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Occupational lung/thoracic diseases are a major global public health issue. They comprise a diverse spectrum of health conditions with complex pathology, most of which arise following chronic heavy workplace exposures to various mineral dusts, metal fumes, or following inhaled organic particulate reactions. Many occupational lung diseases could become irreversible; thus accurate diagnosis is mandatory to minimize dust exposure and consequently reduce damage to the respiratory system. Lung biopsy is usually required when exposure history is inconsistent with imaging, in case of unusual or new exposures, in case of unexpected malignancy, and in cases in which there are claims for personal injury and legal compensation. In this paper, we provide an overview of the most frequent occupational lung diseases with a focus on pathological diagnosis. This is a paper that summarizes the expert opinion from a group of European pathologists, together with contributions from other specialists who are crucial for the diagnosis and management of these diseases. Indeed, tight collaboration of all specialists involved in the workup is mandatory as many occupational lung diseases are misdiagnosed or go unrecognized. This document provides a guide for pathologists in practice to facilitate the accurate diagnosis of occupational lung disease. The review article reports relevant topics discussed during an educational course held by expert pathologists, active members of the Pulmonary Pathology Working Group of the European Society of Pathology. The course was endorsed by the University of Padova as a "winter school" (selected project in the call for "Shaping a World-class University" 2022)., (© 2024. The Author(s).)

Laser-induced breakdown spectroscopy (LIBS) imaging continues to gain strength as an influential bioanalytical technique, showing intriguing potential in the field of clinical analysis. This is because hyperspectral LIBS imaging allows for rapid, comprehensive elemental analysis, covering elements from major to trace levels consistently year after year. In this study, we estimated the potential of a multivariate spectral data treatment approach based on a so-called convex envelope method to detect exotic elements (whether they are minor or in trace amounts) in biopsy tissues of patients with occupational exposure-related diseases. More precisely, we have developed an approach called Interesting Features Finder (IFF), which initially allowed us to identify unexpected elements without any preconceptions, considering only the set of spectra contained in a LIBS hyperspectral data cube. This task is, in fact, almost impossible with conventional chemometric tools, as it entails identifying a few exotic spectra among several hundred thousand others. Once this detection was performed, a second approach based on correlation was used to locate their distribution in the biopsies. Through this unique data analysis pipeline to processing massive LIBS spectroscopic data, it was possible to detect and locate exotic elements such as tin and rhodium in a patient's tissue section, ultimately leading to a possible reclassification of their lung condition as an occupational disease. This review will thus demonstrate the potential of this new diagnostic tool based on LIBS imaging in addressing the shortcomings of approaches developed thus far. The proposed data processing approach naturally transcends this specific framework and can be leveraged across various domains of analytical chemistry, where the detection of rare events is concealed within extensive data sets.

Background: Pneumoconiosis among coal miners in the USA has been resurgent over the past two decades, despite modern dust controls and regulatory standards. Previously published studies have suggested that respirable crystalline silica (RCS) is a contributor to this disease resurgence. However, evidence has been primarily indirect, in the form of radiographic features., Methods: We obtained lung tissue specimens and data from the National Coal Workers' Autopsy Study. We evaluated specimens for the presence of progressive massive fibrosis (PMF) and used histopathological classifications to type these specimens into coal-type, mixed-type and silica-type PMF. Rates of each were compared by birth cohort. Logistic regression was used to assess demographic and mining characteristics associated with silica-type PMF., Results: Of 322 cases found to have PMF, study pathologists characterised 138 (43%) as coal-type, 129 (40%) as mixed-type and 55 (17%) as silica-type PMF. Among earlier birth cohorts, coal-type and mixed-type PMF were more common than silica-type PMF, but their rates declined in later birth cohorts. In contrast, the rate of silica-type PMF did not decline in cases from more recent birth cohorts. More recent year of birth was significantly associated with silica-type PMF., Conclusions: Our findings demonstrate a shift in PMF types among US coal miners, from a predominance of coal- and mixed-type PMF to a more commonly encountered silica-type PMF. These results are further evidence of the prominent role of RCS in the pathogenesis of pneumoconiosis among contemporary US coal miners., Competing Interests: Competing interests: LHTG and RAC report preparing independent medical reviews for individuals with occupational lung disease. JLA, CDC and FHYG report pathology consultation for occupational lung disease., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Tanaka et al. previously reported a case in which nivolumab for recurrent occupational cholangiocarcinoma resulted in complete response persisting for 26 months after discontinuation. Afterward, in that clinical trial, nivolumab was administered to two patients for recurrence. Both patients achieved complete response, suggesting that nivolumab is effective for occupational cholangiocarcinoma., (© 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

In 2016, the French Navy acquired a new high-speed boat, called ECUME. It exposes crewmembers to significant Whole Body Vibrations. This work explores the musculoskeletal diseases among this population. We conducted a retrospective declarative epidemiologic study using anonymous questionnaires. Eighty-four sailors were included. Fifty-six (66.7%) report acute traumas during a nautical raid during the 12 months study period. Sixty (71.4%) report chronic pains, which they associate with their nautical activity. Among them, only 16 (26.7%) have consulted a doctor, but 32 (53.3%) report consuming medication, including 18 through selfmedication. More than half rely to alternatives medicine, especially osteopathy. The traumatic risk of ECUME riding is obvious. Many crewmembers minimize their symptoms, and consult rarely a physician. They give preference to selfmedication and alternative medicines.

