Unusual Ciliary Abnormalities in Three 9/11 Response Workers
After the 9/11 terrorist attacks on the World Trade Center in New York in 2001, thousands of response workers were exposed to complex mixtures of toxins, pollutants, and carcinogens. Many developed illnesses involving the respiratory tract. We report unusual ultrastructural ciliary abnormalities in 3 response workers that corresponded to their respiratory and ciliary functional abnormalities. Each patient had respiratory cilia biopsies that were evaluated for motility and ultrastructural changes. Impaired ciliary motility was seen in 2 of the 3 patients. Each of the patients showed monomorphic ultrastructural abnormalities. Two of the patients showed identical triangular disarray of axonemal microtubules with peripheral doublets 1,4, and 7 forming the corners of the triangle and doublet 9 always more medially displaced than doublets 2, 3, 5, 6, and 8. Two workers had cilia in which axonemes were replaced by homogeneously dense cores. One of these also had cilia with triangular axonemes as previously described. The other had cilia with a geometric triangular to pentagonal shape. The ciliary abnormalities described here may represent a new class of primary ciliary dyskinesia in which abnormalities may have a genetic basis and a phenotypic expression that is prompted at the cellular level by local environmental conditions.
Available from: Morton Lippmann
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ABSTRACT: The World Trade Center (WTC) twin towers in New York City collapsed on 9/11/2001, converting much of the buildings' huge masses into dense dust clouds of particles that settled on the streets and within buildings throughout Lower Manhattan. About 80-90% of the settled WTC Dust, ranging in particle size from ∼2.5 μm upward, was a highly alkaline mixture of crushed concrete, gypsum, and synthetic vitreous fibers (SVFs) that was readily resuspendable by physical disturbance and low-velocity air currents. High concentrations of coarse and supercoarse WTC Dust were inhaled and deposited in the conductive airways in the head and lungs, and subsequently swallowed, causing both physical and chemical irritation to the respiratory and gastroesophageal epithelia. There were both acute and chronic adverse health effects in rescue/recovery workers; cleanup workers; residents; and office workers, especially in those lacking effective personal respiratory protective equipment. The numerous health effects in these people were not those associated with the monitored PM2.5 toxicants, which were present at low concentrations, that is, asbestos fibers, transition and heavy metals, polyaromatic hydrocarbons or PAHs, and dioxins. Attention was never directed at the very high concentrations of the larger-sized and highly alkaline WTC Dust particles that, in retrospect, contained the more likely causal toxicants. Unfortunately, the initial focus of the air quality monitoring and guidance on exposure prevention programs on low-concentration components was never revised. Public agencies need to be better prepared to provide reliable guidance to the public on more appropriate means of exposure assessment, risk assessment, and preventive measures.
Available from: Kathleen Connick
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DESCRIPTION: This review is based on three information sources. First, a systematic search was conducted for peer-reviewed findings on exposure and cancer resulting from the September 11, 2001, terrorist attacks that have been published in the scientific and medical literature between September 11, 2001, and July 1, 2011. Second, findings and recommendations related to cancer were solicited from the WTC Clinical Centers of Excellence and Data Centers, the WTC Health Registry at the New York City Department of Health and Mental Hygiene, and the New York State Department of Health. Third, information from the public about cancer was solicited through a Request for Information published in the Federal Register on March 8, 2011, and March 29, 2011. Overall, this inaugural review of cancer presents findings from the peer-reviewed scientific and medical literature about exposures and cancer resulting from the September 11, 2001, terrorist attacks. In addition, the review provides the status of planned and ongoing research efforts to address questions about cancer related to the exposures resulting from the terrorist attacks. Specifically, Chapter I describes how the bibliographic search of scientific and medical findings was conducted. Chapter II summarizes the information contained in scientific and medical publications about September 11, 2001, exposures. Chapter III cites the very few peer-reviewed study reports that contain any quantitative data about cancer as a health outcome resulting from September 11, 2001, exposures. In Chapter IV, a primer on cancer epidemiology is presented. In Chapter V, input from the public and from the WTC Clinical Centers of Excellence, the WTC Health Registry, and the New York State Department of Health about cancer is presented. Chapter VI discusses the challenge of determining whether an observed association between one or more of the September 11, 2001, exposure variables and the health outcome of cancer is causal. Finally, the review includes updates from researchers about current studies of cancer. It is expected that the second periodic review of cancer will be conducted in early to mid-2012 to capture any emerging findings about exposures and cancer in responders and survivors affected by the September 11, 2001, terrorist attacks." - NIOSHTIC-2
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