Exposure to Bioaerosols During Fish Processing on Board Norwegian Fishing Trawlers.

OBJECTIVES: The main objective was to gain more knowledge on exposure to bioaerosols in the processing area on board fishing trawlers. METHODS: Exposure sampling was carried out during the work shifts when processing fish in the processing area on board five deep-sea fishing trawlers (trawlers 1-5). Exposure samples were collected from 64 fishermen breathing zone and from stationary sampling stations on board five deep-sea fishing trawlers (1-5). Trawlers 2, 3, and 4 were old ships, not originally built for on board processing of the catch. Trawlers 1 and 5 were relatively new and built to accommodate processing machineries. On trawlers 1-4 round fish was produced; the head and entrails were removed before the fishes were frozen in blocks. Trawler 5 had the most extensive processing, producing fish fillets. Samples were analysed for total protein, trypsin activity, parvalbumin, and endotoxin. One side analysis of variance and Kruskal-Wallis H test were used to compare levels of exposure on the different trawlers. RESULTS: Personal exposure to total protein were higher on the three oldest trawlers (2, 3, and 4) compared with the two new trawlers (1 and 5). Highest activity of trypsin was detected on the four trawlers producing round fish (1-4). Parvalbumin was detected in 58% of samples from the fillet-trawler (5) compared with 13% of samples from the four trawlers producing round fish. The highest level of endotoxin was detected when using high-pressure water during cleaning machines and floors in the processing area. CONCLUSIONS: Fishermen in the processing area on board Norwegian trawlers are exposed to airborne bioaerosols as proteins, trypsin, fish allergen parvalbumin, and endotoxin. Levels varied between trawlers and type of production.

Occupational Allergic Sensitization Among Workers Processing King Crab (Paralithodes camtschaticus) and Edible Crab (Cancer pagurus) in Norway and Identification of Novel Putative Allergenic Proteins.

Introduction: Asthma and allergy occur frequently among seafood processing workers, with the highest prevalence seen in the crustacean processing industry. In this study we established for the first time the prevalence of allergic sensitization in the Norwegian king- and edible crab processing industry and characterized the IgE-reactive proteins. Materials and Methods: Two populations of crab processing workers participated; 119 king crab and 65 edible crab workers. The investigation included information on work tasks and health through a detailed questionnaire. Allergic sensitization was investigated by crab-specific IgE quantification and skin prick tests (SPT) to four in-house prepared crab extracts; raw meat, cooked meat, raw intestines and raw shell. Allergen-specific IgE binding patterns were analyzed by IgE immunoblotting to the four allergen extracts using worker serum samples. Total proteins in crab SPT extracts and immunoblot-based IgE binding proteins were identified by mass spectrometric analysis. Results: Positive SPTs were established in 17.5% of king- and 18.1% of edible crab workers, while elevated IgE to crab were demonstrated in 8.9% of king- and 12.2% of edible crab processing workers. There was no significant difference between the king and edible crab workers with respect to self-reported respiratory symptoms, elevated specific IgE to crab or SPT results. Individual workers exhibited differential IgE binding patterns to different crab extracts, with most frequent binding to tropomyosin and arginine kinase and two novel IgE binding proteins, hemocyanin and enolase, identified as king- and edible crab allergens. Conclusions: Occupational exposure to king- and edible crabs may frequently cause IgE mediated allergic sensitization. Future investigations addressing the diagnostic value of crab allergens including tropomyosin and arginine kinase and the less well-known IgE-binding proteins hemocyanin and enolase in a component-resolved diagnostic approach to crab allergy should be encouraged.

Prolonged epileptiform EEG runs are associated with persistent seizures in juvenile myoclonic epilepsy.