Aims: The rising prevalence of metabolic syndrome has made it a major health concern. Chronic occupational exposure to organic solvents affects different systems of the body. This study aimed to investigate the association between exposure to organic solvents and the prevalence of metabolic syndrome in petroleum refinery workers., Method: This study was conducted in 2019-2020 on workers employed in an Iranian petroleum refinery. The demographic and occupational information on the participants was obtained using the interview method. Their height, weight, and blood pressure were measured by the occupational health team, and fasting blood samples were taken from them to measure the paraclinical parameters., Results: In this study, 1009 petroleum refinery workers were analyzed. The prevalence of metabolic syndrome in workers was 20.1% and it was about two times higher in exposed workers (CI 95%: 1.61-3.35) compared to non-exposed ones. Factors associated with the prevalence of metabolic syndrome include age, higher BMI, exercise, and longer exposure to organic solvents., Conclusion: Findings of this study suggested that exposure to organic solvents is associated with increased prevalence of metabolic syndrome (the highest association was observed with elevated serum triglycerides). Besides, longer exposure to organic solvents increased the risk of developing metabolic syndrome., Competing Interests: Declaration of competing interest We declare that there is no Conflict of interest., (Copyright © 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: Coal mine dust lung disease comprises a group of occupational lung diseases including coal workers pneumoconiosis. In many countries, there is a lack of robust prevalence estimates for these diseases. Our objective was to perform a systematic review and meta-analysis of published contemporary estimates on prevalence, mortality, and survival for coal mine dust lung disease worldwide., Methods: Systematic searches of PubMed, EMBASE and Web of Science databases for English language peer-reviewed articles published from 1/1/2000 to 30/03/2021 that presented quantitative estimates of prevalence, mortality, or survival for coal mine dust lung disease. Review was conducted per PRISMA guidelines. Articles were screened independently by two authors. Studies were critically assessed using Joanna Briggs Institute tools. Pooled prevalence estimates were obtained using random effects meta-analysis models. Heterogeneity was measured using the I2 statistics and publication bias using Egger's tests., Results: Overall 40 studies were included, (31 prevalence, 8 mortality, 1 survival). Of the prevalence estimates, fifteen (12 from the United States) were retained for the meta-analysis. The overall pooled prevalence estimate for coal workers pneumoconiosis among underground miners was 3.7% (95% CI 3.0-4.5%) with high heterogeneity between studies. The pooled estimate of coal workers pneumoconiosis prevalence in the United States was higher in the 2000s than in the 1990s, consistent with published reports of increasing prevalence following decades of declining trends. Sub-group analyses also indicated higher prevalence among underground miners, and in Central Appalachia. The mortality studies were suggestive of reduced pneumoconiosis mortality rates over time, relative to the general population., Conclusion: The ongoing prevalence of occupational lung diseases among contemporary coal miners highlights the importance of respiratory surveillance and preventive efforts through effective dust control measures. Limited prevalence studies from countries other than the United States limits our understanding of the current disease burden in other coal-producing countries., Competing Interests: The authors have declared that no competing interests exist.

We aimed to evaluate whether TiO 2 production process induces genotoxic and cytotoxic effects on the first target organ of inhalable particles by a sensitive and noninvasive biomarker of effect. Final aim was to find a useful and suitable tool to assess and manage the risk of TiO 2 occupational exposure. We enrolled 40 workers employed in TiO 2 production, 5 office workers, and 18 external controls. Buccal micronucleus cytome assay (BMCyt assay) was applied because it allows to evaluate micronucleus (MN), nuclear buds (NB), and broken eggs (BE) indicating the presence of chromosomal instability and gene amplification and binucleated cells (BIN), karyolytic cells (KL), and condensed chromatin (CC) indicating cytokinesis defect or arrest, cell death and apoptosis respectively. We characterized the exposure measuring inhalable and respirable particles by personal monitoring. BMCyt-assay showed in exposed workers compared with external controls a higher value of MN frequency (2.57 vs. 0.05‰, p < .001) and MN positivity, evaluated as percentage of subjects with MN frequency higher than a 1.5‰ cut-off value (52.5 vs. 0%). We also found in exposed workers higher frequency of BE + NB (2.41 vs. 0.22‰, p = .002), BIN (9.45 vs. 8.44‰, p = .047) and CC (1.80 vs. 0.21, p = .001) than in controls. Moreover, we found a relationship between personal monitoring results and presence of MN and other cellular anomalies. This study demonstrates induction of genotoxic and cytotoxic effects on buccal cells of workers involved in TiO 2 production, suggesting the suitability of BMCyt assay as tool for risk assessment and management of TiO 2 exposure., (© 2021 Environmental Mutagen Society.)

In most studies on radiation workers, the incidence of thyroid cancer was determined to be higher than among the general population; this is generally assumed to be due to overdiagnosis through thyroid screening. However, there is a lack of evidence on the association between thyroid screening and increased thyroid cancer incidence in most occupational studies. In this study, we compared thyroid cancer screening rates between the general population and radiation workers with various occupations and examined the relationship between these rates and thyroid cancer incidence. We compared thyroid screening rates between radiation workers and the general population with age- and sex-standardized screening ratios (SSRs) using data from two national surveys conducted during 2015-2017 in Korea, and assessed the correlation between these ratios and age- and sex-standardized incidence ratios (SIRs) for thyroid cancer. Screening rates were higher among radiation workers than among the general population, with an overall SSR of 1.58 (95% confidence interval: 1.54-1.62). When various types of occupations were compared, those with an increased SSR also had an increased SIR. SSRs remained high even when the screening period was restricted to the year preceding the survey (the year after the establishment of guidelines for thyroid cancer screening aimed at reducing overdiagnosis). In conclusion, the increased incidence of thyroid cancer among radiation workers compared to that among the general population can be attributed mainly to increased thyroid screening rates. Additional efforts are needed to reduce unnecessary thyroid cancer screening in occupational populations, particularly in those with better access to healthcare, in terms of clinical rationale and for assessing the true increase in thyroid cancer incidence., (©2021 by Radiation Research Society. All rights of reproduction in any form reserved.)

Introduction: Manganese (Mn)-induced parkinsonism involves motor symptoms similar to those observed in Parkinson's disease (PD). Previous literature suggests that chronic Mn- exposure may increase PD risk, although Mn-induced clinical syndromes are considered atypical for PD. This study investigated whether asymptomatic welders display differences in the substantia nigra (SN), the key pathological locus of PD., Method: Brain MRI data and occupational exposure history were obtained in welders (N = 43) and matched controls (N = 31). Diffusion tensor imaging fractional anisotropy (FA; estimate of microstructural integrity) and R2* (estimate of iron and other PD-related brain differences) values in the SN pars compacta (SNc), SN reticulata (SNr), and globus pallidus (GP) were compared between the two groups. The MRI markers of the SN and GP within welders were related to exposure estimates., Results: Compared to controls, welders who had chronic, but low-level, Mn-exposure had similar FA and R2* values in both SN regions (p's > 0.082), but significantly lower FA (p = 0.0013), although not R2* (p = 0.553), in the GP. In welders, FA values in the SN and GP showed a second-order polynomial relationship with cumulative lifetime welding exposure (p's < 0.03)., Conclusion: Neurotoxic processes associated with Mn-exposure may be different from those in PD when the exposure-level is relatively low. Greater welding duration and level, however, were associated with FA differences in the GP and SN, indicating that welding exposures above a certain level may induce neurotoxicity in the SN, a finding that should be explored further in future studies., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The workers at the Mayak nuclear facility near Ozyorsk, Russia are a primary source of information about exposure to radiation at low-dose rates, since they were subject to protracted exposures to external gamma rays and to internal exposures from plutonium inhalation. Here we re-examine lung cancer mortality rates and assess the effects of external gamma and internal plutonium exposures using recently developed Monte Carlo dosimetry systems. Using individual lagged mean annual lung doses computed from the dose realizations, we fit excess relative risk (ERR) models to the lung cancer mortality data for the Mayak Workers Cohort using risk-modeling software. We then used the corrected-information matrix (CIM) approach to widen the confidence intervals of ERR by taking into account the uncertainty in doses represented by multiple realizations from the Monte Carlo dosimetry systems. Findings of this work revealed that there were 930 lung cancer deaths during follow-up. Plutonium lung doses (but not gamma doses) were generally higher in the new dosimetry systems than those used in the previous analysis. This led to a reduction in the risk per unit dose compared to prior estimates. The estimated ERR/Gy for external gamma-ray exposure was 0.19 (95% CI: 0.07 to 0.31) for both sexes combined, while the ERR/Gy for internal exposures based on mean plutonium doses were 3.5 (95% CI: 2.3 to 4.6) and 8.9 (95% CI: 3.4 to 14) for males and females at attained age 60. Accounting for uncertainty in dose had little effect on the confidence intervals for the ERR associated with gamma-ray exposure, but had a marked impact on confidence intervals, particularly the upper bounds, for the effect of plutonium exposure [adjusted 95% CIs: 1.5 to 8.9 for males and 2.7 to 28 for females]. In conclusion, lung cancer rates increased significantly with both external gamma-ray and internal plutonium exposures. Accounting for the effects of dose uncertainty markedly increased the width of the confidence intervals for the plutonium dose response but had little impact on the external gamma dose effect estimate. Adjusting risk estimate confidence intervals using CIM provides a solution to the important problem of dose uncertainty. This work demonstrates, for the first time, that it is possible and practical to use our recently developed CIM method to make such adjustments in a large cohort study., (©2021 by Radiation Research Society. All rights of reproduction in any form reserved.)

