Personal solar ultraviolet radiation dosimetry in an occupational setting across Europe.

BACKGROUND: Work-related solar ultraviolet radiation (UVR) is an important factor in the pathogenesis of non-melanoma skin cancer (NMSC). The World Health Organization, through the International Agency for Research on Cancer, has classified solar UVR as a group 1 carcinogen since 2012. The main problems encountered so far in the study of occupationally induced skin cancer include the lack of accurate occupational UVR dosimetry as well as insufficient distinction between occupational and leisure UVR exposure and underreporting of NMSC. OBJECTIVES: The aim of this study was to collect long-term individual UVR measurements in outdoor workers across European countries. METHODS: A prospective study was initiated through the European Academy of Dermatology and Venereology, Healthy Skin@Work Campaign, measuring UVR exposure doses at occupational settings of masons from five European countries. Measurements were performed for several consecutive months using the GENESIS-UV measurement system. RESULTS: The results identified alarming UVR exposure data. Average daily UVR doses ranged 148.40-680.48 J/m2 in Romania, 342.4-640.8 J/m2 in Italy, 165.5-466.2 J/m2 in Croatia, 41.8-473.8 J/m2 in Denmark and 88.15-400.22 J/m2 in Germany. Results showed an expected latitude dependence with increasing UVR yearly dosage from the north to the south of Europe. CONCLUSIONS: This study shows that outdoor workers from EU countries included in this study are exposed to high levels of occupational solar UVR, vastly exceeding the occupational exposure limits for solar UVR exposure, considered to be 1-1.33 SED/day in the period from May to September. This finding may serve as an evidence-based recommendation to authorities on implementing occupational skin cancer prevention strategies.

Numerical analysis of ion temperature effects to the plasma wall transition using a one-dimensional two-fluid model. I. Finite Debye to ionization length ratio.

A one-dimensional, two-fluid, steady state model is used for the analysis of ion temperature effects to the plasma-wall transition. In this paper, the model is solved for a finite ratio ε between the Debye and the ionization length, while in Part II [T. Gyergyek and J. Kovacic, Phys Plasmas 24, 063506 (2017)], the solutions for [Formula: see text] are presented. Ion temperature is treated as a given, independent parameter and it is included in the model as a boundary condition. It is shown that when the ion temperature larger than zero is selected, the ion flow velocity and the electric field at the boundary must be consistent with the selected ion temperature. A numerical procedure, how to determine such "consistent boundary conditions," is proposed, and a simple relation between the ion temperature and ion velocity at the boundary of the system is found. The effects of the ion temperature to the pre-sheath length, potential, ion temperature, and ion density drops in the pre-sheath and in the sheath are investigated. It is concluded that larger ion temperature results in a better shielding of the plasma from the wall. An attempt is made to include the ion heat flux qi into the model in its simplest form [Formula: see text], where [Formula: see text] is a constant heat conduction coefficient. It is shown that inclusion of such a term into the energy transfer equation introduces an additional ion heating mechanism into the system and the ion flow then becomes isothermal instead of adiabatic even in the sheath.

Bunker probe: A plasma potential probe almost insensitive to its orientation with the magnetic field.

Due to their ability to suppress a large part of the electron current and thus measuring directly the plasma potential, ion sensitive probes have begun to be widely tested and used in fusion devices. For these probes to work, almost perfect alignment with the total magnetic field is necessary. This condition cannot always be fulfilled due to the curvature of magnetic fields, complex magnetic structure, or magnetic field reconnection. In this perspective, we have developed a plasma potential probe (named Bunker probe) based on the principle of the ion sensitive probe but almost insensitive to its orientation with the total magnetic field. Therefore it can be used to measure the plasma potential inside fusion devices, especially in regions with complex magnetic field topology. Experimental results are presented and compared with Ball-Pen probe measurements taken under identical conditions. We have observed that the floating potential of the Bunker probe is indeed little affected by its orientation with the magnetic field for angles ranging from 90° to 30°, in contrast to the Ball-Pen probe whose floating potential decreases towards that of a Langmuir probe if not properly aligned with the magnetic field.

Influence of oral contraceptives on the incidence of premalignant and malignant lesions of the cervix.

The effect of oral contraceptive use on the development of severe dysplasia, carcinoma in situ and invasive carcinoma of the cervix was studied by a prospective longitudinal survey of 32,000 women. They were enrolled into the study between the ages of 15 and 39. Some had started oral contraceptive use before enrollment, others started after enrollment and some remained non-users throughout the study period. They were followed-up to 6-1/2 years. Analyses were performed on data from 24,784 women who met our criteria for incidence. Data were adjusted for years of follow-up, age at enrollment, age at first pregnancy, number of pregnancies, number of smears, and duration of use.

