Pyrolysis processing of PFAS-impacted biosolids, a pilot study

Concentrations of per- and poly-fluoroalkyl substances (PFAS) present in wastewater treatment biosolids are a growing concern. Pyrolysis is a thermal treatment technology for biosolids that can produce a useful biochar product with reduced levels of PFAS and other contaminants. In August 2020, a limited-scope study investigated target PFAS removal of a commercial pyrolysis system processing biosolid with the analysis of 41 target PFAS compounds in biosolids and biochar performed by two independent laboratories. The concentrations of 21 detected target compounds in the input biosolids ranged between approximately 2 µg/kg and 85 µg/kg. No PFAS compounds were detected in the biochar. The PFAS concentrations in the biochar were assumed to equal the compounds' minimum detection limits (MDLs). The pyrolysis system's target PFAS removal efficiencies (REs) were estimated to range between >81.3% and >99.9% (mean >97.4%) with the lowest REs being associated with the lowest detected PFAS concentrations and the highest MDLs. No information on non-target PFAS compounds in influent or effluent media or products of incomplete combustion was considered. Selected gaseous emissions were measured by Fourier transform infrared spectroscopy and gas chromatography time-of-flight mass spectrometry to provide additional information on air emissions after process controls. This limited-scope study indicated that additional research to further understand this process is warranted.Implications: Development of alternative approaches to manage PFAS-impacted biosolids is of emerging international importance. A commercially operating biosolid pyrolysis process was shown to lower target PFAS levels in produced biochar. Additional research is warranted to understand all potential PFAS transformation emission routes and optimal air pollution emissions control strategies for this technology class.

The extent of endoscopic sinus surgery in patients with severe chronic rhinosinusitis with nasal polyps (AirGOs Operative)

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinuses characterized by intense inflammation, decreased health-related quality of life (HRQoL), and in severe cases high frequency of co-morbidities and recurrence despite treatment. Conservative treatment consists of nasal lavage, intranasal corticosteroids, and courses of oral corticosteroids, and antibiotics in exacerbations. Endoscopic sinus surgery (ESS) and/or biological therapy is considered if appropriate conservative treatment is not sufficient. The optimal extent of ESS in recalcitrant CRSwNP is not known. The aim of this randomized controlled trial is to evaluate and compare the efficacy and safety of limited ESS with partial ethmoidectomy with extended ESS with total ethmoidectomy in patients with severe CRSwNP. Methods: AirGOs Operative is a randomized controlled trial. It is an investigator-driven multicenter trial led by Helsinki University Hospital. The two surgery arms are compared. The primary outcome is the change in the SNOT-22 score at the 12-month follow-up. Secondary outcomes include the change in the SNOT-22 score at 24-months follow-up, the changes in polyp score, Lund-Mackay (LM) CT score, health-related quality of life (HRQoL), loss of productivity, nasal patency (peak nasal inspiratory flow (PNIF) ± acoustic rhinometry (ARM), olfaction test (Sniffin’ Sticks, identification), lung function (spirometry and PEF) and findings in pathological analysis at 12/24-months follow-up. Discussion: AirGOs Operative trial will lead to a better understanding of the optimal extent of ethmoidectomy in the treatment of recalcitrant severe CRSwNP.

Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper

The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation.

Persistent asthma, comorbid conditions and the risk of work disability: a prospective cohort study

BACKGROUND

This study examined whether asthma alone or together with chronic comorbidity is associated with an increased risk of long-term work disability.

METHODS

We examined data from 2332 asthmatic and 66 354 nonasthmatic public sector employees in Finland who responded to a survey between 1997 and 2004. Respondents were coded as persistent asthmatics based on the special reimbursement for continuous asthma medication by the Social Insurance Institution. Data on long-term work disability (sickness absences or disability pensions > 90 days) were obtained from national registers. The risk of work disability was examined by Cox proportional hazard models adjusted for age, gender, socioeconomic status, type of employment contract, and type of employer.

RESULTS

Asthma increased the risk of all-cause long-term work disability with hazard ratio (HR) 1.8 (95% CI 1.62-2.09) compared with controls (no asthma). Asthma and one other chronic comorbidity increased the risk of long-term all-cause work disability with HR 2.2 (95% CI 1.78-2.83). Asthma together with two or more other chronic conditions increased the risk with HR 4.5 (95% CI 2.98-6.78). Asthma and depression increased the risk with HR 3.6, and the risk was especially high for permanent work disability (HR 6.8). Among those with asthma, there were more women, obese individuals (BMI ≥ 30), ex-smokers, and lower-grade nonmanual workers.

CONCLUSIONS

Asthma is associated with an increased risk of long-term all-cause work disability. The risk increases further with chronic comorbidities and is especially high in patients with asthma and depression.

