Outcome of the Compensation Process Initiated by an Occupational and Environmental Diseases Center

BACKGROUND

Regional Centers for Occupational and Environmental Pathologies (CRPPE) are responsible for identifying possible occupational etiologies of pathologies. When an occupational origin is determined, an Initial Medical Certificate (IMC) is given to the patient to allow him to initiate a procedure for recognition as an occupational disease (OD) by his health insurance organization.

OBJECTIVES

The main aim of this study was to investigate the outcome of occupational disease claims in patients who received an IMC delivered by the CRPPE of Lyon.

METHODS

A telephone interview was systematically conducted with patients who consulted the CRPPE for a claim for occupational disease recognition between 07/2020 and 06/2021, about six months after the consultation. It was conducted by a physician using a standardized questionnaire.

RESULTS

Out of 128 patients eligible for this study, 98 were included. Diseases of the respiratory system (34.7%) and cancers (28.6%) were the most common pathologies in our population. A process of OD compensation was initiated by 86 patients (87.8%). At the time of the study, the outcome was favorable for 63 patients (73.3%). Moreover, 18 patients (18.4%) wished for additional help from the CRPPE to carry out the procedures. Nine patients requested a new consultation, including five who still needed to complete the process.

CONCLUSION

This study shows the benefit of a consultation by occupational disease consultants. However, difficulties still need to be solved in these procedures. Thus, the systematic follow-up of patients shows its advantages. The provision of support to carry out the process seems necessary.

Changes in the European Union definition for endocrine disruptors: how many molecules remain a cause for concern? The example of crop protection products used in agriculture in France in the six last decades

Background

The endocrine-disrupting effects of phytopharmaceutical active substances (PAS) on human health are a public health concern. The CIPATOX-PE database, created in 2018, listed the PAS authorized in France between 1961 and 2014 presenting endocrine-disrupting effects for humans according to data from official international organizations. Since the creation of CIPATOX-PE, European regulations have changed, and new initiatives identifying substances with endocrine-disrupting effects have been implemented and new PAS have been licensed.

Objectives

The study aimed to update the CIPATOX-PE database by considering new 2018 European endocrine-disrupting effect identification criteria as well as the new PAS authorized on the market in France since 2015.

Methods

The endocrine-disrupting effect assessment of PAS from five international governmental and non-governmental initiatives was reviewed, and levels of evidence were retained by these initiatives for eighteen endocrine target organs.

Results

The synthesis of the identified endocrine-disrupting effects allowed to assign an endocrine-disrupting effect level of concern for 241 PAS among 980 authorized in France between 1961 and 2021. Thus, according to the updated CIPATOX-PE data, 44 PAS (18.3%) had an endocrine-disrupting effect classified as "high concern," 133 PAS (55.2%) "concern," and 64 PAS (26.6%) "unknown effect" in the current state of knowledge. In the study, 42 PAS with an endocrine-disrupting effect of "high concern" are similarly classified in CIPATOX-PE-2018 and 2021, and 2 new PAS were identified as having an endocrine-disrupting effect of "high concern" in the update, and both were previously classified with an endocrine-disrupting effect of "concern" in CIPATOX-PE-2018. Finally, a PAS was identified as having an endocrine-disrupting effect of "high concern" in CIPATOX-PE-2018 but is now classified as a PAS not investigated for endocrine-disrupting effects in CIPATOX-PE-2021. The endocrine target organs associated with the largest number of PAS with an endocrine-disrupting effect of "high concern" is the reproductive system with 31 PAS. This is followed by the thyroid with 25 PAS and the hypothalamic-pituitary axis (excluding the gonadotropic axis) with 5 PAS.

Discussion

The proposed endocrine-disrupting effect indicator, which is not a regulatory classification, can be used as an epidemiological tool for occupational risks and surveillance.

Role of the occupational disease consultant in the multidisciplinary discussion of interstitial lung diseases

BACKGROUND

Diffuse interstitial lung diseases (ILD) constitute a heterogeneous group of conditions with complex etiological diagnoses requiring a multidisciplinary approach. Much is still unknown about them, particularly their relationship with occupational exposures. The primary objective of this study was to investigate the distribution of occupational exposures according to type of ILD. The secondary objectives were to estimate the proportion of ILDs possibly related to occupational exposure and to evaluate the added value of the participation of an occupational disease consultant in ILD multidisciplinary discussions (MDD).