Background: The detection rate of lung nodules has increased significantly among petroleum workers in North China since the low-dose CT (LDCT) screening has been widely carried out. What's more, the number of confirmed early lung cancers is increasing continuously. Therefore, a great deal of concern for the high risk of lung cancer has been shown among petroleum workers., Purpose: To improve the screening efficiency and maximize the benefits of the subjects, the current situation of LDCT lung cancer screening should be understood and the imaging characteristics of early lung cancer should be analyzed for petroleum workers in North China., Materials and Methods: Firstly, the dynamic changes of LDCT early lung cancer screening for petroleum workers in North China were analyzed in recent years. Then, the survey data of 3121 petroleum workers was compared with that of 1868 non-petroleum workers, which was analyzed. Finally, 91 patients (129 nodular lung cancer) confirmed by pathology were retrospectively analyzed, and the data of which was compared with the clinical features obtained from survey data above. The imaging characteristics and related factors of different subtypes of lung adenocarcinoma were discussed and analyzed., Results: Lung nodules were found in 810 cases (25.95%) out of 3121 petroleum workers; and the surgery was chosen by 42 patients, 38 of whom were confirmed as lung cancer. Compared with the data of screened petroleum workers, there were more older people and more females as well as a higher proportion of people with family malignancy history, and a lower proportion of smoking people in 91 patients with lung cancer. As the pathological grade of tumor nodules increased, the volume and diameter of nodules gradually increased, and the mean density, maximum density and standard deviation of density also increased ( p  < 0.001). The volume and diameter of nodules were positively correlated with ages ( p  < 0.05)., Conclusion: The occurrence of lung adenocarcinoma is closely related to the family history of malignant tumors, and the constituent ratio of young women without a history of smoking increased significantly. At the same time, the quantitative information obtained by using CT images has important value in predicting its pathological subtypes.

Pararamosis is a medical condition, described in the latex extracting areas of the Amazon (rubber tree regions), resulting from contact with the caterpillar of the Premolis semirufa moth. The disease can present itself in an acute form-similarly to other erucisms (injuries caused by moth larvae in humans)-or in a chronic form, typically characterized by the occurrence of changes in the joints of the hands. Because of its importance, in the context of tropical diseases, the objective of this article was to review the main facets of the disease, emphasizing the different pathogenic aspects of the interaction between the arthropod and man.

Workers of the Commissariat for Atomic Energy and Alternative Energy (CEA) may be potentially exposed to tritium over long periods. We aimed to assess the effect of tritium exposure on mortality in a cohort of employees followed by radiotoxicological monitoring. A total of 1,746 employees who worked for at least six months at one of three CEA centers were included between 1962 and 2011 (median follow-up 29.6 years). The cumulative dose of tritium was based on the quantification of tritium present from urinary excretion monitoring data from the beginning of occupational exposure to the end of such exposure or December 2011. Mortality was first compared to that in the French population using the standardized mortality ratio (SMR). Then, mortality risk ratios (RRs) per category of cumulative dose of tritium were estimated using categorical Poisson models adjusted for age at the onset of exposure, age, calendar period, sex, smoking, employment status, CEA center, and taking into account the number of person-years. The main causes of mortality were tumors (48%) and cardiovascular diseases (20%). The comparison of mortality within the cohort to that in the French population highlighted a lower rate for all-cause mortality and that due to cancer, related to the healthy worker effect bias. The regression model showed no effect of cumulative dose on all-cause mortality. The risk of death for most malignancies was positive, but not significant for the higher classes of doses relative to the reference class. The highest risk (not significant) was present for the class of higher doses for tumors of the larynx, trachea, bronchi and lung. The risk was significant for the higher doses for tumors of the pancreas and bladder (based on a limited number of cases: five and six deaths, respectively). Significantly more smokers died from tumors of the respiratory system than non-smokers, as expected. We were unable to show an effect of cumulative tritium dose due to the small size of the cohort and the low exposure level. However, our study underlines the need to continue following tritium-exposed workers and conducting multicenter studies., (©2021 by Radiation Research Society. All rights of reproduction in any form reserved.)

Background: Cutaneous sporotrichosis, a subcutaneous mycosis because of Sporothrix schenckii, is sporadic worldwide with local hyperendemic pockets., Objectives: To study clinico-epidemiological and therapeutic aspects of sporotrichosis in our clinic., Methods: We retrospectively analyzed medical records of 152 (M:F 52:100) patients with cutaneous sporotrichosis managed during 2010-2019., Results: All patients were involved in agricultural activities, and 63.2% were aged 21-60 years. Women outnumbered men by nearly two times. Fixed and lymphocutaneous sporotrichosis occurred in 54.6% and 43.4% patients, respectively. Only 2% of patients had multifocal sporotrichosis. Only 48% of patients imputed their disease to prior injuries. Extremities, upper in 53.9% and lower in 21% of patients, were mostly involved. Scrotum involvement in one patient was unusual. A mixed inflammatory infiltrate in 38.7%, chronic granuloma formation in 35%, and presence of spores in 48.9% biopsies was noted. S. schenckii grew on Sabouraud's dextrose agar in 40.2% of cases. Treatment with saturated solution of potassium iodide was curative in 76.8% patients, and lesions healed in 2-9 months (average 5.2 months). Metallic taste was experienced by 42.9% of patients. Itraconazole therapy was safe and effective in seven patients, and the response was better when combined with SSKI compared to either drug used alone., Conclusion: Cutaneous sporotrichosis mostly affects persons during active years of life. The injuries predisposing to infection are mostly forgotten. Both fixed and lymphocutaneous sporotrichosis involving extremities remain common forms. SSKI alone or in combination with itraconazole is safe and effective treatment. Itraconazole is preferable in patients having preexisting hypothyroidism or intolerance to SSKI., (© 2020 the International Society of Dermatology.)

