#Blood #screening for heavy #metals and organic #pollutants in #cancer #patients exposed to #toxic #waste in southern #Italy: A pilot study (J Cell Physiol., abstract)

[Source: Journal of Cellular Physiology, full page: (LINK). Abstract, edited.]

Blood screening for heavy metals and organic pollutants in cancer patients exposed to toxic waste in southern Italy: A pilot study

Iris Maria Forte,  Paola Indovina,  Aurora Costa,  Carmelina Antonella Iannuzzi,  Luigi Costanzo,  Antonio Marfella,  Serena Montagnaro,  Gerardo Botti,  Enrico Bucci,  Antonio Giordano

First published: 15 December 2019 / DOI:  https://doi.org/10.1002/jcp.29399



In Italy, in the eastern area of the Campania region, the illegal dumping and burning of waste have been documented, which could potentially affect the local population’s health. In particular, toxic waste exposure has been suggested to associate with increased cancer development/mortality in these areas, although a causal link has not yet been established. In this pilot study, we evaluated blood levels of toxic heavy metals and persistent organic pollutants (POPs) in 95 patients with different cancer types residing in this area and in 27 healthy individuals. While we did not find any significant correlation between the blood levels of POPs and the provenance of the patients, we did observe high blood concentrations of heavy metals in some municipalities, including Giugliano, where many illegal waste disposal sites have previously been documented. Our results showed that patients with different cancer types from Giugliano had higher blood levels of heavy metals than healthy controls. Despite the obvious limitations of this exploratory study, our preliminary observations encourage further research assessing the possible association between exposure to hazardous waste, increased blood metals, and increased risk of cancer.


Open Research

DATA AVAILABILITY STATEMENT: The data sets used and/or analyzed during the current study are available from the corresponding authors on reasonable request.

Keywords: Toxic chemicals; Environmental pollution; Environmental disasters; Italy; Cancer.


#Veterans with #GulfWar #Illness exhibit distinct #respiratory #patterns during maximal #cardiopulmonary exercise (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]


Veterans with Gulf War Illness exhibit distinct respiratory patterns during maximal cardiopulmonary exercise

Jacob B. Lindheimer , Dane B. Cook, Jacquelyn C. Klein-Adams, Wei Qian, Helene Z. Hill, Gudrun Lange, Duncan S. Ndirangu, Glenn R. Wylie, Michael J. Falvo


Published: November 12, 2019 / DOI: https://doi.org/10.1371/journal.pone.0224833




The components of minute ventilation, respiratory frequency and tidal volume, appear differentially regulated and thereby afford unique insight into the ventilatory response to exercise. However, respiratory frequency and tidal volume are infrequently reported, and have not previously been considered among military veterans with Gulf War Illness. Our purpose was to evaluate respiratory frequency and tidal volume in response to a maximal cardiopulmonary exercise test in individuals with and without Gulf War Illness.

Materials and methods

20 cases with Gulf War Illness and 14 controls participated in this study and performed maximal cardiopulmonary exercise test on a cycle ergometer. Ventilatory variables (minute ventilation, respiratory frequency and tidal volume) were obtained and normalized to peak exercise capacity. Using mixed-design analysis of variance models, with group and time as factors, we analyzed exercise ventilatory patterns for the entire sample and for 11 subjects from each group matched for race, age, sex, and height.


Despite similar minute ventilation (p = 0.57, η2p = 0.01), tidal volume was greater (p = 0.02, η2p = 0.16) and respiratory frequency was lower (p = 0.004, η2p = 0.24) in Veterans with Gulf War Illness than controls. The findings for respiratory frequency remained significant in the matched subgroup (p = 0.004, η2p = 0.35).


In our sample, veterans with Gulf War Illness adopt a unique exercise ventilatory pattern characterized by reduced respiratory frequency, despite similar ventilation relative to controls. Although the mechanism(s) by which this pattern is achieved remains unresolved, our findings suggest that the components of ventilation should be considered when evaluating clinical conditions with unexplained exertional symptoms.