METHODS

From May to December 2020, all consecutive patients with ILD whose cases were reviewed during a MDD in a referral centre for ILD were prospectively offered a consultation with an occupational disease consultant.

RESULTS

Of the 156 patients with ILD whose cases were reviewed in MDD during the study period, 141 patients attended an occupational exposure consultation. Occupational exposure was identified in 97 patients. Occupational exposure to asbestos was found in 12/31 (38.7%) patients with idiopathic pulmonary fibrosis (IPF) and in 9/18 (50.0%) patients with unclassifiable fibrosis. Occupational exposure to metal dust was found in 13/31 (41.9%) patients with IPFs and 10/18 (55.6%) patients with unclassifiable fibrosis. Silica exposure was found in 12/50 (24.0%) patients with autoimmune ILD. The link between occupational exposure and ILD was confirmed for 41 patients after the specialist occupational consultation. The occupational origin had not been considered (n = 9) or had been excluded or neglected (n = 4) by the MDD before the specialised consultation. A total of 24 (17%) patients were advised to apply for occupational disease compensation, including 22 (15.6%) following the consultation. In addition, a diagnosis different from the one proposed by the MDD was proposed for 18/141 (12.8%) patients.

CONCLUSIONS

In our study, we found a high prevalence of occupational respiratory exposure with a potential causal link in patients with ILD. We suggest that a systematic specialised consultation in occupational medicine could be beneficial in the ILD diagnostic approach.

Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review

Isocyanate, whose disease-inducing mechanism is poorly understood, with poor prognosis, is widely used. Asthma is the most frequent manifestation of prolonged exposure. We assessed the evolution of the incidence of isocyanate-induced occupational asthma over time. PubMed and Cochrane databases were systematically searched for studies published since 1990 that assessed the relationship between occupational exposure to isocyanates and asthma. We identified 39 studies: five retrospective cohort studies, seven prospective cohort studies, three of which were inception cohorts), seven observational cross-sectional studies, five literature reviews, two case series, and 13 registry studies. The incidence of occupational asthma secondary to isocyanate exposure has decreased from more than 5% in the early 1990s to 0.9% in 2017 in the United States. Despite the wide use of optimal collective and individual protection measures, the risk of occupational asthma has stabilized. Occupational asthma risk can be assessed with good sensitivity using self-questionnaires and pulmonary function tests. Occupational avoidance should be implemented as soon as possible after the first symptoms appear because the prognosis becomes increasingly poor with the persistence of exposure. It is now necessary to study specifically cutaneous sensitization to isocyanates and to define what protective equipment is effective against this mode of exposure.

Reactions of Vinylcyclopropane and Bicyclopropyl Compounds With Maleic Anhydride

Vinylcyclopropane and bicyclopropyl C6 compounds are studied as diene precursors in the Diels-Alder reaction. Their rearrangement under different thermal and microwave conditions leads to specific isomeric hexa-, penta- or butadienes, condensed with maleic anhydride as a dienophile. Adduct stereochemistries were compared to those of previously-synthesized model compounds, and are fully characterized with 2D NMR and GC-MS spectroscopies. Some unsaturated terpenes bearing vinylcyclopropane moieties were also condensed, and their adduct structures assigned.

Preliminary speciation study of Co(II)-citrate system by ion pairing-reversed phase chromatography coupled to UV detector

This paper describes the ability of ion pairing-reversed phase chromatography coupled to UV detector to determine an experimental speciation of cobalt in the binary Co(II)-citrate system. A method has been developed to investigate aqueous Co(II)-citrate samples at physiological pH as a function of time, by varying metal-to-ligand ratios, concentration and temperature. Solid 1:1 dimeric and 1:2 monomeric Co(II)-citrate complexes previously described have been synthesised and their analysis by IP-RPC-UV allowed the assignation of the solution state separated species. In solution state and at Co(II) concentration of 5×10-2M, 1:2 Co(II)-citrate monomeric species are predominant forms, while 1:1 mono and dimeric complexes are the minor species. At Co(II) concentration lower than 5 mM, only species of 1:1 stoichiometry are involved in the aqueous cobalt distribution. The monitoring of the formed species as a function of time allows highlighting the high inertness of this system. At low concentration ranges, electrospray ionisation-mass spectrometry experiments were carried out to support the chromatographic data. This study is the first one establishing a link among synthetic cobalt-citrate complexes and species existing in solution.

