Annals of Occupational and Environmental Medicine

Original Article

Association of heavy metal complex exposure and neurobehavioral function of children: Minkeun Kim, Chulyong Park, Joon Sakong, Shinhee Ye, So young Son, Kiook Baek; Ann Occup Environ Med 2023;35:e23. Published online July 6, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e23

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Exposure to heavy metals is a public health concern worldwide. Previous studies on the association between heavy metal exposure and neurobehavioral functions in children have focused on single exposures and clinical manifestations. However, the present study evaluated the effects of heavy metal complex exposure on subclinical neurobehavioral function using a Korean Computerized Neurobehavior Test (KCNT).

Methods

Urinary mercury, lead, cadmium analyses as well as symbol digit substitution (SDS) and choice reaction time (CRT) tests of the KCNT were conducted in children aged between 10 and 12 years. Reaction time and urinary heavy metal levels were analyzed using partial correlation, linear regression, Bayesian kernel machine regression (BKMR), the weighted quantile sum (WQS) regression and quantile G-computation analysis.

Results

Participants of 203 SDS tests and 198 CRT tests were analyzed, excluding poor cooperation and inappropriate urine sample. Partial correlation analysis revealed no association between neurobehavioral function and exposure to individual heavy metals. The result of multiple linear regression shows significant positive association between urinary lead, mercury, and CRT. BMKR, WQS regression and quantile G-computation analysis showed a statistically significant positive association between complex urinary heavy metal concentrations, especially lead and mercury, and reaction time.

Conclusions

Assuming complex exposures, urinary heavy metal concentrations showed a statistically significant positive association with CRT. These results suggest that heavy metal complex exposure during childhood should be evaluated and managed strictly.

소아 신경 행동 기능과 중금속 복합 노출의 관련성
목적
중금속 노출은 많은 국가에서 공중보건 관련해서 큰 과제이다. 중금속 노출에 따른 신경계의 영향을 보기 위한 과거 연구들 에서는 노출의 경우 단일 중금속에 대한 노출을, 노출에 따른 결과로는 임상적 징후 또는 질환의 진단을 중점으로 이루어졌다. 본 연구는 중금속 복합 노출과 준임상적 수준을 포함한 신경 행동 기능의 관계를 확인하기 위해 계획되었다.
방법
소변 중 수은, 납, 카드뮴 분석과 한국형 컴퓨터 신경행동검사중 부호 숫자 짝짓기 검사와 선택 반응 시간 검사를 211명의 10-12세의 소아들에게 시행한 자료를 바탕으로, 반응 시간과 소변 중 중금속 수치를 성별과 연령을 보정하여 편상관분석과 회귀분석으로 분석하였다. 그 중 유의미한 결과가 확인되는 항목에 대해 복합노출에 대한 분석을 Bayesian Kernel Machine regression, Weighted Sum Regression analysis, Quantile G-computation 기법을 활용하여 심층 분석하였다.
결과
부호숫자 짝짓기 검사의 경우 203건, 선택반응 검사의 경우 198건에 대해 분석을 수행하였다. 부호숫자 짝짓기 검사의 경우 단일 중금속과 편상관분석 및 다중회귀분석에서 유의미한 관련성이 보이지 않았다. 선택반응 검사의 경우 편상관분석상 개별 중금속과는 별다른 관계를 보이지 않았으나 다중회귀분석에서 수은 및 납과 유의미한 관련성을 보였다. 복합노출에 대한 분석방법인 Bayesian Kernel Machine regression, Weighted Sum Regression analysis, Quantile G-computation 기법에서 소변 중 중금속과 선택 반응 시간 검사의 반응시간 간에 양의 상관관계를 보였으며, 세 분석에서 비교적 일관되게 복합노출 시 수은과 납이 선택 반응 시간 검사의 반응시간에 양의 상관관계를 보였다. 카드뮴의 경우 뚜렷한 양의 상관관계를 보이지 않거나 그 기여도가 적었다.
결론
본 연구 샘플의 요중 수은, 납, 카드뮴의 범위는 임상적인 증상을 나타낼 수 있는 것으로 알려진 여러 기준 수준에 비해 매우 낮은 수준에 있으나, 그 범위 내에서도 선택 반응 검사와 중금속의 복합노출은 통계적으로 유의한 반응시간 차이를 보였다. 위 결과는 소아 중금속 복합 노출이 매우 낮은 농도 수준에서도 신경계에 영향을 미친다는 가능성을 제시하며, 이는 중금속 노출에 대한 더욱 민감하고 엄격한 관리가 필요함을 보여주는 결과이다.

