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Background: Water immersion skin wrinkling (WISW) has been used as a noninvasive test of a limb's sympathetic function. To date, research has not sufficiently explored this phenomenon. The primary aim of this study was to determine the impact of common individual characteristics on WISW., Methods: Demographic information was collected on 39 apparently healthy adults varying widely in age. Each participant submerged one hand in 40°C water for 30 minutes. The degree of WISW was assessed using computer software. Because WISW is often associated with peripheral edema and facial wrinkling, we also evaluated facial wrinkling and hand volume expansion following prolonged immersion., Results: Sex, body mass index, and physical activity habits were not correlated with any of the WISW measures. Age was a predictor of the WISW score (β = -0.38, P = 0.02, R 2  = 0.15). WISW score was significantly lower for participants who reported relevant medical history (cardiovascular, pulmonary, or psychological) than those with no such report. WISW was not associated with face wrinkling or hand volume expansion., Conclusion: We concluded that WISW was reduced in older age and those with medical history but was not affected by physical activity. These results are consistent with the prevalent notion that WISW may be a sympathetically mediated phenomenon., (© 2022 the International Society of Dermatology.)

Introduction: HFE p.C282Y homozygosity is the most common cause of hereditary haemochromatosis. There is currently insufficient evidence to assess whether non-specific symptoms or hepatic injury in homozygotes with moderately elevated iron defined as a serum ferritin (SF) of 300-1000 µg/L are related to iron overload. As such the evidence for intervention in this group is lacking. We present here methods for a study that aims to evaluate whether non-specific symptoms and hepatic fibrosis markers improve with short-term normalisation of SF in p.C282Y homozygotes with moderate elevation of SF., Methods and Analysis: Mi-iron is a prospective, multicentre, randomised patient-blinded trial conducted in three centres in Victoria and Queensland, Australia. Participants who are HFE p.C282Y homozygotes with SF levels between 300 and 1000 μg/L are recruited and randomised to either the treatment group or to the sham treatment group. Those in the treatment group have normalisation of SF by 3-weekly erythrocytapheresis while those in the sham treatment group have 3-weekly plasmapheresis and thus do not have normalisation of SF. Patients are blinded to all procedures. All outcome measures are administered prior to and following the course of treatment/sham treatment. Patient reported outcome measures are the Modified Fatigue Impact Scale (MFIS-primary outcome), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item short form V.2 (SF36v2) and Arthritis Impact Measurement Scale 2 short form (AIMS2-SF). Liver injury and hepatic fibrosis are assessed with transient elastography (TE), Fibrometer and Hepascore, while oxidative stress is assessed by measurement of urine and serum F2-isoprostanes., Ethics and Dissemination: This study has been approved by the Human Research Ethics Committees of Austin Health, Royal Melbourne Hospital and Royal Brisbane and Women's Hospital. Study findings will be disseminated through peer-reviewed publications and conference presentations., Trial Registration: Trial identifier: NCT01631708; Registry: ClinicalTrials.gov., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Unlabelled: Iron is implicated in the pathogenesis of liver injury and insulin resistance (IR) and thus phlebotomy has been proposed as a treatment for nonalcoholic fatty liver disease (NAFLD). We performed a prospective 6-month randomized, controlled trial examining the impact of phlebotomy on the background of lifestyle advice in patients with NAFLD. Primary endpoints were hepatic steatosis (HS; quantified by magnetic resonance imaging) and liver injury (determined by alanine aminotransaminase [ALT] and cytokeratin-18 [CK-18]). Secondary endpoints included insulin resistance measured by the insulin sensitivity index (ISI) and homeostasis model of assessment (HOMA), and systemic lipid peroxidation determined by plasma F2-isoprostane levels. A total of 74 subjects were randomized (33 phlebotomy and 41 control). The phlebotomy group underwent a median (range) of 7 (1-19) venesection sessions and had a significantly greater reduction in ferritin levels over 6 months, compared to controls (-148 ± 114 vs. -38 ± 89 ng/mL; P < 0.001). At 6 months, there was no difference between phlebotomy and control groups in HS (17.7% vs. 15.5%; P = 0.4), serum ALT (36 vs. 46 IU/L; P = 0.4), or CK-18 levels (175 vs. 196 U/L; P = 0.9). Similarly, there was no difference in end-of-study ISI (2.5 vs. 2.7; P = 0.9), HOMA (3.2 vs. 3.2; P = 0.6), or F2-isoprostane levels (1,332 vs. 1,190 pmmol/L; P = 0.6) between phlebotomy and control groups. No differences in any endpoint were noted in patients with hyperferritinemia at baseline. Among patients undergoing phlebotomy, there was no correlation between number of phlebotomy sessions and change in HS, liver injury, or IR from baseline to end of study., Conclusion: Reduction in ferritin by phlebotomy does not improve liver enzymes, hepatic fat, or IR in subjects with NAFLD., (© 2014 by the American Association for the Study of Liver Diseases.)

