The Effects of Free Breathing on Cerebral Venous Flow: A Real-Time Phase Contrast MRI Study in Healthy Adults

Quantifying the effects of free breathing on cerebral venous flow is crucial for understanding cerebral circulation mechanisms and clinical applications. Unlike conventional cine phase-contrast MRI sequences (CINE-PC), real-time phase-contrast MRI sequences (RT-PC) can provide a continuous beat-to-beat flow signal that makes it possible to quantify the effect of breathing on cerebral venous flow. In this study, we examined 28 healthy human participants, comprising of 14 males and 14 females. Blood flows in the right/left internal jugular veins in the extracranial plane and the superior sagittal sinus (SSS) and straight sinus in the intercranial plane were quantified using CINE-PC and RT-PC. The first objective of this study was to determine the accuracy of RT-PC in quantifying cerebral venous flow, relative to CINE-PC. The second, and main objective, was to quantify the effect of free breathing on cerebral venous flow, using a time-domain multiparameter analysis method. Our results showed that RT-PC can accurately quantify cerebral venous flow with a 2 × 2 mm2 spatial resolution and 75 ms/image time resolution. The mean flow rate, amplitude, stroke volume, and cardiac period of cerebral veins were significantly higher from the mid-end phase of expiration to the mid-end phase of inspiration. Breathing affected the mean flow rates in the jugular veins more than those in the SSS and straight sinus. Furthermore, the effects of free breathing on the flow rate of the left and right jugular veins were not synchronous. These new findings provide a useful reference for better understanding the mechanisms of cerebral circulation.

Assessing the Genotoxicity of Cellulose Nanomaterials in a Co-Culture of Human Lung Epithelial Cells and Monocyte-Derived Macrophages

Cellulose micro/nanomaterials (CMNMs) are innovative materials with a wide spectrum of industrial and biomedical applications. Although cellulose has been recognized as a safe material, the unique properties of its nanosized forms have raised concerns about their safety for human health. Genotoxicity is an endpoint that must be assessed to ensure that no carcinogenic risks are associated with exposure to nanomaterials. In this study, we evaluated the genotoxicity of two types of cellulose micro/nanofibrils (CMF and CNF) and one sample of cellulose nanocrystals (CNC), obtained from industrial bleached Eucalyptus globulus kraft pulp. For that, we exposed co-cultures of human alveolar epithelial A549 cells and THP-1 monocyte-derived macrophages to a concentration range of each CMNM and used the micronucleus (MN) and comet assays. Our results showed that only the lowest concentrations of the CMF sample were able to induce DNA strand breaks (FPG-comet assay). However, none of the three CMNMs produced significant chromosomal alterations (MN assay). These findings, together with results from previous in vitro studies using monocultures of A549 cells, indicate that the tested CNF and CNC are not genotoxic under the conditions tested, while the CMF display a low genotoxic potential.

The Impacts of Prescribed Fire on PM2.5 Air Quality and Human Health: Application to Asthma-Related Emergency Room Visits in Georgia, USA

Short-term exposure to fire smoke, especially particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5), is associated with adverse health effects. In order to quantify the impact of prescribed burning on human health, a general health impact function was used with exposure fields of PM2.5 from prescribed burning in Georgia, USA, during the burn seasons of 2015 to 2018, generated using a data fusion method. A method was developed to identify the days and areas when and where the prescribed burning had a major impact on local air quality to explore the relationship between prescribed burning and acute health effects. The results showed strong spatial and temporal variations in prescribed burning impacts. April 2018 exhibited a larger estimated daily health impact with more burned areas compared to Aprils in previous years, likely due to an extended burn season resulting from the need to burn more areas in Georgia. There were an estimated 145 emergency room (ER) visits in Georgia for asthma due to prescribed burning impacts in 2015 during the burn season, and this number increased by about 18% in 2018. Although southwestern, central, and east-central Georgia had large fire impacts on air quality, the absolute number of estimated ER asthma visits resulting from burn impacts was small in these regions compared to metropolitan areas where the population density is higher. Metro-Atlanta had the largest estimated prescribed burn-related asthma ER visits in Georgia, with an average of about 66 during the reporting years.

The respiratory effects of toner exposure according to long-term occupational toner handling history: A longitudinal analysis, 2004-2013

OBJECTIVES

This report shows the relationship between toner exposure and respiratory effects for individuals with a longterm occupational toner-handling history, from 2004 to 2013.

MATERIAL AND METHODS

Authors studied 752 Japanese male workers in toner handling workshops. A total of 673 men who participated in an annual monitoring survey were analyzed in this study. The following monitoring was performed in the same season each year: personal exposure measurements, biological markers, respiratory function tests, a chest X-ray, chronic respiratory symptoms and incidences of respiratory diseases. To evaluate the toner exposure effect, the exposure categories suitable for each evaluation index were established.

