Impaired kidney function among young healthcare workers with long working hours and night work.

OBJECTIVES: We aimed to evaluate the association between long working hours, night work, and estimated glomerular filtration rate (eGFR) among young healthcare workers. METHODS: We conducted a retrospective cohort study among healthcare workers in a tertiary medical center in Taiwan from 2002 to 2021. Other than physicians, all hospital employees aged 20-65 years with documented yearly working hours and an annual blood test including creatinine were eligible. We excluded participants with eGFR <60 ml/min/1.73 m2 and proteinuria at enrollment to focus on early renal impairment. Total working hours, night working hours, and eGFR in each year were collected. We assessed the relationship of total working hours and night and non-night working hours with eGFR using the generalized linear mixed model, adjusting for demographic, comorbidities, and laboratory profiles. RESULTS: The study included 10 677 participants with a mean age of 27.2 (standard deviation 7.1) years. The mean follow-up duration was 6.2 years. For every 10-hour increase in total weekly working hours, the eGFR decreased by 0.86 [95% confidence interval (CI) 0.61-1.11] ml/min/1.73 m2. For every 10-hour increase in weekly night working hours, the eGFR decreased by 0.25 (95% CI 0.07-0.42) ml/min/1.73 m2. In stratified analysis, the negative associations between total working hours and eGFR remained in the subgroups of individuals aged <40 years and those without hypertension or diabetes, with a P-value for interaction of <0.05. CONCLUSIONS: Longer working hours and night work were associated with lower eGFR among healthcare workers.

Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey.

BACKGROUND: It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities. METHODS: We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms. RESULTS: The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (ß1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced. CONCLUSIONS: The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

Environmental asbestos exposure from nephrite jade mining and lung cancer.

BACKGROUND: Nephrite is an asbestos mineral composed of tremolite and actinolite. Fengtian is a community where nephrite was mined between 1970 and 1980 and asbestos was mined between 1960 and 1985. The lung cancer risk to the surrounding community is unknown. AIMS: To analyse the trend of lung cancer caused by environmental contamination from nephrite mining. METHODS: We conducted a field survey of nephrite mines and tracked new cases of lung cancer from 1980 to 2019. We calculated the age-standardized incidence rates (ASIRs) and applied join-point regression to examine the lung cancer trend. We assessed the age effect, period effect, and birth cohort effect on lung cancer risk. RESULTS: The nephrite mines were contaminated with chrysotile and tremolite/actinolite asbestos. A total of 278 new cases of lung cancer were reported during the study period. There was an apparent age effect and a slight period effect for lung cancer. After adjustment for the age and period effects, the birth cohort born between 1970 and 1980 during the period of nephrite mass production had the highest relative risk compared with other birth cohorts. The ASIR of lung cancer increased significantly from 1980 to 2010 (the annual percentage change = 6.8 %, 95 % CI: 4.0-9.7 %, P < 0.01) and then decreased 30 years after the cessation of nephrite jade mining. CONCLUSIONS: Nephrite mining increases the risk of lung cancer in nearby communities.

Advancing accuracy in breath testing for lung cancer: strategies for improving diagnostic precision in imbalanced data.

BACKGROUND: Breath testing using an electronic nose has been recognized as a promising new technique for the early detection of lung cancer. Imbalanced data are commonly observed in electronic nose studies, but methods to address them are rarely reported. OBJECTIVE: The objectives of this study were to assess the accuracy of electronic nose screening for lung cancer with imbalanced learning and to select the best mechanical learning algorithm. METHODS: We conducted a case‒control study that included patients with lung cancer and healthy controls and analyzed metabolites in exhaled breath using a carbon nanotube sensor array. The study used five machine learning algorithms to build predictive models and a synthetic minority oversampling technique to address imbalanced data. The diagnostic accuracy of lung cancer was assessed using pathology reports as the gold standard. RESULTS: We enrolled 190 subjects between 2020 and 2023. A total of 155 subjects were used in the final analysis, which included 111 lung cancer patients and 44 healthy controls. We randomly divided samples into one training set, one internal validation set, and one external validation set. In the external validation set, the summary sensitivity was 0.88 (95% CI 0.84-0.91), the summary specificity was 1.00 (95% CI 0.85-1.00), the AUC was 0.96 (95% CI 0.94-0.98), the pAUC was 0.92 (95% CI 0.89-0.96), and the DOR was 207.62 (95% CI 24.62-924.64). CONCLUSION: Electronic nose screening for lung cancer is highly accurate. The support vector machine algorithm is more suitable for analyzing chemical sensor data from electronic noses.