Citation: Lindheimer JB, Cook DB, Klein-Adams JC, Qian W, Hill HZ, Lange G, et al. (2019) Veterans with Gulf War Illness exhibit distinct respiratory patterns during maximal cardiopulmonary exercise. PLoS ONE 14(11): e0224833. https://doi.org/10.1371/journal.pone.0224833

Editor: Kathryn L. Weston, Teesside University/Qatar Metabolic Institute, UNITED KINGDOM

Received: May 7, 2019; Accepted: October 22, 2019; Published: November 12, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All data were collected at the VA and the signed subject consent forms did not make provision for making individual data records publicly available, even in de-identified form. However the authors can provide the “metadata” – i.e. the numerical (aggregated data) results used to generate the figures. Requests for access can be sent to: Sharmaine Forde-Miller Privacy Officer East Orange Campus of the VA New Jersey Healthcare System 385 Tremont Ave East Orange, NJ 07018 PH: 973-676-1000 x1948 Sharmaine.Forde-Miller@va.gov or Joselyn McLaughlin, PhD Research Compliance Officer Directors’s Office East Orange Campus of the VA New Jersey Healthcare System 385 Tremont Ave East Orange, NJ 07018 PH: 973-676-1000 x2035 Joselyn.McLaughlin@va.gov.

Funding: This work was supported by Department of Veterans Affairs Office of Research & Development; Clinical Science Research & Development: 1I21CX000797 (MJF), 1K2CX001679 (JBL), www.research.va.gov. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Gulf War Illness; Toxic chemicals; Undiagnosed illness; Soldiers; USA; Cardiology.


#Ecigarette, or #vaping, product use associated #lung injury (#EVALI): case series and diagnostic approach (Lancet Resp Med., abstract)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Abstract, edited.]

E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach

Aleksandr Kalininskiy, MD  †, Christina T Bach, MD †, Nicholas E Nacca, MD, Gary Ginsberg, PhD, Jeanna Marraffa, PharmD, Kristen A Navarette, MD, Matthew D McGraw, MD, Daniel P Croft, MD

Published: November 08, 2019 / DOI: https://doi.org/10.1016/S2213-2600(19)30415-1




Since June, 2019, more than 1000 new cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported in the USA. Patients presented with dyspnoea, cough, and were found to be hypoxaemic with bilateral airspace opacities on chest imaging. Most patients required management in the intensive care unit and steroid therapy. All patients recovered with cessation of vaping, supportive care, and steroid therapy and remained symptom free at follow up. E-cigarette use continues to rapidly escalate in the USA, particularly among youth.


Cases were defined as patients admitted to the University of Rochester Medical Center (Rochester, NY, USA) who had used e-cigarettes or another vaping device in the 30 days before presentation, and who had bilateral airspace opacification on chest imaging (CT or x-ray). Case details were obtained via medical record review and patient interviews over the past 3 months including symptomatology, physical exam data, imaging studies, laboratory data, vaping history, and subsequent outpatient follow-up data. In collaboration with the New York State Department of Health, our hospital developed a novel clinical practice algorithm based on statewide physician feedback along with input from experts in environmental health, medical toxicology, infectious disease, epidemiology, and chronic disease prevention.


We report 12 cases treated for suspected EVALI at our medical centre between June 6, 2019, and Sept 15, 2019. Ten (83%) patients had dyspnoea, fever, and emesis and nine (75%) had cough. 11 (92%) patients reported the use of e-cigarette cartridges containing tetrahydrocannabinol oil. Although eight (67%) patients required admission to the intensive care unit for hypoxaemic respiratory failure, no deaths occurred. The median hospitalisation duration was 7 days (IQR 7–8). All patients completing follow up (6 [50%]) had resolution of previous chest CT findings and normal spirometry. The clinical algorithm focuses on the key signs and symptoms of EVALI and the importance of ruling out infection and other cardiopulmonary conditions before making a presumptive diagnosis of EVALI.


Patients with suspected EVALI in our cohort had life-threatening hypoxaemia, with 67% requiring management in the intensive care unit. Despite the severity of presentation, similar to previous reports of patients with EVALI, most patients improved within 1–2 weeks of initial presentation after vaping cessation and administration of systemic corticosteroids when needed. Almost all (92%) patients with suspected EVALI reported vaping a THC product, making THC containing e-liquids or oils a key focus on the ongoing nationwide investigations into the cause of EVALI. Additional research is required to understand the potential toxins, underlying pathophysiological mechanisms, and identification of susceptible individuals at higher risk for hospitalisation due to EVALI. To our knowledge we present the first clinical practice algorithm for the evaluation and management of EVALI, which will be useful for both acute management and improved accurate reporting of this life-threatening respiratory illness.



Keywords: Undiagnosed illness; Toxic chemicals; EVALI; USA.


#Clinical presentation, #treatment, and short-term #outcomes of #lung #injury associated with #ecigarettes or vaping [#EVALI]: a prospective observational cohort study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study

Denitza P Blagev, MD  †, Dixie Harris, MD †, Angela C Dunn, MD, David W Guidry, MD, Prof Colin K Grissom, MD, Michael J Lanspa, MD

Published: November 08, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32679-0




An ongoing outbreak of lung injury associated with e-cigarettes or vaping (also known as E-VALI or VALI) started in March, 2019, in the USA. The cause, diagnosis, treatment, and course of this disease remains unknown.