RESULTS

For those with an occupational toner-handling history, the mean occupational toner-handling period was 14.36 years (standard deviation = 6.62); one participant had 35 years of exposure, which was the longest and one participant had 1 year of exposure which was the shortest. There were no statistically significant differences in the rate of change of respiratory function tests. An ANOVA conducted on blood and urine test results showed that statistically significantly differences were observed for a few items but all the values were very low and within the standard range.

CONCLUSIONS

Authors conducted a 10-year ongoing study, but no obvious negative influences on health were attributed to toner exposure. In a work environment where adequate administrative controls are in place, personal toner exposure levels may be expected to be low, with no adverse effects on human health. Int J Occup Med Environ Health 2018;31(6):809-822.

Case report of asthma associated with 3D printing

Background

Three-dimensional (3D) printing is being increasingly used in manufacturing and by small business entrepreneurs and home hobbyists. Exposure to airborne emissions during 3D printing raises the issue of whether there may be adverse health effects associated with these emissions.

Aims

We present a case of a worker who developed asthma while using 3D printers, which illustrates that respiratory problems may be associated with 3D printer emissions.

Case report

The patient was a 28-year-old self-employed businessman with a past history of asthma in childhood, which had resolved completely by the age of eight. He started using 10 fused deposition modelling 3D printers with acrylonitrile-butadiene-styrene filaments in a small work area of approximately 3000 cubic feet. Ten days later, he began to experience recurrent chest tightness, shortness of breath and coughing at work. After 3 months, his work environment was modified by reducing the number of printers, changing to polylactic acid filaments and using an air purifier with an high-efficiency particulate air filter and organic cartridge. His symptoms improved gradually, although he still needed periodic treatment with a salbutamol inhaler. While still symptomatic, a methacholine challenge indicated a provocation concentration causing a 20% fall in FEV1 (PC20) of 4 mg/ml, consistent with mild asthma. Eventually, his symptoms resolved completely and a second methacholine challenge after symptom resolution was normal (PC20 > 16 mg/ml).

Conclusions

This case indicates that workers may develop respiratory problems, including asthma when using 3D printers. Further investigation of the specific airborne emissions and health problems from 3D printing is warranted.

Electronic cigarettes: One size does not fit all

Electronic cigarettes (ECs) have been growing rapidly in popularity among youth and adults in the United States over the last decade. This increasing prevalence is driven partially by the ability to customize devices, flavors, and nicotine content and the general notion that ECs are harmless, particularly in comparison with conventional cigarettes. In vitro and in vivo murine models have demonstrated a number of harmful biological effects of e-liquids and their aerosols. However, limited clinical data exist on whether these effects translate into detrimental long-term outcomes in human subjects. The short-term harmful respiratory effects of EC use demonstrated in nonsmokers argue against their use. However, slightly more favorable data exist for the respiratory benefits of substituting conventional cigarettes with ECs and the short-term efficacy of ECs as smoking cessation tools. Nonetheless, available research is severely limited in regard to long-term outcomes and by study designs fraught with bias, pointing to the need for additional research efforts with well-designed longitudinal studies to guide US Food and Drug Administration regulatory efforts. The hurdle presented by diverse device designs and e-liquid permutations, which contribute to the inconsistency of available data, also highlights the need for legislative standardization of ECs.

Minimal Risk Level Derivation for Cadmium: Acute and Intermediate Duration Exposures

The Agency for Toxic Substances and Disease Registry (ATSDR) lists cadmium as one of its priority hazardous substances. The agency conducted a comprehensive literature review of cadmium and used the information to develop a toxicological profile that identified the full range of health effects associated with exposure to cadmium. It included an assessment that identified screening levels, termed health guidance values or minimal risk levels (MRLs), below which adverse health effects are not expected. In this paper, we describe how MRLs for cadmium are derived. For the acute inhalation MRL, the traditional no observed adverse effect level or lowest observed adverse effect level (NOAEL/LOAEL) approach is used; for the oral intermediate MRL, the benchmark dose (BMD) approach is used. MRLs were developed for the most sensitive route-specific end points, other than mortality and cancer that were sufficiently supported and justified by the data. These included an acute duration (1-14 day exposure) inhalation MRL of 0.03 µg Cd/m³ for alveolar histiocytic infiltration and focal inflammation in alveolar septa and an intermediate duration (15-365 day exposure) oral MRL of 0.5 µg Cd/kg/day for decreased bone mineral density.