Occupational asthma in professional cleaning work: a clinical study

BACKGROUND

Several epidemiological studies have reported an increased risk of asthma among professional cleaners. To date, however, no analysis of large patient series from clinic of occupational medicine has been published.

AIMS

To describe the cases of occupational asthma (OA) diagnosed at the Finnish Institute of Occupational Health (FIOH) during the period 1994-2004 in workers employed in professional cleaning work.

METHODS

OA was diagnosed according to patient history, lung function examinations and specific challenge tests with measurements of the forced expiratory volume in 1 second and peak expiratory flow values.

RESULTS

Our series comprised 20 patients, all female, with a mean age of 48.8 years (range 27-60 years). The mean duration of cleaning work before the onset of the respiratory symptoms was 14.3 years (range 1-36 years), and the mean duration of cleaning work before the FIOH examinations was 18.6 years (range 3-38 years). OA was triggered by chemicals in 9 cases (45%) and by moulds in 11 cases (55%). The chemicals were cleaning chemicals (wax-removing substances containing ethanolamines in five cases and a cleaning agent containing chloramine-T in one case) and chemicals used in the industrial processes at workplaces (three cases). Of the moulds, the most frequently associated with OA was Aspergillus fumigatus (nine cases).

CONCLUSIONS

OA was attributed not only to cleaning chemicals but also to other chemicals used in work environments. Moulds are presented as a new cause of OA in cleaners.

Carbon sequestration in forest trees of the EU as affected by long-term changes of land use

Abstract

The biomass of forest vegetation expands in all EU countries. This review analyses the long-term development of forest vegetation and, thereby, the sequestration of carbon in forest biomass in the EU, country by country. The sequestration estimates and their uncertainties are assessed focusing on the period 1990-2006. The most recent estimates are compared with those for earlier times. A case study from Finland is presented, which helps understand the causal mechanisms affecting long-term sequestration of carbon in forest vegetation on a centennial scale. The forests of the 27 countries of the European Union (EU-27) represent approximately 4% of global forest area and 5% of global growing stock volume [1]. Despite their relatively small global shares, the region's forests remove carbon from the atmosphere at a surprisingly high rate. During 1990 to 2006 within the 27 countries (that were members of the EU in 2008) the expanding woody biomass annually sequestered 360 to 495 million tonnes CO₂ from the atmosphere (high confidence). The rate of sequestration accelerated over time during the same period (low confidence). Over a more extended decadal scale from 1900 to 2006, the rate accelerated (high confidence). The biomass sink was mainly driven by increasing density of average European forests and to a lesser extent by increasing forest cover (high confidence). Changes in forestry, nature conservation and other land management practices were the main drivers of carbon sequestration (medium confidence). The contribution of carbon sequestration in forests to the national carbon budget varied among countries depending on the extent of forests. Estimates for individual years varied and the accuracy and precision of the national estimates was not high, typically ±30%. A three-year moving average can be recommended as a basis for calculations, because it evens out inter-annual variation. Biomass sequestration has potential to continue in the EU for at least 50 years into the future. If land use trends revert and consumption patterns change, for example, if the demand for agricultural and wood products increases and bioenergy is developed on a large scale, sequestration can decelerate in the very long term. Climate change in itself is a risk factor to forest ecosystems in terms of increasing risks of storm damage, forest fire, forest pests and drought. Losing the biomass sink in EU, notably only a theoretical scenario in the next 20 to 30 years, would become an obstacle to reaching the main goal of climate policy: a stable atmosphere in terms of greenhouse gases. Promoting the sink on the other hand would make a contribution to achieving that goal. If the global trends of deforestation and forest degradation are reverted, forest sequestration of carbon can make an important contribution to stabilizing the atmosphere and preventing a serious climate change. Forest biomass has a potential to expand significantly worldwide.

Cystic fibrosis gene mutations deltaF508 and 394delTT in patients with chronic sinusitis in Finland

Previous studies have shown that cystic fibrosis (CF) gene mutations are linked to several severe chronic infections. Chronic sinusitis is one condition that may well be influenced by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. We studied two prevalent CF mutations (AF508 and 394delTT) in a population with a low incidence of CF. The carrier frequency of the CF mutations in the Finnish population is approximately 1 in 80. We examined DNA specimens from 127 chronic sinusitis patients and found one patient who was heterozygous for 394delTT gene mutation. None of the DNA specimens had any AF508 mutation. This study shows that in a population with a low incidence of CF there was no abnormal carrier distribution of the two most common CF gene mutations in a group of chronic sinusitis patients. Routine screening of sinusitis patients for CF mutations provides no additional information on the etiology of chronic sinusitis.

