Preparation of nanoparticle dispersions for in-vitro toxicity testing

Studies on potential toxicity of engineered nanoparticle (ENP) in biological systems require a proper and accurate particle characterization to ensure the reproducibility of the results and to understand biological effects of ENP. A full characterization of ENP should include various measurements such as particle size and size distribution, shape and morphology, crystallinity, composition, surface chemistry, and surface area of ENP. It is also important to characterize the state of ENP dispersions. In this study, four different ENPs, rutile and anatase titanium dioxides and short single- and multi-walled carbon nanotubes, were characterized in two dispersion media: bronchial epithelial growth medium, used for bronchial epithelial BEAS cells, and RPMI-1640 culture media with 10% of fetal calf serum (FCS) for human mesothelial (MeT-5A) cells. The purpose of this study was to determine the characteristics of ENPs and their dispersions as well as to compare dispersion additives suitable for toxicity tests and thus establish an appropriate way to prepare dispersions that performs well with the selected ENP. Dispersion additives studied in the media were bovine serum albumin (BSA) as a protein resource, dipalmitoyl phosphatidylcholine (DPPC) as a model lung surfactant, and combination of BSA and DPPC. Dispersions were characterized using optical microscopy and transmission electron microscopy. Our results showed that protein addition, BSA or FCS, in cell culture media generated small agglomerates of primary particles with narrow size variations and improved the stability of the dispersions and thus also the relevance of the in-vitro genotoxicity tests to be done.

Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings

The objective of the present study is to determine the feasibility of chest computed tomography (CT) in screening for lung cancer among asbestos-exposed workers. In total, 633 workers were included in the present study and were examined with chest radiography and high-resolution CT (HRCT). A total of 180 current and ex-smokers (cessation within the previous 10 yrs) were also screened with spiral CT. Noncalcified lung nodules were considered positive findings. The incidental CT findings not related to asbestos exposure were registered and further examined when needed. Noncalcified lung nodules were detected in 86 workers. Five histologically confirmed lung cancers were found. Only one of the five cancers was also detected by plain chest radiography and three were from the group of patients with a pre-estimated lower cancer probability. Two lung cancers were stage Ia and were radically operated. In total, 277 individuals presented 343 incidental findings of which 46 required further examination. Four of these were regarded as clinically important. In conclusion, computed tomography and high-resolution computed tomography proved to be superior to plain radiography in detecting lung cancer in asbestos-exposed workers with many confounding chest findings. The numerous incidental findings are a major concern for future screenings, which should be considered for asbestos-exposed ex-smokers and current smokers.

National mesothelioma incidence and the past use of asbestos

In Western Europe, Scandinavia, North America and Australia the manufacture and use of asbestos products peaked in the 1970's. The current incidence of mesothelioma ranges from 14 to 35 cases/million/year in eleven industrialized countries which had used asbestos 2.0 to 5.5 kg/capita/year about 25 years earlier. A significant linear correlation (r = 0.80, p = 0.01) exists between the two variables. Accordingly, about 170 tons of produced and consumed asbestos will cause at least one death from mesothelioma, most often as a consequence of occupational exposure.

Computed tomography of asbestos-related pleural abnormalities

OBJECTIVES

To study the observer agreement in several asbestos-related pleural abnormalities and to define criteria to discriminate between pleural changes in workers with occupational disease, and those in controls.

METHODS

Pleural abnormalities in spiral computed tomography of 602 construction workers with asbestosis or bilateral pleural plaques and 49 controls were reviewed by three radiologists using structured forms.

RESULTS

Intra- and inter-observer agreement (weighted kappa) was 0.4 or better with regard to the calcification, extent and thickness of pleural disease. These factors all correlated positively with the duration of asbestos exposure. There were significant differences in these pleural changes between the workers (mean extent per side 83 cm(2)) and controls (mean extent per side 40 cm(2)). Of the controls, 84% showed pleural lesions with an estimated extent of 10 cm(2) or more, bilateral in 64%. The extent of 45 cm(2) in pleural disease was the best value for discriminating between the controls and diseased workers, with a sensitivity of 82% and a specificity of 66%. The degree of pleural calcification, however, was the best discriminator between these groups, but quantitative methods are necessary for its use in the diagnostics of individuals.

CONCLUSIONS

The extent, calcification and thickness were well-repeatable indicators of benign pleural pathology and thus their use in future classification systems in computed tomography is recommended. In our material, the extent of 45 cm(2) and the degree of calcification were helpful in discriminating between pleural changes in workers with occupational disease, and those in controls who also presented marked pleural pathology.

High-resolution computed tomography classification of lung fibrosis for patients with asbestos-related disease

OBJECTIVES

This study tested a new high-resolution computed tomography (HRCT) scoring method for asbestos-induced parenchymal changes in the lung.

METHODS

HRCT scans of 602 asbestos-exposed workers and 49 referents were reviewed by 3 radiologists. Structured forms were filled out for a semiquantitative HRCT fibrosis score based on several specified parenchymal abnormalities scored separately. Observer agreement was studied with the use of the quadratic-weighted kappa (kappaqw). The HRCT fibrosis score (from 0 to V with definitions and index images given retrospectively) was compared with the radiographic classification of the International Labour Office (ILO) for the same patients. Receiver-operating characteristic (ROC) curves were computed to compare the tests for diagnosing asbestosis.

RESULTS

Good inter- and intraobserver agreements were achieved (kappaqw = 0.64 and 0.72, respectively) as regards the HRCT fibrosis score. All the specified computed tomography findings explained 86% of the variance in the HRCT fibrosis score. Age and occupational group were significant predictors of fibrosis. The area under the ROC curve was significantly greater for the HRCT fibrosis score (0.89) than for the ILO radiographic classification (0.76). The sensitivity (70%) and specificity (91%) of the HRCT fibrosis score (classes I/II-V representing asbestosis) were better than those of the classification published by the International Labour Office (51% and 89%, respectively, score > or = 1/0 representing asbestosis).

