Profiles of tumor-infiltrating immune cells and prognostic genes associated with the microenvironment of bladder cancer

The immune microenvironment in bladder cancer (BC) and its significance still remain poorly understood. The present work aims to investigate tumor-infiltrating immune cells (TIICs) and prognostic genes associated with the tumor microenvironment (TME) of BC. The immune and stromal scores of BC samples from The Cancer Genome Atlas database were downloaded from the ESTIMATE website. Based on these scores, BC samples were assigned to the high and low score groups and 429 intersecting differentially expressed genes were identified. Functional enrichment analysis further revealed that these genes dramatically participated in the immune-related biological processes and signaling pathways. Two TME-related genes, angiotensin II receptor type 2 (AGTR2) and sclerostin domain containing 1 (SOSTDC1), were identified to establish an immune-related risk model using Cox regression analyses. Intriguingly, patients with high-risk scores had poor outcomes (p < 0.001). The areas under the curve for the risk model in predicting 3- and 5-year survival rates were 0.692 and 0.707, respectively. Kaplan-Meier survival analysis showed that the expression of AGTR2 and SOSTDC1 significantly correlated with the overall survival of BC patients. Additionally, 22 TIICs in the BC microenvironment were analyzed with the CIBERSORT algorithm. This study indicated that the effective components of TME affected the clinical outcomes of BC patients and might provide a basis for the development of new immunotherapies for BC patients.

Liver enzyme elevation in patients with ankylosing spondylitis treated with tumor necrosis factor inhibitors: a single-center historical cohort study

BACKGROUND/AIMS

Tumor necrosis factor inhibitors (TNFi) have been known to induce liver enzyme elevation, sometimes associated with viral reactivation or toxic hepatitis. We evaluated the incidence and risk factors of TNFi-associated liver enzyme elevation in Korean ankylosing spondylitis (AS) patients who previously had normal liver enzymes.

METHODS

Retrospectively, we collected data from the records of 363 AS patients treated with TNFi at a tertiary hospital from 2003 to 2017. Liver enzyme elevation was defined as abnormal elevation of aspartate aminotransferase and/or alanine aminotransferase levels on two or more consecutive visits. Patients with previously diagnosed liver disease were excluded.

RESULTS

The incidence of liver enzyme elevation was 23.7% (occurring in 86 of 363 patients). The median duration of TNFi exposure before liver enzyme elevation was 3.72 months (interquartile range, 1.77 to 12.51). There was no difference in the occurrence of liver enzyme elevation with concomitant disease-modifying anti-rheumatic drugs and TNFi compared to TNFi alone (23.9% vs. 23.6%). In multivariate analysis, the hazard ratios for liver enzyme elevation were 4.62 (95% confidence interval [CI], 1.43 to 15.01) for male sex, 4.06 (95% CI, 2.11 to 7.84) for underlying non-alcoholic fatty liver disease, and 2.53 (95% CI, 1.38 to 4.64) for hyperlipidemia. After switching to another TNFi, the liver enzyme elevation was not normalized in nine of 13 patients.

CONCLUSION

Liver enzyme elevation was observed in a quarter of patients with AS receiving a TNFi. Male sex, non-alcoholic fatty liver disease, and hyperlipidemia were independent risk factors for liver enzyme elevation. Switching to another TNFi had a limited effect on restoring normal liver enzyme levels.

Source profiles of PM2.5 emitted from four typical open burning sources and its cytotoxicity to vascular smooth muscle cells

This study investigated the chemical profiles of PM_2.5 from open burning of electronic waste (E-waste), household garbage, wheat residue, and outdoor barbeque in a combustion chamber. Carbonaceous fractions, including polycyclic aromatic hydrocarbons (PAHs), and water-soluble ions and elements in PM_2.5 were quantified. A PM_2.5 exposure study was performed to detect PM_2.5-induced bioreactivities in vascular smooth muscle cells (VSMCs). Among all fractions, organic carbon (OC) exhibited the highest mass contribution to PM_2.5-ranging from 39.9% ± 0.82% to 53.1% ± 8.76%. Proportions of total water-soluble ions and total elements both followed the sequence E-waste > wheat straw > outdoor barbeque > household garbage. Because of the high burning temperature, outdoor barbeque PM_2.5 exhibited the highest total quantified PAHs (29.7‰). E-waste PM_2.5 exhibited the highest heavy metal contents, derived mainly from the materials in printed circuit boards. The coefficients of divergence among the four source profiles ranged from 0.47 to 0.75, indicating that the collinear problems could be avoided in source apportionment in receptor models. The induced production of reactive oxygen species exhibited a significant dose-dependent increase and followed the sequence E-waste > household garbage > outdoor barbeque > wheat residue. Similar patterns and sequence among the four sources were observed in monocyte chemoattractant protein 1 (MCP-1) and interleukin 1β (IL-1β) production. The data indicated that PM_2.5 emitted from E-waste has the highest cytotoxicity and special protections should be aimed at mitigating it. The Pearson correlation coefficient demonstrated that elemental carbon, heavy metals, and nitrated PAHs were strongly correlated with VSMC bioreactivity. Light elements exhibited moderate negative correlations with bioreactivities, implying that light elements (e.g., Ca) could mitigate heavy metal-induced cytotoxicity. This study summarized the chemical profiles of PM_2.5 from four typical open burning sources and demonstrated their high cytotoxicity to the cardiovascular system.

