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Cardiovascular studies during and following simulation and weightlessness.

Two major characteristics of space flight may be simulated to some degree by bed rest and by water immersion. These are inactivity and the lack of the hydrostatic stress on the systematic circulation. Studies prior to the advent of space flight led to the prediction of orthostatic intolerance, muscular weakness, and calcium loss. Prolonged space flight has heightened the interest in these simulations to provide information concerning the temporal cause of the "deconditioning" or disuse syndrome and the value of simulation for testing the effectiveness of remedial measures. This report will evaluate the extent to which the simulation appears valid. In its gross effects, orthostatic intolerance can be studied with respect to its temporal course, etiology and effectiveness of remedial measures. The intolerance develops more rapidly during water immersion with respect to cause as well as effect. The short term of immersion studies does not allow study of the secondary change in blood volume due to red cell mass changes, Remedial measures seem clearly defined in water immersion simulation and less clear in bed rest. Measures of venous pooling following water immersion appear different than those obtained following weightlessness. There also appear to be differences in the results of evaluation of protective devices and measures and in the time course of development and recovery of orthostatic intolerance. Correlates of the cardiovascular responses such as muscle tone, skeletal strength, and endocrine change (catecholamines, vasopressin and aldosterone) suggest a marked alteration in physiology during hypodynamic status. To date, work on exposure to increased G force has provided only extrapolated data concerning metabolic requirements.

Bed Rest↗

TOF-tube, a new protection for acceleromyography, compared with the TOF-Guard/TOF-Watch arm board.

Neuromuscular blockade monitoring at the adductor pollicis has become easier using acceleromyography. In order to guarantee a reliable analysis of its acceleration, the thumb movement has to be free and protected from external influences. To this end, we describe here-in two hand fixation- and protection-devices for use with acceleromyography. After a bolus of 0.3 mg/kg rocuronium, we compared acceleromyography data obtained simultaneously on both hands with, on one side, the cumbersome TOF-Guard/TOF-Watch arm board, and the smaller and handier TOF-tube on the other. Results showed little differences between the two devices. Yet, a short and clinically irrelevant delay was observed for TOF-tube data during recovery. This was probably caused by a difference in thumb position and repositioning technique. In conclusion, the more convenient TOF-tube can be used as well as the TOF-Guard/TOF-Watch arm board in daily clinical practice.

Adult↗

Factors associated with hearing loss among workers of the airline industry in Korea.

Noise-induced hearing loss (NIHL) is a major occupational hazard. Occupational noise exposure threatens the hearing of many workers. In addition to noise exposure in the workplace, multiple factors affect individual susceptibility to NIHL. The purpose of this study was to identify factors associated with hearing loss in airport workers. A cross-sectional epidemiological design was used. Study subjects were 255 high noise-exposed full-time male workers at a large metropolitan airport in Korea. Data were collected by a self-administered questionnaire, blood pressure measurement, audiological assessment, and a record review of baseline hearing and noise levels of locations where the employee worked. The result of multivariate analysis showed that both occupational noise exposure (noise exposure level, years of noise exposure) and personal risk factors including non-occupational noise exposure, history of ear disease, ototoxic drug use, cigarette smoking, hypertension, and use of hearing protective devices (HPDs) were significantly associated with hearing loss. An aggressive hearing conservation program is needed at the airport, emphasizing both job-related noise exposure and personal risk factors for hearing loss.

Adult↗

Eye injuries in the young in Ile-Ife, Nigeria.

One hundred and seventeen children aged 0-17 years treated for eye injuries at the Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria were studied. Seventy-five were males and 42 were females with a mean age of 10 years 4 months. Injuries occurred with increasing frequency after the age of 4 years and were commonly sustained by children at play (50.4%); during corporal punishment (10.3%); assault (9.4%) and street hawking (9.4%). Causative agents were mostly sticks and twigs, followed by missiles and fall. Visual prognosis was best in patients with contusion injuries (48.3%) and worst in those with perforating eye injuries (30.5%). Blindness of the injured eye occurred in one-third of the patients and another 17.5% had significant visual impairment. This study shows a variation in the aetiology and visual outcome of eye injuries in the young. Strategies for the prevention of eye injuries are mainly health education, improved supervision of children at play, change in the method of corporal punishment and provision of protective devices for adolescents at work. Early diagnosis and prompt management will improve visual prognosis.

Adolescent↗

[RISKOFDERM: European research project for assessment of occupational skin exposure to chemicals].