CONCLUSIONS

The examined HRCT scoring method proved to be a simple, reliable, and reproducible method for classifying lung fibrosis and diagnosing asbestosis also in large populations with occupational disease, and it would be possible to use it as a part of an international classification.

Inorganic fibres in the lung tissue of Hungarian and German lung cancer patients

OBJECTIVE

To ascertain the lung burden of asbestos fibres in Hungarian lung cancer patients in comparison with the cumulative asbestos exposure estimated from the occupational history.

METHODS

For 25 Hungarian lung cancer patients, lung tissue fibre analysis was performed by scanning transmission electron microscopy (STEM) and counting of ferruginous bodies (FBs) by light microscopy. Cumulative asbestos exposure in fibre-years was assessed from a standardised occupational history using the report "fibre years" of the German Berufsgenossenschaften.

RESULTS

Median and maximum concentrations of fibres longer 5 microns per gram dry lung tissue (g dry) were 0.03 and 7.38 million fibres/g dry for chrysotile, 0.00 and 0.21 million fibres/g dry for amphibole and 0.22 and 0.62 million fibres/g dry for other mineral fibres (OMFs). The maximum values were observed in one patient for whom a high asbestos exposure was evident in advance from the occupational history.

CONCLUSIONS

In comparison with reference values obtained by the same method for German patients with no indication of workplace asbestos exposure, increased concentrations of more than 0.2 million chrysotile fibres/g dry were obtained for six of the 25 Hungarian patients (24%). For one of them, the second highest estimate of a workplace exposure of 60 fibre-years and the highest tissue concentration of 7.38 million chrysotile fibres/g dry substantiate a high probability of a causal relationship to asbestos. A further comparison can be made with the results for 66 German patients treated by surgical lung resection for a disorder other than mesothelioma, mainly lung cancer. For the Hungarian lung cancer patients, similar amounts of chrysotile but distinctly lower amounts of amphibole fibres and distinctly higher amounts of OMFs were observed. A correlation between exposure estimates from occupational history and concentration of fibres in the lung tissue was observed for amphibole (Spearman: R = 0.66, P < 0.001, Pearson: R = 0.50, P = 0.01) and for chrysotile (Pearson: R = 0.48, P = 0.02).

Amphibole fibres in Chinese chrysotile asbestos

Ten chrysotile bulk samples originating from six Chinese chrysotile mines were studied for amphibole fibres. Five of the mines operate on ultramafic rocks whereas one exploits a dolomite-hosted deposit. The asbestos fibre content in lung tissue was examined from seven deceased workers of the Shenyang asbestos plant using these raw materials. The bulk samples were pretreated with acid/alkali-digestion, and thereafter, scanning and transmission electron microscopy, X-ray microanalysis, selected area electron diffraction and X-ray powder diffractometry were used to identify the minerals. Sample preparation of lung tissue involved drying and low-temperature ashing. All of the bulk samples contained amphibole fibres as an impurity. The amphibole asbestos contents were between 0.002 and 0.310 w-%. Tremolite fibres were detected in every sample but anthophyllite fibres were present only in the sample originating from the dolomite-hosted deposit. In comparison, anthophyllite (71%), tremolite (9%) and chrysotile (10%) were the main fibre types in the lung tissue samples indicating faster pulmonary clearance of chrysotile fibres. The total levels ranged from 2.4 to 148.3 million fibres (over 1 microm in length) per gram of dry tissue, and they were consistent with heavy occupational exposure to asbestos.

Role of occupational asbestos exposure in Hungarian lung cancer patients

OBJECTIVE

What is the frequency of occupational asbestos exposure among patients suffering from malignant respiratory tumours and how many of these tumours are associated with asbestos in Hungary?

METHODS

An internationally established questionnaire with 29 questions, covering the most characteristic activities of asbestos exposure at the workplace was completed for 300 patients with respiratory malignancies, i.e. 297 patients with lung cancer and three with mesothelioma of the pleura. From the questionnaire, the smoking habits were estimated and cumulative asbestos exposure was assessed in fibre-years. Additionally, lung X-rays were classified and the national data on the incidence of malignant pleura mesothelioma were analysed.

RESULTS

A cumulative asbestos exposure of 25 fibre-years or more was detected in 11 patients with lung cancer (4%) and in each of the three patients with pleural mesothelioma (100%). In a further 72 patients (24%), cumulative occupational asbestos exposure was assessed as below 25 fibre-years (between 0.01 and 23.9 fibre-years). In this group, car and truck mechanics, and installation and construction workers using asbestos-cement were registered. Among patients with an asbestos exposure of 25 fibre-years or more, six asbestos-cement production workers were observed, among them the three mesothelioma cases. A weak but significant association between positive X-ray findings and exposure estimates could be demonstrated. Additionally, results of the lung tissue fibre counts by scanning transmission electron microscopy were available for 25 of the lung cancer patients. A good correlation was observed between the asbestos fibre counts and the assessment of cumulative asbestos exposure. In Hungary, 84 cases of pleural mesothelioma were registered in 1997 and 73 in 1998. These numbers correspond to an annual incidence of about one new case per 100,000 inhabitants older than 15 years.

CONCLUSIONS

The annual incidence of lung cancer in Hungary is about 6,000. Since in our series of lung cancer patients about 4% were observed, which could be accepted as representing occupational disease because of a cumulative exposure to 25 fibre-years or more, the annual asbestos related lung tumour incidences may be estimated to be approximately 150 or more. The proportion of nearly two estimated cases of lung cancer per case of pleural mesothelioma corresponds to international experience. Up to now, lung cancer cases only exceptionally have been registered as occupational diseases, i.e. they were seriously under-diagnosed in Hungary. For improving this situation, diagnostic assistance by a self-interview with a questionnaire covering the working history for all newly diagnosed lung cancer patients would be helpful.

