During the last ten years, several patients have presented to the Renal Unit of Groote Schuur Hospital with acute renal failure following the use of traditional (N'anga or Gqirha) medication. The history together with abnormal liver-function tests and renal failure was thought to be suggestive of a toxic aetiology. The specific toxin however remained unknown, until during the admission of one patient, a relative brought in the medication, analysis of which revealed a high concentration of potassium dichromate. Subsequently elevated levels of chromium were demonstrated by atomic absorption spectrometry in the blood and urine of this patient. Following this case there have been six further cases of acute renal failure resulting from use of dichromate containing traditional remedies. These remedies were obtained from a variety of sources including street-hawkers, herbal chemists, and traditional healers. Clinical and laboratory data relating to these seven patients will be presented.

Contexte : Le cancer du poumon est le cancer le plus associé aux expositions professionnelles. Bien que l’amiante soit sans doute le facteur étiologique professionnel le plus connu, plusieurs éléments suggèrent également l’implication de facteurs modifiables d’origine environnementale ou professionnelle, beaucoup plus rarement étudiés, parmi lesquels les agents biologiques. Si les endotoxines - toxines situées dans la membrane externe des bacilles Gram négatif - sont fréquemment associées à une réduction du risque de cancer du poumon, les infections à papillomavirus humains sont suspectées d’augmenter ce risque. Les résultats des études épidémiologiques sur le sujet sont divergents et sont régulièrement limités par de nombreuses faiblesses méthodologiques incluant entre autres la non prise en compte du tabagisme et de l’exposition à l’amiante.Objectifs : L’objectif de cette thèse est d’étudier le rôle des agents biologiques présents sur les lieux de travail dans la survenue des cancers broncho-pulmonaires. Plus spécifiquement, les objectifs de ce travail sont : (1) d’étudier le rôle de l’exposition professionnelle aux endotoxines sur le risque de cancer du poumon, d’évaluer les aspects de la relation dose-effet ainsi que les interactions possibles avec les antécédents des maladies respiratoires; (2) de s’intéresser plus particulièrement à l’industrie textile, source de fortes expositions aux endotoxines, en étudiant le risque de cancer du poumon associé à l’exposition professionnelle aux poussières textiles ; (3) d’étudier le risque de cancer du poumon dans l’industrie de la viande en testant, notamment l’hypothèse d’une exposition à un agent viral.Population et méthodes : Ce travail s’est appuyé sur les données de l’étude cas-témoins en population générale ICARE. Les cas de cancer du poumon ont été identifiés dans 10 départements français abritant un registre général de cancer. Au total, 2276 cas de cancer du poumon et 2780 témoins hommes ont été inclus ainsi que 650 cas de cancers du poumon et 775 témoins femmes. Les descriptions détaillées de l’histoire professionnelle complète recueillies par des questionnaires standardisés ont permis de coder les professions et les secteurs d’activités de chaque emploi selon les classifications CITP 1968 et NAF 2000.Résultats : Nous avons trouvé une association inverse entre les expositions professionnelles aux endotoxines et le risque de cancer du poumon particulièrement plus marquée chez les travailleurs de l’élevage (tous types) et de la collecte et traitements des déchets. Les odds ratios de cancer du poumon diminuent avec la durée et l’indice cumulé d’exposition aux endotoxines. Nos résultats ne soutiennent pas l'existence d'une forte association entre l'exposition professionnelle aux poussières textiles et le cancer du poumon, néanmoins, ils montrent une diminution significative de 30% du risque de cancer du poumon chez les travailleurs du coton avec OR= 0,7 ; IC 95% [0,5-0,9]. Par ailleurs, nous observons une association positive significative avec le risque de cancer du poumon chez les travailleurs de l’industrie de la viande (OR= 1,46 [1,0-2,1]). Cependant, les antécédents de verrues de la main ne semblent pas avoir d’effet modificateur dans l’association entre le travail dans l’industrie de la viande et le risque de cancer du poumon.Conclusion : Nos résultats soutiennent le rôle important des expositions professionnelles comme déterminants du risque de cancer du poumon. Ils confirment les associations inverses entre les expositions aux endotoxines et le risque de cancer du poumon suggérant fortement l’hypothèse d’un effet anti-tumoral des endotoxines vis-à-vis du poumon. Par ailleurs, ils semblent indiquer que le travail dans l’industrie de la viande est une situation d’exposition à risque de cancer du poumon sans toutefois conclure formellement quant à l’implication des infections à papillomavirus humains. / Background: Lung cancer is the most common cancer associated with occupational exposures. Although asbestos is the best known occupational etiologic factor, several hypotheses suggest the involvement of some environmental or occupational modifiable factors, much more rarely studied, including biological agents. Endotoxins-toxins being part of the outer membrane of Gram-negative bacilli- are commonly associated with reduced risk of lung cancer, while human papillomavirus infections are suspected of increasing the risk. However, the majority