Objectives: This article synthesizes discussion of collaborative research results, interventions and policy engagement for St Lawrence Island (SLI), Alaska, during the years 2000-2012., Methods: As part of on-going community-based participatory research (CBPR) studies on SLI, 5 discrete exposure-assessment projects were conducted: (a) a biomonitoring study of human blood serum; (b-d) 3 investigations of levels of contaminants in environmental media at an abandoned military site at Northeast Cape--using sediment cores and plants, semi-permeable membrane devices and blackfish, respectively; and (e) a study of traditional foods., Results: Blood serum in residents of SLI showed elevated levels of polychlorinated biphenyls (PCBs) with higher levels among those exposed to the military site at Northeast Cape, an important traditional subsistence-use area. Environmental studies at the military site demonstrated that the site is a continuing source of PCBs to a major watershed, and that clean-up operations at the military site generated PCB-contaminated dust on plants in the region. Important traditional foods eaten by the people of SLI showed elevated concentrations of PCBs, which are primarily derived from the long-range transport of persistent pollutants that are transported by atmospheric and marine currents from more southerly latitudes to the north., Interventions: An important task for all CBPR projects is to conduct intervention strategies as needed in response to research results. Because of the findings of the CBPR projects on SLI, the CBPR team and the people of the Island are actively engaging in interventions to ensure cleanup of the formerly used military sites; reform chemicals policy on a national level; and eliminate persistent pollutants internationally. The goal is to make the Island and other northern/Arctic communities safe for themselves and future generations., Conclusions: As part of the CBPR projects conducted from 2000 to 2012, a series of exposure assessments demonstrate that the leaders of SLI have reason to be concerned about the health of people due to the presence of carcinogenic chemicals as measured in biomonitoring and environmental samples and important traditional foods.

Marine mammals (bowhead whale, walrus, and various seals) constitute the major component of the diet of the Yupik people of St. Lawrence Island, Alaska. St. Lawrence Island residents have higher serum concentrations of polychlorinated biphenyls (PCB) than in the general U.S. population. In order to determine potential sources, traditional food samples were collected from 2004 to 2009 and analyzed for PCBs, three chlorinated pesticides, and seven heavy metals (mercury, copper, zinc, arsenic, selenium, cadmium, and lead). Concentrations of PCB in rendered oils (193-421 ppb) and blubber (73-317 ppb) from all marine mammal samples were at levels that trigger advisories for severely restricted consumption, using U.S. Environmental Protection Agency (EPA) fish consumption advisories. Concentrations of pesticides were lower, but were still elevated. The highest PCB concentrations were found in polar bear (445 ppb) and the lowest in reindeer adipose tissue (2 ppb). Marine mammal and polar bear meat in general have PCB concentrations that were 1-5% of those in rendered oils or adipose tissue. PCB concentrations in organs were higher than meat. Concentrations of metals in oils and meats from all species were relatively low, but increased levels of mercury, cadmium, copper, and zinc were present in some liver and kidney samples. Mercury and arsenic were found in lipid-rich samples, indicating organometals. These results show that the source of the elevated concentrations of these contaminants in the Yupik population is primarily from consumption of marine mammal blubber and rendered oils.

Objectives: To determine serum levels of polychlorinated biphenyls (PCBs) in Siberian Yupik adults from St. Lawrence Island, Alaska, and to determine the relative contribution of atmospheric transport of PCBs and local contamination to body burdens., Study Design: Siberian Yupiks of various ages were recruited from three populations: residents of the village of Gambell, residents of the village of Savoonga who did not have family hunting camps near the Northeast Cape (NEC), a Formerly Used Defense Site (FUDS) known to be contaminated with PCBs, and residents of Savoonga whose families had a hunting camp at the NEC., Methods: Levels of PCBs were measured in serum samples from 130 people, ages 19-76. These Alaska Natives follow a traditional diet high in marine mammals and fish, which bioconcentrate organochlorine compounds that migrate to the Arctic via global air transport and ocean currents., Results: The lipid-adjusted serum PCB levels of those members of families with hunting camps at the NEC had a mean lipid-adjusted PCB concentration of 1,143 ppb, whereas other residents of Savoonga had values of 847 ppb and residents of Gambell had values of 785 ppb., Conclusions: Our observations suggest that atmospheric transport of PCBs contributes to levels in the Yupik people, but that the abandoned military site at the NEC may also contribute to the human body burden in those individuals who have either spent substantial time or consumed food from there.