Mechanisms mediating lipoprotein responses to diets with medium-chain triglyceride and lauric acid.

Medium-chain triglycerides (MCT) are often used in specialized formula diets or designer fats because of their special properties. Yet their influence on lipid metabolism is not completely understood. In this two-period cross-over study, the effects of MCT (8:0 + 10:0) in contrast to a similar saturated fatty acid (12:0) were compared. Eighteen healthy women ate a baseline diet [polyunsaturated (PUFA)/saturated fat = 0.9] for 1 wk. Then, they consumed test diets (PUFA/saturated fat = 0.2) for 4 wk. Monounsaturated fat and cholesterol were constant in baseline and treatment diets. MCT and 12:0, substituted for part of the PUFA, provided 14 energy (en)% of the test diets. In comparison to the PUFA baseline diet, a 16% increase in mean serum low density lipoprotein (LDL)-cholesterol (C) on the 12:0 diet was accompanied by a 21% decrease in mean receptor-mediated degradation of LDL by freshly isolated mononuclear cells (MNC) in vitro. The MNC assay theoretically gives an indication of receptor-mediated degradation of LDL. In contrast, the MCT diet raised mean receptor-mediated degradation of LDL by 42%, a finding out of line with the mean 11% increase in serum LDL-C. Perhaps MCT, by increasing the rate of LDL-C production, overcame the rate of LDL-C clearance. The 12:0 diet enhanced some factors involved in reverse cholesterol transport (e.g., high density lipoprotein fractions) while MCT had a different or less pronounced effect. The overall effects of MCT on cholesterol metabolism may or may not be desirable, whereas those of 12:0 appear largely undesirable as previously reported.

Endometrial and other primary cancers after tamoxifen treatment of breast cancer -- results of retrospective cohort study.

OBJECTIVES: The aim of the retrospective cohort study was to evaluate the relationship between the influence of tamoxifen on the development of endometrial and other second primary cancers in the patients with invasive breast cancer. STUDY DESIGN: A cohort of 630 women diagnosed with breast cancer from 1987 to 1994 was selected from a population-based registry; 440 patients were treated with tamoxifen and 190 patients without it. The observation period was 8.5 years (range 5-12 years). The data were analysed by the relative risk (RR) calculation at a confidence interval (CI) of 95%, using a Mantel-Haenszel chi(2)-test and Fisher's p-test to evaluate statistical significance. RESULTS: There were no statistically significant differences between the group of breast cancer patients treated with tamoxifen and without it as regards the age at the breast cancer diagnosis, family medical histories, body mass, age at menopause, fertility, diabetes, hormone replacement therapy and oestrogen-hormone replacement therapy. In 41/440 (9.3%) tamoxifen-treated patients and in 8/190 (4.2%) non-users of tamoxifen, diagnostic curettage was performed due to benign endometrial changes and endometrial cancer (EC). The difference in the proportions of patients with diagnostic curettage in both group was statistically significant (chi(2)=4.45, p=0.03). In the group of patients treated with tamoxifen, with the median treatment duration of 40 months (range 1-97 months) and in the group of patients without tamoxifen, EC was diagnosed in 11 and in two patients, respectively. The evaluated RR was 2.38 (0.53-10.61, 95% CI). The second primary cancer, excluding contralateral breast cancer and EC, was diagnosed in the group of breast cancer patients treated with tamoxifen and without it in almost the same percentage, i.e. in 12 patients (3%) in the group of patients who were treated with tamoxifen and in 10 patients (5%) in the group of patients without tamoxifen treatment. CONCLUSION: Despite the fact that the calculated RR of EC in our study (2.4) was not statistically significant, due to a small number of patients, our results support the IARC evaluation that tamoxifen is carcinogenic to humans. Our data also suggest that tamoxifen does not increase the risk of other second primary cancers. However, the risk of individual second primary cancers cannot be reliably assessed due to a limited number of patients.

Umbilical cord cortisol in breech delivery.