of published studies had small numbers of cases and some methodological issues such as inadequate adjustment for tobacco smoking and occupational exposure to asbestos.Objectives: The aim of the present work is to study the role of biological agents found in the workplace on lung cancer risk and more specifically: (1) to investigate the role of occupational exposure to endotoxins on lung cancer risk, to assess dose-response relationship aspects and possible interactions with history of respiratory disease; (2) to focus on the textile industry, which is a source of high exposure to endotoxins, by examining the risk of lung cancer associated with occupational exposure to textile dust; (3) to study the risk of lung cancer in the meat industry by testing the hypothesis of an exposure to a viral agent.Population and methods: This work was based on a large population-based case-control study, ICARE. Cases and controls were recruited from 10 French departments. Incident cases were identified through French cancer registries. A total of 2,926 lung cancer cases (2,276 men and 650 women) and 3,555 controls (2,780 men and 775 women) were included. Detailed information on lifetime occupation was collected through standardized questionnaires. Jobs and sectors were coded according to the ISCO 1968 and the NAF 2000 classifications.Results: Our results showed an inverse association between exposure to endotoxins and lung cancer risk particularly among livestock (all types) and waste collection and treatment workers. Negative trends were shown with duration and cumulative exposure. Furthermore, our findings do not the existence of strong association between occupational exposure to textile dust and lung cancer. A decreased risk was suggested for distant exposures and for work with cotton fibres (OR = 0.7; 95% CI [0.5-0.9]). On the other hand, we observe a significantly increased risk among meat workers OR = 1.46 [1.1-2.1]). However, the history of hand warts does not seem to have any modifying effect on the association between work in the meat industry and the risk of lung cancer.Conclusion: Our findings support the important role of occupational exposures as a determinant of lung cancer risk. This confirms the inverse associations between endotoxin exposures and the risk of lung cancer strongly suggesting an anti-tumor effect of endotoxins towards the lung. This also seems to indicate that working in the meat industry is a risky situation for lung cancer without, however, formally concluding about the involvement of human papillomavirus infections.

Diisocyanates are very reactive low molecular weight chemicals that are widely used in the manufacture of polyurethane products. Diisocyanate exposure is one of the most commonly reported causes of occupational asthma. Although diisocyanates have been identified as causative agents of respiratory diseases, the specific mechanisms by which these diseases occur remain largely unknown. Tandem mass spectrometry was used to unambiguously identify the binding site of isocyanates within four model peptides (Leu-enkephalin (Leu-enk, YGGFL), Angiotensin I (DRVYIHPFHL), Substance P-amide (RPKPQQFFGLM-NH2), and Fibronectin-adhesion promoting peptide (FAPP, WQPPRARI)). In each case, isocyanates were observed to react to the N-terminus of the peptide. No evidence of side chain/isocyanate adduct formation exclusive of the N-terminus was observed. However, significant intra-molecular diisocyanate crosslinking between the N-terminal amine and a side chain amine group was observed for arginine, when located within two residues of the N-terminus. Addition of multiple isocyanates to the peptide occurs via polymerization at the N-terminus, rather than addition of multiple isocyanate molecules to varied residues within the peptide. Toluene diisocyanate (TDI)-specific monoclonal antibodies (mAbs) with potential use in immunoassays for exposure and biomarker assessments were produced. A total of 59 unique mAbs were produced (29 IgG1, 14 IgG2a, 4 IgG2b, 2 IgG3 and 10 IgM) against 2,4 and 2,6 TDI bound protein. The reactivities of these mAbs were characterized by a solid phase indirect enzyme-linked immunosorbent assay (ELISA), Dot ELISA and Western immunoblot against various monoisocyanate, diisocyanate and dithioisocyanate protein conjugates. A subset of the mAbs were specific for 2,4 or 2,6 TDI-conjugated proteins only while others reacted to multiple dNCO conjugates including methylene diphenyl diisocyanate- and hexamethelene diisocyanate- human serum albumin . Western blot analyses demonstrated that some TDI conjugates form inter- and intra-molecular links resulting in multimers and a change in the electrophoretic mobility of the conjugate. In general, 2,4/2,6 TDI reactive mAbs displayed (1) stronger recognition of monoisocyanate haptenated proteins when the isocyanate was in the ortho position relative to the tolyl group, and were able to discriminate between (2) isocyanate and isothiocyanate conjugates (i.e. between the urea and thiourea linkage); and (3) between aromatic and aliphatic diisocyanates. The mAbs produced were not carrier protein specific with estimated affinity constants toward toluene diisocyanate conjugated human serum albumin ranging from 2.21 x 107 to 1.07 x 1010 M-1 for IgG mAbs. Studies using TDI vapor exposed lung and epithelial cell lines suggest potential utility of these mAbs for both research and biomonitoring of isocyanate exposure.