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Valery Erkudov, Andrey Pugovkin, Kenjabek Rozumbetov, Azat Matchanov, Shanika Arachchi, Upaka Rathnayake
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Association Between Multiple Heavy Metal Exposures and Cholesterol Levels in Residents Living Near a Smelter Plant in Korea
Sun-In Moon, Dong-Hyuk Yim, Kyunghi Choi, Sang-Yong Eom, Byung-Sun Choi, Jung-Duck Park, Heon Kim, Yong-Dae Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef

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Research Article

Environmental health survey for children residing near mining areas in South Gobi, Mongolia: Ulziikhishig Surenbaatar, Byoung-gwon Kim, Jeong-Wook Seo, Hyoun-Ju Lim, Jung-Yeon Kwon, Min-Kyung Kang, Enkhjargal Altangerel, Tsogtbaatar Byambaa, Suvd Batbaatar, Oyunchimeg Myagmardorj, Chul-Woo Lee, Young-Seoub Hong; Ann Occup Environ Med 2021;33:e10. Published online March 31, 2021; DOI: https://doi.org/10.35371/aoem.2021.33.e10

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Background

We evaluated the level and factors of heavy metal exposure to children residing in the Togttsetsii, Khanbogd, and Bayandalai soums of South Gobi province, Mongolia.

Methods

A total of 118 children aged 9–12 years were surveyed, and the level of heavy metal exposure in their bodies was investigated. Exposure was investigated by measuring concentrations of heavy metals such as cadmium, lead, and mercury in the blood; mercury concentration in the hair; and total arsenic in the urine.

Results

Blood cadmium concentration had geometric averages of 0.16 µg/L in the children from Bayandalai, 0.15 µg/L Tsogttsetsii, and 0.16 µg/L Khanbogd. Blood lead concentration showed a relatively higher geometric average of 7.42 µg/dL in the children from Bayandalai compared to 4.78 µg/dL and 5.15 µg/dL in those from Tsogttsetsii and Khanbogd, respectively. While blood mercury concentration was the highest in the children from Bayandalai, with a value of 0.38 µg/L, those from Tsogttsetsii and Khanbogd had similar concentrations of 0.29 µg/L and 0.29 µg/L, respectively. Hair mercury concentration was the highest in the children from Bayandalai, with a value of 78 µg/g, a particularly significant difference, with a concentration of 0.50 µg/g in those from Khanbogd. Urine arsenic concentration was the highest in the children from Khanbogd, with a value of 36.93 µg/L; it was 26.11 µg/L in those from Bayandalai and 23.89 µg/L in those from Tsogttsetsii.

Conclusions

The high blood lead concentration of children in Bayandalai was judged to be due to other factors in addition to mine exposure; the reason why blood and hair mercury concentration was higher in children from Bayandalai may have been due to exposure to many small-scale gold mines in the area. In the case of Khanbogd, it was estimated that the high arsenic level in urine was caused by the effect of mines.