Review of the health effects of wildland fire smoke on wildland firefighters and the public

Each year, the general public and wildland firefighters in the US are exposed to smoke from wildland fires. As part of an effort to characterize health risks of breathing this smoke, a review of the literature was conducted using five major databases, including PubMed and MEDLINE Web of Knowledge, to identify smoke components that present the highest hazard potential, the mechanisms of toxicity, review epidemiological studies for health effects and identify the current gap in knowledge on the health impacts of wildland fire smoke exposure. Respiratory events measured in time series studies as incidences of disease-caused mortality, hospital admissions, emergency room visits and symptoms in asthma and chronic obstructive pulmonary disease patients are the health effects that are most commonly associated with community level exposure to wildland fire smoke. A few recent studies have also determined associations between acute wildland fire smoke exposure and cardiovascular health end-points. These cardiopulmonary effects were mostly observed in association with ambient air concentrations of fine particulate matter (PM2.5). However, research on the health effects of this mixture is currently limited. The health effects of acute exposures beyond susceptible populations and the effects of chronic exposures experienced by the wildland firefighter are largely unknown. Longitudinal studies of wildland firefighters during and/or after the firefighting career could help elucidate some of the unknown health impacts of cumulative exposure to wildland fire smoke, establish occupational exposure limits and help determine the types of exposure controls that may be applicable to the occupation.

Evaluation of a spatially resolved forest fire smoke model for population-based epidemiologic exposure assessment

Exposure to forest fire smoke (FFS) is associated with multiple adverse health effects, mostly respiratory. Findings for cardiovascular effects have been inconsistent, possibly related to the limitations of conventional methods to assess FFS exposure. In previous work, we developed an empirical model to estimate smoke-related fine particulate matter (PM2.5) for all populated areas in British Columbia (BC), Canada. Here, we evaluate the utility of our model by comparing epidemiologic associations between modeled and measured PM2.5. For each local health area (LHA), we used Poisson regression to estimate the effects of PM2.5 estimates and measurements on counts of medication dispensations and outpatient physician visits. We then used meta-regression to estimate the overall effects. A 10 μg/m(3) increase in modeled PM2.5 was associated with increased sabutamol dispensations (RR=1.04, 95% CI 1.03-1.06), and physician visits for asthma (1.06, 1.04-1.08), COPD (1.02, 1.00-1.03), lower respiratory infections (1.03, 1.00-1.05), and otitis media (1.05, 1.03-1.07), all comparable to measured PM2.5. Effects on cardiovascular outcomes were only significant using model estimates in all LHAs during extreme fire days. This suggests that the exposure model is a promising tool for increasing the power of epidemiologic studies to detect the health effects of FFS via improved spatial coverage and resolution.

Repeating cardiopulmonary health effects in rural North Carolina population during a second large peat wildfire

BACKGROUND

Cardiovascular health effects of fine particulate matter (PM2.5) exposure from wildfire smoke are neither definitive nor consistent with PM2.5 from other air pollution sources. Non-comparability among wildfire health studies limits research conclusions.

METHODS

We examined cardiovascular and respiratory health outcomes related to peat wildfire smoke exposure in a population where strong associations were previously reported for the 2008 Evans Road peat wildfire. We conducted a population-based epidemiologic investigation of associations between daily county-level modeled wildfire PM2.5 and cardiopulmonary emergency department (ED) visits during the 2011 Pains Bay wildfire in eastern North Carolina. We estimated changes in the relative risk cumulative over 0-2 lagged days of wildfire PM2.5 exposure using a quasi-Poisson regression model adjusted for weather, weekends, and poverty.

RESULTS

Relative risk associated with a 10 μg/m(3) increase in 24-h PM2.5 was significantly elevated in adults for respiratory/other chest symptoms 1.06 (1.00-1.13), upper respiratory infections 1.13 (1.05-1.22), hypertension 1.05 (1.00-1.09) and 'all-cause' cardiac outcomes 1.06 (1.00-1.13) and in youth for respiratory/other chest symptoms 1.18 (1.06-1.33), upper respiratory infections 1.14 (1.04-1.24) and 'all-cause' respiratory conditions 1.09 (1.01-1.17).

CONCLUSIONS

Our results replicate evidence for increased risk of cardiovascular outcomes from wildfire PM2.5 and suggest that cardiovascular health should be considered when evaluating the public health burden of wildfire smoke.

Air quality of nursing homes and its effect on the lung health of elderly residents

In industrialized countries the elderly spend most of their time indoors. The elderly may be at a higher risk of suffering from indoor air pollution-related diseases compared to the rest of the population, because of their increased exposure to potential indoor risk factors. This editorial aims to critically analyze the recent literature regarding this important topic. Results of studies performed on the elderly living in nursing homes clearly highlight that they are at risk of respiratory health impairment, even at moderate air pollutant concentrations, particularly if they are over 80 years of age and living in poorly ventilated nursing homes. The future epidemiological research on ageing and respiratory diseases should investigate the underlying biological and physiological mechanisms, in addition to the adverse health effects of potential indoor risk factors, in order to help defining effective strategies for healthy ageing.