Over the past 20 years, Genome-Wide Association Studies (GWAS) have identified thousands of variants in the genome linked to genetic diseases. However, these associations often reveal little about underlying genetic etiology, which for many phenotypes is thought to be highly heterogeneous. This work investigates statistical methods to move beyond conventional GWAS methods to both improve estimation of associations and to extract additional etiological insights from known associations, with a focus on schizophrenia. This thesis addresses the above aim through three primary topics: First, we describe DNA.Land, a web platform to crowdsource the collection of genomic data with user consent and active participation, thereby rapidly increasing sample sizes and power required for GWAS. Second, we describe methods to characterize the latent genomic contributors to heterogeneity in GWAS phenotypes. We develop a Z-score test to detect heterogeneity using correlations between variants among affected individuals, and we develop a contrastive tensor decomposition to explicitly characterize subtype-specific SNP effects independently of confounding heterogeneity such as ancestry. Using these methods we provide evidence of significant heterogeneity in GWAS cohorts for schizophrenia. Lastly, a major avenue of investigation beyond GWAS is identifying the genes through which associated SNPs mechanistically affect the presentation of phenotypes. We develop a method to improve estimation of expression quantitative trait loci by joint inference over gene expression reference data and GWAS data, incorporating insights from the liability threshold model. These methods will advance ongoing efforts to explain the complex etiology of genetic diseases as well as improve the accuracy of disease prediction models based on these insights.

Background and aims: Chronic intestinal failure (CIF) has been long-recognized, however the underlying etiology and risk factors have not been historically well-studied. We aim to study the underlying etiologies of CIF and predictive factors for long-term parenteral support (PS). Methods: We retrospectively identified patients with newly diagnosed CIF who received PS to maintain nutrition at the Cleveland Clinic between 2000 and 2017. Long-term PS was defined as a duration of more than 3 months. Univariable and multivariable logistic regression analyses were performed to identify the predictors of the need for long-term PS. Results: We identified 350 patients with CIF, 150 (43%) and 200 (57%) were diagnosed before and after 2010, respectively. The most common etiology was Crohn's disease (CD) in both cohorts (34.7% versus 30.5%, p = 0.41). Graft-versus-host-disease (GVHD) was a less frequent cause of CIF after 2010 (12.7% versus 2.5%, p = 0.0002). The type of PS was mostly total parenteral nutrition before and after 2010, 95% and 96%, respectively (p = 0.55). On univariable analysis, absence of ileocecal valve (p < 0.0001), ischemic bowel disease (p = 0.009), and whole colon resection (p = 0.033) were associated with the need for long-term PS. On multivariable analysis, absence of ileocecal valve (OR 2.19, p = 0.011) and ischemic bowel disease (OR 3.04, p = 0.003) remained statistically significant predictors of long-term PS. Conclusion: In our cohort of patients with CIF, CD remains the leading etiology over the last 20 years, whereas GVHD is less common after 2010. The absence of ileocecal valve and ischemic bowel disease were reliable predictive factors for requiring long-term PS.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Understanding the factors that increase patients susceptibility to orthodontically induced root resorption is of the utmost importance to the practicing clinician. Numerous studies have been conducted that investigated contributing and etiological factors that tend to increase the amount of external apical root resorption a patient may incur during orthodontic treatment. However, there has been little research that has attempted to determine if patients treated with different slot size orthodontic brackets exhibit the same amount of external apical root resorption. The purpose of this research was to determine if patients treated with the 0.018 x 0.025 slot size bracket and patients treated with the 0.022 x 0.028 exhibited similar amounts of external apical root resorption during orthodontic treatment. Pre and Post treatment panoramic films from 91 consecutively treated orthodontic patients from a private orthodontic practice were used for this study. Each case that was included in the study had been treated with standard edgewise brackets using the Tweed-Merrifield philosophy of treatment. Forty-three cases from the 0.018 group and 48 from the 0.022 group were obtained. Each film that was analyzed was blinded prior to measuring to minimize observer bias. Mitutoyo Digimatic® calipers accurate to the nearest tenth of a millimeter were used for obtaining tooth measurements. Measurements were made from the Cemento-enamel junction and from incisal/occlusal to most apical portion of each incisor and all first molars. Statistical analysis was performed and the results showed no significant correlation between the size of the bracket and the amount of root resorption. No significant correlations existed between the groups for patient age, time in treatment, gender, and angle classification. Statistically significant differences were noted for cases in which extraction of four bicuspids was performed. Subjects belonging to the extraction group demonstrated significantly more external apical root resorption than those in which extractions were not done. This study demonstrated that the incidence of EARR that a patient may incur during treatment is independent of the size of the slot of the orthodontic bracket.