Pulmonary mineral fibers after occupational and environmental exposure to asbestos in the Russian chrysotile industry

BACKGROUND

As an indicator of occupational, domestic, and environmental exposure, the level and type of asbestos fibers were determined from lung tissue samples of workers and residents who resided in the area of the world's largest asbestos mine at Asbest, Russia.

METHODS

Electron microscopy was used to analyze and measure the concentration of asbestos fibers in a series of 47 autopsies at the Asbest Town Hospital. Work histories were obtained from pathology reports and employment records.

RESULTS

In 24 chrysotile miners, millers, and product manufacturers, the pulmonary concentrations of retained fibers (over 1 microm in length) were 0. 8-50.6 million f/g for chrysotile, and < 0.1-1.9 million f/g for amphiboles (tremolite and anthophyllite). The concentrations were lower in 23 persons without any known occupational contact with asbestos; 0.1-14.6 million f/g for chrysotile, and < 0.1-0.7 million f/g for amphiboles. On average, 90% of all inorganic fibers were chrysotile, and 5% tremolite/anthophyllite. No amosite or crocidolite fibers were detected in any of the samples.

CONCLUSIONS

The mean and range of pulmonary chrysotile concentrations were about the same as reported previously from the Canadian mining and milling industry. In the Russian samples, the mean concentration of tremolite fibers were less by at least one order of magnitude. Occupational contact was the most important source of asbestos exposure.

Follow-up of asbestosis patients and predictors for radiographic progression

OBJECTIVE

We followed a group of 85 Finnish asbestosis patients radiographically for an average of 6.5 (range 2-10) years to examine the progression of the disease and to assess possible explanations for the progression.

METHODS

The examinations included full-size chest radiographs and a blood specimen analysis. The radiographs were classified according to the 1980 International Labor Office (ILO) classification. Progression was accepted if the second or third radiography was estimated (in a side-by-side comparison) to have more profusion of small opacities qualitatively than the first, even if the radiographs were classified into the same profusion category.

RESULTS

In all, 38% of the patients showed progression during the follow-up period. The average progression of small opacities ranged from ILO 1/1 to ILO 2/2 (0.4 minor ILO categories/year). The asbestosis was progressive more often among the sprayers than among the insulators and asbestos factory workers [cross-tabulation, odds ratio (OR) 5.0, 95% confidence interval (95% CI) 1.2-20]. In the logistic regression model the ILO classification category at the beginning of the follow-up (OR 1.54; 95% CI 0.96-2.47), the fibronectin (OR 1.01; 95% CI 1.00-1.01) and angiotensin-converting enzyme (ACE; OR 1.10; 95% CI 1.00-1.20) levels, and the erythrocyte sedimentation rate (ESR; OR 1.05; 95% CI 1.00-1.10) were statistically associated with the radiographic progression of small opacities. Abnormalities of the pleura were found to progress more often among the patients with progressive parenchymal opacities.

CONCLUSION

For the progression of small-opacity profusion the significant predictors in the logistic regression model were the ILO profusion category at the beginning of the follow-up period, the fibronectin level, the ACE value, and the ESR. The model correctly classified 94% of the patients with progression and 65% of those without progression. The differences in the mean values recorded for the biomarkers between the progressors and nonprogressors, however, were small and may therefore not be of any importance to the clinician.

Guidelines for mineral fibre analyses in biological samples: report of the ERS Working Group. European Respiratory Society

Microscopic techniques for analysing asbestos fibres in lung tissue and bronchoalveolar lavage have provided major information in the understanding of asbestos-related diseases. These analyses are increasingly applied for clinical work and medicolegal problems. Differences in sampling, preparation and counting techniques, definitions of reference populations and expression of results have caused major difficulties in comparing results from different laboratories. Therefore it appeared necessary to set a goal to harmonize these analyses between the European laboratories active in this field. This article summarizes the work of a European Respiratory Society working group with participation from nine European laboratories. The five main issues touched upon are: 1) definitions of control populations and reference levels; 2) sampling, preparation and analytical techniques; 3) asbestos fibres in lung tissues in different pathologies; 4) asbestos bodies in lung tissue, bronchoalveolar lavage and sputum; and 5) basis for the interpretation of fibres and asbestos bodies in biological samples. These guidelines indicate the crucial importance of several factors for the interpretation of the results; namely, adequate sampling, comparable analytical procedures and expression of the results, the use of well-defined reference populations, and a comprehensive understanding of the factors affecting the fibre retention and the dose-responses associated with the different asbestos-related diseases.

Radiographic abnormalities among Finnish construction, shipyard and asbestos industry workers

OBJECTIVES

The prevalence of asbestos-related radiographic abnormalities was surveyed among Finnish construction, shipyard, and asbestos industry workers.

METHODS

The radiographic screening focused on active and retired workers who were under the age of 70 years and had been employed for at least 10 years in construction or for at least 1 year in shipyards or in the asbestos industry. In 1990-1992, 18,943 people participated in an X-ray examination of the lungs and an interview on work history and exposure. The criteria for a positive radiological finding were (i) small irregular lung opacities clearly consistent with interstitial pulmonary fibrosis (ILO 1/1 or higher), (ii) lung opacities indicating mild pulmonary fibrosis (ILO 1/0) with unilateral or bilateral pleural plaques, (iii) marked adhesions with or without thickening of the visceral pleura, or (iv) findings consistent with bilateral pleural plaques.

RESULTS

Fulfilling the criteria were 4133 workers (22%) (22% from construction, 16% from shipyards, and 24% from the asbestos industry). The radiological findings included signs of pulmonary fibrosis (3%), changes in the visceral pleura (7%), bilateral plaques (17%), and unilateral plaques (10%). Occupational disease was diagnosed according to the Finnish insurance regulations for three-fourths of those referred for further examinations, 96% being abnormalities in the pleura and 4% being asbestosis.