Mixed umbilical cord blood samples were obtained in 31 cases immediately after vaginal breech delivery at term and in 31 cases immediately after vaginal vertex delivery at term. The total cortisol concentrations were determined using a direct radioimmunologic method (Amerlex cortisol kit). The mean umbilical cord total cortisol concentration was 790 +/- 363 nmol/liter in breech delivery as compared with 493 +/- 125 nmol/liter in vertex delivery. The difference was highly significant (p less than 0.0005). There was a highly positive correlation (r = 0.59, p less than 0.0005) between duration of labor and total cortisol concentrations in umbilical plasma after breech delivery. In contrast to that we found only a slightly positive correlation between duration of labor and total cortisol concentrations after vaginal vertex delivery (r = 0.23, p less than 0.10). Significant differences in pH values between breech and vertex deliveries (p less than 0.01) and a slight but significant correlation (r = 0.35, p less than 0.002) between umbilical vein pH values and umbilical total cortisol concentrations indicate that the increase in cortisol during vaginal breech delivery could be attributed partially to some hypoxic events. These results support the concept that the increase in cortisol in the umbilical cord plasma during labor reflects the fetal adrenal response secondary to stress in utero and contribute to our understanding of why an increased risk exists for the fetus during vaginal breech delivery of long duration.

Relationship between endometriosis and ovarian cancer.

PURPOSE: To investigate the occurrence of ovarian cancer (OC) arising in ovarian endometriosis (OE) diagnosed in our laboratory, and the relation of the disease to patient age. METHODS: Histopathological reports were reviewed in cases of endometriosis and ovarian cancer diagnosed between 1982 and 1989 and in 1997. The occurrence of OE and OC was studied in relation to patient age. RESULTS: Of the 796 OE cases, 36 (4.5%) ovarian cancers were found in the eight-year period, and of the 216 OC cases 36 (16.7%) were associated with OE; 12 patients (1.7%) were under 50 years old and 24 (22.9%) were over 50. In 1997 there were 168 cases of OE, and 4 cases were associated with OC. Of the 60 OC cases 4 cases arose in endometriosis. Two patients were over 50 and two under 50. CONCLUSION: In our report the occurrence of OC arising in OE was most influenced by patient age, the extent of sampling and the consistency of histologic reports about the presence of endometriosis in ovarian adenocarcinoma.

Prognostic factors in endometrial cancer.

The 5 year survival rates of 228 patients with endometrial cancer treated in the period 1978-1982 according to the prognostic factors (stage, grade, depth of myometrial invasion, lymph node metastasis) is presented. All patients were treated with primary surgery consisting of classical Wertheim operation with lymphadenectomy (98 cases-43%), total abdominal hysterectomy with bilateral salpingo-oophorectomy with lymphadenectomy (52 cases-48%) and without lymphadenectomy (55 cases-52%) and vaginal hysterectomy with bilateral salpingo-oophorectomy (23 cases-10%). All patients except 6.6% were postoperatively irradiated. The 5 year survival for all stages was 74.6%. In SI cases it was 83.8%, in SII 57.9% and only 37.5% in SIII group. The survival was 90.1% in patients with superficial myometrial invasion and 56.4% in cases of deeper invasion. The survival of patients with node metastasis (8.6%) was only 39.5%, irrespective of the type of surgery and postoperative external irradiation. Vaginal recurrences were observed in 3.9%, and all the patients died. To improve the results it is necessary to individualize the treatment according to the pathologic and clinical prognostic factors.

Epidemiological evaluation of cervical cancer screening in Slovenia up to 1986.

In 1986 invasive cervical cancer (CC) in Slovenia, with its incidence rate of 15/100.000, was still the sixth most common cancer in females. In the period 1977-1986 the incidence was stabilized. However, in the age group 60-64 the trend increased steeply (5.3%). The incidence of the intraepithelial form was stabilized after the year 1981, the rates were increasing in the age group 30-39 (3.3%) only. On average, the intraepithelial/invasive CC ratio in Slovenia was 1.2. The ratios differed by communes, however. In 35 of 60 communes they were under 1, the median value being 0.8 only. The mortality rates due to CC differed by regions too. Relatively high invasive CC incidence rates (25-36/100.000) accompanied by a low intraepithelial/invasive CC ratio, and relatively high mortality rates (9.7 and 10.5/100.000) were observed in the health region Maribor, and in the three coastal communes (Piran, Izola, Koper). An independent analysis in depth of Ljubljana region revealed a stabilization in the incidence (15/100.000) as well as in mortality (5.6/100.000) in the last decade too. A better organized screening program is needed in Slovenia. At least in the high-risk regions a systematic screening every three year after two negative smears for all sexually active women aged 27-55 years should be introduced and carried out.

Epidemiological evaluation of early detection of cervical cancer in Slovenia till 1981.