Self-administration of 1-methyl-4-pheny]-1,2,3,6-tetrahydropyridine (MPTP) has resulted in irreversible symptoms of Parkinson's disease in several young drug abusers. It was found that this neurotoxicant selectively destroys neuronal cells in the substantia nigra of humans and other primates. Although the mechanism of action of MPTP is not fully understood, it is now generally believed that the crucial species for MPTP neurotoxicity is not MPTP itself, but rather some of its metabolites. MPDP⁺, an intermediate in the metabolism of the neurotoxin MPTP, was found to generate superoxide radical (⋅O₂⁻) during its autoxidation process. The generation of ⋅O₂⁻ was detected by their ability to reduce ferricytochrome c. Superoxide dismutase (SOD) inhibited this reduction in a dosedependent manner. The rate of reduction of ferricytochrome c was dependent not only on the concentration of MPDP⁺, but also on the pH of the system. Thus, the rate of autoxidation of MPDP⁺ and the sensitivity of this autoxidation to superoxide dismutase inhibitable ferricytochrome c reduction were both augmented as the pH was raised from 7.0 to 10.5. The rate constant (k_c) for the reaction of superoxide radical with ferricytochrome c to form ferrocytochrome c was found to be 3.48 x 10⁵ M⁻¹S⁻¹. The rate constant (k_MPDP⁺) for the reaction of MPDP⁺ with ferricytochrome c was found to be 4.86 M⁻¹S⁻¹. The generation of ⋅O₂⁻ was further confirmed by spin-trapping in combination with EPR techniques using 5, 5-dimethyl-1-pyrrolonine-N-oxide (DMPO) as the spin trapping agent. The rate of formation of spin adduct (DMPO-O₂⁻) was dependent not only on the concentrations of MPDP⁺ and oxygen but also on the pH of the system. Superoxide dismutase inhibited the spin adduct formation in a dose-dependent manner. The ability of DMPO to trap superoxide radicals, generated during the autoxidation of MPDP⁺, and of SOD to effectively compete with this reaction for the available ⋅O₂⁻, was used as a convenient competition reaction to quantitatively determine various kinetic parameters. Using this technique, the rate constant for scavenging of superoxide radicals by superoxide dismutase was found to be 7.56 x 10⁹ M⁻¹S⁻¹. The maximum rate of superoxide generation at a fixed spin trap concentration using different amounts of MPDP⁺ was found to be 4.48 x 10⁻¹⁰ M⋅S⁻¹. The rate constant (k₁) for MPDP⁺ making superoxide radical was found to be 3.97 x 10⁻⁶ Sec⁻¹. The second order rate constant (k_DMPO) for DMPO trapping superoxide radicals was found to be 10.2 M⁻¹S⁻¹. The life time of superoxide radical at pH 10.0 was calculated to be 1.25 seconds. These data indicate that superoxide radicals are produced during spontaneous oxidation of MPDP⁺ and that EPR spin trapping techniques can be used to determine the rate constants and life time of free radicals generated in aqueous solution. Monoamine oxidase type B (MAO-B), an enzyme present in mitochondrial membranes, is known to metabolize MPTP to MPDP⁺, which then spontaneously oxidizes to MPP⁺. In the studies of MAO-B catalyzed oxidation of MPTP, the neurotoxicant was found to generate reactive oxygen species during its interaction with the enzyme. The kinetic parameters, K_m and V_max, for MAO-B catalyzed oxidation of MPTP to the corresponding species MPDP⁺ were found to be 0.194 mM and 0.335 µM/min, respectively. The generation of ⋅O₂⁻ and hydroxyl (⋅OH) radicals was detected as the DMPO spin adduct by spin trapping in combination with EPR techniques. Addition of Fe²⁺ (10 µM) to this system caused a 5-fold enhancement in EPR signal intensity of the DMPO-OH adduct. Catalase, a scavenger of hydrogen peroxide (H₂O₂), inhibited the DMPO-OH spin adduct formation in a dose-dependent manner, indicating that H₂O₂ is produced in the MAO-B catalyzed oxidation of MPTP. Ethanol, a well known scavenger of hydroxy] radical, rapidly produced an alpha-hydroxyethyl radical signal. SOD inhibited the formation of DMPO-O₂⁻ and DMPO-OH spin adducts in a dose-dependent fashion. These data suggest that ⋅O₂⁻ are produced during the oxidation of MPTP by MAO-B and that the generation of H₂O₂ and ⋅OH was secondary to the production of ⋅O₂⁻. MPTP and its metabolites, MPDP⁺ and MPP⁺, were found to inhibit the activity of acetylcholinesterase (AChE). The