Predictors of epilepsy presentation in unruptured brain arteriovenous malformations: a quantitative evaluation of location and radiomics features on T2 weighted imaging.

Predictors of epilepsy presentation in unruptured brain arteriovenous malformations: a quantitative evaluation of location and radiomics features on T2 weighted imaging.

World Neurosurg. 2019 Feb 13;:

Authors: Zhang Y, Yan P, Liang F, Ma C, Liang S, Jiang C

Abstract
OBJECTIVE: To explore predictors of epilepsy presentation in unruptured bAVMs with quantitative evaluation of location and radiomics features on T2 weighted imaging.
METHODS: This retrospective study identified 117 patients with unruptured bAVMs. Cases were randomly split into training (n=90) and test dataset (n=27). On the training dataset, we applied atlas-based analysis (ABA) to identify epilepsy-susceptible brain regions of bAVMs and then applied radiomics technique to explore shape, intensity and textural features that were correlated with epilepsy presentation. Informative radiomics predictors were selected by Least Absolute Shrinkage and Selection Operator (LASSO) with 3-fold cross-validation. A linear classification score was then constructed, and we tested if we can precisely identify epilepsy-susceptible bAVMs with the location and radiomics predictors.
RESULTS: 2 brain regions and 4 radiomics features were screened out as predictors for epilepsy. The percentage damage of right precentral gyrus (PrCG_R) and right superior longitudinal fasciculus (SLR_R) was associated with epilepsy presentation. The 4 radiomics features were Original_firstorder_Median, Wavelet-LHL_firstorder_InterquartileRange, Wavelet-HHL_firstorder_InterquartileRange and Wavelet-HHH_glrlm_RunVariance. Epileptogenic bAVMs had larger variance of run lengths, larger median value and interquartile range of voxel intensities. On the training dataset, these 6 predictors were able to classify epilepsy-susceptible bAVMs with accuracy at 0.822 and the area under the curve (AUC) was 0.866 (95% CI: 0.791-0.940). On the test dataset, sensitivity, specificity and accuracy of classification reached 0.786, 0.769 and 0.778.
CONCLUSIONS: Epilepsy-susceptible bAVMs had distinct locations and radiomics features on T2 weighted imaging.

PMID: 30771548 [PubMed - as supplied by publisher]

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Brain Abscess with Intracranial Bone Fragments Migration.

Brain Abscess with Intracranial Bone Fragments Migration.

World Neurosurg. 2019 Feb 13;:

Authors: Hu B, Mao X, Gao P, Wang J, Lv B, Tian X, Li P, Zhang X, Cheng H

PMID: 30771547 [PubMed - as supplied by publisher]

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Bilateral extradural PICA origins at the point at which the VA ascends between the transverse foramina of C-2 and C-1, simultaneously exist right double origin PICA: a rare case report and literature review.

Bilateral extradural PICA origins at the point at which the VA ascends between the transverse foramina of C-2 and C-1, simultaneously exist right double origin PICA: a rare case report and literature review.

World Neurosurg. 2019 Feb 13;:

Authors: Wang X, Tang G, Li M

Abstract
BACKGROUND: The location of the origin of the PICA is highly variable. An extracranial origin PICA from the vertebral artery(VA) is not rare. But, the PICA originated extradurally at the point at which the VA ascends between the transverse foramina of C-2 and C-1 is one very rare anatomic variant. Double origin PICA (DOPICA) is another one very rare anatomic variant observed in 1% to 4% of patients in which 2 PICA branches converge distally.
CASE DESCRIPTION: We present an rare cadaveric anatomy case which both the PICAs originated extradurally between the vertebrae C1 and C2, simultaneously exist right double origin PICA . For this case,the right PICA was a double-origin PICA, Including one extradural orgin which the VA ascends between the transverse foramina of C-2 and C-1,another one was intradural and Intracranial one.
CONCLUSIONS: To our knowledge, this is the first report of cadaveric anatomy case of bilateral PICA originated extradurally between the vertebrae C1 and C2,and simultaneously exist right double origin PICA (DOPICA).This kind of case is very rare,but the understanding of this anatomical variation is very important.To avoid complications during surgery at the craniovertebral junction, these potential variations should be correctly identified preoperatively.