Cervical cancer screening is performed in all Slovenia in connection with normal clinical practice since 1960. The results based on the data of Cancer Registry of Slovenia: trends in age, specific incidence rates and the distribution of intraepithelial and invasive cervical cancer incidence rates by communes revealed that cervical cancer screening is efficient in Slovenia; in two commune aggregates only and up to the age 40. A detailed analysis of cases of FIGO stage I into Ia and Ib stage demonstrated a shift of the peak of Ib stage to younger age in the two commune aggregates mentioned. The question is whether this shift of the peak of Ib stage could be an indicator of the unavoidable percentage of rapidly growing tumors in the population of SR Slovenia.

Association of risk factors for cervical cancer and human papilloma viruses in invasive cervical cancer.

Our study was carried out on 70 patients with invasive squamous carcinoma of the uterine cervix (CC) or invasive adenocarcinoma of the uterine cervix at all stages, admitted to the University Department of Gynecology and/or to the Institute of Oncology in Ljubljana. The patients were not selected by age. A questionnaire on known risk factors in CC was filled in for each of the 70 patients, and two tumor smears were taken for the determination of human papilloma viruses (HPV) 16 and 18 by means of in situ hybridization and polymerase chain reaction (PCR). Each patient also had the serum level of vitamin A determined. The results of our study revealed a correlation between HPV 16 or 18 infection (60:40) and CC. When analysing some already known risk factors, no statistically significant difference could be established for any of the factors studied, except for the age at first birth.

Prognostic factors in ovarian cancer.

The improvement in the treatment of ovarian cancer is based on the recognition of the prognostic factors. The 5-year survival rate of 174 patients with epithelial ovarian malignancies after primary operation at the University Department of Obstetrics and Gynecology in Ljubljana and treated with adjuvant therapy at the Institute of Oncology in Ljubljana in the period 1970-1980 was 29.3% (56% for stage I, 36% for stage II, 23% for stage III and 4.5% for stage IV). The amount of residual tumor after the primary operation was prognostically very important (5-year survival in stage III in cases of residual tumor less than 2 cm is 46.6%, in tumor greater than 2 cm only 18.6%). The histological type of tumor, considering the stage, was not important prognostically. On the contrary the grade of differentiation was prognostically very important even in advanced cases: 5 year survival for stage III in cases of well differentiated serous tumors was 61%, in moderately and poorly differentiated cases it was only 7%. Younger patients have better prognosis than older ones, because the tumors are better differentiated, too. Since ovarian cancers are diagnosed too late in 65% of cases in advanced stages, today all efforts should be focussed on early diagnosis, which is probably the only factors that can lead to the dramatic fall of the mortality rate.

The treatment of invasive carcinoma of the cervix at the Department of Gynecology and Obstetrics in Ljubljana.

In this report the treatment of carcinoma of the cervix in the period from 1965 through 1972 at the Department of Gynecology and Obstetrics in Ljubljana, is presented. In that period 651 patients were admitted for treatment and 488 were operated; the operability was 73.8%. The primary mortality rate was 1.02% and the frequency of ureteral fistulas 1.93%. The 5-year survival rate were: for stage I 81.8%-94.5% for stage Ia and 76.2% for stage Ib, for stage II 57.83% and for stage III 28.38%. The treatment and mortality for cases with positive lymph-nodes is discussed, and the results of treatment are also presented.

Management of life-threatening trauma.

The response to major traumatic injury is a clinical challenge for even a well-trained hospital team. Efficient, effective treatment must be initiated as life-threatening problems are identified, often without the benefit of a definitive diagnosis. Therapy focuses on maximizing oxygen delivery and oxygen utilization in a hypermetabolic patient by improving gas exchange and blood flow. An algorithmic approach to patient care during a fast-paced, high-stress resuscitation is known to optimize this therapy and to improve outcome. Even with their proven benefit in facilitating patient care, algorithms have inherent limitations that require attention and common sense on the part of the attending clinician. It is true that "trauma can take you anywhere" and even a minor injury, especially if improperly managed, can lead to life-threatening complications and death. No algorithm can include all of trauma and all the possible sequelae without being too difficult for practical application. The algorithms cannot include basic common sense, which, right or wrong, is assumed to be a part of each doctor's decision-making skills. The algorithms are inherently in series, whereas emergency patient care requires the management of complex problems in parallel. The clinician is required to understand the priorities outlined in the algorithms, to have the skill to identify life-threatening problems, to use the appropriate protocol, and to move forward or backward in the protocol when the patient's condition demands a change of focus and priority. The algorithms enhance but are not a substitute for up-to-date medical knowledge, familiarity with anatomy, good clinical skills, and experience. Finally, although these algorithms are based on years of clinical experience, they have not been tested with the appropriate prospective clinical studies needed to generate veterinary outcome statistics. Future modifications in algorithm protocol will be based on such studies.