Heat exposure and chronic kidney disease: a temporal link in a Taiwanese agricultural county.

Heat stress-related kidney injury has drawn public health attention. This study explored the temporal relationships between impaired kidney function and preceding outdoor heat exposure Taiwan. Data of participants collected through a health screening program was used to assess the association between chronic kidney disease (CKD) and average ambient temperature with various time lag structures. A total of 1,243 CKD cases and 38,831 non-CKD participants were included in the study. After adjusting for demographic, socioeconomic, lifestyle factors, and comorbidities, CKD was positively associated with the ambient temperature within 1-9 months. The 9-month average ambient temperature yielded the highest odds ratio of CKD (OR = 1.22; 95% CI = 1.09-1.37). Furthermore, females and farmers were found to be more vulnerable to CKD risk after outdoor heat exposure. These findings suggest that the prevention of heat stress-related kidney injury should consider relevant time frames and focus on vulnerable populations.

Chronic Kidney Disease Among Agricultural Workers in Taiwan: A Nationwide Population-Based Study.

Introduction: Chronic kidney disease (CKD) in agricultural communities is a significant public health issue. We aimed to investigate the epidemiology of CKD among Taiwanese farmers and its association with outdoor heat exposure. Methods: A nested case-control study was conducted on participants in the National Adult Health Examination (NAHE) from 2012 to 2018. The farming occupation was identified through National Health Insurance data. The primary outcomes of interest were the development of CKD, defined as a decreased estimated glomerular filtration rate (eGFR) with diagnosis by physicians, and CKD of undetermined etiology (CKDu), defined as CKD excluding common traditional etiologies. We calculated the county-wide average ambient temperature from a climate reanalysis dataset (ERA5-Land). All CKD cases were matched 1:2 to non-CKD participants by age and biological sex. We estimated the odds ratios (ORs) of CKD and CKDu for farmers and changes in mean ambient temperature (°C) before the examination. Results: We identified 844,412 farmers and 3,750,273 nonfarmers. Among 24.9% of farmers and 7.4% of nonfarmers with reduced kidney function, only 1 in 7 received a diagnosis of CKD. The farming occupation was independently predictive of CKDu (OR = 1.09, 95% confidence interval [CI] = 1.001-1.18) but not CKD. Increased ambient temperature (°C) was associated with a higher risk of CKD (OR = 1.023, 95% CI = 1.017-1.029), with particularly strong associations observed among middle-aged participants and diabetics. Conclusions: Taiwanese farmers might have a higher risk of developing CKDu. Outdoor heat exposure is associated with the development of CKD, and middle-aged participants and those with diabetes are more vulnerable than the general population.

Relationship of long working hours and night shift working hours with incident diabetes: a retrospective cohort study in Taiwan.

