Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

Provoking factors, including chemicals, in Dutch patients with vitiligo.

BACKGROUND: In vitiligo, many provoking factors have been described, but epidemiological data, especially on the role of contact with chemicals, are scarce. OBJECTIVE: To obtain an insight into the patient-reported factors provoking vitiligo, including contact with chemicals. METHODS: A retrospective cohort study was conducted on all 1264 patients with vitiligo who visited the Netherlands Institute for Pigment disorders from January 2003 to December 2007. Patients for whom an exogenous provoking factor was recorded were sent a questionnaire. Subsequently, patients who mentioned a chemical provoking factor were contacted to elucidate the alleged causal relationship between exposure to the chemical and the onset of vitiligo. RESULTS: A total of 300 out of the 1264 patients indicated that provoking factors had played a role in their disease. Two hundred and forty-six patients were sent a questionnaire, which was returned by 177 (response rate of 72%). Emotional stress was indicated as a provoking factor in 98 patients (55.4%), 51 patients (28.8%) recorded sunburn, 34 patients (19.2%) recorded mechanical factors and 20 patients (11.3%) other factors. Of 29 patients (16.4%) who indicated a chemical factor, a presumed causal relationship could be corroborated in four. The chemicals involved were para-tertiary butylphenol (n = 2), captan (n = 1) and diphencyprone (n = 1). CONCLUSION: The majority of the patients with vitiligo from this study did not mention provoking factors, but the ones who did point to emotional stress in more than half of the cases. Of the 29 patients who assigned chemical provoking factors, solvents were mainly indicated. However, a presumed relationship with the chemical could be corroborated in only four patients.

Effects of cell wall degrading enzymes on carbohydrate fractions and metabolites in stomach and ileum of pigs fed wheat bran based diets.

Pigs were fed diets containing 40% wheat bran incubated with a water: acetic acid mixture (control, C) and a cellulase (Cel-i) or xylanase (Xyl-i) preparation or with addition of the cellulase (Cel-a) or xylanase (Xyl-a) preparation immediately before feeding. Stomach and ileal samples were analysed for pH, osmolality, soluble saccharides, volatile fatty acids (VFA) and lactic acid. Incubation of wheat bran resulted in a small reduction of NDF and an increase in the amount of soluble starch, B-glucans and saccharides (glucose, xylose and arabinose), especially after incubation with the cellulase preparation. Two hours after feeding, significantly higher arabinose and xylose concentrations were present in the stomach for diets Cel-i, Cel-a and Xyl-i. In the ileum xylose and arabinose concentrations were higher 2 to 4 and 6 to 8 hours after feeding the enzyme-treated diets. In stomach and ileum there were no differences between the diets in pH, osmolality, VFA and lactic acid concentrations, but ileal VFA concentration from 4 h after feeding tended to be higher for diets Cel-i and Xyl-i. It can be concluded that the amount of soluble saccharides in stomach and small intestine and the ileal VFA concentration may be increased by cell wall degrading enzyme preparations.

Beta-glucanase and xylanase activities in stomach and ileum of growing pigs fed wheat bran based diets with and without enzyme treatment.

Pigs were fed diets containing 40% wheat bran incubated with a water: acetic acid mixture (control C) and a cellulase (Cel-i) or xylanase (Xyl-i) preparation or with addition of the cellulase (Cel-a) or xylanase (Xyl-a) preparation immediately before feeding. Stomach and ileal samples were analysed for xylanase and beta-glucanase activities by a standard method based on release of reducing substances and a modified method in which the actual pH of the sample was used. After feeding Cel-treated diets xylanase and beta-glucanase activities were higher in the stomach up to 4 hours after feeding. In the stomach the modified method gave significantly lower xylanase activities than the standard method. Ileal xylanase activity was significantly higher 2-6 hours after feeding Xyl-treated diets and ileal beta-glucanase activity was higher 4-6 hours after feeding Cel-treated diets. In ileal samples, the modified method gave significantly higher xylanase and lower beta-glucanase activities than the standard method. It is concluded that xylanase and beta-glucanase activities can be measured in digesta samples with the methods employed and that the added enzymes were largely inactivated between the feedings. Measuring digesta enzyme activities in conditions (pH) similar to the ones in the gastrointestinal tract may give a more reliable picture of the actual activity of added enzymes.

