Trace and Major Element Concentrations in Cadaveric Lung Tissues from World Trade Center Health Registry Decedents and Community Controls.

Studies of the health impacts of the 11 September 2001 terrorist attacks on New York City's (NYC's) World Trade Center (WTC) towers have been hindered by imprecise estimates of exposure. We sought to identify potential biomarkers of WTC exposure by measuring trace and major metal concentrations in lung tissues from WTC-exposed individuals and less exposed community controls. We also investigated associations of lung tissue metal concentrations with self-reported exposure and respiratory symptoms. The primary analyses contrasted post-mortem lung tissue concentrations obtained from autopsies in 2007-2011 of 76 WTC Health Registry (WTCHR) enrollees with those of 55 community controls. Community controls were frequency-matched to WTCHR decedents by age at death, calendar quarter of death, gender, race, ethnicity and education and resided at death in NYC zip codes less impacted by WTC dust and fumes. We found WTCHR decedents to have significantly higher iron (Fe) lung tissue concentrations than community controls. Secondary analyses among WTCHR decedents adjusted for sex and age showed the log(molybdenum (Mo)) concentration to be significantly associated with non-rescue/recovery exposure. Post hoc analyses suggested that individuals whose death certificates listed usual occupation or industry as the Sanitation or Police Departments had elevated lung tissue Fe concentrations. Among WTCHR decedents, exposure to the WTC dust cloud was significantly associated with elevated lung tissue concentrations of titanium (Ti), chromium (Cr) and cadmium (Cd) in non-parametric univariable analyses but not in multivariable analyses adjusted for age and smoking status. Logistic regression adjusted for age and smoking status among WTCHR decedents showed one or more respiratory symptoms to be positively associated with log (arsenic (As)), log(manganese (Mn)) and log(cobalt (Co)) concentrations, while new-onset wheezing and sinus problems were negatively associated with log(Fe) concentration. Fe concentrations among individuals with wheezing, nonetheless, exceeded those in community controls. In conclusion, these data suggest that further research may be warranted to explore the utility as biomarkers of WTC exposure of Fe in particular and, to a lesser extent, Mo, Ti, Cr and Cd in digestions of lung tissue.

Long-term effects of carvedilol or metoprolol on left ventricular function in ischemic and nonischemic cardiomyopathy.

Data regarding the effects of beta blockers on left ventricular (LV) function after 12 months are scarce in ischemic and nonischemic cardiomyopathy. Echocardiograms of 72 patients with ischemic and nonischemic cardiomyopathy, who were free of clinical events susceptible to alter LV function while receiving carvedilol or metoprolol for at least 24 months, were prospectively reanalyzed. Twelve months after beta-blocker initiation, LV ejection fraction (EF) increased by > or = 5% in 75% of patients, whereas EF failed to increase by 5% or decreased in the remaining 25%. Over the subsequent 32 months, LVEF increased further in patients who had experienced an initial EF increase by > or = 5%, whereas EF tended to further decrease in patients who had experienced an initial EF increase of <5% or a decrease. Thus, the benefits of carvedilol or metoprolol on LV function are long lasting in patients with ischemic or nonischemic cardiomyopathy who are free of events susceptible to alter LV function while receiving beta blockade.