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The impacts of mining on soil pollution with metal(loid)s in resource-rich Mongolia
Václav Pecina, David Juřička, Josef Hedbávný, Martin Klimánek, Jindřich Kynický, Martin Brtnický, Renata Komendová
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Eunyoung Park, Suwhan Kim, Seunghyeon Cho, Hyeonjun Kim, Inho Jung, Jai-Dong Moon, Won-Ju Park
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Research Article

The effects of exposure to lead, cadmium and mercury on follicle-stimulating hormone levels in men and postmenopausal women: data from the Second Korean National Environmental Health Survey (2012–2014): Tae-Woo Lee, Dae Hwan Kim, Ji Young Ryu; Ann Occup Environ Med 2019;31:e21. Published online August 28, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e21

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Background

Follicle-stimulating hormone (FSH), a gonadotropin secreted by the pituitary gland, is a representative secondary sex hormone and an important indicator of reproductive function. The effects of heavy metals such as lead, cadmium, and mercury on humans have been studied, but reports on their effects on sex hormone levels are lacking. Therefore, we investigated the relationship between heavy metal exposure and FSH levels in Korean men and postmenopausal women.

Methods

A total of 4,689 adults (2,763 men and 1,926 postmenopausal women aged 50 years or over) who participated in the Second Korean National Environmental Health Survey (2012–2014) were included. We compared differences in serum FSH levels by demographic characteristics using the t-test and analysis of variance. Multiple linear regression analysis was used to determine the relationship between the blood levels of lead and mercury and the urine cadmium level, and serum FSH levels.

Results

On multiple linear regression analysis, lead exposure was positively associated with serum FSH concentrations in postmenopausal women (β = 2.929, p = 0.019). However, we found no significant association between serum FSH concentration and blood lead and mercury levels, or urine cadmium level, in men.

Conclusions

This study suggests that lead exposure can affect the FSH level in postmenopausal women. Further studies are needed to evaluate the effects of low-dose long-term exposure to heavy metals on sex hormones.

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Case Report

Collective exposure to lead from an approved natural product-derived drug in Korea: Dae-Young Lim, Won-Yang Kang, Ji-Sung Ahn, Seunghyeon Cho, Suwhan Kim, Jai-Dong Moon, Byung-Chan Lee, Won-Ju Park; Ann Occup Environ Med 2019;31:e20. Published online August 26, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e20

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Background

In Asian countries, including Korea, lead poisoning caused by traditional herbal medicines is often observed in the clinic. However, there have been no reports thus far of lead poisoning caused by drugs that were approved by the Korea Food and Drug Administration (KFDA). Here, we describe seven patients who ingested a problematic natural product-derived drug (NPD).

Case presentation

In July 2018, seven patients visited a university hospital after ingesting an NPD, S. capsules. These patients complained of various symptoms, and their blood lead levels (BLLs) were elevated relative to those of the general population (arithmetic mean: 19.5 ± 11.6 µg/dL, range: 6.28–35.25 µg/dL). The total doses and BLLs were directly proportional to each other among the patients (r = 0.943, p = 0.001). After the patients discontinued drug intake, their BLLs decreased gradually. The capsule was confirmed to contain lead above the standard value (arithmetic mean: 2,547 ± 1,821.9 ppm).

Conclusion

This incident highlights the need to strengthen standards for the management of NPD ingredients in Korea. NPDs are more likely to be contaminated than other drugs. Thorough management by the KFDA is essential to prevent a recurrence. Moreover, systematic health care is needed for many patients who have taken problematic NPDs.

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Research Article

Environmental exposure of heavy metal (lead and cadmium) and hearing loss: data from the Korea National Health and Nutrition Examination Survey (KNHANES 2010–2013): Gu Hyeok Kang, Jun Young Uhm, Young Gon Choi, Eun Kye Kang, Soo Young Kim, Won Oh Choo, Seong Sil Chang; Ann Occup Environ Med 2018;30:22. Published online April 17, 2018; DOI: https://doi.org/10.1186/s40557-018-0237-9

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Background

Lead and cadmium have been identified as risk factors for hearing loss in animal studies, but large-scale studies targeting the general human population are rare. This study was conducted to investigate the link between heavy metal concentrations in blood and hearing impairment, using a national population-based survey.