kinetic parameter, K_m for the substrate (acetylthiocholine), was found to be 0.216 mM and K_i values for MPTP, MPDP⁺ and MPP⁺ to inactivate AChE were found to be 2.14, 0.265 and 0.197 mM, respectively. The inactivation of AChE by these neurotoxicants was found to be dose-dependent. It was found that MPTP, MPDP⁺ and MPP⁺ are neither substrates of AChE nor the time-dependent inactivators. The studies of reaction kinetics indicate that the inactivation of ACHE by these inactivators is via a mixed-type inhibition. The dilution of the enzyme-inhibitor complex completely reversed the MPTP inhibition but only partially reversed the MPDP+ and MPP+ inhibition. These data indicate that MPTP and its metabolites can inactivate AChE and thereby increase ACh level in the basal ganglia of the brain, leading to potential cell dysfunction. These results suggest that once MPTP enters the basal ganglia of the brain, it can be catalyzed by MAO-B to generate a series of reactive species, including ⋅O₂⁻, H₂O₂ and ⋅OH, which are known to destroy cell membranes, enzymes and other important biological molecules. The nigrostriatal toxicity by MPTP leading to Parkinson's disease-like syndrome may largely be due to the reactivity of these reactive oxygen species in combination with the inactivation of the AChE enzyme in the brain, leading to potential cell dysfunction. / Ph. D.

Background: Epidemiological studies suggest an increased incidence of osteoarthritis among workers in occupations requiring squat-lifting such as in construction, mining and farming. Squat-lifting postures can induce heavy mechanical loads on the joint, causing the articulating surfaces to deform. This can result in changes of vibration characteristics of the joint surfaces. Differences in the vibration characteristics of normal and pathological joints have been established and used in the past for classifying severity of disease. The purpose of this study was to examine the influence of cumulative mechanical load on the vibration properties of the knee joint and to gain an understanding of how these properties may relate to an increase in cumulative load placed on the joint. Methods: In this study, cumulative load was measured as the resultant knee joint torque during squat lifting, while a piezoelectric accelerometer was used to capture vibration signals from points on the knee during flexion and extension. Twelve university students were recruited for a repeated measures study. Each participant attended one session where they had to perform a series of six squat-lifting tasks on a force platform. Motion capture equipment was used to obtain kinematic data. The cumulative 3-D moment on the joint was calculated using inverse dynamics. Results: A visual inspection of an ensemble average constructed for the frequency spectrum of all participants revealed that differences may exist in the 750 Hz - 2000 Hz bandwidth for vibrations coming from the patella during flexion. Further statistical analysis by a t-test and ANOVA showed a decrease in the RMS power of the signal captured in this bandwidth before and after mechanical load was induced by squat lifting. A linear regression analysis indicated a significant correlation between cumulative 3-D moment on the knee joint and the median frequency of vibration signals from the patella during flexion in the 1000 Hz - 2500 Hz range. Conclusions: Overall, the results of this study indicate the possibility of a relationship between mechanical exposure on the knee joint and its vibration properties during joint movement. Despite the small sample size, a declining trend was observed in the normalized RMS power of signals with increase in loading. However, the quantitative nature of this relationship is not clear and the current study points towards a non-linear relationship between joint exposure and knee vibrations. Future studies must investigate this possibility using direct measures of joint loading, cartilage deformation and their relation to joint vibrations. / Master of Science

Xie, Shaohua = 室內燃香與香港華人的鼻咽癌發病風險 : / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 124-153). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese. / Xie, Shaohua = Shi nei ran xiang yu Xianggang Hua ren de bi yan ai fa bing feng xian :