A second-generation association study of the 5q31 cytokine gene cluster and the interleukin-4 receptor in asthma

We have analyzed a dense set of single-nucleotide polymorphisms (SNPs) and microsatellites spanning the T-helper cytokine gene cluster (interleukins 3, 4, 5, 9, and 13, interferon regulatory factor-1, colony-stimulating factor-2, and T-cell transcription factor-7) on 5q31 and the gene encoding the interleukin-4 receptor (IL4R) on 16p12 among Finnish families with asthma. As shown by haplotype pattern mining analysis, the number of disease-associated haplotype patterns differed from that expected for the 129Q allele polymorphism in IL13 for high serum total immunoglobulin (Ig) E levels, but not for asthma. The same SNP also yielded the best haplotype associations. For IL4R, asthma-associated haplotype patterns, most spanning the S411L polymorphism, showed suggestive association. However, these haplotypes consisted of the major alleles for the intracellular part of the receptor and were very common among both patients and controls. The minor alleles 503P and 576R have been reported to be associated with decreased serum IgE levels and changes in the biological activity of the protein, especially when inherited together. In the Finnish population, these two polymorphisms segregated in strong linkage disequilibrium. Our data support previous findings regarding L4R, indicating that 503P and 576R may act as minor protecting alleles for IgE-mediated disorders.

A susceptibility locus for asthma-related traits on chromosome 7 revealed by genome-wide scan in a founder population

The genetics of asthma and atopy have been difficult to determine because these diseases are genetically heterogeneous and modified by environment. The pedigrees in our study (n=86) originate in eastern central Finland (Kainuu province). According to census records, this region had only 200 households (2,000 inhabitants) in the mid sixteenth to mid seventeenth centuries. The current population of 100,000 represents the expansion of these founders within the past 400 years. Because this population is relatively homogeneous, we hypothesized that the molecular genetic mechanisms underlying asthma might also have reduced heterogeneity and therefore be easier to dissect than in mixed populations. A recent twin family study supported a strong genetic component for asthma in Finland. We carried out a genome-wide scan for susceptibility loci in asthma in the Kainuu subpopulation. We identified two regions of suggestive linkage and studied them further with higher-density mapping. We obtained evidence for linkage in a 20-cM region of chromosome 7p14-p15 for three phenotypes: asthma, a high level of immunoglobulin E (IgE; atopy) and the combination of the phenotypes. The strongest linkage was seen for high serum IgE (non-parametric linkage (NPL) score 3.9, P=0.0001), exceeding the threshold for genome-wide significance based on simulations. We also observed linkage between this locus and asthma or atopy in two independent data sets.

The IL9R region contribution in asthma is supported by genetic association in an isolated population

Interleukin 9 (IL9) is involved in mast cell maturation and the enhancement of IgE production by B cells. Furthermore, linkage data in human and mice have suggested that IL9 may contribute to asthma. Since our genetic analysis of the 5q cytokine cluster did not support a genetic role for the IL9 gene, we became interested in the IL9 receptor gene (IL9R) in the pseudoautosomal region. We genotyped markers sDF2 and sDF1 close to the IL9R gene among 289 affected and 368 family-based controls. The results were studied by using linkage, transmission disequilibrium, association and homozygosity analyses. Linkage analyses remained negative, presumably because of our low power for linkage study. However, all the other analyses yielded evidence that the IL9R gene region may have a role in the development of asthma. The sDF2*10 allele was more frequently transmitted than untransmitted to asthmatic offspring (34 vs 16, pchi2 < or = 0.01), and it was found homozygotic among asthma patients more often than expected (Psimul2 = 0.009). Also, a specific X chromosomal haplotype, sDF2*10-sDF1*6 associated with asthma (40 vs 7, Pchi2 < 0.005, Psimul1 = 0.04).

Association study of the chromosomal region containing the FCER2 gene suggests it has a regulatory role in atopic disorders

On the basis of studies with animal models, the gene for the low-affinity receptor for immunoglobulin E (IgE) (FCER2, CD23) has been implicated as a candidate for IgE-mediated allergic diseases and bronchial hyperreactivity, or related traits. Given evidence for genetic complexity in atopic disorders, we sought to study two European subpopulations, Finnish and Catalonian. We studied three phenotypic markers: (1) total serum IgE level; (2) asthma; and (3) specific IgE level for a mixture of the most common aeroallergens in Finland. Altogether, eight polymorphic markers spanning a region of 10 cM around the FCER2 gene on chromosome 19p13 were analyzed in 124 families. The physical order of the markers and the location of the FCER2 gene were confirmed by using radiation hybrids. The allele and haplotype association study showed a suggestive haplotype association (significance of p </= 0.03 based on a permutation test) for a high serum IgE response. In a subset of chromosomes segregating with asthma in families with two or more affected members, a single haplotype was found to be highly enriched (p = 8.3 x 10(-6)). However, sequence polymorphisms, which would verify structural differences in the FCER2 gene, were not detected in the coding region of the receptor. Our results suggest that chromosome 19p13 might harbor a genetic determinant of IgE-related traits. Studies in other population samples are needed to verify this finding.