PURPOSE: The relationship among long working hours, night shift working hours, and diabetes is still unclear. We aimed to evaluate the association of long working hours and night shift working hours with diabetes among health care workers. METHODS: We conducted a retrospective cohort study among health care workers in a tertiary medical center in Taiwan from 2002 to 2019. We compared the risk of diabetes among tertiles of total working hours (35-41, 42-45, and ≥46 h per week) and evaluated the relationship between long working hours and diabetes risk. We divided participants into three work patterns: day work only, evening shift workers, and night shift workers. In night shift workers, we further evaluated night shift working hours and incident diabetes using tertiles of night shift working hours (<17, 17-45, and ≥46 h per month). We estimated hazard ratios and 95% confidence intervals for incident diabetes using multivariable Cox proportional hazards models. RESULTS: The study included 7081 participants. There were 301 incident cases of diabetes during 52,454 person-years. The adjusted hazard ratio (95% confidence interval) for participants who worked greater than or equal to 46 working hours per week was 3.45 (1.27, 9.39) compared with those who worked 35-41 hours. Compared with night shift workers who worked less than 17 h, the adjusted hazard ratios (95% confidence interval) for those who worked 17-45 and ≥46 night shift working hours per month were 2.26 (1.08, 4.75) and 2.60 (1.27, 5.33), respectively. CONCLUSIONS: Long working hours and night shift working hours increased the risk of diabetes.

Extreme temperature increases the risk of stillbirth in the third trimester of pregnancy.

Epidemiological studies have reported the association between extreme temperatures and adverse reproductive effects. However, the susceptible period of exposure during pregnancy remains unclear. This study aimed to assess the impact of extreme temperature on the stillbirth rate. We performed a time-series analysis to explore the associations between temperature and stillbirth with a distributed lag nonlinear model. A total of 22,769 stillbirths in Taiwan between 2009 and 2018 were enrolled. The mean stillbirth rate was 11.3 ± 1.4 per 1000 births. The relative risk of stillbirth due to exposure to extreme heat temperature (> 29 °C) was 1.18 (95% CI 1.11, 1.25). Pregnant women in the third trimester were most susceptible to the effects of extreme cold and heat temperatures. At lag of 0-3 months, the cumulative relative risk (CRR) of stillbirth for exposure to extreme heat temperature (29.8 °C, 97.5th percentile of temperature) relative to the optimal temperature (21 °C) was 2.49 (95% CI: 1.24, 5.03), and the CRR of stillbirth for exposure to extreme low temperature (16.5 °C, 1st percentile) was 1.29 (95% CI: 0.93, 1.80). The stillbirth rate in Taiwan is on the rise. Our findings inform public health interventions to manage the health impacts of climate change.

Aristolochic acid and the risk of cancers in patients with type 2 diabetes: Nationwide population-based cohort study.

BACKGROUND: Both aristolochic acid (AA) exposure and diabetic can increase risk of certain cancers,whetherAAexposureincreases cancer risk in diabetic patientsisunknown. The purpose of this study was to investigate the association between the use of Chinese herbal products containing AA and the risk of cancer in diabetic patients. METHODS: A cohort study was conducted using the National Health Insurance Research Database in Taiwan. Patients older than 18 years who were diagnosed with diabetes between 1997 and 2010 were enrolled in our cohort. The use of Chinese herbal products containing AA was recorded from the beginning of 1997 until the ban of herbs containing AA in November 2003. Patients were individually tracked to identify cancer incidence between 1997 and 2013. Only patients who visited traditional Chinese medicine clinics between 1997 and 1 year before the end of follow-up were included in the cohort to ensure comparability. Cox proportional hazards regression was used to calculate the hazard ratio for the association between the use of Chinese herbal products containing AA and the occurrence of cancer. RESULTS: Among the 430 377 male and 431 956 female patients with diabetes enrolled in our cohort, 37 554 and 31 535 cancer diagnoses were recorded during the study period, respectively. The use of AA-containing herbal products was associated with a significantly higher risk of liver, colorectum, kidney, bladder, prostate, pelvis, and ureter cancer in a dose-dependent manner. An increased risk of extrahepatic bile duct cancer in women was also associated with AA exposure at doses of more than 500 mg. CONCLUSIONS: Association between AA exposure and the risk of some cancers were found in this study. AA exposure might increase risk of kidney,bladder,pelvis, ureter,liver,colorectum,andprostatecancer in all patientsandextrahepatic bile duct cancerin women.

Indoor Air Pollution Increases the Risk of Lung Cancer.