Objectives: The natural history of coal workers' pneumoconiosis (CWP) after cessation of exposure remains poorly understood., Methods: We characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression., Results: A total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR., Conclusions: This study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Up to 10% of Bladder Cancers may arise following occupational exposure to carcinogens. We hypothesised that different cancer phenotypes reflected different patterns of occupational exposure., Methods: Consecutive participants, with bladder cancer, self-completed a structured questionnaire detailing employment, tasks, exposures, smoking, lifestyle and family history. Our primary outcome was association between cancer phenotype and occupational details., Results: We collected questionnaires from 536 patients, of whom 454 (85%) participants (352 men and 102 women) were included. Women were less likely to be smokers (68% vs. 81% Chi sq. p<0.001), but more likely than men to inhale environmental tobacco smoke at home (82% vs. 74% p = 0.08) and use hair dye (56% vs. 3%, p<0.001). Contact with potential carcinogens occurred in 282 (62%) participants (mean 3.1 per worker (range 0-14)). High-grade cancer was more common than low-grade disease in workers from the steel, foundry, metal, engineering and transport industries (p<0.05), and in workers exposed to crack detection dyes, chromium, coal/oil/gas by-products, diesel fumes/fuel/aircraft fuel and solvents (such as trichloroethylene). Higher staged cancers were frequent in workers exposed to Chromium, coal products and diesel exhaust fumes/fuel (p<0.05). Various workers (e.g. exposed to diesel fuels or fumes (Cox, HR 1.97 (95% CI 1.31-2.98) p = 0.001), employed in a garage (HR 2.19 (95% CI 1.31-3.63) p = 0.001), undertaking plumbing/gas fitting/ventilation (HR 2.15 (95% CI 1.15-4.01) p = 0.017), undertaking welding (HR 1.85 (95% CI 1.24-2.77) p = 0.003) and exposed to welding materials (HR 1.92 (95% CI 1.27-2.91) p = 0.002)) were more likely to have disease progression and receive radical treatment than others. Fewer than expected deaths were seen in healthcare workers (HR 0.17 (95% CI 0.04-0.70) p = 0.014)., Conclusions: We identified multiple occupational tasks and contacts associated with bladder cancer. There were some associations with phenotype, although our study design precludes robust assessment., Competing Interests: The authors have read the journal’s policy and have the following potential competing interests: SH has received research funding from CR UK, MRC/NIHR, UHB charities, CCC charities, North West Cancer Research and reimbursement for consultancy from Bayer, Janssen, Boehringer Ingelheim, Pierre Fabre, Eli Lilly. SAH Advisory board/Consultancy: Roche, MSD, AstraZeneca, BMS, Janssen, Pfizer, Astellas, Bayer, Pierre Fabre, Sotio, GSK, Ipsen and Eisai. JWFC has received reimbursement for consultancy from Astra Zeneca, Roche and Janssen, speaker fees from BMS, MSD, Nucleix and Roche, and honoraria for membership of an advisory board for Ferring. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

The health of workers in the concrete and cement industries can be at risk due to occupational exposure to silica dust. The purpose of this study was to evaluate the changes of pulmonary parameters and risk of mortality from lung cancer in concrete workers exposed to crystalline silica. This cross-sectional study was performed on 72 male workers exposed to silica at a concrete manufacturing plant in Neyshabur, Iran. Respiratory zone air sampling was performed using the standard NIOSH7602 method using individual sampling pumps and membrane filters. Then, the amount of silica in the samples was determined using the Fourier Transform Infrared technique. The risk of death from lung cancer was determined using Rice et al.'s model. Respiratory indices were measured using a spirometer. Data were analyzed by the SPSS 20 software. Occupational exposure to silica was 0.025 mg/m3 and mortality was estimated to be 7-94 per thousand. All spirometry indices significantly decreased during these 4 years of exposure to silica dust. The respiratory pattern of 22% of the exposed workers was obstructive and this prevalence was significantly higher than the control group. The results showed that although the average occupational exposure to silica in these concrete workers was below the recommended threshold of national and international organizations, their risk of death was significantly higher; and workers' lung indices had significantly decreased over four years. Therefore, appropriate measures should be taken to reduce silica exposure among these workers.

Nurses consist of an occupational group that is particularly exposed to harmful work-related factors such as prolonged working hours, severe stress, fatigue, and excessive strain on the musculoskeletal system. According to nurses, the limitation of the application of ergonomic principles of work may contribute to the occurrence of numerous dangerous behaviors, improper eating habits, or deficiency of systematic physical activity. The most common consequences are nutritional disorders and musculoskeletal system dysfunctions. This prospective observational study was aimed at evaluating selected parameters of the body composition of professionally active nurses and at determining work-related risks during nursing activities. The study group consisted of 37 active nurses (38.38 ± 11.33 years). The research tool was a device for bioelectrical impedance analysis (BIA). A questionnaire designed by the authors was also implemented, which covered ergonomic principles, musculoskeletal injuries, and nutritional habits. In the present study, it was shown that all average values of the tested nurses' body composition parameters were within the normal range. The majority of respondents (97.3%) reached a high level of body water. A statistically significant correlation was found between the knowledge of the workplace ergonomic principles and body mass index. In conclusion, musculoskeletal pain and lack of implementation of ergonomic behaviors are a significant problem among nurses, which may be the cause of overweight or obesity in this occupational group., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Anna Kołcz et al.)