Effects of source of starch on net portal flux of glucose, lactate, volatile fatty acids and amino acids in the pig.

The ileal digestibilities of maize starch and native pea starch do not differ. However maize starch is digested faster than pea starch and the ileal amino acid digestibility of a diet containing pea starch is lower. In the present study, the net portal fluxes of glucose, lactate, volatile fatty acids (VFA) and amino acids were measured for diets including 650 g maize starch or pea starch/kg. The diets were fed at a level 870 kJ digestible energy/kg0.75 twice daily (06.00 and 18.00 hours) to four female pigs in a crossover design. Portal vein blood flow did not differ between maize and pea starches (1620 and 1484 ml/min respectively; SED 100; P = 0.23). For maize starch portal glucose flux was significantly higher during the first 6 h after feeding, was not different 8 h after feeding and was significantly lower thereafter. Net portal glucose flux was higher for maize starch than for pea starch (1759 and 1265 mmol/12 h respectively; SED 182; P = 0.054). Net portal lactate flux was not significantly different between maize and pea starches (36.5 and 67.2 mmol/12 h respectively; SED 24.1; P = 0.27) and net portal VFA flux was lower for maize starch than for pea starch (169 and 218 mmol/12 h respectively; SED 18; P = 0.054). Net portal fluxes of valine, isoleucine, phenylalanine, tryptophan, arginine, serine, cystine, tyrosine, lysine, histidine and the sum of essential amino acids tended to be or were higher (P < 0.1 or P < 0.05) and net portal flux of aspartic acid tended to be lower for pea starch (P < 0.1). It can be concluded that, although ileal digestibility of both starches is equal, the rate of appearance of glucose in the portal vein was higher for maize starch, influencing the net portal flux of amino acids.

Effect of resistant starch on net portal-drained viscera flux of glucose, volatile fatty acids, urea, and ammonia in growing pigs.

Net portal-drained viscera (PDV) flux of glucose, VFA, ammonia, and urea was determined in pigs fed diets with or without resistant starch. Diets consisted of 65% cornstarch (diet CS), 32.5% cornstarch and 32.5% raw potato starch (diet CPS), or 65% raw potato starch (diet PS); the remaining 35% supplied all amino acids, fat, fiber, minerals, and vitamins. The diets contained twice the maintenance requirement for energy and were fed twice daily to four barrows (initial BW 56 kg) in three periods in a crossover design. The pigs were fitted with catheters in a mesenteric vein, a mesenteric-artery, and the portal vein, and net PDV flux was calculated by multiplying portal-arterial concentration differences and corresponding portal vein flow. Net PDV flux of glucose was significantly less after feeding diets CPS and PS, and portal absorption of ileally digested glucose was 89, 66, and 41% for diets CS, CPS, and PS, respectively. Net PDV flux of VFA was lowest after feeding diet CS and three to four times higher after feeding diets CPS and PS. Net PDV flux of ammonia was highest for diet CS and almost halved after feeding diets CPS and PS. There was a small negative net PDV flux of urea for diets CS and CPS, which significantly increased after feeding diet PS. These results suggest that excretion of nitrogen is shifted from urine to feces primarily by reduction of the net PDV flux of ammonia when resistant starch is fed.

Nutrient fluxes in splanchnic tissue of dairy cows: influence of grass quality.