OBJECTIVE: In juvenile myoclonic epilepsy (JME), various EEG characteristics have been suggested as poor prognostic signs, but their significance is unclear. The aim of this study was to assess the influence of EEG variables on seizure and psychosocial outcome after a follow-up exceeding 20 years. METHODS: 396 EEG recordings were available for assessment in 40 patients (42 complete digital, 330 paper segments and 24 written reports only). Mean follow-up was 31 years (range 20-68). The number of EEGs per patient ranged from 2 to 23 (mean 9). Twenty-one patients were in remission for >5 years, whereas 19 had persistent seizures. Favorable psychosocial outcome was found in 14 of 37. EEGs were retrospectively categorized into four main groups; normal, slowing, epileptiform discharges or both slowing and epileptiform discharges, with further sub-classification. Hyperventilation and photoparoxysmal responses were also evaluated. Scoring of EEG findings was blinded to seizure and psychosocial outcome. RESULTS: Significant associations were found between poor seizure control and prolonged ≥3s epileptiform runs, p=0.03 (8/19 vs 2/21), long ≥3s photoparoxysmal runs, p=0.04 (6/19 vs 1/21) and long ≥3s hyperventilation-induced epileptiform runs, p=0.02 (5/19 vs 0/21). The strongest association between persistent seizures and EEG was found when all epileptiform runs ≥3s were combined (p=0.007), with a positive predictive value equal to 79% and a negative predictive value equal to 69%. Fast (4-5c/s) spike-wave runs were also more frequent in patients with persistent seizures compared to the remission group, p=0.04 (9/19 vs 3/21). Other epileptiform elements occurred equally in the two prognostic groups. Psychosocial outcome was not influenced by EEG findings. Prolonged runs within 6 months from first recording did also predict clinical outcome, p=0.03; (8/19 vs 2/21), with a positive predictive value equal to 80% and a negative predictive value equal to 63%. SIGNIFICANCE: Fast spike-wave runs and prolonged (≥3s) epileptiform runs, including photoparoxysmal and hyperventilation-induced runs were associated with persistent seizures in JME. Focal EEG abnormalities were not associated with clinical outcome. Conceivably, the duration of epileptiform bursts reflects the degree of deficient intracortical inhibition. Prolonged runs may represent an essential predictive feature for poor seizure control in JME.

Lung function and prevalence of respiratory symptoms in Norwegian crab processing workers.

BACKGROUND: Seafood processing workers have an increased risk of developing occupational asthma. This has not been studied among Norwegian crab processing workers, nor has the respiratory health of exposed workers been compared to a control group. OBJECTIVES: Assessing the impact of working in the crab processing industry on workers' respiratory health. DESIGN: A cross-sectional study of the respiratory health in two types of crab processing workers compared to a control group. METHODS: The study included 148 king crab (Paralithodes camtschaticus) workers, 70 edible crab (Cancer pagurus) workers and 215 controls. Workers answered a questionnaire and performed spirometry measurements. χ2 and Fishers exact tests were performed on self-reported respiratory symptoms. Regression analyses and t-tests were used to assess lung function values. RESULTS: Self-reported respiratory symptoms were higher among crab processing workers compared to controls, and higher among king crab workers compared to edible crab workers. There was no significant difference between crab processing workers and controls in lung function measurements. Self-reported doctor-diagnosed asthma prevalence was highest in the control group. CONCLUSIONS: Increased respiratory symptoms reported by crab processing workers were not reflected in impaired lung function values or asthma diagnose. We suggest a healthy worker effect among crab processing workers in Norway.

Occupational Exposure to Bioaerosols in Norwegian Crab Processing Plants.

INTRODUCTION: Aerosolization of components when processing king crab (Paralithodes camtschaticus) and edible crab (Cancer pagurus) may cause occupational health problems when inhaled by workers. METHODS: A cross-sectional study was carried out in three king crab plants and one edible crab plant. Personal exposure measurements were performed throughout work shifts. Air was collected for measurement of tropomyosin, total protein, endotoxin, trypsin, and N-acetyl-ß-d-glucosaminidase (NAGase). T-tests and ANOVAs were used to compare the levels of exposure in the different plants and areas in the plants. RESULTS: Total protein and tropomyosin levels were highest in the edible crab plant, endotoxin levels were highest in king crab plants. King crab exposure levels were highest during raw processing. Tropomyosin levels were highest during raw king crab processing with geometric mean (GM) 9.6 versus 2.5ng m(-3) during cooked processing. Conversely, edible crab tropomyosin levels were highest during cooked processing with GM 45.4 versus 8.7ng m(-3) during raw processing. Endotoxin levels were higher in king crab plants than in the edible crab plant with GM = 6285.5 endotoxin units (EU) m(-3) versus 72 EU m(-3). In the edible crab plant, NAGase levels were highest during raw processing with GM = 853 pmol4-methylumbelliferone (MU) m(-3) versus 422 pmol4-MU m(-3) during cooked processing. Trypsin activity was found in both king crab and edible crab plants and levels were higher in raw than cooked processing. Differences in exposure levels between plants and worker groups (raw and cooked processing) were identified. CONCLUSIONS: Norwegian crab processing workers are exposed to airborne proteins, tropomyosin, endotoxins, trypsin, and NAGase in their breathing zone. Levels vary between worker groups and factories.