OBJECTIVES: RISKOFDERM is a research project whose aim is to develop instruments to assess and manage occupational dermal exposure to chemical substances. METHODS: The research, funded by the European Commission, involves 15 Institutes from 10 member countries; it is a continuation of the Dermal Exposure Network experience and consists of four interrelated parts. The first phase (Qualitative survey) assumed that dermal exposure can be extrapolated from one compound to another when it is task-based: therefore six Dermal Exposure Operation units (DEOu) were defined that lead back to the variety of occupational dermal exposure conditions and an extensive Questionnaire was developed for on-site surveys to perform standard observations in selected working situations (scenarios). RESULTS: The Italian group, participating in the research, obtained a set of observations relating to two "scenarios" in different working sectors: asphalt, ceramic and pottery workers, spectacle decorators and paint production: the aim was to verify the validity of the methodology in assessing the risk of percutaneous absorption, time, frequency and extension of skin exposure. CONCLUSIONS: From the observations made it was shown that the perception of risk was poor; it is necessary to rationalise work organization, and train and inform the employees on the correct use of personal protection devices.

Europe↗

Respiratory symptoms and peak expiratory flow rates in workers of a Nigerian soap and detergent industry.

This comparative cross-sectional study was carried out to assess the respiratory symptoms and peak expiratory flow rates of the factory(study group) and office(control group) workers in a soap and detergent industry in Ilorin in relation to the occupational hazards of chemical fumes and detergent dust in the industry. Upper respiratory tract infections were found in 67.5% and 10.6% of the study group and control group respectively. The study shows that the factory workers experienced hazards (e.g. chemical fumes and detergent dust) at work more than the office workers. Personal protective devices such as boots, face masks, gloves, earmuffs and goggles were not consistently used since they were inadequate in supply, worn out and of substandard qualities. The general reduction in the mean values of peak expiratory flow rate in the factory workers than in the office workers as observed in this study may possibly, be a pointer to the effect of industrial exposure to chemical fumes and detergent dust over the years. There is the need to follow up these workers in order to detect early any possible disease and complications that may arise.

Adult↗

Prevention of occupational asthma.

Occupational asthma (OA) is a type of bronchial asthma due to causes and conditions attributable to a particular occupational environment. It is the most prevalent occupational lung disease in industrialized countries, accounting for approximately 5% of asthma in adults. Since OA has important medical, social and economic consequences, its prevention is mandatory, and the most important measure is primary prevention at the workplace. Control of environmental exposure can be realized by completely eliminating the causative substances, or, failing that, by reducing exposure to the lowest practicable levels. This goal may be achieved in a variety of ways, e.g. by automation of a process, improvement of ventilation, modification of the process or agents, and use of personal protection devices. However, the control of environmental exposure presents several difficulties. First of all, exposure levels that favour respiratory sensitization to high molecular weight (HMW) or low molecular weight (LMW) agents are not completely defined. There is a critical need for the development of methods able to quantify the airbone levels of sensitizing agents at the workplace and to establish limits of exposure for respiratory sensitization. Development of assays (e.g. immunochemical assays) able to quantify airbone allergen levels should facilitate determination both of exposure-response relationships and of exposure limits for preventing respiratory sensitization and development of OA. Quantification of risk at the workplace is also often rough and based on indirect markers of exposure. At present, the target for an optimal approach to the primary prevention of OA is the development of methods able to evaluate both the sensitizing and the asthmogenic properties of the substances before their introduction in the work environment.

Asthma↗

NTP Toxicology and Carcinogenesis Studies of 2-Chloroacetophenone (CAS No. 532-27-4) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