In this multicentre, prospective, observational, cohort study, we collected data on all patients with lung injury associated with e-cigarettes or vaping seen in Intermountain Healthcare, an integrated health system based in Utah, USA, between June 27 and Oct 4, 2019. Telecritical care, based in Salt Lake City, UT, USA, was used as the central repository for case validation, public reporting, and system-wide dissemination of expertise, which included a proposed diagnosis and treatment guideline for lung injury associated with e-cigarettes or vaping. We extracted data on patient presentation, treatment, and short-term follow-up (2 weeks after discharge) from chart review and interviews with patients undertaken by the Utah Department of Health (Salt Lake City, UT, USA).


60 patients presented with lung injury associated with e-cigarettes or vaping at 13 hospitals or outpatient clinics in the integrated health system. 33 (55%) of 60 were admitted to an intensive care unit (ICU). 53 (88%) of 60 patients presented with constitutional symptoms, 59 (98%) with respiratory symptoms, and 54 (90%) with gastrointestinal symptoms. 54 (90%) of 60 were given antibiotics and 57 (95%) were given steroids. Six (10%) of 60 patients were readmitted to an ICU or hospital within 2 weeks, three (50%) of whom had relapsed with vaping or e-cigarette use. Of 26 patients who were followed up within 2 weeks, despite clinical and radiographic improvement in all, many had residual abnormalities on chest radiographs (ten [67%] of 15) and pulmonary function tests (six [67%] of nine). Two patients died and lung injury associated with e-cigarettes or vaping was thought to be a contributing factor, but not the cause of death, for both.


Lung injury associated with e-cigarettes or vaping is an emerging illness associated with severe lung injury and constitutional and gastrointestinal symptoms. Increased awareness has led to identification of a broad spectrum of severity of illness in patients who were treated with antibiotics and steroids. Despite improvement, at short-term follow-up many patients had residual abnormalities. Lung injury associated with e-cigarettes or vaping remains a clinical diagnosis with symptoms that overlap infectious and other lung diseases. Maintaining a high index of suspicion for this disease is important as work continues in understanding the cause or causes, optimal therapy, and long-term outcomes of these patients.


Intermountain Healthcare.

Keywords: Undiagnosed illness; Toxic chemicals; EVALI; USA.


Application of national #pollutant #inventories for #monitoring trends on #dioxin #emissions from stationary #industrial sources in #Australia, #Canada and #EU (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]


Application of national pollutant inventories for monitoring trends on dioxin emissions from stationary industrial sources in Australia, Canada and European Union

Khushbu Salian , Vladimir Strezov, Tim J. Evans, Mark Taylor, Peter F. Nelson


Published: October 25, 2019 / DOI: https://doi.org/10.1371/journal.pone.0224328



Industrial sources, including iron ore sintering, municipal waste incineration and non-ferrous metal processing have been prominent emitters of dioxins to the environment. With the expanding industrial sectors, many international conventions were established in order to reduce the emission of dioxins in the past two decades. The Stockholm convention, a global monitoring treaty, entered into force in 2004 with the aim to promote development of strategies to reduce or eliminate dioxin emissions. According to the convention, parties are required to develop national inventory databases to report emission levels and develop a national implementation plan (NIP) to reduce further dioxin emissions. In order to understand the trend of dioxin emissions since 1990s this study provides a comparative assessment of dioxin emissions from different industrial sources by deriving emission data from the national inventory databases of Australia, Canada and the 28 European countries (EU-28). According to the data collected, iron and steel production and electricity generation were the highest emitters of dioxins in 2017 for Europe, Canada and Australia, when compared to other stationary industrial sources. The change in the trend of dioxin emissions from the iron and steel industry and the public electricity sector was also assessed. The emission of dioxins during 1990–2017 from both iron and steel production and electricity generation revealed a relative decreasing trend, except for Spain and Italy who showed higher level of emissions from iron and steel production in 2017. Furthermore, comparing emission data for metal production revealed that the blast furnace process was the prominent emitter of dioxins comparing to electric arc furnace process. Further investigation was performed to compare the amount of dioxin emitted from three different fuel types, black coal, brown coal and natural gas, used for electricity generation in Australia. The study showed that dioxin emissions from brown coal were higher than black coal for the last two years, while power production from natural gas emits the lowest amounts of dioxins to the environment.


