Heavy metals are naturally occurring elements that have a high atomic weight and a density at least five times greater than that of water. Their multiple industrial, domestic, agricultural, medical, and technological applications have led to their wide distribution in the environment, raising concerns over their potential effects on human health and the environment. Their toxicity depends on several factors including the dose, route of exposure, and chemical species, as well as the age, gender, genetics, and nutritional status of exposed individuals. Because of their high degree of toxicity, arsenic, cadmium, chromium, lead, and mercury rank among the priority metals that are of public health significance. These metallic elements are considered systemic toxicants that are known to induce multiple organ damage, even at lower levels of exposure. They are also classified as human carcinogens (known or probable) according to the US Environmental Protection Agency and the International Agency for Research on Cancer. This review provides an analysis of their environmental occurrence, production and use, potential for human exposure, and molecular mechanisms of toxicity, genotoxicity, and carcinogenicity.

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Heavy metal toxicity and the environment.

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Physiological functions of mineral micronutrients (Cu, Zn, Mn, Fe, Ni, Mo, B, Cl).

해외산업간호정보 - 미국 산업안전보건연구원(National Institute for Occupational Safety and Health) 소개

Raman spectroscopy is a potentially important clinical tool for real-time diagnosis of disease and in situ evaluation of living tissue. The purpose of this article is to review the biological and physical basis of Raman spectroscopy of tissue, to assess the current status of the field and to explore future directions. The principles of Raman spectroscopy and the molecular level information it provides are explained. An overview of the evolution of Raman spectroscopic techniques in biology and medicine, from early investigations using visible laser excitation to present-day technology based on near-infrared laser excitation and charge-coupled device array detection, is presented. State-of-the-art Raman spectrometer systems for research laboratory and clinical settings are described. Modern methods of multivariate spectral analysis for extracting diagnostic, chemical and morphological information are reviewed. Several in-depth applications are presented to illustrate the methods of collecting, processing and analysing data, as well as the range of medical applications under study. Finally, the issues to be addressed in implementing Raman spectroscopy in various clinical applications, as well as some long-term directions for future study, are discussed.

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Prospects for in vivo Raman spectroscopy.

Arsenic and arsenic containing compounds are human carcinogens. Exposure to arsenic occurs occupationally in several industries, including mining, pesticide, pharmaceutical, glass and microelectronics, as well as environmentally from both industrial and natural sources. Inhalation is the principal route of arsenic exposure in occupational settings, while ingestion of contaminated drinking water is the predominant source of significant environmental exposure globally. Drinking water contamination by arsenic remains a major public health problem. Acute and chronic arsenic exposure via drinking water has been reported in many countries of the world, where a large proportion of drinking water is contaminated with high concentrations of arsenic. General health effects that are associated with arsenic exposure include cardiovascular and peripheral vascular disease, developmental anomalies, neurologic and neurobehavioural disorders, diabetes, hearing loss, portal fibrosis, hematologic disorders (anemia, leukopenia and eosinophilia) and multiple cancers: significantly higher standardized mortality rates and cumulative mortality rates for cancers of the skin, lung, liver, urinary bladder, kidney, and colon in many areas of arsenic pollution. Although several epidemiological studies have documented the sources of exposure and the global impact of arsenic contamination, the mechanisms by which arsenic induces health effects, including cancer, are not well characterized. Further research is needed to provide a better understanding of the pathobiology of arsenic-induced diseases and to better define the toxicologic pathology of arsenic in various organ systems. In this review, we provide and discuss the underlying pathology and nature of arsenic-induced lesions. Such information is critical for understanding the magnitude of health effects associated with arsenic exposure throughout the world.

https://journals.sagepub.com/doi/pdf/10.1080/01926230390242007

Carcinogenic and systemic health effects associated with arsenic exposure--a critical review.