A crossover design was used to investigate the effects of high (450 kg of N/ha) or low (150 kg of N/ha) N fertilization of ryegrass on fermentation and nutrient fluxes in splanchnic tissue of dairy cows fed those grasses. Grass that was fertilized with the high amount of N contained more N and less sugar than did grass that was fertilized with less N. In rumen fluid, the concentration of NH3 N was lower for ryegrass that was fertilized with the low amount of N. The NH3 release by portal-drained viscera and urea synthesis in the liver were higher for cows fed ryegrass that was fertilized with the high amount of N. The concentration of NH3 N in rumen fluid, NH3 N release in portal-drained viscera, urea synthesis in the liver, urea release from the liver, and urea concentrations in milk were highly correlated. The release of acetate and propionate in portal-drained viscera was similar for both grasses and was well correlated with the proportion of volatile fatty acids in rumen fluid. The proportion of butyrate in rumen fluid was closely correlated with the release of butyrate and beta-hydroxybutyrate in portal-drained viscera. Glucose synthesis in the liver indicated gluconeogenesis from amino acids, which corresponded well with urea synthesis in the liver. For the grass fertilized with more N, availability of energy sources for rumen microbes was low, and, therefore, cows did not use the N in that grass efficiently.

Effect of dietary neutral detergent fiber on ileal digestibility and portal flux of nitrogen and amino acids and on nitrogen utilization in growing pigs.

Two experiments were conducted to determine the effects of dietary NDF on apparent ileal and fecal digestibility and portal flux of nitrogen (N) and amino acids, and on N retention in growing pigs. In four equal portions (at 0600, 1200, 1800, and 2400) barrows on Treatment B received a basal diet, based on casein, cornstarch, and dextrose, at a feeding level of 2.6 times energy for maintenance. Barrows on Treatment B+NDF received an additional amount of 15% (wt/wt) of purified wheat bran NDF (pNDF). In Exp. 1, four ileally cannulated barrows (40 to 75 kg) were used in a crossover arrangement comprising two treatments and three periods. The addition of pNDF decreased ileal N digestibility from 94.1 to 88.9% (P < .001), whereas ileal digestibility of most amino acids was 2 to 5.5 percentage units lower (P < .001). Utilization of ileally digested N increased from 64 to 72% with the addition of pNDF, presumably because of the contribution of pNDF to the energy supply. In Exp. 2, three barrows (30 to 54 kg) fitted with catheters in the portal vein and the mesenteric vein and artery were used in a crossover arrangement comprising two treatments and five periods. Portal absorption of nutrients was derived by multiplying the porto-arterial plasma concentration differences by portal vein plasma flow. The pNDF did not significantly affect the absorption of ileally digested amino acids and the portal flux of ammonia and urea. The results showed that addition of NDF reduced amino acid digestibility, but not the portal flux of digested amino acids, and NDF energy presumably improved utilization of ileally digested amino acids.

Free amino acids in plasma and muscle of high yielding dairy cows in early lactation.

Free AA in plasma and muscle were monitored in 36 dairy cows from 2 wk before until 15 wk after parturition. Cows were kept indoors and fed individually. The AA concentrations in plasma from 6 to 15 wk of lactation were compared with precalving concentrations. Plasma concentrations of Met, Phe, Glu, and Gln decreased by 16, 24, 25, and 25%, respectively. The ranking of the essential AA according to their decrease in plasma corresponded to the order in which they generally appear to be limiting for milk protein synthesis. The decrease of Glu and Gln in plasma exceeded that of the essential AA and contrasted strongly with all other nonessential AA. The change in the AA profile in muscle from pregnancy to lactation resembled that described for the catabolic state in mammals and suggests that muscle protein was degraded for supply of AA to the udder, despite excess protein and energy supply 15 wk into lactation. In muscle, the decrease in the pool of free Gln exceeds 25% and is higher than for any other AA. These observations support our hypothesis that Gln is potentially limiting for milk protein synthesis in the high yielding dairy cow.

Occupational contact dermatitis due to acrylonitrile.

Within DSM Chemicals BV, a producer of acrylonitrile, skin complaints are frequent. The majority of these are of an irritant nature, while a smaller portion is based on acquired allergies. Allergological examination revealed 5 employees with an allergy to acrylonitrile. 1 of these subjects also developed paraesthesiae in the skin sites affected, a finding not previously described for acrylonitrile. In the guinea pig maximization test (GPMT), acrylonitrile showed strong allergenic potential. For prevention and treatment of contact allergologic disorders, close cooperation between occupational health officer, dermatologist and toxicologist in chemical companies is recommended.