CONCLUSIONS

Exposure to asbestos dust has been common in ordinary construction work, and, consequently, radiographic abnormalities (mostly pleural) occur frequently among active and retired construction workers.

Exposure to soluble nickel in electrolytic nickel refining

Past and present exposure to nickel was studied in an electrolytic nickel refinery, where an increased incidence of nasal cancer had been reported, using nickel analyses in air, blood and urine. Genotoxic effects were studied using analysis of micronuclei from acridine orange-stained smears from the buccal mucosa of the workers. Workers used respirators or masks in tasks where the exposure was expected to be high. Inside the mask, nickel concentrations were 0.9-2.4 micrograms m-3 in such tasks. In those tasks where masks were not used, nickel concentrations in the breathing zone were 1.3-21 micrograms m-3. Air-borne nickel concentrations (stationary sampling) varied between 230 and 800 micrograms m-3 in 1966-1988 with no systematic change; thereafter lower concentrations (170-460 micrograms m-3) have been observed. After-shift urinary concentrations of nickel were 0.1-2 mumol l-1; they showed no correlation with nickel concentrations in the air. Concentrations of nickel in the urine were still elevated after a 2-4 week vacation. The frequency of micronucleated epithelial cells in the buccal mucosa of nickel refinery workers was not significantly elevated by comparison with referents. No relationship was observed between micronucleus frequencies and levels of nickel in air, urine or blood.

Occupational exposure to nickel salts in electrolytic plating

An occupational hygiene survey was made in 38 nickel plating shops in Finland and exposure to nickel was studied by means of biological measurements and, in three shops, by using air measurements. The average after-shift urinary nickel concentration of 163 workers was 0.16 mumol l.-1 (range 0.001-4.99 mumol l.-1). After the 1-5 week vacation the urinary nickel concentration was higher than the upper reference limit of non-exposed Finns indicating that a part of water-soluble nickel salts is accumulated in the body. Urinary nickel concentrations in the shops considered clean in the industrial hygiene walk-through were not different from those observed in the shops considered dirty. The correlation between the concentrations of nickel in the air and in the urine was low, and the amount of nickel excreted in the urine exceeded the calculated inhaled amounts, indicating exposure by other routes such as ingestion.

Screening for asbestos-induced diseases in Finland

Screening for asbestos-induced diseases in Finland was carried out in 1990-1992 as a part of the Asbestos Program of the Finnish Institute of Occupational Health. The aim of the present study was to find the workers who had developed an asbestos-induced disease in certain occupations. Examination of active or retired workers included a personal interview on work history and asbestos exposure, and a chest X-ray. The target group for the screening comprised workers under 70 years of age who had worked at least for 10 years in construction, 1 year in a shipyard or in the manufacture of asbestos products. A preliminary questionnaire was sent to 54,409 workers, 18,943 of whom finally participated in the screening examination. The mean age of the workers was 53 years; 95% were employed in construction, 2% in shipyards, and 3% in the asbestos industry. The criteria for a positive screening result were (1) a radiographic finding clearly indicating lung fibrosis (at least ILO category 1/1), (2) a radiographic finding indicating mild lung fibrosis (ILO category 1/0) with unilateral or bilateral pleural plaques, (3) marked abnormalities of the visceral pleura (marked adhesions with or without pleural thickening), or (4) bilateral pleural plaques. The positive cases totalled 4,133 (22%) and were sent for further investigation. In addition to the screening, information on the presence of asbestos in the work environment, prevention of asbestos exposure, as well as on the health effects of asbestos exposure and smoking were given to the participating workers. The screening acted as a preliminary survey to prompt further national follow-up of asbestos-induced diseases among the workers who have been exposed to asbestos. This article presents the material, methods, and overall results of the screening.

Radiographic small lung opacities and pleural abnormalities in relation to smoking, urbanization status, and occupational asbestos exposure in Finland

The role of smoking and an urban living environment in the etiology of radiographic pleural and pulmonary abnormalities was studied in a population sample that was representative of the Finnish adult population. A total of 7095 full-size chest radiographs were classified according to the International Labor Organization's 1980 classification of radiographs of pneumoconioses, with some modifications. The risk of bilateral pleural plaques was significantly higher among urban men (RR, 2.0) and women (RR, 3.8), even when adjusted for age and probability of occupational asbestos exposure and smoking. The risks of small lung opacities and abnormalities of the visceral pleura were not higher in urban areas. Risks of small lung opacities and thickening of the visceral pleura were positively associated with smoking, and the risk of small lung opacities was also higher among smokers than never-smokers in the population fraction with unlikely occupational asbestos exposure.

Radiographic small lung opacities and pleural abnormalities as a consequence of asbestos exposure in an adult population

OBJECTIVES

The purpose of this study was to estimate the role of past asbestos exposure as a cause of radiographic small lung opacities and pleural abnormalities in the Finnish adult population.

METHODS

The study was conducted in 1978-1981 and was based on a population sample (N = 8000) representative of the Finnish population aged 30 years or over. Full-size chest radiographs and a complete job title history were available for 3811 women and 3274 men. The radiographs were classified according to the 1980 classification of radiographs of pneumoconioses published by the International Labour Office and the work histories according to the probability of occupational asbestos exposure. Age- and smoking-adjusted relative risks of radiographic parenchymal and pleural abnormalities were calculated with the analysis of covariance according to the probability of asbestos exposure.