A historical cohort study in workers occupationally exposed to chrysotile was set up in the town of Asbest, the Russian Federation, to study their cause-specific mortality, with a focus on cancer. Chrysotile has different chemical and physical properties compared with other asbestos fibres; therefore it is important to conduct studies specifically of chrysotile and in different geographical regions to improve the knowledge about its carcinogenicity. Setting was the town of Asbest, Sverdlovsk oblast, the Russian Federation. Participants were all current and former employees with at least one year of employment between 1/1/1975 and 31/12/2010 in the mine, enrichment factories, auto-transport and external rail transportation departments, the central laboratory, and the explosives unit of the company. Of the 35,837 cohort members, 12,729 (35.5%) had died (2,373 of them of cancer, including 10 of mesothelioma), 18,799 (52.5%) were known to be alive at the end of the observation period (2015), and 4,309 (12.0%) were censored before the end of 2015. Mean follow-up duration was 21.7 years in men and 25.9 years in women. The mean age at death was 59.4 years in men and 66.5 years in women. This is the largest occupational cohort of chrysotile workers to date, and the only one with a large proportion of exposed female workers., Competing Interests: Dr Kovalevskiy and Dr Kashanskiy reported receiving, on behalf of their institutes and personally through consulting firms, payments from companies to evaluate exposure to asbestos and risk of asbestos-related disease in those workplaces. All other authors have no competing interests to declare. For full transparency, Dr Kovalevskiy reported participation as an occupational and environmental health expert as part of the delegation of the Russian Ministry of Health at multiple World Health Assembly meetings as well as at the Conference of the Parties to the Basel and Rotterdam Conventions. Dr Kovalevskiy and Dr Kashansky reported attending meetings organized by the International Chrysotile Association and reported that all expenses for attendance were paid by their respective institutes. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: There are few reported cases in the literature of spinal injuries from the past, and all of them resulted in the death of the individual or led to severe health consequences. From the historical record, it is well known there were no cures or treatments for spinal lesions in the past. Given the paucity of historical documents focused on this topic, anthropological research on spinal injuries can contribute with important information regarding the medical history of this kind of trauma. Moreover, skeletal trauma and occupational markers may be crucial for the reconstruction of habitual behaviors and the identification of causes and timing of death. We report results of an anthropological study of a case of vertebral injury discovered in an individual from the Italian Iron Age that highlights this important topic. The aim of this study was to assess the habitual activity pattern and manner of death of an ancient inhabitant of Spina in Padanian Etruria (northeastern Italy)., Methods: We performed a detailed anthropological and paleopathological analysis of skeletal remains., Results: The unknown individual was identified as a middle-aged man characterized by a particular trauma to the spine. Lesion analysis revealed a perimortem injury at the L2-L3 level. Characteristic markers on the bones indicated intense physical activity carried out during his life., Conclusions: This Etruscan, in all likelihood a sailor according to the occupational markers, did not survive a stabbing attack with a bladed weapon., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: To investigate changes in brain functional activity among occupational noise-induced hearing loss (NIHL) with tinnitus patients, using resting-state brain magnetic resonance imaging (Rs-fMRI) and voxel-based morphometry (VBM)., Methods: Mild (27) and Relative severe (15) patient groups, 30 matched healthy group, scanned by Rs-fMRI and T1WI 3D fast spoiled gradient echo, FSPGR, using voxel-based morphometry and amplitude of low frequency fluctuation to analyze the differences., Results: Brain gray matter volume was significantly different among the three groups in the left occipitotemporal lateral gyrus, the anterior cingulate gyrus, the bilateral angular gyrus, the precuneus, and near the midline area of the cerebellum. The Rs-fMRI changes showed that amplitude of low frequency fluctuation differed significantly among the three groups in the right superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus., Conclusion: All this provides a new perspective for understanding the pathophysiological mechanism of occupational noise-induced hearing loss and provides some theoretical bases for subsequent treatment.

Disturbed sleep is the most common effect of shift work. A large corpus of research indicates an association between sleep disturbance and depressive symptom in shift workers. In this study, we proposed the mediating role of grey matter (GM) structure in the relationship between sleep disturbance and depressive symptom. We collected structural MRI (sMRI) data as well as assessing the level of sleep disturbance and depressive symptom with the Pittsburgh Sleep disturbance Index and Zung Self-Rating Depression Scale, respectively, in 20 shift-working nurses and 19 day-working nurses. The shift-working nurses reported greater severity of sleep disturbance and depressive symptom, and furthermore, they exhibited reduced GM volume in the left postcentral gyrus (PostCG), right PostCG, right paracentral lobule, and left superior temporal gyrus (STG), compared to the day-working nurses. For each of the four brain regions, we formulated a mediation hypothesis by developing a mediation model that represents a causal chain between GM volume, sleep disturbance, and depressive symptom. Tests of the hypothesis on the mediation of GM volume revealed that inter-individual variations in left PostCG volume and left STG volume accounted for the influence of sleep disturbance on depressive symptom. These results suggest that structural alterations in PostCG and STG play an intervening role in the development of depressive symptom following sleep disturbance. We propose the need of considering neuroanatomical abnormalities in explaining and understanding symptomatic changes induced by sleep disturbance.

Objective: To investigate the association between occupational exposure to welding and the risk of head and neck cancer in a large French population-based case-control study, the I nvestigation of occupational and environmental CA uses of RE spiratory cancers study., Methods: Analyses were restricted to men (2703 controls and 1588 cases of squamous-cell carcinoma of the oral cavity, oropharynx, hypopharynx and larynx). Welding activity and potential confounders were assessed by detailed questionnaires. ORs and CIs (95% CI) were estimated by unconditional logistic regression, adjusted for age, area of residence, tobacco smoking, alcohol consumption and occupational exposure to asbestos., Results: Welding was associated with an increased risk of head and neck cancer overall (OR=1.31, 95% CI 1.03 to 1.67). The association was strongest for laryngeal cancer (OR=1.66, 95% CI 1.15 to 2.38) and the risk increased with the cumulative duration (p-trend <0.01) and the weighted duration (p-trend <0.01) of welding. A cumulative duration and a weighted duration of welding of more than 10 years were also associated with a significantly increased risk of oral cancer (OR=1.82, 95% CI 1.09 to 3.04; OR=2.10, 95% CI 0.99 to 4.45, respectively). A long duration of arc welding was associated with laryngeal cancer, whereas a long duration of spot welding was associated with oral cancer. Welding was not associated with the risk of oropharyngeal and hypopharyngeal cancer., Conclusion: Our findings suggest that welding and several welding-related tasks increase the risk of laryngeal cancer and to a lesser extent oral cancer., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Persistent respiratory symptoms following post-9/11 military deployment to Iraq and Afghanistan are well-recognized, but the spectrum of respiratory diseases remains poorly characterized. This study describes deployment-related respiratory diseases and the diagnostic utility of resting and exercise pulmonary function testing., Methods: Between 2009 and 2017, 127 consecutive military workers ("deployers") with new-onset respiratory symptoms underwent clinical evaluation. Deployment-related respiratory diseases were classified as proximal and/or distal. Using descriptive statistics and logistic regression, we analyzed lung function parameters associated with deployment-related distal lung disease (DDLD)., Results: Common deployment-related respiratory diseases included asthma (31.5%), intermittent laryngeal obstruction (14.2%), rhinosinusitis (15%), and DDLD (68.5%). Decreased diffusion capacity (odds ratio [OR] = 4.6, 95% confidence interval [CI]: 1.4 to 15.1, P = 0.01) was significantly associated with DDLD., Conclusions: A comprehensive diagnostic approach may identify a spectrum of proximal and distal respiratory diseases that can occur in symptomatic post-9/11 deployers, requiring a personalized approach to care.