Efectividad de distintas técnicas de activación en la remoción de medicación de hidróxido de calcio de las paredes radiculares / Effectiveness of different activation techniques in the removal of calcium hydroxide medication from root canal walls

Objetivos: Investigar distintos protocolos de irrigación y soluciones para la remoción de hidróxido de calcio de las paredes radiculares mediante Microscopía Electrónica de Barrido (MEB). Metodología: Se seleccionó una muestra de 48 raíces palatinas de molares superiores. Los conductos fueron instrumentados, irrigados, secados y obturados con medicación a base de hidróxido de calcio. Los dientes fueron aleatoriamente asignados en 6 grupos, dependiendo de la técnica utilizada para activar hipoclorito sódico y Smear Clear para la remoción de la medicación intraconducto: Grupo 1, Irrigación positiva con jeringa (P), Grupo 2, Irrigación Ultrasónica (UI), Grupo 3, Irrigación por presión apical negativa (ANP), Grupo 4: Irrigación ultrasónica pasiva e irrigación por presión apical negativa (UI + ANP). Se incluyeron dos grupos control: Grupo 5: Grupo control positivo (C+), que fue obturado con hidróxido de calcio, pero no se eliminó del conducto, y Grupo 6: Grupo control negativo (C-), que no fue obturado con hidróxido de calcio. Todos los conductos fueron observados con microscopio electrónica de barrido (MEB). Se evaluó la presencia de material residual usando un sistema de medición en los tercios apical, medio y coronal. Los resultados fueron analizados estadísticamente mediante los test de Kruskal-Wallis y Bonferroni (p < 0,05). Resultados: Se encontraron diferencias estadísticamente significativas entre todos los grupos en todos los tercios a estudio (p < 0,05). El uso combinado de UI y ANP resultó en una remoción más eficiente de hidróxido de calcio de las paredes radiculares, independientemente del área analizada. Conclusiones: La utilización de irrigación ultrasónica pasiva e irrigación por presión apical negativa como activación final, sugiere una mejor limpieza de los conductos. Ninguna técnica es capaz de remover completamente el hidróxido de calcio de las paredes radiculares

Aim: To investigate different irrigation protocols and solutions to remove Ca(OH)2 from the root canal walls by using Scanning Electron Microscopy (SEM). Methodology. Forty-eight palatal roots from upper molars were selected. The root canals were instrumented, irrigated, dried and filled with a calcium hydroxide medication. Teeth were then randomly assigned to one of 6 groups depending on which technique was used to activate NaOCl and Smear Clear irrigants to remove medication: Group 1, Positive syringe irrigation (P); Group 2, Ultrasonic Irrigation (UI); Group 3, Apical Negative Pressure irrigation (ANP); Group 4, Passive Ultrasonic Irrigation and Apical Negative Pressure irrigation (UI + ANP). 2 control groups were also included: Group 5, positive control (C+), which were filled with calcium hydroxide that was not removed from the canal and Group 6, negative controls (C-), which were not filled with calcium hydroxide. All root canals were observed through SEM. Presence of residual material was evaluated using a score system for the coronal, middle, and apical portions. Data were statistically analysed using the Kruskal-Wallis and Bonferroni tests (P < 0.05). Results. There was a statistically significant difference among all groups at all root levels (P < 0.05). The combined use of UI and ANP irrigation resulted more efficient in the removal of calcium hydroxide from the root canal walls, irrespective of the area analyzed. Conclusions. The use of passive ultrasonic irrigation and apical negative pressure as a final activation is suggested to improve cleaning of the root canals. No technique is able to completely remove calcium hydroxide dressing from the root canal walls

Molecular and immunological approaches in quantifying the air-borne food allergen tropomyosin in crab processing facilities.