RESULTS

About 13% of the men and 0.8% of the women were classified as probably exposed to asbestos. There was more than 90% agreement in the repeated work history evaluations. The risk of small lung opacities was significantly increased among the probably exposed men [risk ratio (RR) 1.7 for ILO profusion category 1/1 or more and RR 1.6 for profusion category 1/0]. The risk of pleural plaques was increased both among the men (RR 3.0) and the women (RR 4.8) with probable exposure. The risk of thickened horizontal interlobar fissure was also increased among the probably exposed men (RR 1.7). Among the men, the etiologic fraction attributable to occupational asbestos exposure was about 30% for small lung opacities, about 40% for pleural plaques, and about 20% for thickened horizontal fissure. Among the women the etiologic fractions for asbestos were similar for pleural abnormalities, but much lower for parenchymal ones.

CONCLUSIONS

Occupational asbestos exposure has been common among Finnish men, and it plays a significant role in the etiology of both pleural and parenchymal abnormalities also at the level of the general population.

Asbestos and cancer in Finland

Primary prevention carried out today can reduce the disease incidence in the future decades. The present disease panorama is the consequence of past asbestos exposure mainly before the 1970s. The peak incidence of asbestos-induced diseases will be reached around 2010 in Finland. The number of asbestos-related premature deaths is at present annually about 150 which exceeds the figure of fatal work accidents. Asbestos-related cancer will increase still for 15-20 years and reach its maximum, about 300 cases, in 2010, and will start to decrease after that. More than 20,000 asbestos-exposed workers have participated in the medical screening and follow-up. The termination of exposure, antismoking campaigns, improved diagnostics and careful attention to compensation issues, as well as other potentials for prevention, were the central issue of the Asbestos Program of the Finnish Institute of Occupational Health. An important objective of research work is to improve early diagnostics, and thereby treatment prospects, in case of asbestos-induced cancers.

Finnish Institute of Occupational Health Asbestos Program 1987-1992

In 1987-1992, the Finnish Institute of Occupational Health (FIOH) implemented a nationwide asbestos program aimed at preventing asbestos-related risks in good cooperation with governmental authorities, industry, trade unions, the health care and insurance systems, and mass media. The goals were to minimize all exposure to asbestos, identify people exposed at work, and improve the diagnostics of asbestos diseases, especially cancers. The program entailed several concrete actions and extensive dissemination of information, training, services, and scientific research. As proposed by the State Asbestos Committee, new use of asbestos products was banned and strict regulations were applied to renovation and inspection of old buildings. The screening study of asbestos-induced diseases included 18,943 current and retired workers from house building, shipyard, and asbestos industries. Pleural and parenchymal changes were found in 4,133 persons (22%), who were referred to further clinical examinations as suspected cases of an occupational disease. It was estimated that past exposure of asbestos among the Finnish population of 5 million causes > 150 mesotheliomas and lung cancers annually, totalling > 2,000 asbestos-induced cancer deaths by the year 2010. Although several major control actions were made or started during the program, the bulk of the preventive work still lies ahead.

Retention of asbestos fibers in the human body

The number, type, and size of retained asbestos fibers were measured by scanning electron microscopy (SEM) in lung tissues of 10 workers who had died from lung cancer or mesothelioma. The levels were 190-3000 x 10(6) fibers/g of dry tissue in three crocidolite sprayers, 6-39 x 10(6) fibers/g of dry tissue in two asbestos product workers and 13-280 x 10(6) fibers/g of dry tissue in five insulators exposed to anthophyllite. The duration of past exposure corresponding to the limit of 1 million fibers/g of dry tissue was 1 to 2 days in spraying, 3 to 10 days at the production plant and 1 to 4 months in insulation work. No long-term clearance of amphibole fibers, > 5 microns in length, could be demonstrated. In one of the sprayers the fiber concentrations of lung parenchyma, visceral and parietal pleura, hilar lymph nodes, and kidney cortex were orders of magnitude higher than in a series of unselected autopsies. The size and aspect ratio of crocidolite fibers in various tissues were similar, indicating that the translocation processes are rather unselective in respect to fiber dimensions.

Pleural plaques and exposure to mineral fibres in a male urban necropsy population

OBJECTIVES

The study aimed to evaluate the risk of pleural plaques according to the degree of past exposure to asbestos, type of amphibole asbestos, and smoking, as well as to estimate the aetiologic fraction of asbestos as a cause of plaques among urban men.

METHODS

The occurrence and extent of pleural plaques were recorded at necropsies of 288 urban men aged 33 to 69 years. The pulmonary concentration of asbestos and other mineral fibres was analysed with scanning electron microscopy. The probability of past exposure was estimated from the last occupation.

RESULTS

Pleural plaques were detected in 58% of the cases and their frequency increased with age, probability of past occupational exposure to asbestos, pulmonary concentration of asbestos fibres, and smoking. The risk of both moderate and widespread plaques was raised among asbestos exposed cases, and the risk estimates were higher for widespread plaques than for moderate plaques. The age adjusted risk was higher for high concentrations of crocidolite/amosite fibres than for anthophyllite fibres. The aetiologic fraction of pulmonary concentration of asbestos fibres exceeding 0.1 million fibres/g was 43% for widespread plaques and 24% for all plaques. The median pulmonary concentrations of asbestos fibres were about threefold greater among cases with widespread plaques than among those without plaques. No increased risk of pleural plaques was associated with raised total concentrations of non-asbestos fibres.

CONCLUSION

The occurrence of pleural plaques correlated closely with past exposure to asbestos. The risk was dependent on the intensity of exposure. Due to methodological difficulties in detecting past exposures to chrysotile and such low exposures that may still pose a risk of plaques, the aetiologic fractions calculated in the study probably underestimate the role of asbestos.

Is there an association between pleural plaques and lung cancer without asbestosis?

OBJECTIVES

A recent review or meta-analysis of epidemiologic studies concluded that persons with asbestos-related pleural plaques do not have an increased risk of lung cancer in the absence of parenchymal asbestosis. The reviewer inferred that this conclusion provided indirect supportive evidence for the proposition that asbestosis is a necessary precursor of asbestos-related lung cancer. The objective of the present communication is to contest these claims.