2-Chloroacetophenone is a potent lacrimator that has been used as a riot control agent and in tear gas formulations for personal protection devices. NTP Toxicology and Carcinogenesis studies were conducted by exposing groups of F344/N rats and B6C3F1 mice of each sex to air containing 2-chloroacetophenone vapor for 14 days, 13 weeks, 15 months, or 2 years. Genetic toxicology studies were conducted in Salmonella typhimurium and Chinese hamster ovary (CHO) cells. Fourteen-Day Studies: In 14-day studies, exposure concentrations of 2-chloroacetophenone ranged from 4.8 to 64 mg/m3. All rats exposed to 19, 43, or 64 mg/m3 died during the first week of the studies and 1/5 male rats exposed to 10 mg/m3 died during the second week of the study. Rats exposed to 10 mg/m3 lost weight; the final mean body weights of male or female rats exposed to 4.8 mg/m3, the lowest concentration used, were 23% or 15% lower than that of controls. During the exposure, rats showed partial closure of the eyelids, excessive lacrimation (dacryorrhea), dyspnea, and erythema. All mice exposed to 10 mg/m3 or higher concentrations of 2-chloroacetophenone died during the first week of the studies. The final mean body weights of mice exposed to 4.8 mg/m3 were similar to those of controls. Dacryorrhea was observed in exposed mice. Thirteen-Week Studies: The exposure concentrations of 2-chloroacetophenone ranged from 0.25 to 4 mg/m3 for rats and mice. All rats lived to the end of the studies. The final mean body weights of rats exposed to 4 mg/m3 were 9% lower than those of controls. Eye irritation during exposure was evident in rats exposed to 0.5 mg/m3 or higher concentrations of 2-chloroacetophenone. One of 10 female mice exposed to 4 mg/m3 and 1/10 female mice exposed to 0.5 mg/m3 died before the end of the study. The final mean body weights of exposed mice were 7%-12% lower than that of controls for males and 12%-15% lower for females. No chemical-related gross or microscopic lesions were observed in rats or mice. In the 2-year studies, groups of 60 rats of each sex were exposed to a vapor of 0 (chamber control), 1, or 2 mg/m3 (0, 0.15, or 0.3 ppm) 2-chloroacetophenone, 6 hours per day, 5 days per week. Groups of 60 mice of each sex were exposed to 0 (chamber control), 2, or 4 mg/m3 (0, 0.3, or 0.6 ppm) on the same schedule. Ten animals from each group were killed and examined at 15 months; the remaining animals continued on study for 2 years. Fifteen-Month Studies: In the 15-month studies, minimal-to-mild focal squamous metaplasia and hyperplasia of the respiratory epithelium were seen at increased incidences in rats exposed to 2 mg/m3. No exposure-related lesions were observed in mice of either sex. Body Weight and Survival in the Two-Year Studies: Mean body weights and survival of exposed and chamber control rats were similar throughout most of the studies (survival-male: control, 14/50; 1 mg/m3, 22/50; 2 mg/m3, 17/50; female: 23/50; 20/50; 24/50). Mean body weights of male mice exposed to 4 mg/m3 were about 5%-12% lower than those of controls after week 30; small differences between mean body weights of exposed and control female mice were not clearly exposure related. The survival of female mice exposed to 2 mg/m3 was significantly lower than that of chamber controls after week 98. No other differences in survival were observed between any groups of mice (male: control, 34/50; 2 mg/m3, 36/50; 4 mg/m3, 33/50; female: 40/50; 28/50; 32/50). Nonneoplastic and Neoplastic Effects in the Two-Year Studies: Fibroadenomas of the mammary gland occurred in female rats with positive trends, and the incidence in the 2 mg/m3 group was greater than that in chamber controls (control, 12/50; 1 mg/m3, 19/50; 2 mg/m3, 23/50). The incidences of adenomas or adenocarcinomas of the mammary gland were not increased in the exposed groups. Minimal-to-mild suppurative inflammation of the nasal mucosa was observed at increased incidences in exposed male rats. Hyperplasia and squamous metaplasia of the nasal respiratory epithelium were observed at increased incidences in exposed ry epithelium were observed at increased incidences in exposed male and female rats. In mice, squamous metaplasia of the respiratory epithelium of the nasal passage was seen in four females and two males exposed to 4 mg/m3 2-chloroacetophenone. Inflammation, ulcers, and squamous hyperplasia of the forestomach were observed at increased incidences in exposed female rats. Genetic Toxicology: 2-Chloroacetophenone was not mutagenic in S. typhimurium strains TA98, TA100, TA1535, or TA1537 with or without exogenous metabolic activation. In cytogenetic tests with CHO cells, 2-chloroacetophenone did not induce sister chromatid exchanges with or without activation, but a weak positive increase in chromosomal aberrations was observed in the absence of metabolic activation. Conclusions: Under the conditions of these 2-year inhalation studies, there was no evidence of carcinogenic activity of 2-chloroacetophenone for male rats exposed to 1 or 2 mg/m3. There was equivocal evidence of carcinogenic activity for female F344/N rats, based on a marginal increase in fibroadenomas of the mammary gland. There was no evidence of carcinogenic activity for male or female B6C3F1 mice exposed to 2 or 4 mg/m3 2-chloroacetophenone. Synonyms: a-chloroacetophenone; 2-chloro-1-phenylethanone; CN; phenacyl chloride; phenylchloromethylketone Trade Names: Mace®.; Chemical Mace®.

Journal Article↗

Current status in cervical carotid artery stent placement.