Purpose: The article reports on a comparative analysis of biological specimens of lung tissues collected from workers with pulmonary fibrosis induced by internal exposure to plutonium alpha-particles (plutonium-induced pulmonary fibrosis [PuPF]) and with etiologically different pulmonary fibrosis (non-PuPF) that developed as an outcome of a chronic obstructive pulmonary disease (COPD). Materials and methods: To perform histological examinations, lung tissues were sampled during autopsy. Six samples of various lung regions (the apical region, the lingula of the left lung and the inferior lobe) were collected from each donor. The resected tissue samples were fixed in 10% neutral-buffered formalin during 24 h and embedded into paraffin blocks (FFPE). FFPE blocks with lung tissue specimens collected from 56 workers with PuPF, 34 workers with non-PuPF and 35 workers without any lung disease were used in the study. To perform microscopic examination, lung tissue specimens were hematoxylin and eosin stained. To examine the connective-tissue scaffold of lung stroma and identify foci of pulmonary fibrosis, the cut sections of paraffin blocks were stained by Van Gizon's method (to assess the total volume of fibrosis-affected tissues), Gomori's technique (to define the reticular scaffold of lung stroma) and Weigert's technique (to examine elastic fibers). Morphological patterns of all biological specimens were studied using immunohistochemistry. To fit the empirical data, the Weibull's model was used. Results and conclusions: The study found qualitative and quantitative morphological features specific for PuPF compared to non-PuPF. The study demonstrated that hyper-production of collagen type V plays a key role in PuPF. The collagen type V content in fibrotic foci in lung tissue specimens from workers with PuPF was found to be increased.

Objectives: To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS., Material and Methods: Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded., Results: A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands., Conclusions: The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

We analyzed the relationship between polymorphic loci of CYP3A genes (CYP3A4 (rs2740574), CYP3A5 (rs776746) and CYP3A7 (rs2257401)) with the development of chronic mercury intoxication. Of 170 men examined, 120 were workers chronically exposed to mercury vapors and 50 were carriers of GG-HSPA1B (+1267A/G) genotype associated with chronic mercury intoxication. Urinary content of 4-hydroxyantipyrine (4-HAP) generated in the reaction predominantly catalyzed by CYP3A4/CYP3A5 was studied in workers without chronic mercury intoxication (group 1, N=46) and patients in the delayed period of chronic mercury intoxication (group 2, N=74) depending on the genotypes of CYP3A4 and CYP3A5. For polymorphic loci CYP3A5 and CYP3A7, a tendency to an increase in the frequency of genotypes with rare alleles was found (p=0.071 and p=0.078) in the combined group (group 2 together with GGHSPA1B genotype carriers) relative to group 1. The high level of linkage disequilibrium was noted, especially for the pair rs776746 and rs2257401 (LD (r)=0.89). In group 2, a trend to 4-HAP decrease compared to group 1 (p=0.056 and p=0.065) was revealed for carriers of AA-CYP3A4 and GG-CYP3A5 genotypes. The involvement of CYP3A in the development of mercury neurotoxic effect remains unclear.

Although a compromised epidermal permeability barrier can contribute to the development of contact dermatitis, whether subjects with hand eczema display abnormalities in baseline epidermal permeability barrier function in their uninvolved skin remains unknown. The aim of the present study was to assess epidermal permeability barrier function in subjects with and without hand eczema in clothing manufacturers. Upon approval by the institutional review board, volunteers were recruited from clothing manufacturers in Guangzhou City, China. An 11-item questionnaire was used to collect general data from the volunteers. The diagnoses of self-proclaimed hand eczema were further confirmed by a dermatologist. Epidermal biophysical properties, including transepidermal water loss (TEWL) rates, stratum corneum hydration and skin surface pH were measured on the flexural surface of the left forearm in all volunteers. Epidermal biophysical properties were compared among cohorts of subjects with active hand eczema, a prior history of hand eczema and without any history of hand eczema. A total of 650 questionnaires were collected from 462 females and 188 males, with a mean age of 36.7 ± 0.46 years (range 16-69 years; 95% CI 35.8-37.59). Thirty-five subjects (5.4%) currently had hand eczema, while 28 subjects (4.3%) reported a prior history of hand eczema that was inactive currently. The prevalence of hand eczema did not differ significantly between genders. Neither a prior personal nor a family history of allergies was associated with the prevalence of hand eczema, but certain occupations and frequent contact with disinfectants were independently associated with the prevalence of hand eczema. In the overall cohort, males displayed higher TEWL rates and stratum corneum hydration levels than did females. Both skin surface pH and TEWL rates differed significantly among normal controls and subjects with active hand eczema or a prior history of hand eczema (p < 0.05). In conclusion, the uninvolved skin site of subjects with hand eczema exhibits abnormalities in epidermal perme-ability barrier, supporting a pathogenic role of epidermal dysfunction in hand eczema. Whether subjects with hand eczema in other occupations also display altered epidermal function on uninvolved skin remains to be explored., (© 2020 S. Karger AG, Basel.)

Liver cancer is associated with genetic mutations caused by environmental exposures, including occupational exposure to alpha radiation emitted by plutonium. We used whole exome sequencing (WES) to characterize somatic mutations in 3 histologically distinct primary liver tumors (angiosarcoma of the liver (ASL), cholangiocarcinoma (CCA) and hepatocellular carcinoma (HCC)) from Mayak worker subjects occupationally exposed to ionizing radiation (IR) to investigate the contribution of IR to the mutational landscape of liver cancer. DNA sequence analysis revealed these tumors harbor an excess of deletions, with a deletions:substitutions ratio similar to that previously reported in radiation-associated tumors. These tumors were also enriched for clustered mutations, a signature of radiation exposure. Multiple tumors displayed similarities in abrogated gene pathways including actin cytoskeletal signaling and DNA double-strand break (DSB) repair. WES identified novel candidate driver genes in ASL involved in angiogenesis and PIK3CA/AKT/mTOR signaling. We confirmed known driver genes of CCA, and identified candidate driver genes involved in chromatin remodeling. In HCC tumors we validated known driver genes, and identified novel putative driver genes involved in Wnt/β-catenin signaling, chromatin remodeling, PIK3CA/AKT/mTOR signaling, and angiogenesis. This pilot study identifies several novel candidate driver mutations that are likely to be caused by IR exposure, and provides the first data on the mutational landscape of liver cancer after IR exposure.

Leprosy, or Hansen's disease (HD), is caused by the bacterium Mycobacterium leprae and is a significant cause of morbidity worldwide. Clinical manifestations range from isolated skin rash to severe peripheral neuropathy. Treatment involves a prolonged course of multiple antimicrobials. Although rare in the U.S., with only 168 new cases reported in 2016, HD remains a prevalent disease throughout the world, with 214,783 new cases worldwide that same year. 1 It remains clinically relevant for service members born in and deployed to endemic regions. This report describes a case of HD diagnosed in an active duty soldier born and raised in Micronesia, a highly endemic region.