METHODS

Finnish epidemiologic data and population statistics were used to estimate the apparent risk ratio of lung cancer associated with radiographic signs of pleural plaques. Power calculations were applied to compute the needed population sizes to demonstrate that the association is statistically significant.

RESULTS

Unrealistically large population studies would be needed to observe the statistical relation between pleural plaques and lung cancer, quantitated as a risk ratio of 1.1, resulting from relatively low levels of environmental asbestos exposure. In realistic and valid epidemiologic studies on heavily exposed subpopulations, a two- or threefold risk can be identified.

CONCLUSIONS

Uninformative studies should not be interpreted as providing suppressive evidence that pleural plaques are a noncausal risk indicator of lung cancer. Even for the null hypothesis, the inference that asbestosis is a necessary causal link between asbestos and lung cancer is illogical.

Asbestos exposure and pulmonary fiber concentrations of 300 Finnish urban men

OBJECTIVES

The aim of the study was to determine the pulmonary concentrations of mineral fibers in the Finnish male urban population and to evaluate the analysis of pulmonary fiber burden by scanning electron microscopy (SEM) as an indicator of past fiber exposure.

METHODS

The pulmonary concentration of mineral fibers was determined by SEM and compared with occupational history for a series of 300 autopsies of urban men aged 33 to 69 years.

RESULTS

The concentration of fibers (f) longer than 1 micron ranged from < 0.3 to 163.10(6) per gram of dry tissue (f.g-1). Asbestos fiber concentrations exceeding 1.10(6) f.g-1 were observed in 33% of the cases with probable occupational exposure to asbestos and 1% of the cases with unlikely occupational exposure. Even asbestos fiber concentrations of 0.3 to 1.10(6) f.g-1, especially of crocidolite-amosite fibers, were rare among the men with unlikely occupational exposure. Fiber concentrations exceeding or equaling 1.10(6) f.g-1 were 10 times more frequent among the men more than 60 years of age as compared with those less than 40 years of age. Inorganic fibers other than asbestos had a weaker correlation with occupational history and age. Smoking habits had no significant effect on the pulmonary fiber counts.

CONCLUSIONS

Asbestos fiber concentrations exceeding 1.10(6) f.g-1 are highly indicative of past occupational exposure to asbestos. The distribution of fiber concentrations in the different age groups of this study indicated decreasing asbestos exposure in Finland since the 1970s.

Asbestos exposure according to different exposure indices among Finnish lung cancer patients

During a 6-month period all lung cancer patients in a university hospital chest clinic were investigated for asbestos exposure by means of personal interview, bronchoalveolar lavage (BAL), roentgenograms, lung function testing, histology and measurement of fibre concentrations in lung tissue samples using scanning electron microscopy (SEM). About one-third of the patients (33%) were classified as having been exposed to asbestos on the basis of the interview. BAL was performed and AB counts were done in 51 patients. Fourteen (27%) BAL specimens had AB counts of 1 or more AB/ml, which is the conventional limit for non-trivial asbestos exposure. For a subgroup of 25 operated lung cancer patients fibre analysis was also available. In six cases (30%) the asbestos-containing samples had asbestos fibre concentrations equal to or more than 1 million fibres/g dry lung. In eight (32%) of the operated lung cancer patients histopathologically confirmed fibrosis was seen; five of these patients were in the two highest exposure classes. Pleural plaques on X-ray films were seen in six (24%) of the operated cases. With each indicator of exposure about 30% of lung cancer patients were found to have been exposed, confirming the "one-third rule"; however, when all the information was collated there were three cases (12%) in which exposure was most obvious according to the different parameters used in this study. In these three cases the cancer could well be attributed to asbestos. Anthophyllite was present in all asbestos-containing samples and anthophyllite was the main fibre type in 61% of these samples.

Urinary and blood manganese in occupationally nonexposed populations and in manual metal arc welders of mild steel

To obtain reference values for blood and serum manganese levels, blood specimens were collected from 29 men and 36 women. Mn in blood showed a normal distribution; its upper 97.5% limit in blood was 0.38 mumol/l. Mn in serum showed a skewed distribution, which did not differ from the normal one after logarithmic transformation. The respective reference limit was 19 nmol/l. In both specimens, the levels of Mn were significantly lower in men than in women. To obtain reference values for Mn in urine, midday urine specimens were collected from 58 men and 96 women. Mn in urine also showed a skewed distribution, and the upper 97.5% limit was 38 nmol/l. The levels of Mn in blood and urine were statistically significantly higher in manual metal arc (MMA) welders of mild steel (MS) than in the reference populations. Five MMA/MS welders were subjected to a further study in which the ambient intramask Mn levels and urinary Mn excretion were monitored throughout a full working week. For two welders the correlation of Mn in urine specimens voided in the afternoon was good with the before noon Mn concentrations in the hygienic measurements; for the rest the correlation was minimal. Mn in diurnal urine specimens collected in six portions showed fluctuation if specific gravity or creatinine in urine was used to standardize for the urinary flow, but it was less evident for urinary Mn excretion rate. Our results seem to indicate that the measurement of Mn in urine or blood may be used for monitoring Mn exposure in MMA/MS welders only at the group level.

Relative risk of mesothelioma associated with different levels of exposure to asbestos

The relative risk of mesothelioma associated with different levels of exposure to asbestos was evaluated. The exposure was assessed from work histories of 51 mesothelioma cases and 51 sarcoidosis referents. The lung fiber concentration of the mesothelioma patients was compared with that of two reference groups (13 random autopsy cases and 43 male lung cancer patients). When the categories definite and probable were used as an estimated probability of occupational exposure, an odds ratio of 17.7 [90% confidence interval (90% CI) 3.4-253] and 3.0 (90% CI 0.9-10.6), respectively, was obtained. A lung fiber concentration of greater than 1 million fibers/g of dry tissue as an indicator of accumulated exposure gave an odds ratio of 14.4 (90% CI 2.5-178) for the men in comparison with the autopsy cases and 3.1 (90% CI, 1.3-7.5) in comparison with the lung cancer patients. Elevated risk of mesothelioma was shown to be associated with a lung fiber concentration of greater than 1 million fibers/g of dry tissue.