A comprehensive analysis of published data indicates that arsenic exposure induces cardiovascular diseases, developmental abnormalities, neurologic and neurobehavioral disorders, diabetes, hearing loss, hematologic disorders, and various types of cancer. Although exposure may occur via the dermal, and parenteral routes, the main pathways of exposure include ingestion, and inhalation. The severity of adverse health effects is related to the chemical form of arsenic, and is also time- and dose-dependent. Recent reports have pointed out that arsenic poisoning appears to be one of the major public health problems of pandemic nature. Acute and chronic exposure to arsenic has been reported in several countries of the world where a large proportion of drinking water (groundwater) is contaminated with high concentrations of arsenic. Research has also pointed significantly higher standardized mortality rates for cancers of the bladder, kidney, skin, liver, and colon in many areas of arsenic pollution. There is therefore a great need for developing a comprehensive health risk assessment (RA) concept that should be used by public health officials and environmental managers for an effective management of the health effects associated with arsenic exposure. With a special emphasis on arsenic toxicity, mutagenesis, and carcinogenesis, this paper is aimed at using the National Academy of Science's RA framework as a guide, for developing a RA paradigm for arsenic based on a comprehensive analysis of the currently available scientific information on its physical and chemical properties, production and use, fate and transport, toxicokinetics, systemic and carcinogenic health effects, regulatory and health guidelines, analytical guidelines and treatment technologies.

Arsenic toxicity, mutagenesis, and carcinogenesis--a health risk assessment and management approach.

Millions now suffer the effects of chronic arseniasis related to environmental arsenic exposure. The biological mechanisms responsible for arsenic-induced toxicity and especially chronic effects, including cancer, are not well known. The U.S. Armed Forces Institute of Pathology (AFIP) is participating in an international research effort to improve this understanding by the development of the International Tissue and Tumor Repository for Chronic Arsenosis (ITTRCA). The ITTRCA obtains, archives, and makes available for research purposes, tissues from subjects exposed to arsenic. We provide here a short overview of arsenic-induced pathology, briefly describe arsenic-induced lesions in the skin and liver, and present five case reports from the ITTRCA. Arsenic-induced skin pathology includes hyperkeratosis, pigmentation changes, Bowen disease, squamous cell carcinoma, and basal cell carcinomas. A unique spectrum of skin lesions, known as arsenical keratosis, is rather characteristic of chronic arseniasis. Bowen disease, or squamous cell carcinoma in situ of the skin, has been well documented as a consequence of arsenical exposure. A spectrum of liver lesions has also been attributed to chronic arseniasis. Of these, hepatocellular carcinoma, angiosarcoma, cirrhosis, and hepatoportal sclerosis have been associated with arsenic exposure. We present case reports that relate to these health conditions, namely, squamous cell carcinoma, basal cell carcinoma, and Bowen disease of the skin and hepatocellular carcinoma and angiosarcoma of the liver. Four patients had been treated with arsenical medications for such conditions as asthma, psoriasis, and syphilis, and one case occurred in a boy chronically exposed to arsenic in drinking water.

Pathology related to chronic arsenic exposure.

All living organisms are composed of major, minor, and trace elements, given by nature and supplied by geology.