Verification of self-reported asthma and allergy in subjects and their family members volunteering for gene mapping studies

Studies which aim at mapping genes contributing to the development of asthma and atopy demand that hundreds of patients and their family members be assessed. In Finland, the Social Insurance Institution (SII) grants substantial reimbursement for medication to all patients who meet diagnostic criteria of asthma, which include a history of asthmatic symptoms and a measured reversibility of bronchial obstruction. To recruit a large number of asthma patients efficiently in a short period of time, we took advantage of the national reimbursement procedure and retrospectively collective data on patients' medical history and lung function test results at the time of diagnosis. First, we wanted to investigate if the reimbursements could be regarded as objective verification for self-reported asthma. Altogether 335 adult self-reported asthma patients were evaluated, 87% of them were verified as having chronic asthma. Reimbursement for medication showed a sensitivity of 95% and a specificity of 76% for verified asthma. Second, we were interested to see if self-reported nasal allergic symptoms or self-reported physician diagnosed allergic rhinitis were sensitive and specific measures of allergy. The self-reported allergic nasal symptoms had a poor specificity (31% in the proband group and 59% in the family members group) when compared to the allergy screening test (Phadiatop). The best verification for self-reported asthma was achieved by combining the information on self-reported disease, granted reimbursement by the SII and the medical records. For allergies, the specificity of self-reporting was far too low to be used alone, and a positive allergy screening test together with relevant symptoms was chosen as a marker of allergy.

Genetic control of serum IgE levels and asthma: linkage and linkage disequilibrium studies in an isolated population

Immunoglobulin E (IgE) concentration in serum is elevated in atopic diseases such as asthma. A large genomic region on chromosome 5 has previously been implicated in the control of IgE levels and bronchial hyperreactivity and may, therefore, harbor genes predisposing to asthma. In an effort to confirm this linkage and to delimit the critical region, we took advantage of an isolated founder subpopulation in Finland to study genetic linkage and haplotype associations. Sixteen polymorphic markers, including the Interleukin-4 and -9 genes (IL4, IL9), were physically ordered and genotyped in 157 nuclear families. Genetic linkage studies involving sib- and cousin-pair analyses found no evidence of genetic linkage between markers in 5q and either serum IgE levels or asthma. Haplotype association studies were also performed. Although initial inspection suggested the possibility of linkage disequilibrium in the region of IL9, we developed a rigorous permutation test for assessing association and determined that the association was no greater than would be expected by chance. Sequence analysis of the IL9 gene in three patients sharing a possibly conserved haplotype revealed a T113M coding polymorphism, but this variant showed no association with either serum IgE levels or asthma. We conclude that allelic variation at chromosome 5q31 is not likely to contribute to inheritance of serum IgE levels or the development of asthma in this Finnish subpopulation.

Ocular characteristics in nephropathia epidemica or Puumala virus infection

PURPOSE

We documented the largest series so far concerning the ocular characteristics of nephropathia epidemica.

METHODS

A total of 37 consecutive nephropathia epidemica patients underwent a comprehensive ophthalmic examination during hospitalization for systemic infection, and a control examination after recovery.

RESULTS

The most common ocular symptoms were: frontal headache or periocular pain (75.6%), blurred vision (54.1%) and photophobia (10.8%). The best corrected visual acuity of 7 patients (18.9%) was reduced during the acute phase as compared to the later control examination. Myopic shift was found in 15 patients (40.5%), three of whom (8.1%) developed real transient myopia. There were no attacks of angle closure glaucoma in this series. On the contrary, the intraocular pressure was decreased in 49 eyes (66.2%) during the acute stage of the disease. Lid edema was present in 28 eyes (37.8%), conjunctival injection in 20 eyes (27.0%), chemosis in 8 eyes (10.8%) and subconjuctival bleeding in 3 eyes (4.1%). Signs of acute anterior uveitis were found in 10 eyes (13.5%), however, this resolved without treatment. In one eye retinal edema with hemorrhages was detected. Ultrasonography revealed narrowing of the anterior chamber during the acute phase in 69 eyes (93.2%) and thickening of the crystalline lens in 64 eyes (86.5%).

CONCLUSION

Ophthalmic findings in nephropathia epidemica are not uncommon. The symmetry of the clinical manifestations reflects the systemic nature of the underlying infection.