Fungi carried from farmers' work into farm homes

Airborne fungal spore concentrations and main fungal genera were compared in rural and urban living environments in Finland during the winter. In addition to conventional viable fungal spore counts (based on the six-stage impactor sampling and cultivation), total spore concentrations were obtained by scanning electron microscope (SEM) investigation of filter samples. The viable spore counts were only 0.2%-25% of the number of total spore aggregates. A high correlation between these two methods was noted, however, at the recommended measuring ranges of the methods. In the farm houses, viable and total spore levels were 10(3) to 10(4) colony forming units/m3 (cfu/m3) and 10(4) to 10(5), spores/m3, respectively. These counts were 10-10(3)-fold higher than the concentrations in an urban apartment. The spore levels of farmers' homes, however, were somewhat lower than those observed in their cow barns. Aspergillus, Cladosporium, and Penicillium spores were present in both urban and rural environments. Actinomycetes and some fungal genera--such as Acremonium, Alternaria, Botrytis, and Chrysosporium--which were detected in cow barns and in farm houses, were not present in urban environment. The results indicated that airborne fungal spores may be carried from cow barns to farmers' homes.

Mineral fiber concentration in lung tissue of mesothelioma patients in Finland

The mineral fibers in lung tissue samples of 19 mesothelioma patients and 15 randomly selected autopsy cases were analyzed using low-temperature ashing, scanning electron microscopy (SEM) and x-ray microanalysis. The fiber concentration ranged from 0.5 to 370 million fibers per gram of dry tissue in the mesothelioma group and from less than 0.01 to 3.2 million fibers per gram of dry tissue in the autopsy group. In 80% of the mesothelioma patients and in 20% of the autopsy cases, the fiber concentration exceeded 1 million fibers per gram of dry tissue. Amphibole asbestos fibers predominated in both groups, and only a few chrysotile fibers were found. In the lungs of six mesothelioma patients, anthophyllite was the main fiber type. The overall analytical precision of sample preparation and fiber counting with SEM was 22%.

Cytotoxic effects of four types of welding fumes on macrophages in vitro: a comparative study

The effects of fume particles given off by the manual metal arc (MMA) and metal inert gas (MIG) welding of stainless steel (SS) and mild steel (MS) were studied on rat alveolar macrophage cultures in vitro. The fumes were generated by welding, and particulate material obtained was collected on membrane filters. The macrophage cultures were exposed to the total dust and to its water-insoluble fractions. Cell variability and the release of both lactate dehydrogenase and one lysosomal enzyme from the cells to the medium were measured after an exposure period of 24 h. The cytotoxic control dust was DQ 12 quartz, and the inert control dust was pure titanium dioxide. According to the parameters studied, SS/MMA and MS/MMA welding fumes were cytotoxic to rat alveolar macrophages. The cytotoxic effect of SS/MMA welding fumes decreased after the samples had been washed with phosphate-buffered salt solution. The MIG welding fumes of SS and MS had markedly smaller effects on the cells. Diluted solutions of potassium chromate were also tested in order to investigate its role in the cytotoxicity of SS/MMA welding fumes. The results suggest that hexavalent chromium may be responsible for the cytotoxicity of SS/MMA.

Cardiorespiratory strain in jobs that require respiratory protection

Twenty-one workers in the construction, foundry, shipyard, and metal industries, and nine firemen were studied in jobs that require the regular use of various industrial respirators. The subjects' heart rates (HR) were continuously recorded during 1 to 2 workshifts or during special tasks. Their oxygen consumption (VO2) and ventilation rates were measured during main work phases. The subjects' VO2max were determined by a submaximal bicycle-ergometer test. In construction and industrial jobs, when a filtering device or an air-line apparatus was worn, the subjects' mean HR-values ranged from 66 to 132 beats min-1, which is equivalent to a relative aerobic strain of 12 to 57% VO2max. In smog-diving and repair and rescue tasks with self-contained breathing apparatus and protective clothing, the corresponding mean values were 142 to 160 beats min-1 and 54-74% VO2, respectively. The field results were compared with those measured in the laboratory with the same type of respirator. The suitability of different respirators in practical work situations was then evaluated, as were the physical qualifications required of the wearer.

Urinary excretion of chromium as an indicator of exposure to trivalent chromium sulphate in leather tanning

Two workers exposed to trivalent chromium sulphate in a leather tannery had high concentrations of chromium in the urine. The concentration of chromium showed a workshift-related diurnal fluctuation, but it was remarkably high even after a vacation, indicating accumulation of chromium in the body. The concentrations of chromium in the workplace air, as collected on filters using standard techniques, were below 30 micrograms/m3. The chromium in the air was present in the form of large droplets not collected by the standard techniques. In the blood stream, chromium was transported exclusively in the plasma. No absorption of chromium through the skin could be detected. Absorption from the gastrointestinal tract was calculated to explain the findings.

Exceptional pharmacokinetics of trivalent chromium during occupational exposure to chromium lignosulfonate dust

The excretion of chromium in the urine of workers exposed to chromium lignosulfonate was studied. The chromium in the dust was in the trivalent (III) oxidation state, and 30% of the particles were less than 5 micron in diameter. Chromium (III) lignosulfonate dust was rapidly absorbed, and a peak of urinary excretion was seen immediately after exposure. No appreciable accumulation of chromium occurred over 3 d, as evaluated by comparison with preshift urinary chromium concentrations. The addition of ethylenediaminetetra-acetate to the urine of exposed persons greatly enhanced the capacity of chromium to traverse a dialysis membrane; the same effect was seen with chromium (III) chloride. It is concluded that chromium (III) lignosulfonate yields chromium (III), which acts pharmacokinetically like water-soluble hexavalent chromium compounds.