Aim of this paper is to provide background information and the latest developments and studies pertaining to carotid artery stent placement in the treatment of carotid artery occlusive disease. A review of current literature combined with personal experience in the field of carotid stenting is presented. Endovascular stent placement for carotid artery occlusive disease is evolving from its initial controversial position to that of an alternative treatment of extracranial carotid artery disease. The high technical success (98-99%) as well as the relatively few complications makes carotid stenting a substitute for carotid endarterectomy for symptomatic patients and especially those with high medical comorbidities. With the advent of distal embolic protection, the complication rates for carotid stenting have decreased by approximately 50% to 2-4% for most major centers. Hence, with improved technology, carotid stenting is becoming an option for asymptomatic patients, especially those with high surgical risk. Early results for patency and neurological follow-up have also been encouraging. When we first began performing carotid stenting in 1995, we used a mixture of peripheral and coronary techniques. As stent design, guide catheters and cerebral protection devices have become dedicated and sophisticated, the technical success, patency and complication rates have improved. Carotid stenting will increase in application in the future especially among high surgical-risk patients with symptomatic and asymptomatic carotid occlusive disease.

Angioplasty, Balloon↗

Distal embolization during directional coronary atherectomy.

We report 2 cases of directional coronary atherectomy performed by using the Percu-Surge System to prevent distal embolization. A discrete amount of material was aspirated after the procedure. No clinical sequelae occurred in the immediate follow-up. These cases underline the problem of distal embolization during directional atherectomy, and the possibility to prevent it by using protection devices.

Atherectomy, Coronary↗

[Equipment for SARS control in patient care units and in units that process infected samples. 2003].

The information on severe acute respiratory syndrome (SARS) that has been gathered up to this point has made it possible to prepare recommendations concerning the equipment needed to protect health workers responsible for patient care and for processing potentially infected samples. Protecting such personnel is a key element in the strategy to control the spread of SARS. The needed equipment includes clothing; footwear; such protective devices as masks, safety glasses, and gloves; disinfectant solutions; laboratory equipment; and materials for obtaining and transporting samples. Prepared by the Western Pacific Regional Office of the World Health Organization, this list will help implement measures to contain the epidemic. The list gives the recommended quantities, specifications for the items, and possible alternatives for some items. This list of equipment is not exhaustive; it is intended to provide a small emergency supply for a period of 3 or 4 days for a single isolation unit with approximately 50 workers. To guarantee the availability of the equipment in the needed quantities, infection control authorities should take into account the number of isolation units needed and the length of time that containment measures will need to be in place. Adequate reserves should be available 24 hours a day, and plans should be made for rapid access to larger stocks in the event of a larger outbreak.

Communicable Diseases, Emerging↗

Effect of dose on the percutaneous absorption of 2- and 4-chloronitrobenzene in rats.

The effect of dose on the dermal absorption of 2- and 4-chloronitrobenzene (2- and 4-CNB) has been investigated in rats following nonocclusive protective dermal application on an area of 4 cm2 per animal at approximately 0.0325, 0.325, and 3.25 mg/cm2 (0.65, 6.5, and 65 mg/kg, respectively). At the three-dose levels, 33-40% and 51-62% of the dose of 2- and 4-CNB, respectively, was absorbed from the skin within 72 hr. The balance of the dose was recovered in the protective device and the organic trap (i.e. that portion unavailable for dermal absorption). The absorbed radioactivity was excreted in urine (21-28% of dose, 2-CNB; 43-45%, 4-CNB) and feces (11-15%, 2-CNB; 5-12%, 4-CNB). The extent and rate of dermal absorption and urinary and fecal excretion of 2-CNB were linear over the 0.65-65 mg/kg dose range; for 4-CNB they were linear over the 0.65-6.5 mg/kg dose, and nonlinear at the 65 mg/kg dose.

Administration, Cutaneous↗

Measurement of the exposure of workers to pesticides.

There is not a single pesticide for which the interrelationships between occupational exposure by different routes, the fate of the compound in the human body, and its clinical effects are all adequately known.Results of the direct measurement of exposure to pesticides may be used in evaluating the relative hazard of different routes of exposure, different operational procedures, and different protective devices. Results of the indirect measurement of exposure may be of use for the same purpose; in addition, these indirect measures may be used in relating exposures under observed conditions to clinical effects.This paper describes and evaluates detailed procedures for the use of air samples, pads, and washes in the direct measurement of the dermal and respiratory exposure of workers to pesticides. Good methods are not available for measuring oral exposure. Any measure of the absorption, storage, physiological effect, or excretion of a compound constitutes an indirect indication of exposure to it.