An interdisciplinary approach to investigate the impact of cobalt in a human keratinocyte cell line

Since in nuclear power plants, risks of skin contact contamination by radiocobalt are significant, we focused on the impact of cobalt on a human cutaneous cell line, i.e. HaCaT keratinocytes. The present paper reports an interdisciplinary approach aimed at clarifying the biochemical mechanisms of metabolism and toxicity of cobalt in HaCaT cells. Firstly, a brief overview of the used instrumental techniques is reported. The following parts present description and discussion of results concerning: (i) toxicological studies concerning cobalt impact towards HaCaT cells (ii) structural and speciation fundamental studies of cobalt-bioligand systems, through X-ray absorption spectroscopy (XAS), ab initio and thermodynamic modelling (iii) preliminary results regarding intracellular cobalt speciation in HaCaT cells using size exclusion chromatography/inductively coupled plasma-atomic emission spectroscopy (SEC/ICP-AES) and direct in situ analysis by ion beam micropobe analytical techniques.

Use of electrospray ionization mass spectrometry for the study of Ln(III) complexation and extraction speciation with calixarene-CMPO in the fuel partitioning concept

The calixarene-bearing CMPO groups belong to a family of extracting agents recently developed for nuclear reprocessing. These molecules exhibit specific properties to separate actinides(III) from lanthanides(III) in nitric acid solution. Speciation of two distinct calixarene-CMPO (carbamoyl phosphine oxide), substituted either in the wide rim or in the narrow rim with lanthanides (La, Eu, Yb), was undertaken. The complexation behaviour in single phase or in liquid-liquid extraction was examined with two different electrospray spectrometer source geometries. The stoichiometries of the different complexes were reported and the selectivity of these calixarenes towards lanthanides was determined. The results obtained were concordant for the two spectrometers and confirm that electrospray mass spectrometry is a useful tool to study non-covalently bonded complexes.

Study of the nitration of di-n-octylcrown-6 calix[4]arene using LC–MS, NMR, and molecular modelling

The selective HNO3 nitration of di-n-octylcrown-6 calix[4]arene using different conditions, studied with LC–MS and NMR (1H and 13C) spectroscopic techniques, lead to the identification of most of the expected nitro derivative isomeric compounds. The formation of these isomers under acidic and radiolytic conditions is discussed with the help of molecular modelling.Key words: calix crown compounds, nitration of calixarenes, NMR of isomeric nitrocalixarenes, LC-ESI-MS.

High-performance liquid chromatography with electrospray ionisation mass spectrometry and diode array detection in the identification and quantification of the degradation products of calix[4]arene crown-6 under radiolysis

The extraction of 135Cs from high-activity liquid waste, arising from reprocessing of spent nuclear fuel, can be achieved by using calix[4]arene crown-6 compounds. The radiolytic degradation of di(n-octyloxy)calix[4]arene crown-6 (octMC6), in aliphatic or aromatic solvent in contact with 3 M nitric acid, was studied by high-performance liquid chromatography directly coupled to electrospray ionisation mass spectrometry (LC/ESI-MS). More than 50 distinct degradation products were observed, and about 30 of these were identified. These compounds can be assigned to three categories, namely, products of reactions involving radical cleavage or addition, of oxidation reactions, or of aromatic substitution reactions. The major product, corresponding to substitution by an NO2 group, was quantified by external standard calibration using a purified synthetic sample. Despite the observation of all these degradation compounds, octMC6 appears to be remarkably stable under these drastic conditions, combining hydrolysis (HNO(3) 3 M) and an extreme exposure to radiolysis (10(6) Gy). Less than 35% degradation of octMC6 was observed in aromatic solvent under these conditions.