Tropomyosin is a cross-reactive allergenic protein present in ingested shellfish species. Exposure and sensitization to this protein via inhalation is particularly important in the crustacean processing industry where workers are continuously exposed to the aerosolized form of this allergen. The aim of this study was to develop an antibody-based immunoassay to enable the specific and sensitive quantification of aerosolized tropomyosin present in the environment of two crab processing facilities. Anti-tropomyosin antibody was generated in rabbits against tropomyosins from four different crustacean species. These antibodies were purified using recombinant tropomyosin using an immuno-affinity column. The recombinant tropomyosin was also used as an allergen standard for the sandwich ELISA. In order to quantify aerosolized tropomyosin, air collection was performed in the personal breathing zone of 80 workers during two crab processing activities, edible crab (Cancer pagurus) and king crab (Paralithodes camtschaticus) using polytetrafluoroethylene filters. The purified antibody was able to detect tropomyosin selectively from different crustaceans but not from vertebrate sources. The limit of detection (LOD) for the developed sandwich ELISA was 60 picogram/m(3) and limit of quantitation (LOQ) 100 picogram/m(3). Immunoassay validation was based on linearity (R(2) 0.999), matrix interference test (78.8±6.5%), intra-assay CV (9.8%) and inter-assay CV (11%). The novel immunoassay was able to successfully identify working activities, which generated low, medium or high concentrations of the aerosolized food allergen. We describe an IgG antibody-based immunoassay for quantification of the major food allergen tropomyosin, with high sensitivity and specificity. This modified immunological approach can be adapted for the detection of other aerosolized food allergens, assisting in the identification of high-risk allergen exposure areas in the food industry.

Clinical heterogeneity of juvenile myoclonic epilepsy: follow-up after an interval of more than 20 years.

PURPOSE: The view that juvenile myoclonic epilepsy (JME) is a uniform and life-long disorder is currently being challenged. The aim of this study was to assess the seizure and psychosocial outcome of JME at least 20 years after onset. METHODS: In 1992, 42 patients with JME were identified. In 2012, 37 agreed to a semi-structured interview. In the remaining five, only medical records were available. RESULTS: Of 40 patients with known seizure outcome, 21 were in remission for >5 years. Seven were off antiepileptic drugs (AEDs), four being seizure free for >10 years. Myoclonic seizures (MC) evolving to generalized tonic-clonic seizures (GTC) were associated with seizure persistence (p=0.013), whereas >1 year between MC and GTC onset was associated with a trend to GTC remission (p=0.069). Of 19 patients with uncontrolled seizures, eight experienced remission with second generation AEDs. Favorable psychosocial outcome by interview was found in a third, whereas another third had psychiatric comorbidity, seven with substance or alcohol abuse. Psychosocial and seizure outcome did not correlate. CONCLUSION: This study corroborates the heterogeneity of JME in terms of seizure and psychosocial outcome, but without a clear association between the two. It confirms that seizure control may persist after AED withdrawal in some and supports MC evolving to GTC as a predictor of seizure persistence. Moreover, it suggests that newer broad spectrum AEDs may improve the prognosis of JME; their impact should be focus of prospective studies.

Cross-sectional associations between prevalent vertebral fracture and pulmonary function in the sixth Tromsø study.

BACKGROUND: Persons with vertebral fracture may have reduced pulmonary function, but this association has not been much studied. The aim of this cross-sectional study was therefore to examine the relationship between vertebral fracture and pulmonary function in a general, elderly population. METHODS: Vertebral morphometry was used for vertebral fracture assessment in 2132 elderly men (n = 892) and women (n = 1240) aged 55 to 87 years in the population-based Tromsø Study 2007-08. Pulmonary function was examined by spirometry. Pulmonary function was expressed as FVC% predicted, FEV1% predicted, and FEV1/FVC% predicted values, adjusted FVC, FEV1, and FEV1/FVC, and obstructive and restrictive ventilatory impairment. Vertebral fracture was classified according to appearance, number, severity, and location of fractures. Associations were analyzed using general linear and logistic models. RESULTS: FVC% predicted and FEV1% predicted values were not associated with vertebral fracture (P > 0.05), whereas FEV1/FVC% predicted ratio was associated with both prevalent fracture, number of fractures, severity of fractures, and fracture site in men (P < 0.05), but not in women. When FVC, FEV1, and FEV1/FVC values were adjusted for multiple covariates, we found no significant association with vertebral fracture. Obstructive and restrictive ventilatory impairment was not associated with prevalent vertebral fracture. CONCLUSIONS: In conclusion, this study did not confirm any clinically relevant associations between prevalent vertebral fracture and ventilatory impairment in elderly individuals.