In September and October 2017, elevated atmospheric ruthenium contamination was measured in several European countries. The most probable origin of this release of radionuclides was reconstructed to be the Southern Ural region. During that time, five workers from a German company stayed up to 2 wk about 120 km from the Chelyabinsk region in Ekaterinburg, Russia. No clinical symptoms were reported during or after the suspected radiation exposure, and no internal contamination was found in whole-body measurements. However, to investigate radiation protection issues and to clarify the workers' situation in order to reassure them, as they planned to continue working in Ekaterinburg, our laboratory was urgently requested by the company's occupational physician to perform biodosimetry using dicentric analysis to determine if the workers have been exposed to radiation by incorporation of radionuclides. The workers' dicentric yields have been compared to reference data of background frequencies in unexposed individuals, but, as it is not reasonable to quantify individual absorbed radiation doses from internalized beta emitters due to various confounding factors, individual dose estimation has not been performed. Dicentric frequencies for two workers differed significantly from the mean laboratory background level, which could have been induced by an exposure to incorporated radionuclides due to beta emissions by Ru or to gamma irradiation by the decay nuclide of Ru. However, the maximum absorbed radiation doses calculated for a resident in the Ru-contaminated area during that time does not correspond to the observed dicentric frequencies. It cannot be excluded that their dicentric frequencies were already elevated before September 2017, potentially induced by an earlier radiation exposure to diagnostic x rays or even by chance.

Flavorings-related lung disease is a potentially disabling and sometimes fatal lung disease of workers making or using flavorings. First identified almost 20 years ago in microwave popcorn workers exposed to butter-flavoring vapors, flavorings-related lung disease remains a concern today. In some cases, workers develop bronchiolitis obliterans, a severe form of fixed airways disease. Affected workers have been reported in microwave popcorn, flavorings, and coffee production workplaces. Volatile α-dicarbonyl compounds, particularly diacetyl (2,3-butanedione) and 2,3-pentanedione, are implicated in the etiology. Published studies on diacetyl and 2,3-pentanedione document their ability to cause airway epithelial necrosis, damage biological molecules, and perturb protein homeostasis. With chronic exposure in rats, they produce airway fibrosis resembling bronchiolitis obliterans. To add to this knowledge, we recently evaluated airway toxicity of the 3-carbon α-dicarbonyl compound, methylglyoxal. Methylglyoxal inhalation causes epithelial necrosis at even lower concentrations than diacetyl. In addition, we investigated airway toxicity of mixtures of diacetyl, acetoin, and acetic acid, common volatiles in butter flavoring. At ratios comparable to workplace scenarios, the mixtures or diacetyl alone, but not acetic acid or acetoin, cause airway epithelial necrosis. These new findings add to existing data to implicate α-dicarbonyl compounds in airway injury and flavorings-related lung disease.

Objective: To analyze the epidemiological, occupational characteristics and clinical manifestations of reported cases of occupational brucellosis (OB) in Hulunbeier city from 2008 to 2018, so as to provide scientific basis for the formulation of prevention and control measures for occupational brucellosis. Methods: China Information System for Disease Control and Prevention had exported the network report data of "occupational diseases and occupational health information monitoring" from January 1, 2008 to December 31, 2018 and had created the database; The epidemiological characteristics, clinical manifestations and laboratory examinations of OB were analyzed. Results: There were 262 OB cases in Hulunbuir from 2008 to 2018, including male in 235 cases, female in 27 cases. The most age was 41-50 years old (97 cases, 37%) . The length of service was concentrated in 0-10 years (146 cases, 55.7%) ; in the time distribution, the incidence in January was mostly (87 cases, 33.2%) . The industry distribution of veterinarians was the most (139 cases, 53.1%) , followed by epidemic prevention workers (58 cases, 22.1%) . The regional distribution is mainly concentrated in Ergun city (51 cases, 19.5%) , Hailar District (43 cases, 16.4%) , Orogen Autonomous Banner (40 cases, 15.3%) . The main clinical features were asthenia (194 cases, 74.0%) , hyperhidrosis (144 cases, 55.0%) , joint and muscle pain (156 cases, 59.5%) . The course of disease was mostly chronic (181 cases, 69.1%) . Conclusion: The cases of OB in Hulunbuir city are distributed in the developed areas of animal husbandry, and the incidence months are concentrated. Veterinarians are the key high-risk occupational groups.

Objective: Trapezius myalgia or, more specifically, myofascial dysfunction of the upper trapezius mainly affects women performing jobs requiring prolonged low level activation of the muscle. This continuous low muscle load can be accompanied by a shift to a more anaerobic energy metabolism, causing pain. The aim of the study was to investigate whether morphological signs of an impaired aerobic metabolism are present in female office workers with trapezius myalgia., Design: Muscle biopsy analysis, using electron and light microscopy, was performed to compare mitochondrial and fat droplet morphology, and irregular muscle fibers, between female office workers with (n = 17) and without (n = 15) work-related trapezius myalgia., Results: The patient group showed a significantly higher mean area (P = 0.023) and proportion (P = 0.029) for the subsarcolemmal and intermyofibrillar mitochondria respectively, compared with the control group. A significantly lower mean area of subsarcolemmal lipid droplets was found in the patient group (P = 0.015), which also displayed a significantly higher proportion of lipid droplets touching the mitochondria (P = 0.035). A significantly higher amount of muscle fibers with cytochrome c oxidase-deficient areas were found in the patient group (P = 0.030)., Conclusions: The results of the present study may be indicative for an impaired oxidative metabolism in work-related trapezius myalgia. However, additional research is necessary to confirm this hypothesis.

Portal hypertension, liver fibrosis, and angiosarcoma of the liver (ASL) have been reported among workers exposed to vinyl chloride monomer (VCM) since the 1970s. In 2007, the International Agency for Research on Cancer established the association of VCM with hepatocellular carcinoma (HCC), though only on the basis of the few cases available. Thereafter, recent reports from the United States cohort and a European sub-cohort of vinyl chloride workers provided compelling evidence of a strong association between cumulative VCM exposure and HCC risk. Further areas of research include the risk of liver cancer at lower levels of exposure and different patterns of risk of ASL and HCC with the time since exposure. The evidence of interaction between VCM exposure and other known liver carcinogens such as alcohol and chronic viral infection provides clues for the health surveillance of exposed workers. Notably, also the risk of VCM-associated chronic liver disease is modulated by alcohol consumption, viral infection, and genetic polymorphism. A counter-intuitive finding from cohort studies of exposed workers is the lower mortality from liver cirrhosis with respect to the general population; this can be attributed to the healthy worker effect and to the selection of liver cancer as the cause of death in the presence of concomitant chronic liver disease. Studies designed to overcome these intricacies confirmed an association between cumulative VCM exposure and the risk of liver cirrhosis., Competing Interests: Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.