Humans↗

Coronary intervention in thrombus-rich lesions: beyond stents and glycoprotein IIb/IIIa inhibitors.

Despite widespread use of stents and GP IIb/IIIa antagonists, complications following percutaneous treatment of thrombus-rich lesions continue to plague patients with ACS. In these patients the angiographically evident coronary thrombosis may represent a high degree of thrombus burden, which leads to a higher level of microembolization and its clinical sequelae. New catheter-based thrombus burden reduction systems and distal protection devices show promise for improving the prognosis of these high risk patients by decreasing distal microembolization, and thereby preventing myonecrosis. Careful procedural timing and patient selection are also likely to improve outcomes and resource utilization in the management of ACS patients.

Angioplasty, Balloon, Coronary↗

[Stroke prevention: carotid stenting or carotid endarterectomy?].

Carotid angioplasty and stenting (CAS) has been introduced as an alternative to carotid endarterectomy (CEA) for treatment of carotid atherosclerosis. This paper summarizes benefits and limitations of CAS and CEA, describes the main technical points of CAS procedure, use of protection devices and adjunctive pharmacotherapy to reduce procedure related incidents.

Carotid Artery Diseases↗

Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.

This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized. In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.

Adenovirus Infections, Human↗

Renal function and survival after renal artery stent revascularization may be influenced by embolic debris.

UNLABELLED: Four years of follow-up renal function and survival data were obtained on 544 patients who underwent 714 successful renal artery stenosis (RAS) stent revascularizations. The mean serum creatinine (SCr) was unchanged at 4 years (1.6+/-1.0 mg/dl versus 1.6+/-0.9 mg/dl). The 2-year paired comparison analysis revealed no change in the reciprocal of the SCr (1/SCr), when compared with baseline or 1-year follow-up values. Simple linear regression analysis revealed flat post-procedure trend line slopes within all patient subsets, which implied renal functional stabilization. The 4-year mortality rate was 20%; variables directly affecting survival were presence of 1 or 2 kidneys, whether 1 or 2 renal arteries were stenotic [survival: unilateral 87%, bilateral 80%, and solitary kidney 60% (p<0.05)], as well as the degree of renal dysfunction [normal renal function patients had a significantly better (p<0.05) survival (88%) than those with moderate (60%) or severe dysfunction (47%)]. Surprisingly, medication controlled blood pressure (BP) patients fared worse than those with poorly controlled BP (56% versus 70%, respectively; p<0.05), with the worst outcomes in controlled BP patients with bilateral disease compared to poorly controlled BP patients (35% versus 69%, respectively; p<0.05). CONCLUSION: Renal function remained stable following stent revascularization for RAS, and survival was adversely affected by the variables of unilateral or bilateral RAS, presence of one/two kidneys, renal function impairment and medically controlled BP. These data underscored the premise that the malignant nephropathy associated with RAS was more likely to be segmental than uniform, and resulted from recurrent debris embolization from the obstructing lesion rather than persistent ischemia. Thus, a randomized stent revascularization trial utilizing an embolic protection device, coupled with an effort to collect retrospective preoperative SCr values, may be able to demonstrate post-stent functional stabilization, halting of progressive functional deterioration and, potentially, improvement in survival.

Adolescent↗

Oro-facial trauma in amateur secondary school footballers in Ibadan, Nigerian: a study of mouthguards.

To assess the awareness and frequency of use of mouth-guards for football among secondary school children in Ibadan, Nigeria, as well as the amount of oro-facial trauma previously associated with football game in these adolescents, a questionnaire - based cross-sectional study was conducted. Six hundred and thirty -one amateur footballers - 465 (73.7%) males and 166 (26.3%) females in the age range of 10 - 19 years (mean age, 15.01 +/- 2.86SD) completed the questionnaire giving a response rate of 90.1%. Majority (58.8%) of the subjects was within the 10-15 years age group. Awareness of mouth-guards was claimed by 69.7% of the respondents but significantly more of them who made the claim were not using the protective device for football games (p<0.05). More boys significantly claimed the usage of mouth-guards than girls (p<0.05). In all, 59.7% agreed that wearing mouth-guard was helpful in oro-facial injury prevention during sports with significantly more boys in agreement than girls (p<0.05). About 36% of the subjects sustained one form of oro-facial trauma or the other with significant sex difference (p<0.05). Secondary schools should serve as good starting points in the campaign for use of mouth-guards for contact sports before some go into professional sports.

Adolescent↗