Preliminary study of the stability of calix[4]arene crown compounds under radiolysis

The extraction of (135)Cs from high activity waste arising from reprocessing of spent fuel can be achieved by using calix[4]arene crown compounds. The radiolytic degradation of calix[4]arene crowns as well as their solvent, o-nitrophenyloctyl ether (NPOE), was studied using electrospray ionization mass spectrometry (ESI-MS) (that formed Cs(+) or Na(+) adducts) in nitric acid, as well as by chemical ionization tandem mass spectrometry (MS/MS) experiments. The structures of major degradation products were identified with MS and specifically labelled nitric acid. Although NPOE and calix[4]arene crowns alone are relatively stable, under simulated conditions resembling the real industrial processes involving radiolysis in the presence of nitric acid, several products resulting from nitration and oxidation were observed.

Application of gas chromatography-tandem mass spectrometry to the analysis of inhibition of dimerisation of tributylphosphate under radiolysis. Identification of isomeric tributylphosphate-alkylbenzene inhibitor coupling products

Tributylphosphate (TBP), solvent used as extractant for reprocessing spent nuclear fuel, can dimerise under radiolysis. This occurs by radical radical recombination, leading to 10 isomeric dimers (TBP-TBP). These species are complexation agents and are responsible of fission product retention in the organic phase that increases the solvent degradation. In order to limit their formation two free radical inhibitors (In), isopropyl and 1,4-diisopropylbenzenes, were used. These additives reduce by about 50% the concentration of TBP-TBP dimers but this reduction is not strictly followed by TBP regeneration as mixed coupling products from TBP and inhibitor are detected. By using GC-MS-MS and selectively deuterated compounds, the identification of these different isomers (TBP-In) has been realised. From these identifications and from the analysis of the proportion of the different isomers, the major primary TBP radical generated under radiolysis was determined.

Recognition and oxidative metabolism of cyclodipeptides by hepatic cytochrome P450

Possible recognition of peptide derivatives by hepatic cytochrome P450 3A has been suggested by binding and metabolism of numerous pseudopeptidic compounds such as ergot derivatives and cyclosporin. Natural linear or cyclic dipeptides containing hydrophobic amino acids produced by microorganisms and present in mammals are able to interact with the P450 active site through either iron-amine interactions (Type II) or hydrophobic Type I interactions. P450 3A from dexamethasone-treated rats or yeast-expressed P450 human 3A4 are the most potent in such interactions, which are particularly strong with peptides containing a histidyl residue. Some cyclodipeptides are rapidly transformed by rat cytochrome P450 3A to mono- or dihydroxylated metabolites, with turnovers around 3 nmoles min(-1) P450(-1). Linear peptides are poorly transformed in these conditions. This metabolism of cyclodipeptides occurs in 8 species including man. Such interactions and metabolism have only minor consequences in terms of P450 3A binding and metabolism of classical P450 3A substrates. These data reinforce the concept that, in addition to their effect on the regulation of P450 neosynthesis, naturally occurring endogenous peptides are also substrates of P450 3A. The physiological activities of these peptides may be modulated by their metabolism.

Characterization of zirconium complexes of interest in spent nuclear fuel reprocessing by electrospray ionization mass spectrometry

Liquid-liquid extraction of zirconium, one of the most important fission products, was followed using electrospray ionization mass spectrometry under conditions simulating reprocessing of nuclear spent fuel. Zr(IV) can precipitate from the organic phase after extraction by dibutylphosphoric acid (HDBP), the most common degradation product of tributylphosphate (TBP) radiolysis. Different complexes were detected with electrospray used in positive or negative ion modes, according to the extraction conditions such as the ligand/metal ratio. Stoichiometry of the Zr(IV) complexes was determined by combining isotopic labeling [H(15)NO(3)] of the aqueous phase in the extraction system and tandem mass spectrometry experiments. These results were compared with the species observed using other techniques reported in the literature. The mechanisms of ionization/desorption of these complexes are proposed depending on the organic ligand character (neutral (L) such as TBP, or acidic (HL') such as HDBP), and the ionization mode used. Copyright 2000 John Wiley & Sons, Ltd.