This study was conducted to estimate the current prevalence of hypertension, cardiovascular condition and hearing difficulty of workers exposure to occupational noise, and to analyze any associations between these abnormal signs and occupational noise exposure. The subjects included 5205 noise-exposed workers. Workers with high noise exposure were more likely to have a higher threshold value than low exposure ones (P < 0.05). Subjects in the high exposure group had a significantly higher risk of hypertension and hearing loss than the ones in low exposure group. Between the ages of 30 and 45, high-level occupational noise exposure led to a significantly raising risk of both hypertension (Adjusted OR = 1.59, 95% CI, 1.19-2.11) and hearing loss (Adjusted OR = 1.28, 95% CI, 1.03-1.60) when comparing to low-level noise exposure. In male workers, the prevalence of hearing difficulty in high exposure group was approximately 1.2 times worse than in low group (P = 0.006). In addition, exposure to high noise level demonstrated a significant association with hypertension and hearing loss when the duration time to occupational noise was longer than 10 years. Hypertension and hearing difficulty is more prevalent in the noise-exposed group (higher than 85 dB[A]). Steps to reduce workplace noise levels and to improve workplace-based health are thus urgently needed.

Mycobacterium avium complex (MAC) and Mycobacterium avium paratuberculosis (MAP) cause zoonotic infections transmitted by birds and livestock herds. These pathogens have remained as serious economic and health threats in most areas of the world. As zoonotic diseases, the risk of development of occupational disease and even death outcome necessitate implementation of control strategies to prevent its spread. Zoonotic MAP infections include Crohn's disease, inflammatory bowel disease, ulcerative colitis, sarcoidosis, diabetes mellitus, and immune-related diseases (such as Hashimoto's thyroiditis). Paratuberculosis has classified as type B epidemic zoonotic disease according to world health organization which is transmitted to human through consumption of dairy and meat products. In addition, MAC causes pulmonary manifestations and lymphadenitis in normal hosts and human immunodeficiency virus (HIV) progression (by serotypes 1, 4, and 8). Furthermore, other subspecies have caused respiratory abscesses, neck lymph nodes, and disseminated osteomyelitis in children and ulcers. However, the data over the occupational relatedness of these subspecies is rare. These agents can cause occupational infections in susceptible herd breeders. Several molecular methods have been recognized as proper strategies for tracking the infection. In this study, some zoonotic aspects, worldwide prevalence and control strategies regarding infections due to MAP and MAC and related subspecies has been reviewed., (© 2019 Wiley Periodicals, Inc.)

The skeleton is one of the major retention sites for internally deposited actinides. Thus, an accurate estimation of the total skeleton content of these elements is important for biokinetic modeling and internal radiation dose assessment. Data from 18 whole-body donations to the US Transuranium and Uranium Registries with known plutonium intakes were used to develop a simple and reliable method for estimation of plutonium and Am activity in the total skeleton from single-bone analysis. A coefficient of deposition Kdep, defined as the ratio of actinide content in the patella to that in the skeleton, was calculated for Pu, Pu, and Am. No statistical difference was found in Kdep values among these radionuclides. Variability in Kdep values was investigated with relation to skeleton pathology (osteoporosis). The average Kdep of 0.0051 ± 0.0009 for the osteoporotic group was statistically different from Kdep of 0.0032 ± 0.0010 for nonosteoporotic individuals. The use of Kdep allows for rapid estimation of the total skeletal content of plutonium and Am with up to 35% uncertainty. To improve accuracy and precision of total skeleton activity estimates, regression analysis with power function was applied to the data. Strong correlation (r > 0.9) was found between Pu, Pu, and Am activities measured in the patella bone and total skeleton activity. The results of this study are specifically important for the optimization of bone sample collection for US Transuranium and Uranium Registries partial-body donations.

A cluster of nine mesothelioma cases was observed among 341 registrants' deaths in the US Transuranium and Uranium Registries. Descriptive analysis showed that mesothelioma cases had the highest average cumulative external radiation dose compared with lung cancer, other cancer, and noncancer deaths. Further analysis indicated that the mesothelioma cluster was very different demographically from lung cancer, other cancer, and noncancer deaths. Therefore, an internally matched case-control approach was applied to evaluate the differences in an average cumulative external radiation dose between mesothelioma deaths and other causes of death. A Monte Carlo t test was used to examine the statistical significance of the differences. The results showed that there were no significant statistical differences in an average cumulative external radiation dose between mesothelioma and lung cancer, other cancers, or noncancers for the internally matched cases and controls.

Military personnel may be exposed to circumstances (e.g., large energy deficits, sleep deprivation, cognitive demands, and environmental extremes) of external stressors during training and combat operations (i.e., operational stressors) that combine to degrade muscle protein. The loss of muscle protein is further exacerbated by frequent periods of severe energy deficit. Exposure to these factors results in a hypogonadal state that may contribute to observed decrements in muscle mass. In this review, lessons learned from studying severe clinical stressed states and the interventions designed to mitigate the loss of muscle protein are discussed in the context of military operational stress. For example, restoration of the anabolic hormonal status (e.g., testosterone, insulin, and growth hormone) in stressed physiological states may be necessary to restore the anabolic influence derived from dietary protein on muscle. Based on our clinical experiences, restoration of the normal testosterone status during sustained periods of operational stress may be advantageous. We demonstrated that in severe burn patients, pharmacologic normalization of the anabolic hormonal status restores the anabolic stimulatory effect of nutrition on muscle by improving the protein synthetic efficiency and limiting amino acid loss from skeletal muscle. Furthermore, an optimal protein intake, and in particular essential amino acid delivery, may be an integral ingredient in a restored anabolic response during the stress state. Interventions which improve the muscle net protein balance may positively impact soldier performance in trying conditions.

Applying the two-stage clonal expansion model to epidemiology of lung cancer among uranium miners, it has been revealed that radon acts as a promoting agent facilitating the clonal expansion of already mutated cells. Clonal expansion rate increases non-linearly by radon concentration showing a plateau above a given exposure rate. The underlying mechanisms remain unclear. Earlier we proposed that progenitor cell hyperplasia may be induced upon chronic radon exposure. The objective of the present study is to test whether the induction of hyperplasia may provide a quantitative explanation for the plateau in clonal expansion rate. For this purpose, computational epithelium models were prepared with different number of basal cells. Cell nucleus hits were computed by an own-developed Monte-Carlo code. Surviving fractions were estimated based on the number of cell nucleus hits. Cell division rate was computed supposing equilibrium between cell death and cell division. It was also supposed that clonal expansion rate is proportional to cell division rate, and therefore the relative increase in cell division rate and clonal expansion rate are the same functions of exposure rate. While the simulation results highly depend on model parameters with high uncertainty, a parameter set has been found resulting in a cell division rate-exposure rate relationship corresponding to the plateau in clonal expansion rate. Due to the high uncertainty of the applied parameters, however, further studies are required to decide whether the induction of hyperplasia is responsible for the non-linear increase in clonal expansion rate or not. Nevertheless, the present study exemplifies how computational modelling can contribute to the integration of observational and experimental radiation protection research., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)