PMID: 30771546 [PubMed - as supplied by publisher]

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Computational fluid dynamics analysis of a carotid-ophthalmic aneurysm with concomitant ophthalmic artery infundibulum in a patient-specific model.

Computational fluid dynamics analysis of a carotid-ophthalmic aneurysm with concomitant ophthalmic artery infundibulum in a patient-specific model.

World Neurosurg. 2019 Feb 13;:

Authors: Ba D, Zhu Z, Yue X, Xu P, Yan P, Xiao D

Abstract
BACKGROUND: Although previous studies have reported cases of coexistence of carotid-ophthalmic aneurysm (COA) and ophthalmic artery (OA) infundibulum, the hemodynamic characteristics of this complicated structure and its damaging effect on vision remain to be elucidated. The aim of this study was to analyze this specific artery structure using computational fluid dynamics (CFD) techniques.
METHODS: We presented a patient diagnosed with COA, who had been suffering from blurred vision. Transient analysis was performed to investigate blood flowing in the parent artery. Hemodynamic parameters such as streamline, wall shear stress, oscillatory shear index, and relative residence time were obtained.
RESULTS: When the inlet velocity of the parent artery was at the second peak, the flow rate and intensity of the vortex reached their maximum. In the aneurysm neck, a region of high TAWSS and a region of low TAWSS with high OSI coexisted; besides, a relaxation area was found. In the aneurysm dome, the minimum TAWSS was 2.5Pa, the maximum OSI was 0.48, and the two regions did not overlap. In the OA infundibulum, the maximum OSI and RRT were 0.47 and 39.2, respectively; the minimum TAWSS was 0.59Pa.
CONCLUSIONS: We detected aneurysm regions that were susceptible to further expansion and assessed the rupture risk of each region; the relaxation area could promote aneurysm progression. Besides, the location of the vortex shear force center varied with time. In addition, double vortex streamlines influenced blood supply through the OA, thus impairing vision; infundibulum may promote thrombus formation and hence retard OA blood flow.

PMID: 30771545 [PubMed - as supplied by publisher]

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Evaluation of Radiological Features of the Posterior Communicating Artery and their Impact on Efficacy of Saccular Aneurysm Treatment with the Pipeline Embolization Device: A Case Series Study.

Evaluation of Radiological Features of the Posterior Communicating Artery and their Impact on Efficacy of Saccular Aneurysm Treatment with the Pipeline Embolization Device: A Case Series Study.

World Neurosurg. 2019 Feb 13;:

Authors: Enriquez-Marulanda A, Ravindran K, Salem MM, Ascanio LC, Kan P, Srinivasan VM, Griessenauer CJ, Schirmer CM, Jain A, Moore JM, Ogilvy CS, Thomas AJ, Alturki AY

Abstract
BACKGROUND AND PURPOSE: Posterior communicating artery segment aneurysms are one of the most frequent intracranial aneurysms. Currently, there is limited literature describing the use of the pipeline embolization device in these aneurysms.
MATERIAL AND METHODS: We conducted a multicenter retrospective review of 3 prospectively-collected databases of patients treated with pipeline between January 2013 and December 2017. The primary objective was to assess the efficacy and safety of the pipeline in the treatment of saccular posterior communicating artery aneurysms. We also assessed the impact of anatomical variations on angiographic and clinical outcomes, including the presence of fetal posterior communicating artery, the vessel origin relationship to the aneurysm, and patency following pipeline placement.
RESULTS: We identified 57 patients with 60 saccular aneurysms; Mean age was 60.5 years, and 49 (86.0%) patients were female. A total of 55 (91.7%) aneurysms were unruptured. Median imaging last follow-up was 8.5 months. Complete occlusion at last imaging follow-up was 84.0%. At last follow-up, 94.5% of patients had an mRS≤2. Presence of fetal posterior communicating artery, type of origin, and patency on follow-up were not found to have a significant impact on aneurysm occlusion (p=0.61, p=0.40, and p=0.14, respectively).
CONCLUSION: Pipeline treatment of posterior communicating artery aneurysms results in acceptable occlusion rates. This study did not find that the presence of fetal posterior communicating artery, its origin, and its patency on follow-up to have an impact on aneurysm occlusion.

