Comparative Toxicity of Standard Nickel and Ultrafine Nickel in Lung after Intratracheal Instillation: Qunwei ZHANG, et al.; Department of Environmental Health, School of Medicine, FukuiMedical University-A comparison was made of the bronchoalveolar lavage fluid (BALF) response to ultrafine nickel (Uf-Ni) and standard-sized nickel (StdNi). Rats were intratracheally instilled with 0, 0.1, 0.5, 1 and 5 mg Uf-Ni and Std-Ni, respectively. At 3 d after instillation, the body weight and wet lung weight were determined. At the same time, BALF was analyzed for lactate dehydrogenase (LDH), total protein (TP), tumor necrosis factor-alpha (TNF-alpha), and total cell and differential cell counts. The results showed that indicators of lung injury and inflammation in BALF were markedly raised with increased Uf-Ni and Std-Ni for each from 0 to 1 mg, and there were no differences in the indices between instillation of Uf-Ni at 1 mg and 5 mg. The results also showed that the effects of Uf-Ni on the indices were significantly higher than those of Std-Ni. Additional groups of rats were intratracheally instilled with 1 mg of Uf-Ni or Std-Ni, and wet lung weight and BALF profiles were analyzed at 1, 3, 7, 15 and 30 d later. The effect of Uf-Ni and Std-Ni on indices that can be presumed to reflect epithelial injury and p e r m e a b i l i t y ( L D H o r T P ) , a n d r e l e a s e o f proinflammatory cytokine (TNF-alpha) were increased throughout the 30 d post-exposure and the effects of Uf-Ni on these indices were significantly higher than those of Std-Ni from 1 to 30 d after instillation. Moreover, the number of neutrophils and LDH activity in BALF of rats after exposure to Uf-Ni were significantly Received May 10, 2002; Accepted Oct 7, 2002 Correspondence to: Y. Kusaka, Department of Environmental Health, School of Medicine, Fukui Medical University, Matsuoka-cho, Fukui 910-1193 greater than those of Std-Ni-exposed rats up to 30 d after instillation. Our findings suggest that Uf-Ni has a much more toxic effect on the lung than St-Ni, but the mechanism remains to be elucidated. (J Occup Health 2003; 45: 23-30)

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Reliability of the Proposed International Classification of High-Resolution Computed Tomography for Occupational and EnvironmentalRespiratory Diseases: Narufumi SUGANUMA, et al. Department of Environmental Medicine, Kochi Medical School-Purpose: We have developed a classification of high-resolution computed tomography (HRCT) images for screening, surveillance and epidemiological studies of respiratory diseases caused by occupational and environmental factors. The proposed classification consists of three parts: a guideline explaining the elements of the classification scheme, a reading sheet, and reference films to aid in assessing thin-section CT films. We assessed the reliability of the proposed classification system by blinded, independent trial reading. Materials and Methods: Seven independent radiologists and pulmonologists performed a trial reading to measure the reliability of the classification system using HRCT films from 27 pneumoconiosis patients and 7 normal controls. Results: The agreement was moderate to good for rounded opacities (weighted κ=0.68 and 0.64), irregular opacities (0.59, 0.48), honeycombing (0.65, 0.47), emphysema (0.76, 0.62) and large opacities (0.48, 0.52). Ground glass opacities (0.16, 0.20) showed poor to fair agreement. Intra-reader agreement of each of the seven readers was moderate to good (mean: weighted κ=0.52-0.80) for parenchymal findings, but the agreement was relatively low (mean weighted κ=0.52) for ground glass opacities. Conclusion: The proposed classification is able to describe early dust-related fibrotic changes and provide a semi-quantitative description of the HRCT features of major fibrotic changes in the parenchyma and pleura. Reliability, as measured by inter-reader agreement, was satisfactory. (J Occup Health 2009; 51: 210-222)

Thirty-two patients with advanced gastric cancer underwent continuous hyperthermic peritoneal perfusion (CHPP) combined with surgery: to prevent peritoneal recurrence in 15 patients without peritoneal metastasis (prophylactic CHPP) and to treat 17 patients with peritoneal metastases (therapeutic CHPP). The postoperative outcome was compared with that of control patients treated with surgery alone. Peritoneal recurrence was less frequent (26%) and the 5-year survival rate was significantly higher (39%) in the patients with prophylactic CHPP than in 40 control patients (42 and 17%, respectively). The patients with therapeutic CHPP showed significantly better median survival than did 20 control patients (11 vs. 6 months). Cox multivariate regression analysis revealed that CHPP was an independent prognostic factor in the prophylactic study (hazard ratio = 0.3965), and that the independent prognostic factor in the therapeutic study was not CHPP but complete resection of the peritoneal metastasis. Thus, CHPP has no marked benefit for established peritoneal metastasis. CHPP for the prevention of peritoneal recurrence may have a beneficial effect on long-term survival, but a prospective randomized trial is needed to clarify its prognostic value.