Methods

The study participants comprised 6409 Koreans aged 20 or older, who were included in the Fifth and Sixth Korea National Health and Nutrition Examination Surveys (KNHANES 2010–2013). Hearing impairment was categorized into two types, low- and high-frequency hearing impairment, using pure tone audiometry. Low-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 0.5, 1, and 2 kHz exceeding 25 dB, and high-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 3, 4, and 6 kHz exceeding 25 dB. The blood levels of heavy metals (lead and cadmium) were classified into quartiles. Cross-sectional association between hearing impairment and the level of heavy metals (lead and cadmium) was examined in both sexes. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Among men, the prevalence of low- and high- frequency hearing impairment was 13.9% and 46.7%, respectively, which was higher than the prevalence among women (11.8% and 27.0%, respectively). Regarding lead, the adjusted OR of high-frequency hearing impairment for the highest blood level group versus the lowest group was significant in both men (OR = 1.629, 95% CI = 1.161–2.287) and women (OR = 1.502, 95% CI = 1.027–2.196), after adjusting for age, body mass index, education, smoking, alcohol consumption, exercise, diagnosis of diabetes mellitus, hypertension, and noise exposure (occupational, loud, firearm noises). No links were found between blood lead levels and low-frequency hearing impairment, or between blood cadmium levels and low- or high-frequency hearing impairment in either sex.

Conclusions

The present study findings suggest that even exposure to low-level lead is a risk factor for high-frequency hearing loss. A prospective epidemiologic study should be conducted to identify the causal relationship between human health and exposure to heavy metals, and efforts to reduce heavy metal exposure in the general population should continue.

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Research Article

Blood cadmium and volume of uterine fibroids in premenopausal women: Shinhee Ye, Hye Won Chung, Kyungah Jeong, Yeon-Ah Sung, Hyejin Lee, So Yun Park, Hyunjoo Kim, Eun-Hee Ha; Ann Occup Environ Med 2017;29:22. Published online June 22, 2017; DOI: https://doi.org/10.1186/s40557-017-0178-8

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Background

A number of studies have found associations between heavy metals and uterine fibroids, but the results are inconsistent. Here, we conducted this research to demonstrate the relationships between blood heavy metal concentrations and uterine fibroid volume as well as the rate of uterine fibroid presence.

Methods

In a cross-sectional study, we collected data from 308 premenopausal women aged 30–49 years in Seoul; uterine fibroids are ascertained by past history of myomectomy and pelvic ultrasonography. In the analytic phase, we first analyzed the presence of the fibroids and the concentrations of heavy metals via logistic regression. In subgroup analysis, we used simple and multiple linear regression analyses to examine the associations between heavy metals and uterine fibroid volume.

Results

There was no connection between the heavy metal concentrations and the presence of uterine fibroids, but the odds of women having fibroids were higher with three particular metals. In subgroup analysis, the association between blood cadmium concentrations and uterine fibroid volume was statistically significant (adjusted beta coefficient = 2.22, 95% confidential interval: 0.06–4.37). In contrast, blood mercury and lead concentrations were not significantly associated with uterine fibroid volume.

Conclusions

Our findings are the first that we know to report the association of blood cadmium concentrations with the volume of uterine fibroids. We expect that our findings will be used as evidence for supporting policies to improve premenopausal Korean women’s health.

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Research Article

Air pollution and urinary n-acetyl-B-glucosaminidase levels in residents living near a cement plant: Min Soo Jung, Jae Yoon Kim, Hyun Seung Lee, Chul Gab Lee, Han Soo Song; Ann Occup Environ Med 2016;28:52. Published online September 29, 2016; DOI: https://doi.org/10.1186/s40557-016-0138-8

Abstract PDF PubReader ePub

Background

To identify adverse renal effects due to air pollution derived from a cement plant in Korea. Urinary n-acetyl-B-glucosaminidase (U-NAG) levels in residents living near a cement plant were compared to those in a group who lived farther away from the plant.