PMID: 30771544 [PubMed - as supplied by publisher]

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Validity and Reliability of the Arabic Patient Health Questionnaire-9 (PHQ-9) in Spinal Cord Injury Patients in Lebanon.

Validity and Reliability of the Arabic Patient Health Questionnaire-9 (PHQ-9) in Spinal Cord Injury Patients in Lebanon.

World Neurosurg. 2019 Feb 13;:

Authors: Summaka M, Zein H, Abbas LA, Elias C, Elias E, Fares Y, Naim I, Nasser Z

Abstract
BACKGROUND: Depression is a prevalent and disabling condition associated with spinal cord injury. Such associated negative factor warrants the use of valid and reliable psychological assessment tools among this group. One of the available assessment means is the Patient Health Questionnaire-9, a short screening measure which evaluates depression status.
OBJECTIVE: Our aim is to test the psychometric properties of the Arabic version of the Patient Health Questionnaire-9 including validity and reliability among Lebanese individuals with spinal cord injury.
METHODS: This is a cross-sectional study conducted between January and June 2018, including 51 spinal cord injury participants. A questionnaire and assessment measures were administered to the subjects. The internal consistency, test-retest reliability and the factor structure of the Patient Health Questionnaire-9 were evaluated in addition to the convergent validity that was established by comparing the scale's total score with the scores of the Hamilton Depression Rating Scale.
RESULTS: Exploratory factor analysis revealed three factors accounting for 66.2% of the total variance. The scale demonstrated good internal consistency (Cronbach's alpha = 0.71) and test-retest reliability (Intraclass correlation coefficient = 0.88). Significant correlation was found between the Patient Health Questionnaire-9 and the Hamilton Depression Rating Scale (r = 0.71) suggesting good convergent validity.
CONCLUSION: Our findings suggest that the Patient Health Questionnaire-9 has good psychometric properties and is a valid and reliable measure of depression among the Lebanese individuals with spinal cord injury.

PMID: 30771543 [PubMed - as supplied by publisher]

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Feasibility of Staged Bilateral Radiofrequency Vim Thalamotomy for Bilateral Essential Tremor.

Feasibility of Staged Bilateral Radiofrequency Vim Thalamotomy for Bilateral Essential Tremor.

World Neurosurg. 2019 Feb 13;:

Authors: Prajakta G, Horisawa S, Kawamata T, Taira T

PMID: 30771542 [PubMed - as supplied by publisher]

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The Herpes simplex's reactivation after surgical treatment of Trigeminal Neuralgia. A retrospective cohort study.

The Herpes simplex's reactivation after surgical treatment of Trigeminal Neuralgia. A retrospective cohort study.

World Neurosurg. 2019 Feb 13;:

Authors: Berra LV, Armocida D, Pesce A, Di Rita A, Santoro A

Abstract
BACKGROUND: The Herpes Simplex Virus (HSV) reactivation after surgical procedure for trigeminal neuralgia (TN) has been known and recognized since a long time. To date, only few studies, focused on this complication and at present its real incidence remains unknown. The aim of the present paper is to investigate the real incidence of postoperative Herpes Labialis in a cohort of patients treated alternatively with PBC or MVD to outline potentially significant differences among different treatments.
METHODS: In the period between 2010 and 2017, 92 patients were operated on for TN with MVD (Group A) or PBC (Group B) and retrospectively evaluated for this study. The two subgroups of patients were compared according to history of previous Herpes Labialis, the incidence of postoperative Herpes Labialis.
RESULTS: The final cohorts consisted of respectively 56 males and 36 females. The average age was 58.50 years; 30 male patients belonged to Group A while the remaining to Group B. The incidence of episodes of Herpes Labialis during the life, prior to the operation was 18/58 patients in Group A (31.0%) and 12/34 in Group B (35.3%) with no statistically significant difference among subgroups, while postoperatively 1/56 experienced an Herpes Labialis condition for what the Group A (1.7%) is concerned versus 5/34 in regards to Group B (14.7%), with a strong stastically significant difference between the two subgroups.
CONCLUSIONS: In our clinical experience, HSV reactivation after surgery for TN is a not so rare and still not completely understood eventuality. The postoperative HSV reactivation could result as a consequence of a direct mechanical injury on Gasserian ganglion neurons, more common after PBC.

PMID: 30771541 [PubMed - as supplied by publisher]

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The first case report of bilateral spontaneous otogenic pneumocephalus.

The first case report of bilateral spontaneous otogenic pneumocephalus.

World Neurosurg. 2019 Feb 13;:

Authors: Voldřich R, Májovský M, Chovanec M, Netuka D

Abstract
BACKGROUND: Pneumocephalus is commonly associated with cranial trauma including surgical interventions. Spontaneous pneumocephalus on the other hand is a rare diagnosis. Reported cases were predominantly unilateral. We report unique case of a bilateral spontaneous pneumocephalus probably related to bilateral tegmen defect related to repeated Politzer maneuvers.
CASE DESCRIPTION: A 78-year-old man suffered from vertigo, tinnitus, instability and mild expressive aphasia. In the last 12 weeks before clinical deterioration he underwent series of Politzer maneuvers performed for repetitive inflammation of upper respiratory tract with otitis media. Brain computed tomography revealed a large bilateral collection of intracranial air with associated tegmen defects. Primarily, surgical revision of middle fossa and multilayer reconstruction of the dura and skull base defect on the left side was performed. After five days, the other side was reconstructed in similar way. Postoperative course was uneventful with brisk improvement of symptomatology. Both computed tomography scans undertaken after the first and second surgery showed satisfying regression of intracranial air.
CONCLUSION: Spontaneous pneumocephalus represents a very rare condition often associated with increased middle ear pressure that can be caused by autoinflation (e.g. Valsalva or Politzer maneuver), sneezing or coughing. Described case represents unique presentation of the bilateral spontaneous pneumocephalus associated with bilateral tegmen and dura mater defects managed surgically. Despite its rarity spontaneous pneumocephalus originating from the temporal bone should be considered as a possible diagnosis in patients with suggestive otologic presentation (e.g. tinnitus, instability, hearing loss) and associated non-specific neurological symptomatology.

PMID: 30771540 [PubMed - as supplied by publisher]

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Endoscopic transnasal cryo-assisted removal of orbital cavernous hemangiomas: case report and technical hints.

Endoscopic transnasal cryo-assisted removal of orbital cavernous hemangiomas: case report and technical hints.

World Neurosurg. 2019 Feb 13;:

Authors: Castelnuovo P, Arosio AD, Leone F, Ravasio A, Azzolini C, De Maria F, Pistochini A, Volpi L, Bignami M

