and 18th yr of age. Each examination included the collection of urine over 24 hr. The daily urinary output of 6-OHMS of the overall 621 samples was quantified by enzyme-linked immunosorbent assay. The analyses clearly revealed for the first time that, despite huge inter-individual differences, melatonin production remains constant in one and the same individual during childhood and adolescence. Additionally, neither a significant sex difference was observed nor was the 6-OHMS output affected by season. The dramatic decrease of plasma melatonin levels as described in the literature is mainly related to an increase in body size rather than to decreasing pineal secretion.

Real-time PCR analysis of the N-acetyltransferase NAT1 allele *3, *4, *10, *11, *14 and *17 polymorphism in squamous cell cancer of head and neck

Although tobacco smoke has been established as a main risk factor in the development of head and neck squamous cell cancer (HNSCC), genetic polymorphisms of xenobiotic metabolizing enzymes are supposed to modulate an individual's susceptibility to smoking-related HNSCC. N-acetyltransferase (NAT) 1 gene is known to be polymorphic and its protein product is implicated in the activation and detoxification of carcinogens, such as aromatic amines, present in tobacco smoke. We developed a rapid and reproducible LightCycler-assisted real-time polymerase chain reaction (PCR) for NAT1 genotyping, which allowed the parallel differentiation of NAT1*3, *4, *10 and *11 alleles and separately of NAT1*14 and *17 alleles within 60 min without the need for further post-PCR processing. In order to investigate the role of the NAT1 gene polymorphism as a risk-modifying factor in HNSCC, we tested for the presence of NAT1*3, *4, *10, *11, *14 and *17 alleles in a case-control study of 291 HNSCC patients and 300 healthy controls of Caucasian origin. Our findings suggest that in Caucasians, the risk of HNSCC is not associated with NAT1 polymorphism. The overall distribution of NAT1 allele frequencies was not significantly different among cases and controls. The presence of the fast acetylator NAT1*10 and NAT1*11 alleles did not significantly increase the risk of HNSCC and no modifying effect of NAT1*10 was observed among smokers. This new approach in NAT1 genotyping substantially increases throughput of sample analysis and, therefore, enhances opportunities to study NAT1 as a risk factor in different cancers in large-scale studies.

Long-Term stability of 6-hydroxymelatonin sulfate in 24-h urine samples stored at -20 degrees C

The purpose of the present feasibility study was to determine whether the concentration of 6-hydroxymelatonin sulfate (6-OHMS) remains stable in urine samples stored over at least 15 yr. To test this, 117 twenty-four-hour urine samples were analyzed, which were obtained from healthy children ages 8 to 9 yr within the periods of 1985-1987,1991-1993, and 1997-1999. 6-OHMS concentrations were determined by enzyme-linked immunosorbent assay. The statistical analyses clearly indicate that the concentration of 6-OHMS remains stable for at least 15 yr if the urine is stored at -20 degrees C.

Pathological excretion patterns of urinary proteins in miners highly exposed to dinitrotoluene

A cohort of 161 underground miners who had been highly exposed to dinitrotoluene (DNT) in the copper-mining industry of the former German Democratic Republic was reinvestigated for signs of subclinical renal damage. The study included a screening of urinary proteins excreted by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and quantitations of the specific urinary proteins alpha 1-microglobulin and glutathione-S-transferase alpha (GST alpha) as biomarkers for damage of the proximal tubule and glutathione-S-transferase pi (GST pi) for damage of the distal tubule. The exposures were categorized semiquantitatively (low, medium, high, and very high), according to the type and duration of professional contact with DNT. A straight dose-dependence of pathological protein excretion patterns with the semiquantitative ranking of DNT exposure was seen. Most of the previously reported cancer cases of the urinary tract, especially those in the higher exposed groups, were confined to pathological urinary protein excretion patterns. The damage from DNT was directed toward the tubular system. In many cases, the appearance of Tamm-Horsfall protein, a 105-kD protein marker, was noted. Data on the biomarkers alpha 1-microglobulin, GST alpha, and GST pi consistently demonstrated a dose-dependent increase in tubular damage, which confirmed the results of screening by SDS-PAGE and clearly indicated a nephrotoxic effect of DNT under the given conditions of exposure. Within the cluster of cancer patients observed among the DNT-exposed workers, only in exceptional cases were normal biomarker excretions found.

Association of CYP1B1 codon 432 mutant allele in head and neck squamous cell cancer is reflected by somatic mutations of p53 in tumor tissue

Tobacco use is causally associated with head and neck squamous cell cancer (HNSCC). Here, we present the results of a case-control study that investigated the effects that the genetic variants of the cytochrome (CYP)1A1, CYP1B1, glutathione-S-transferase (GST)M1, GSTT1, and GSTP1 genes have on modifying the risk of smoking-related HNSCC. Allelisms of the CYP1A1, GSTT1, GSTM1, and GSTT1 genes alone were not associated with an increased risk. CYP1B1 codon 432 polymorphism was found to be a putative susceptibility factor in smoking-related HNSCC. The frequency of CYP1B1 polymorphism was significantly higher (P < 0.001) in the group of smoking cases when compared with smoking controls. Additionally, an odds ratio (OR) of 4.53 (2.62-7.98) was discovered when investigating smoking and nonsmoking cases for the susceptible genotype CYP1B1*2/*2, when compared with the presence of the genotype wild type. In combination with polymorphic variants of the GST genes, a synergistic-effect OR was observed. The calculated OR for the combined genotype CYP1B1*2/*2 and GSTM1*2/*2 was 12.8 (4.09-49.7). The calculated OR for the combined genotype was 13.4 (2.92-97.7) for CYP1B1*2/*2 and GSTT1*2/*2, and 24.1 (9.36-70.5) for the combination of CYP1B1*2/*2 and GSTT1-expressors. The impact of the polymorphic variants of the CYP1B1 gene on HNSCC risk is reflected by the strong association with the frequency of somatic mutations of the p53 gene. Smokers with susceptible genotype CYP1B1*2/*2 were 20 times more likely to show evidence of p53 mutations than were those with CYP1B1 wild type. Combined genotype analysis of CYP1B1 and GSTM1 or GSTT1 revealed interactive effects on the occurrence of p53 gene mutations. The results of the present study indicate that polymorphic variants of CYP1B1 relate significantly to the individual susceptibility of smokers to HNSCC.