Methods

From June to August 2013 and from August to November 2014, laboratory tests for U-NAG and heavy metal were conducted on 547 study participants. Based on the level of air pollution exposure, subjects were divided into the “less exposed group,” (LEG) which consisted of 66 persons who lived more than 5 km away from the cement plant, the “more exposed group from the rural area” (MEG-R), which consisted of 272 persons, and the “more exposed group from downtown area” (MEG-D), which consisted of 209 persons who lived within a 1 km radius of the cement plant. U-NAG levels >5.67 U/L were defined as “higher U-NAG” levels. We compared the prevalence of higher U-NAG levels and estimated the adjusted odds ratio (OR) by air pollution exposure using a chi-square test and multiple logistic regression analysis. Further, we estimated the interaction between air pollution exposure and heavy metal exposure in renal toxicity.

Results

The OR of higher U-NAG levels by MEG-D and MEG-R compared to LEG was 2.13 (95 % CI 0.86–4.96) and 4.79 (95 CI 1.65–10.01), respectively. Urinary cadmium (U-Cd), urinary mercury (U-Hg), age, occupation, hypertension, and diabetes had a significant association with higher U-NAG levels. However, blood lead (B-Pb), sex, and smoking were not associated with higher U-NAG. Especially, concurrent exposure to heavy metals (U-Hg or/and U-Cd) and air pollution had an additive adverse effect. In the group with both 4^th quartile heavy metal exposure (U-Cd or/and U-Hg) and air pollution exposure, the OR in MEG-R and MEG-D was 6.49 (95 % 1.42–29.65) and 8.12 (95 % CI 1.74–37.92), respectively, after adjustment for age, occupation, hypertension, diabetes.

Conclusions

U-NAG levels seem to be affected by air pollution exposure as well as age, hypertension, diabetes, and even low levels of cadmium and low levels of mercury. Moreover, concurrent exposure to heavy metals and air pollution can have additive cytotoxic renal effects.

Citations

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Mechanisms of microbial resistance against cadmium – a review
Monu Sharma, Sonu Sharma, Paavan, Mahiti Gupta, Soniya Goyal, Daizee Talukder, Mohd. Sayeed Akhtar, Raman Kumar, Ahmad Umar, Abdulrab Ahmed M. Alkhanjaf, Sotirios Baskoutas
Journal of Environmental Health Science and Engineering.2023; 22(1): 13. CrossRef
The Validity of Benchmark Dose Limit Analysis for Estimating Permissible Accumulation of Cadmium
Soisungwan Satarug, David A. Vesey, Glenda C. Gobe, Aleksandra Đorđević
International Journal of Environmental Research and Public Health.2022; 19(23): 15697. CrossRef
Mitigation of Cadmium Toxicity through Modulation of the Frontline Cellular Stress Response
Soisungwan Satarug, David A. Vesey, Glenda C. Gobe
Stresses.2022; 2(3): 355. CrossRef
Evidence for Ovarian and Testicular Toxicities of Cadmium and Detoxification by Natural Substances
Martin Massányi, Soisungwan Satarug, Roberto Madeddu, Robert Stawarz, Peter Massányi
Stresses.2021; 2(1): 1. CrossRef
Particulate matter pollution and hospital outpatient visits for endocrine, digestive, urological, and dermatological diseases in Nanjing, China
Ce Wang, Guangcan Zhu, Lei Zhang, Kai Chen
Environmental Pollution.2020; 261: 114205. CrossRef
Cadmium and Lead Exposure, Nephrotoxicity, and Mortality
Soisungwan Satarug, Glenda C. Gobe, David A. Vesey, Kenneth R. Phelps
Toxics.2020; 8(4): 86. CrossRef
Cement plant emissions and health effects in the general population: a systematic review
Elena Raffetti, Michele Treccani, Francesco Donato
Chemosphere.2019; 218: 211. CrossRef