(1) Background: Cooking and burning incense are important sources of indoor air pollutants. No studies have provided biological evidence of air pollutants in the lungs to support this association. Analysis of pleural fluid may be used to measure the internal exposure dose of air pollutants in the lung. The objective of this study was to provide biological evidence of indoor air pollutants and estimate their risk of lung cancer. (2) Methods: We analyzed 14 common air pollutants in the pleural fluid of 39 cases of lung adenocarcinoma and 40 nonmalignant controls by gas chromatography-mass spectrometry. (3) Results: When we excluded the current smokers and adjusted for age, the adjusted odds ratios (ORs) were 2.22 (95% confidence interval CI = 0.77-6.44) for habitual cooking at home and 3.05 (95% CI = 1.06-8.84) for indoor incense burning. In females, the adjusted ORs were 5.39 (95% CI = 1.11-26.20) for habitual cooking at home and 6.01 (95% CI = 1.14-31.66) for indoor incense burning. In pleural fluid, the most important exposure biomarkers for lung cancer were naphthalene, ethylbenzene, and o-xylene. (4) Conclusions: Habitual cooking and indoor incense burning increased the risk of lung adenocarcinoma.

Accuracy of the Electronic Nose Breath Tests in Clinical Application: A Systematic Review and Meta-Analysis.

(1) Background: An electronic nose applies a sensor array to detect volatile biomarkers in exhaled breath to diagnose diseases. The overall diagnostic accuracy remains unknown. The objective of this review was to provide an estimate of the diagnostic accuracy of sensor-based breath tests for the diagnosis of diseases. (2) Methods: We searched the PubMed and Web of Science databases for studies published between 1 January 2010 and 14 October 2021. The search was limited to human studies published in the English language. Clinical trials were not included in this review. (3) Results: Of the 2418 records identified, 44 publications were eligible, and 5728 patients were included in the final analyses. The pooled sensitivity was 90.0% (95% CI, 86.3-92.8%, I2 = 47.7%), the specificity was 88.4% (95% CI, 87.1-89.5%, I2 = 81.4%), and the pooled area under the curve was 0.93 (95% CI 0.91-0.95). (4) Conclusion: The findings of our review suggest that a standardized report of diagnostic accuracy and a report of the accuracy in a test set are needed. Sensor array systems of electronic noses have the potential for noninvasiveness at the point-of-care in hospitals. Nevertheless, the procedure for reporting the accuracy of a diagnostic test must be standardized.

The investigation of the volatile metabolites of lung cancer from the microenvironment of malignant pleural effusion.

For malignant pleural effusions, pleural fluid cytology is a diagnostic method, but sensitivity is low. The pleural fluid contains metabolites directly released from cancer cells. The objective of this study was to diagnose lung cancer with malignant pleural effusion using the volatilomic profiling method. We recruited lung cancer patients with malignant pleural effusion and patients with nonmalignant diseases with pleural effusion as controls. We analyzed the headspace air of the pleural effusion by gas chromatography-mass spectrometry. We used partial least squares discriminant analysis (PLS-DA) to identify metabolites and the support vector machine (SVM) to establish the prediction model. We split data into a training set (80%) and a testing set (20%) to validate the accuracy. A total of 68 subjects were included in the final analysis. The PLS-DA showed high discrimination with an R2 of 0.95 and Q2 of 0.58. The accuracy of the SVM in the test set was 0.93 (95% CI 0.66, 0.998), the sensitivity was 83%, the specificity was 100%, and kappa was 0.85, and the area under the receiver operating characteristic curve was 0.96 (95% CI 0.86, 1.00). Volatile metabolites of pleural effusion might be used in patients with cytology-negative pleural effusion to rule out malignancy.

Epidemiology of chronic kidney disease of undetermined aetiology in Taiwanese farmers: a cross-sectional study from Changhua Community-based Integrated Screening programme.