Wollastonite exposure and lung fibrosis

Wollastonite is a naturally occurring acicular or fibrous metasilicate used in ceramics and as a substitute for asbestos in some applications. Wollastonite fibers are rather similar in form, length, and diameter to amphibole asbestos fibers but mineralogically they are different. Dust measurements in both the Finnish limestone--wollastonite quarry and in the flotation plant yielded high concentrations of both total dust and respirable fibers in some operational stages. The clinical study comprised a total of 46 men who had been exposed to wollastonite at the quarry for at least 10 years. Three of the fifteen nonsmokers showed chronic bronchitis. Radiographs revealed slight lung fibrosis among fourteen men, and slight bilateral pleural thickening among thirteen men. Their sputum specimens were normal. Spirometry and nitrogen single breath tests indicated the possibility of small airways disease.

Exposure limits and medical surveillance in occupational health

The standards for pollutants in workplace air constitute a social consensus or agreement about acceptable levels of occupational hygiene. This agreement to exposures up to these limits inevitably includes a finite risk to the health of the workers. The numeric values of standards are needed to assess the requirements for ventilation and other occupational hygiene conditions. Planning and everyday practice in industry also need hygienic standards so that practical hygienic and safety measures can be maintained. These standards are not, however, levels below which there is no risk to health. While the hygienic standard itself carries acceptance of a certain risk, doctors cannot ethically accept any health risk to workers whatever the source of exposure. Thus personnel working in occupational health have to think about the risks of ill health even when the hygienic standards are met. The physician in occupational health has to be especially concerned to discover and estimate the risks to anyone particularly susceptible to exposures within the hygienically acceptable conditions. To do this, the occupational health physician uses medical examinations and specific investigations. In the follow-up of workers, health occupational health personnel use medical examinations in order to detect possible risks or to assess the general health status of individual workers. Health examinations are also used to detect specific injuries caused by the agents to which workers are known to be exposed in their work.

Asbestos disease in Finland

Finland was the world's main producer of anthophyllite asbestos between 1918 and 1975. The total amount of mined anthophyllite asbestos was 350,000 tons of which 230,000 tons were exported. Anthophyllite quarry workers who had worked at least five years between 1936 and 1972 showed the highest risk of asbestosis, in comparison with other groups of asbestos workers.

Polycyclic aromatic hydrocarbons in foundries

Air and dust samples from iron foundries were analyzed for polycyclic aromatic hydrocarbons (PAH) by glass capillary gas chromatography, mass spectrometry, and thin-layer chromatography. Fifty compounds were identified as PAH, among them known carcinogens and cocarcinogens. Benzo[a]pyrene (B[a]P) was measured quantitatively. The results were grouped according to the types of organic additives in the molding sand. The B[a]P concentrations were highest in foundries using coal tar pitch and in the work phases of shake-out, casting, and molding. In the Ames assay the dust samples showed mutagenic activity, but in most cases lower than that calculated from the concentration of B[a]P. It is suggested that B[a]P can be used as a hygienic marker in branches of industry with PAH problems.

Application of mathematical modelling for assessing the biological half-times of chromium and nickel in field studies

The biological half-times of urinary chromium and nickel excretion and plasma nickel concentration were calculated for four welders and four electroplaters. A linear one-compartment kinetic model gave estimates of the half-times ranging from 15 to 41 hours for chromium in urine, from 17 to 39 hours for nickel in urine, and from 20 to 34 hours for nickel in plasma. The model allows a precise description to be made of a worker's state of exposure as affected by a varying concentration of the metals in the air.

Determination of quartz on membrane filters by X-ray diffraction

An X-ray diffraction method is described for the quantitative determination of quartz in dust samples. The analysis was done directly on a collecting cellulose ester membrane filter of the type used in an air sampler. Quantitation was achieved by the measurement of the quartz line intensities with a digital integrator and by the comparison of these values with those measured from calibration standards prepared on similar filters with water suspensions. The overall precision of the procedure was 8%. When the method was applied to foundry dusts, the accuracy of the quartz analysis was fou,d to be within 10% at the 1- to 10-mg level of total loading. The detection limit for quartz was below 0.1 mg.

Magnetic measurements of pulmonary contamination

The magnitic determination of pulmonary contamination is based on the remanent magnetization of ferromagnetic contaminating particles. The remanent field of the externally magnetized particles is proportional to their amount and shows their distribution. Although only magnetizable particles are detected with this method, the amount of the inhaled ferromagnetic substance can be used when the total dust exposure of the worker is estimated. In this work five shipyard welders were studied. First the particles disposed to the lungs were externally magnetized and then their distribution was mapped with a sensitive magnetometer. The magnitudes of the remanent fields measured from the welders differed from the fields measured from controls by several orders of magnitude. The radiographic findings showed a good correlation with the magnetic measurements, and further experiments will prove whether this method can partly replace presently used radiological investigations.

Lens changes in car painters exposed to a mixture of organic solvents

The relationship between exposure to organic solvents and the prevalence of lens changes was studied in a group of 92 car painters and a comparison group of 92 engineers from the Finnish State Railways. Both groups were examined ophthalmologically. Among the 92 car painters, with a mean age of 34.9 years (range of 21--64 years; S.D. 10.4 years), two had been operated on for a cataract and 46 had lens changes, mainly nuclear sclerosis, clefts, lamellar separation, or cortical and subcortical opacities not affecting visual acuity. In 69 age-matched pairs, for whom the factors inducing false-positive results had been excluded, 2 car painters had more lens changes than their age-matched pairs. Lens changes occurred with increased frequency after 10 years of exposure.