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Original Article

Analysis of Korean Analytical Quality Assurance Program for the Special Health Examination from 1995 to 1999: Seong Kyu Kang, Jeong Sun Yang, Mi Young Lee, In Jeong Park, Ho Keun Chung; Korean Journal of Occupational and Environmental Medicine 2000;12(1):139-147. Published online March 31, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.1.139

Abstract PDF

OBJECTIVE: The accuracy of analytical results of blood and urine heavy metals came out to the main issue on occupational health from late eighties. The discrepancy of the results for same samples from different laboratories made the diagnosis for occupational diseases be unreliable. Therefore, a quality control program for analysis of samples taken from workplace had been introduced in Korea since 1992. This study aims to show the quality control program f'or analysis of blood and urine samples and its proficient rates from 1992 to 1999 and to know how they have been being used in occupational health.
METHODS
The quality control program runs twice a year with mandatory items of blood lead and urine hippuvic acid and voluntary items of blood cadmium and manganese and urine mandellic acid and methyl hippuric acid. Participant laboratories are receiving three levels for each items and two out of three samples have to be qualified for being a proficient laboratory for the item. The acceptable range of blood lead and urine hippuric acid is +/-15% and that of the others is within 3 SD(standard deviation) from the reference values.
RESULTS
The proficient rates of blood lead and urine hippuric acid was 89%, 90%, repectively, however those of the other voluntary items have been from 51% to 62%. The proficient rates of urine mercury and urine N-methylformamide(NMF), which are introduced since 1999, were very poor. Urine hippuric acid and blood lead were analyzed frequently for the purpose of biological monitoring conducting by special health examination organizations. Urine and blood manganese and urine metabolites of trichloroethylene, urine phenol, methylhippuric acid and cadmium were followed.
CONCLUSIONS
In conclusion, the quality control program for biological monitoring has dramatically improve the ability of analysing blood and urine samples and eventually contributes to diagnose occupational diseases and to prevent occupational poisoning. However, some biological monitoring data, such as urine manganese, mercury and NMF, have been still reported from laboratories that were not accepted as a proficient laboratory.

Citations

Citations to this article as recorded by

External Quality Assessment Scheme for Biological Monitoring of Occupational Exposure to Toxic Chemicals
Mi-Young Lee, Jeong Sun Yang, Seong-Kyu Kang
Safety and Health at Work.2011; 2(3): 229. CrossRef

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Original Article

Plasma Malondialdehyde, alpha-tocopherol and Erythrocyte Superoxide Dismutase Activity with Blood Level of Heavy Metals in Welders: Won Jin Lee, Cheon Hyun Hwang, Soung Hoon Chang, Byung Chul Chun, Hae Joon Kim; Korean Journal of Occupational and Environmental Medicine 1998;10(2):240-250. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.240

Abstract PDF: We investigated the association between the oxidative stress and the concentration of heavy metals in blood among welders. The study subjects were male manual CO2 welders(N=127) exposed to several heavy metals. The age distribution was from 20 to 63 (GM=33.7) and the geometric mean(GM) of work duration was 4.2 years. We analyze the level of blood lead, cadmium, managese and chromium which was related with the oxidative stress in the animal studies. Blood selenuim, plasma malondialdehyde (MDA), plasma alpha-tocopheol and orythrocyte superoxide dismutase (SOD) were analyzed as biological markers of the oxidative stress. The results of univariate analysis showed that the plasma MDA was significantly correlated with D-tocopherol (r=0.327) and blood selenium (r=0.313) concentration. But we could not find out any relationship between the erythrocyte SOD activities and those metal concentrations. Neither smoking nor alcohol consumption was related to the level of heavy metals and the oxidative stress biomarkers. As the results of multiple regression analysis with stepwise selection method, 1) the change of MDA level were dependant with the level of alpha-tocopherol and blood selenium concentration (R2=19.7), 2) the plasma alpha-tocopherol level was dependant with MDA and blood chromium concentration (R2=15.6), 3) in case of erythrocyte SOD activity, only the duration of work was significantly selected.

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