OBJECTIVES: Chronic kidney disease of undetermined or non-traditional aetiology (CKDu or CKDnT) has been reported in Mesoamerica among farmers under heat stress. Epidemiological evidence was lacking in Asian countries with similar climatic conditions. The objective of this study was to investigate the prevalence of CKDu and possible risk factors. METHODS: We used the data from the Changhua Community-based Integrated Screening programme from 2005 to 2014, which is the annual screening for chronic diseases in Taiwan's largest rice-farming county since 2005. Our study population included farmers and non-farmers aged 15-60 years. CKDu was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 at age under 60 years without hypertension, diabetes, proteinuria, haematuria or using Chinese herbal medicine. We estimated the adjusted prevalence OR (POR) of CKDu by farmers, age, sex, education, urbanisation, smoking, body mass index, hyperuricaemia, hyperlipidaemia, heart disease and chronic liver disease. RESULTS: 5555 farmers and 35 761 non-farmers were included in this study. CKDu accounted for 48.9% of all CKD cases. The prevalence of CKDu was 2.3% in the farmers and 0.9% in the non-farmers. The crude POR of CKDu in farmers compared with non-farmers was 2.73 (2.13-3.50), and the adjusted POR was 1.45 (1.10-1.90). Dehydration (blood urea nitrogen-to-creatinine ratio >20) was found in 22% of the farmers and 14% of the non-farmers. CONCLUSIONS: Farmers in subtropical Asian countries are at increased risk of CKDu. Governments should take the CKDu epidemics seriously and provide farmers with occupational health education programmes on thermal hazards.

The Impact of Temperature on the Risk of COVID-19: A Multinational Study.

The current understanding of ambient temperature and its link to the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The objective of this study was to explore the environmental and climatic risk factors for SARS-CoV-2. For this study, we analyzed the data at the beginning of the outbreak (from 20 January to 31 March 2020) to avoid the influence of preventive or control measures. We obtained the number of cases and deaths due to SARS-CoV-2, international tourism, population age, universal health coverage, regional factors, the SARS-CoV-2 testing rate, and population density of a country. A total of 154 countries were included in this study. There were high incidence rates and mortality risks in the countries that had an average ambient temperature between 0 and 10 °C. The adjusted incidence rate for temperatures between 0 and 10 °C was 2.91 (95% CI 2.87-2.95). We randomly divided the data into a training set (80% of data) for model derivation and a test set (20% of data) for validation. Using a random forest statistical model, the model had high accuracy for predicting the high epidemic status of a country (ROC = 95.5%, 95% CI 87.9-100.0%) in the test set. Population age, temperature, and international tourism were the most important factors affecting the risk of SARS-CoV-2 in a country. An understanding the determinants of the SARS-CoV-2 outbreak can help to design better strategies for disease control. This study highlights the need to consider thermal effect in the prevention of emerging infectious diseases.

Impact of team-based community healthcare on preventable hospitalisation: a population-based cohort study in Taiwan.

OBJECTIVES: The objective of this study was to explore the impact of Taiwan's Family Practice Integrated Care Project (FPICP) on hospitalisation. DESIGN: A population-based cohort study compared the hospitalisation rates for ambulatory care sensitive conditions (ACSCs) among FPICP participating and non-participating patients during 2011-2015. SETTING: The study accessed the FPICP reimbursement database of Taiwan's National Health Insurance (NHI) administration containing all NHI administration-selected patients for FPICP enrolment. PARTICIPANTS: The NHI administration-selected candidates from 2011 to 2015 became FPICP participants if their primary care physicians joined the project, otherwise they became non-participants. INTERVENTIONS: The intervention of interest was enrolment in the FPICP or not. The follow-up time interval for calculating the rate of hospitalisation was the year in which the patient was selected for FPICP enrolment or not. PRIMARY OUTCOME MEASURES: The study's primary outcome measures were hospitalisation rates for ACSC, including asthma/chronic obstructive pulmonary disease (COPD), diabetes or its complications and heart failure. Logistic regression was used to calculate the ORs concerning the influence of FPICP participation on the rate of hospitalisation for ACSC. RESULTS: The enrolled population for data analysis was between 3.94 and 5.34 million from 2011 to 2015. Compared to non-participants, FPICP participants had lower hospitalisation for COPD/asthma (28.6‰-35.9‰ vs 37.9‰-42.3‰) and for diabetes or its complications (10.8‰-14.9‰ vs 12.7‰-18.1‰) but not for congestive heart failure. After adjusting for age, sex and level of comorbidities by logistic regression, participation in the FPICP was associated with lower hospitalisation for COPD/asthma (OR 0.91, 95% CI 0.87 to 0.94 in 2015) and for diabetes or its complications (OR 0.87, 95% CI 0.83 to 0.92 in 2015). CONCLUSION: Participation in the FPICP is an independent protective factor for preventable ACSC hospitalisation. Team-based community healthcare programs such as the FPICP can strengthen primary healthcare capacity.