Abstract
BACKGROUNDS: Cryoprobe devices are used by ophthalmic and orbital surgeons for the extraction of fluid-filled intraorbital lesions. No series described cryo-dissection via an exclusive transnasal approach. The authors describe two cases of purely endoscopic transnasal removal of intraconal orbital hemangiomas with the aid of a dedicated cryoprobe.
METHODS: All the transnasal endoscopic intraorbital procedures were collected and analyzed. The cases in which the intraorbital dissection was performed with the use of Optikon® Cryo-line probe were considered, analyzing clinical features, histology, size and location of the lesion, early and late complications, time of the surgical procedures and hospital stay. Patients were followed up with endoscopic endonasal evaluations performed at 2, 4 and 8 weeks after surgery and with ophthalmologic and orthoptic evaluations performed 2 days and 2 months after the surgery.
RESULTS: Two transnasal intraorbital endoscopic procedures with the aid of the dedicated cryo-line probe were collected. The lesions were located in the intraconal space, medial to the optic nerve. In both of the patients the histological evaluation was compatible with cavernous hemangioma and a complete resection was obtained. Mean hospital stay was 5.5 days. The two months post-operative ophthalmologic and orthoptic evaluations revealed complete resolution of the preoperative symptoms complained.
CONCLUSIONS: Cryoprobes represent an adjunctive tool in the orbital surgeons' armamentarium, useful in the extraction of fluid-filled intraorbital lesions. This preliminary experience suggests that their use can ease the removal of intraconal hemangiomas with exclusive transnasal approach. The analysis of further cases is necessary to confirm safety and efficacy.

PMID: 30771539 [PubMed - as supplied by publisher]

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Eosinophilic granuloma of the cervical spine in adults: A review.

Eosinophilic granuloma of the cervical spine in adults: A review.

World Neurosurg. 2019 Feb 13;:

Authors: Prasad GL, Divya S

Abstract
PURPOSE: Spinal eosinophilic granulomas(EGs) are uncommon tumors, constituting <1% of all bone tumors. They are mostly seen in the pediatric age group while adult onset is rare. Cervical spine is an infrequent location for involvement by EG. Available literature remains sparse regarding the clinical and management aspects of these lesions, especially in adults.
MATERIALS AND METHODS: Literature review was performed by searching online databases to analyze all the reported cases of adult onset cervical EG.
RESULTS: Sixty-two cases were identified and analysed. The male:female ratio was 3.1:1. The mean age at presentation was 32.8years(range18-71 years). Neck pain, limb weakness and restriction of movement were the most frequent symptoms. C2 vertebra was the most frequently involved. Vertebral body was involved in >80% cases and only two had vertebra plana morphology. The cervical lesions involved single vertebra in 42(82%) cases while 9(18%) cases had multiple vertebral involvement. Fifteen patients were managed conservatively, of whom seven failed requiring surgery later, 40 cases underwent definitive surgery and 17 received adjuvant treatment. Posterior-only surgeries were performed in 5, anterior-only in 20, and circumferential in 14 cases. The mean follow-up duration was 68 months (12-268months). Outcome was good to excellent in all, except one, irrespective of type of treatment received.
CONCLUSIONS: Cervical spine EG is rare in adults and usually presents as an osteolytic lesion involving the vertebral body and vertebra plana is very rare. Surgery is typically reserved for cases with severe neurological deficits and bony instability. Outcome appears good in majority of the cases.

PMID: 30771538 [PubMed - as supplied by publisher]

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Pulmonary Artery Sling Presenting as Pneumonia and Inhalation of a Foreign Body

Pulmonary artery sling is a rare cause of respiratory distress created by compression of the lower trachea and right mainstem bronchus due to an aberrant origin of the left pulmonary artery. The condition is frequently associated with recurrent respiratory infections and other congenital malformations including tracheal rings. We present the case of an infant presenting with pulmonary distress and a history of recurrent respiratory infection. The infant underwent surgery to remove a foreign object; however, the symptoms did not resolve. Bronchoscopy revealed bronchus stenosis, and subsequent echocardiogram and CT scans revealed the presence of a pulmonary artery sling. We prescribed infection prophylaxis with the immunomodulator OM-85 to mitigate the risk of further infections prior to surgery. PAS and bronchus stenosis were corrected successfully by surgical intervention leading to resolution of symptoms of respiratory distress and a reduction in the incidence of respiratory infection.