Citation: Salian K, Strezov V, Evans TJ, Taylor M, Nelson PF (2019) Application of national pollutant inventories for monitoring trends on dioxin emissions from stationary industrial sources in Australia, Canada and European Union. PLoS ONE 14(10): e0224328. https://doi.org/10.1371/journal.pone.0224328

Editor: Bing Xue, Institute for Advanced Sustainability Studies, GERMANY

Received: May 21, 2019; Accepted: October 10, 2019; Published: October 25, 2019

Copyright: © 2019 Salian et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Sources are referenced.

Funding: This research was funded by the Australian Government through the Australian Research Council Linkage Projects funding scheme, project number LP160101600 (https://www.arc.gov.au/) to VS, TE, MT and PF. ARC played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Environmental pollution; Toxic chemicals; Dioxins; EU; Australia; Canada.


#Pulmonary #Illness Related to #ECigarette Use in #Illinois and #Wisconsin — Preliminary #Report (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

Jennifer E. Layden, M.D., Ph.D., Isaac Ghinai, M.B., B.S., Ian Pray, Ph.D., Anne Kimball, M.D., Mark Layer, M.D., Mark Tenforde, M.D., Ph.D., Livia Navon, M.S., Brooke Hoots, Ph.D., Phillip P. Salvatore, Ph.D., Megan Elderbrook, M.P.H., Thomas Haupt, M.S., Jeffrey Kanne, M.D., et al.




E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation.


We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools.


There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.


Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

Keywords: Pneumonia; Undiagnosed illness; Toxic chemicals; USA; Illinois; Wisconsin.


Heavy #metal #pollution and co-selection for #antibiotic #resistance: A microbial #palaeontology approach (Environ Int., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Environ Int. 2019 Aug 29;132:105117. doi: 10.1016/j.envint.2019.105117. [Epub ahead of print]

Heavy metal pollution and co-selection for antibiotic resistance: A microbial palaeontology approach.

Dickinson AW1, Power A2, Hansen MG3, Brandt KK3, Piliposian G4, Appleby P4, O’Neill PA5, Jones RT6, Sierocinski P7, Koskella B8, Vos M9.

Author information: 1 College of Life and Environmental Science, University of Exeter, Penryn, UK; UK Centre for Astrobiology, School of Physics and Astronomy, University of Edinburgh, Edinburgh, UK. Electronic address: A.W.Dickinson@sms.ed.ac.uk. 2 Biocatalysis Centre, University of Exeter, Exeter, UK. 3 Department of Plant and Environmental Sciences, University of Copenhagen, Thorvaldsensvej 40, DK-1871 Frederiksberg, Denmark. 4 Department of Mathematical Sciences, University of Liverpool, Liverpool, UK. 5 Welcome Trust Biomedical Informatics Hub, Geoffrey Pope Building, University of Exeter, Exeter, UK. 6 School of Geography, College of Life and Environmental Sciences, University of Exeter, Amory Building, Rennes Drive, Exeter, UK. 7 College of Life and Environmental Science, University of Exeter, Penryn, UK. 8 Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA.
9 European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Penryn, UK.



Frequent and persistent heavy metal pollution has profound effects on the composition and activity of microbial communities. Heavy metals select for metal resistance but can also co-select for resistance to antibiotics, which is a global health concern. We here document metal concentration, metal resistance and antibiotic resistance along a sediment archive from a pond in the North West of the United Kingdom covering over a century of anthropogenic pollution. We specifically focus on zinc, as it is a ubiquitous and toxic metal contaminant known to co-select for antibiotic resistance, to assess the impact of temporal variation in heavy metal pollution on microbial community diversity and to quantify the selection effects of differential heavy metal exposure on antibiotic resistance. Zinc concentration and bioavailability was found to vary over the core, likely reflecting increased industrialisation around the middle of the 20th century. Zinc concentration had a significant effect on bacterial community composition, as revealed by a positive correlation between the level of zinc tolerance in culturable bacteria and zinc concentration. The proportion of zinc resistant isolates was also positively correlated with resistance to three clinically relevant antibiotics (oxacillin, cefotaxime and trimethoprim). The abundance of the class 1 integron-integrase gene, intI1, marker for anthropogenic pollutants correlated with the prevalence of zinc- and cefotaxime resistance but not with oxacillin and trimethoprim resistance. Our microbial palaeontology approach reveals that metal-contaminated sediments from depths that pre-date the use of antibiotics were enriched in antibiotic resistant bacteria, demonstrating the pervasive effects of metal-antibiotic co-selection in the environment.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Antimicrobial resistance; Co-selection; Cross-resistance; Metal pollution; Sediment archive

PMID: 31473413 DOI: 10.1016/j.envint.2019.105117

Keywords: Antibiotics; Drugs Resistance; Toxic chemicals; Environmental pollution; UK.