Breath biopsy of breast cancer using sensor array signals and machine learning analysis.

Breast cancer causes metabolic alteration, and volatile metabolites in the breath of patients may be used to diagnose breast cancer. The objective of this study was to develop a new breath test for breast cancer by analyzing volatile metabolites in the exhaled breath. We collected alveolar air from breast cancer patients and non-cancer controls and analyzed the volatile metabolites with an electronic nose composed of 32 carbon nanotubes sensors. We used machine learning techniques to build prediction models for breast cancer and its molecular phenotyping. Between July 2016 and June 2018, we enrolled a total of 899 subjects. Using the random forest model, the prediction accuracy of breast cancer in the test set was 91% (95% CI: 0.85-0.95), sensitivity was 86%, specificity was 97%, positive predictive value was 97%, negative predictive value was 97%, the area under the receiver operating curve was 0.99 (95% CI: 0.99-1.00), and the kappa value was 0.83. The leave-one-out cross-validated discrimination accuracy and reliability of molecular phenotyping of breast cancer were 88.5 ± 12.1% and 0.77 ± 0.23, respectively. Breath tests with electronic noses can be applied intraoperatively to discriminate breast cancer and molecular subtype and support the medical staff to choose the best therapeutic decision.

Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan.

BACKGROUND: The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care. METHODS: This population-based cohort study used Taiwan's National Health Insurance Administration data on FPICP (fiscal year 2015-2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE). RESULTS: The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE. CONCLUSION: Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.

A novel lung alveolar cell model for exploring volatile biomarkers of particle-induced lung injury.

Quartz can increase oxidative stress, lipid peroxidation, and inflammation. The objective of this study was to explore the volatile biomarkers of quartz-induced lung injury using a lung alveolar cell model. We exposed the human alveolar A549 cell line to 0, 200, and 500 µg/mL quartz particles for 24 h and used gas chromatography-mass spectrometry to measure the volatile metabolites in the headspace air of cells. We identified ten volatile metabolites that had concentration-response relationships with particles exposure, including 1,2,4-oxadiazole, 5-(4-nitrophenyl)-3-phenyl- (CAS: 28825-12-9), 2,6-dimethyl-6-trifluoroacetoxyoctane (CAS: 61986-67-2), 3-buten-1-amine, N,N-dimethyl- (CAS: 55831-89-5), 2-propanol, 2-methyl- (CAS: 75-65-0), glycolaldehyde dimethyl acetal (CAS: 30934-97-5), propanoic acid, 2-oxo-, ethyl ester (CAS: 617-35-6), octane (CAS: 111-65-9), octane, 3,3-dimethyl- (CAS: 4110-44-5), heptane, 2,3-dimethyl- (CAS: 3074-71-3) and ethanedioic acid, bis(trimethylsilyl) ester (CAS: 18294-04-7). The volatile biomarkers are generated through the pathways of propanoate and nitrogen metabolism. The volatile biomarkers of the alkanes and methylated alkanes are related to oxidative and lipid peroxidation of the cell membrane. The lung alveolar cell model has the potential to explore the volatile biomarkers of particulate-induced lung injury.