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A New Approach for the Diagnosis of Systemic and Oral Diseases Based on Salivary Biomolecules

Early diagnosis represents the target of contemporary medicine and has an important role in the prognosis and further treatment. Saliva is a biofluid that generated a high interest among researchers due to its multiple advantages over other body fluids. The multitude of components that can act as biomarkers influenced the existing technologies to develop protocols that could allow saliva to become the new noninvasive diagnostic method. Saliva as a diagnostic tool can bring substantial addition to the diagnostic armamentarium, providing important information about oral and general health. The diagnostic applications of saliva extended and had a rapid evolution due to the advancement in salivaomics. The present review summarizes the latest researches in saliva-related studies and explores the information and correlations that saliva can offer regarding the systemic and oral diseases, highlighting its great potential of diagnosis. It is expected that in the future specific guidelines and results regarding the salivary diagnostics are to be available, together with high-sensitivity and specificity tests for multiple systemic and oral diseases.

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Salivary pH and flow rate in menopausal women

OBJECTIVE: This study aims at determining pH and Flow Rate (FR) of Unstimulated Whole Saliva (UWS) in a sample of 120 (60 menopausal women and 60 healthy fertile women with similar mean age); detecting the DMFT index (Decayed, Missing, Filled Teeth index) and evaluating any correlations between pH, FR, age and DMFT.

PATIENTS AND METHODS: Concerning the day before sample collection, patients were advised to keep a relaxed attitude and not to practice sports. They were also told to not eat or drink during the hour preceding sampling procedures. Saliva was collected via "spitting" method. Each sampling session started at 11:00 a.m., lasted for 5 minutes and used a pre-weighed, dry, deionized and sterile test tube. The procedure took place under controlled environmental temperature and humidity conditions (means 23.27°C; 60.08%). FR was evaluated via weighing technique and pH was measured with a portable pH-meter.

RESULTS: There was a minimal but significant pH difference (0.11; p<0.05) between menopausal women (6.75 ± 0.34) and fertile women (6.86 ± 0.24); and a FR difference (0.19; p<0.0001) between menopausal women (0.29 ± 0.17 mL/min) and fertile women (0.48 ± 0.19 mL/min). Correlation (R2) between pH and age was 0.0135 for fertile women and 0.0055 for menopausal women; while the correlation between FR and age was 0.0673 for fertile women and 0.139 for menopausal women. Mean DMFT was 11.93 ± 7.14 in menopausal women and 12.23 ± 6.37 in fertile women.

CONCLUSIONS: We observed a minimal decrease in pH and a decrease in FR in menopausal women. Further studies will be needed to investigate the possible role of other environmental and individual variables in the determination of such values.

L'articolo Salivary pH and flow rate in menopausal women sembra essere il primo su European Review.

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Microplate Design Enhances Fluorescence & Luminescence Measurement

Incorporating individual clear cups moulded into either a black or white polypropylene matrix using a patented `two-shot` manufacturing process totally eliminates the well-to-well optical crosstalk inherent with other clear-bottomed microplate designs. As a result - Krystal 2000 plates enable you to achieve unmatched luminescence and fluorescence assay readings in terms of accuracy, repeatability and sensitivity. Designed to the standard ANSI/SLAS format – each 96-well Krystal 2000 micropl...

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Cover Image

The cover image, by Min Yu and Xuemei Gao, is based on the Original Article Tongue pressure distribution of individual normal occlusions and exploration of related factors DOI: 10.1111/joor.12741.

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Issue Information

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Trump science adviser calls for more collaboration between industry and government

Trump science adviser calls for more collaboration between industry and government

Trump science adviser calls for more collaboration between industry and government, Published online: 16 February 2019; doi:10.1038/d41586-019-00574-3

Meteorologist Kelvin Droegemeier emphasized the importance of private science funding in his first public speech since taking office.