Medical Geology: Impacts of the Natural Environment on Public Health

Scalding, baking, suffocating or slow poisoning—Mother Earth has many ways of severely affecting your health. Medical geology is defined as the science dealing with the relationship between natural geological factors and health problems in man and animals. Ever since the catastrophe at Herculaneum and Pompeii in 79 AD, it has been obvious that volcanoes can be bad for human health but, with the passing of time, the more insidious effects of natural poisoning began to be recognised. For example, contemporary writers noted that Roman criminals, used as slaves to mine cinnabar (a mercury ore) at Almaden, Spain, had a life-expectancy of less than three years, by the 16th century, descriptions of mercury poisoning of miners began to appear (Paracelsus, 1567; Scopoli, 1761; Pares y Franques, 1778). In an account of the numerous diseases to which miners were prone, Agricola (1556, Book VI), included dust-induced “asthma” and a disease afflicting miners in the Carpathian Mountains which caused premature death from a “terrible consumption”. Paracelsus (1567) who, like Agricola, worked as a physician in the town of Jacymov (Joachimsthal) in the Erzgebirge (Ore mountains) which separate the present-day Czech Republic from Germany, also reported a high mortality rate from lung diseases amongst miners. Radon (222Rn) gas, originally known as “radium emanation”, was discovered by Friedrich Dorn in 1900 and these latter accounts have been assumed by modern writers to refer to the radon-induced lung-cancer now recognised to have occurred amongst miners working the uranium-bearing cobalt and silver mines at Jacymov (Czech Republic) and the near-by Schneeberg (Germany). Appleton’s paper in this volume gives an undated observation (p. 239) that “air escaping from an open uranium mine gallery in the town of Schneeberg, Germany, contained up to 10,000 Bq m-3 radon”. This is of the same order as measurements made in the 1950s which recorded ~5,500 to 7,000 Bq m-3 radon in the mine galleries. As a yardstick, remediation measures on a domestic dwelling in the UK would be regarded as essential if the annual average radon concentration level exceeded 200 Bq m-3 (p. 258). A causal connection between the miners’ lung cancer and the presence of radon was first postulated by Ludewig and Lorenser (1924), but it was a study by Hueper (1942), which showed definitively that both nonoccupational factors (e.g. smoking) and occupational factors other than radon could be eliminated from consideration, although complete proof of causation came with quantitative studies of radiation carcinogenesis in the 1950s. A catalogue of additional adverse health effects in both man and animals as a result of either elemental excess or deficiency in soils, water or air, are encountered in Essentials of Medical Geology, a thick and sumptuously produced book, printed in China with 267 illustrations, almost all of which are in colour, and 178 tables. It is a pleasure to read, although with an approximately A4-size page and over 800 pages of coated paper, it is rather heavy. Its background lies in an initiative of the International Union of Geological Sciences, which established an International Working Group on Medical Geology in 1996 with the aim of increasing awareness of this topic among scientists, the medical world and the general public. In 2000, Medical Geology became Project 454 of the United Nations Educational, Scientific and Cultural Organisation’s International Geological Correlation Programme. This led to a number of short courses on Medical Geology being offered around the world and these resulted in the production of this book, first planned in 1998. Its stated aim “as a reference and as a general textbook” is to emphasise “the importance of geology in health and disease in humans and animals”. What makes it so interesting is that its authorship ranges from geochemists to pathologists, epidemiologists, analytical chemists and toxicologists, each of whom contribute to different Chapters. The majority (27) of the 59 contributors come from the USA, plus eleven from the UK, five each from Canada and Sweden, two each from Australia, Denmark and Jamaica, and one each from Germany, Italy, Kenya, New Zealand, and Taiwan. Following a Preface by the editors (of whom Olle Selinus of the Geological Survey of Sweden is Editorin-Chief), Chapter 1, (entitled ‘Medical Geology: Perspectives and Prospects’; 13 pp., 80 references) by B. E. Davies, C. Bowman, T. C. Davies and O. Selinus, gives a brief history of the development of the subject and serves as a background to the rest of the volume. Although there are references in their paper to work by members of the former Applied Geochemistry Research Group (AGRG) at Imperial College, London, led by Professor John Webb, I think it is a pity that the groundbreaking Wolfson Geochemical Atlas of England and Wales (Webb et al., 1978) did not rate a mention (although it is briefly cited, as authored by an unexplained “AGRG”, in Chapter 11). Following from Webb’s early interest in geochemistry and agricultural problems (Webb 1964, 1971; Webb et al. 1968), it demonstrated the feasibility of his concept of a regional multi-purpose multi-element geochemical atlas based on relatively high density drainage sediment sampling, and set a standard for geochemical atlases later to be undertaken by geological surveys in many parts of the world. The rest of the book’s contents is divided into four sections: ‘Environmental Biology’, ‘Pathways and Exposures’, ‘Environmental Toxicology, Pathology, and Medical Geology’ and ‘Techniques and Tools’.

Jose A. Centeno

Papers

Carcinogenic and systemic health effects associated with arsenic exposure--a critical review.

Arsenic toxicity, mutagenesis, and carcinogenesis--a health risk assessment and management approach.

Pathology related to chronic arsenic exposure.

Medical Geology: Impacts of the Natural Environment on Public Health

Essentials of medical geology : impacts of the natural environment on public health