Bilateral Bell's palsy in a pregnant woman.

Bell's palsy is a peripheral facial palsy of unknown etiology. During pregnancy, there is an increased incidence of idiopathic facial paralysis (Bell's palsy). Nevertheless, bilateral facial paralysis in pregnant woman is a rare phenomenon with only a few case reports in medical literature. We report on a patient with bilateral facial paralysis in pregnancy, with a review of the literature and possible etiologic factors. The patient was treated conservatively and the left facial palsy resolved completely, whereas on the right side there was a residual lesion of facial function. The etiology, treatment and prognosis of Bell's palsy in pregnancy remain controversial.

Osteoma of the internal auditory canal.

Osteomas of the internal auditory canal, inaccesible to clinical examination, are rare lesions. There are only 14 cases of osteomas and exostoses of the internal auditory canal reported in the international medical literature. A patient with an osteoma of the internal auditory canal is presented, along with differential diagnosis and possible etiologic factors for the lesion. The auditory brainsteam evoked response testing showed increased absolute latencies of 1 wave and discrepancy of the wave morphology due to bony compression of the eight nerve in the internal auditory canal. Computed tomography showed a bony growth in the internal auditory canal. Magnetic response showed no abnormalities. No surgery was performed since the symptoms improved by conservative therapy.

Pilocarpine in the prevention of postirradiation xerostomia.

During radiation therapy to the head and neck region, salivary gland hypofunction commonly develops. The aim of our study was to evaluate whether the sialogogue pilocarpine given during radiation therapy may reduce the severity of xerostomia and salivary dysfunction. Our results showed the pilocarpine-treated group to have a lower frequency of oral symptoms during the treatment than the placebo-treated group. Although salivary flow decreased in all patients, the pilocarpine-treated group had smaller flow reductions. No drug effect was observed in the glands that were completely irradiated. Thus, pilocarpine appeared to stimulate salivary tissues outside the radiation field.

Clinical interpretation of brainstem evoked response audiometry abnormalities in cochlear pathology.

This investigation involved 45 patients with sensorineural hearing loss (SNHL): 24 with Meniere's disease, 18 with acoustic trauma, and 3 with SNHL due to ototoxic drugs. They all underwent pure tone audiometry and standard brainstem evoked response audiometry (BERA). In patients without wave I in auditory brainstem response, electrocochelography (ECochG) was performed. The findings are presented showing that cochlear lesions (beside threshold elevation) cause latency prolongation of wave I, III and V relative to normal latencies at the actual click hearing level. At high stimulation levels, this effect is almost completely compensated for by the fact that cochlear recruiting ears exhibit steeper latency-intensity curves than do normal ears. But, at the same time this pathology does not cause latency prolongation of central conduction time (CCT). Beside this, cochlear lesions will cause, in some cases, deterioration of replicability (poor waveform resolution) of waves preceding wave V. In such cases, the authors strongly recommend electrocochleography (ECochG) to make wave I visible, because they think that it is the best way to verify the diagnosis of cochlear lesion using BERA.

The profibrotic cytokine transforming growth factor-ß1 increases endothelial progenitor cell angiogenic properties.

BACKGROUND: Transforming growth factor-ß1 (TGF-ß1) is a profibrotic cytokine that plays a major role in vascular biology, and is known to regulate the phenotype and activity of various vascular cell populations. Because most fibrotic diseases, such as idiopathic pulmonary fibrosis (IPF), are associated with vascular remodeling, and as endothelial progenitor cells (EPCs) may be involved in this process, we investigated the impact of TGF-ß1 modulation of EPC angiogenic properties. METHODS: TGF-ß1 plasma levels were determined in 64 patients with IPF and compared with those in controls. The effect of TGF-ß1 on angiogenesis was studied in vivo in a Matrigel plug model and in vitro on endothelial colony-forming cells (ECFCs). We studied the effects of inhibiting the expression of the three main receptors of TGF-ß1 in ECFCs by using short interfering RNA. RESULTS: Total TGF-ß1 plasma levels were significantly increased in patients with IPF as compared with controls (P < 0.0001). TGF-ß1 had proangiogenic effects in vivo by increasing hemoglobin content and blood vessel formation in Matrigel plugs implanted in C57/Bl6 mice, and in vitro by enhancing ECFC viability and migration. The effects were abolished by silencing the three main TGF-ß1 receptors. CONCLUSIONS: TGF-ß1 is proangiogenic in vivo and induces ECFC angiogenic properties in vitro, suggesting that TGF-ß1 may play a role during vascular remodeling in fibrotic disease states via EPCs.