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Job-exposure matrix for historical exposures to rubber dust, rubber fumes and n-Nitrosamines in the British rubber industry

Objectives

To develop a quantitative historical job-exposure matrix (JEM) for rubber dust, rubber fumes and n-Nitrosamines in the British rubber industry for 1915–2002 to estimate lifetime cumulative exposure (LCE) for a cohort of workers with 49 years follow-up.

Methods

Data from the EU-EXASRUB database—rubber dust (n=4157), rubber fumes (n=3803) and n-Nitrosamines (n=10 115) collected between 1977 and 2002—were modelled using linear mixed-effects models. Sample year, stationary/personal measurement, industry sector and measurement source were included as fixed explanatory variables and factory as random intercept. Model estimates and extrapolations were used to construct a JEM covering all departments in both sectors of the rubber manufacturing industries for the years 1915–2002. JEM-estimates were linked to all cohort members to calculate LCE. Sensitivity analyses related to assumptions about extrapolation of time trends were also conducted.

Results

Changes in rubber dust exposures ranged from –6.3 %/year (crude materials/mixing) to –1.0 %/year (curing) and –6.5 %/year (crude materials/mixing) to +0.5 %/year (finishing, assembly and miscellaneous) for rubber fumes. Declines in n-Nitrosamines ranged from –17.9 %/year (curing) to –1.3 %/year (crude materials and mixing). Mean LCEs were 61 mg/m³-years (rubber dust), 15.6 mg/ m³-years (rubber fumes), 2483.2 µg/m³-years (n-Nitrosamines sum score), 18.6 µg/m³-years (N-nitrosodimethylamine) and 15.0 µg/m³-years (N-itrosomorpholine).

Conclusions

All exposures declined over time. Greatest declines in rubber dust and fumes were found in crude materials and mixing and for n-Nitrosamines in curing/vulcanising and preprocessing. This JEM and estimated LCEs will allow for evaluation of exposure-specific excess cancer risks in the British rubber industry.

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Lifetime exposure to rubber dusts, fumes and N-nitrosamines and cancer mortality in a cohort of British rubber workers with 49 years follow-up

Objectives

To quantitatively evaluate exposure-response associations between occupational exposures to rubber dust, fumes and N-nitrosamines and cancer mortality in the UK rubber industry.

Methods

Competing risk survival analyses were used to examine cancer mortality risk in a cohort of 36 441 males aged 35+ years employed in the British rubber industry in 1967, followed up to 2015 (94% mortality). Exposure measurements are based on a population-specific quantitative job-exposure matrix for rubber dust, rubber fumes and N-nitrosamines from the EU-EXASRUB project.

Results

Exposure (lifetime cumulative (LCE))-response associations were found for N-nitrosomorphiline and all cancers (subdistribution HR (SHR) 1.48, 95% CI 1.39 to 1.57) and cancers of the bladder, stomach, multiple myeloma, oesophagus, prostate and pancreas, as well as for N-nitrosodimethylamine and all cancers (SHR 2.08, 95% CI 1.96 to 2.21) and cancers of the bladder, stomach, leukaemia, multiple myeloma, prostate and liver. LCE to the N-nitrosamines sum were associated with increased risks from all cancers (SHR 1.89, 95% CI 1.78 to 2.01) and cancers of the lung, non-Hodgkin's lymphoma and brain. LCE to rubber dust and fumes are associated with increased mortality from all cancers (rubber dust SHR 1.67, 95% CI 1.58 to 1.78; rubber fumes SHR 1.91, 95% CI 1.80 to 2.03) and cancers of the bladder, lung, stomach, leukaemia, multiple myeloma, non-Hodgkin's lymphoma, oesophagus, prostate, pancreas and liver.

Conclusions

Consistent with previous studies, N-nitrosamines exposures are associated with mortality from cancers of the bladder, lung, stomach, leukaemia, multiple myeloma, oesophagus, prostate, pancreas and liver. The long follow-up with nearly complete mortality enabled estimations of lifetime cancer mortality risk from occupational exposures in the rubber industry.

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