Metal bioaccessibility, particle size distribution and polydispersity of playground dust in synthetic lysosomal fluids

Inhalation of playground dust-derived fine particles in schoolyards poses a risk from exposure to metal(oids) and minerals. In this work, we obtained the total concentration and bioaccessibility of metal(oids) with Gamble Solution (GS) and Artificial Lysosomal Fluid (ALF) synthetic solutions, simulating the extracellular neutral pH environment of the lung and the intracellular conditions of the macrophage, respectively. Scanning Electron Microscope (SEM), and Dynamic Light Scattering analysis (DLS) techniques were used to characterize particles with a size smaller than 2.5 μm, which can be assimilated by macrophages in the deep part of the lung. Arsenic (As), lead (Pb), copper (Cu), manganese (Mn), zinc (Zn), and iron (Fe) showed concentrations of 39.9, 147.9, 286, 1369, 2313, 112,457 mg·kg^-1, respectively. The results indicated that all studied elements were enriched when compared to (i) local geochemical background and (ii) findings reported in other cities around the world. Bioaccessibility of metal(oids) in GS was low-moderate for most studied elements. However, in ALF assays, bioaccessibility was high among the samples: for lead (Pb = 34-100%), arsenic (As = 14.7-100%), copper (Cu = 17.9-100%), and zinc (Zn = 35-52%) possibly related to hydrophobic minerals in dust. SEM and DLS image analysis showed that playground dust particles smaller than 2.5 μm are dominant, particularly particles with a size range of 500-600 nm. The polydispersity detected in these particle sizes showed that most of them might be crystalline compounds (elongated shapes) forming agglomerates instead of combustion particles (spheres). Moreover, the circularity detected varies from 0.57 to 0.79 (low roundness), which corroborates this finding. The presence of agglomerates of ultrafine/nanoparticles containing highly bioaccessible metals in playground sites may have severe implications in children's health. Therefore, further studies are required to characterize the size distribution, structure, shape and composition of such minerals which are essential factors related to the toxicology of inhaled dust particles.

Emission characteristics of particulate matter, odors, and volatile organic compounds from the grilling of pork

Meat-grilling restaurants are considered to be residential emission sources of air pollutants. To investigate the emission characteristics of particulate matter (PM), odors, and volatile organic compounds (VOCs) from the grilling of meat, a grilling apparatus equipped with butane gas burners was used to grill pork belly and marinated pork ribs in a laboratory setting. When grilling the pork belly, the emission factor for PM with a diameter of 2.5 μm or below (PM_2.5) was 754 mg-PM·kg-meat^-1, accounting for 99% of total suspended particles (TSPs), while that of the marinated pork ribs was 137 mg-PM·kg-meat^-1 (96% of TSPs). Ammonia and acetaldehyde were the most common odors emitted during grilling at 43-88 mg·kg-meat^-1 and 22-30 mg·kg-meat^-1, respectively. Aldehydes were the most significant contributor to total odor intensity (36%-67%). Benzene, vinyl acetate, and hexene were the most abundant VOCs for the pork belly, while butane, vinyl acetate, and n-dodecane were the most abundant for the marinated ribs. Among the VOCs emitted from the pork grilling process, hexene, butane, and toluene were the dominant ozone precursors. The information obtained in this study is useful for furthering the understanding of the characteristics of air pollutants emitted from actual meat-grilling restaurants. Additionally, knowledge of the PM, odor, and VOC emission characteristics and their emission factors is useful for establishing management strategies for air pollutants from meat-grilling restaurants.

Relationship between indoor and outdoor size-fractionated particulate matter in urban microenvironments: Levels, chemical composition and sources

Exposure to particulate matter (PM) has been associated with adverse health outcomes, particularly in susceptible population groups such as children. This study aims to characterise children's exposure to PM and its chemical constituents. Size-segregated aerosol samples (PM0.25, PM0.25-0.5, PM0.5-1.0, PM1.0-2.5 and PM2.5-10) were collected in the indoor and outdoor of homes and schools located in Lisbon (Portugal). Organic and elemental carbon (OC and EC) were determined by a thermo-optical method, whereas major and trace elements were analysed by X-Ray Fluorescence. In school, the children were exposed to higher PM concentrations than in home, which might be associated not only to the elevated human occupancy but also to outdoor infiltration. The pattern of PM mass size distribution was dependent on the location (home vs. school and indoor vs. outdoor). The presence of EC in PM0.25 and OC in PM0.25-0.5 was linked to traffic exhaust emissions. OC and EC in PM2.5-10 may be explained by their adhesion to the surface of coarser particles. Generally, the concentrations of mineral and marine elements increased with increasing PM size, while for anthropogenic elements happened the opposite. In schools, the concentrations of mineral matter, anthropogenic elements and marine aerosol were higher than in homes. High mineral matter concentrations found in schools were related to the close proximity to busy roads and elevated human occupancy. Overall, the results suggest that exposure to PM is relevant and highlights the need for strategies that provide healthier indoor environments, principally in schools.

Risk Assessment for the Population of Kyiv, Ukraine as a Result of Atmospheric Air Pollution

BACKGROUND

According to the World Health Organization, 92% of the world's population lives in places where air quality levels exceed recommended limits. Recently, Ukraine had the most deaths per every 100,000 people (out of 120 countries) attributed to atmospheric air pollution. High levels of atmospheric air pollution have been observed not only in typically industrial regions, but in Ukraine's capital, Kyiv, as well.

OBJECTIVES

The aim of the present study was to establish the state of air pollution in Kyiv and perform a risk assessment of associated human health effects.

METHODS

Using official statistics and state monitoring data, the study aimed to identify and analyze risks to the health of Kyiv's population associated with air pollution. The following methods were used: systematic, functional and comparative analysis, risk theory, mathematical modeling, probability theory and mathematical statistics, as well as geographic information system technologies for digital map design and objective-oriented methodology for software design systems.

RESULTS

The risk values across different areas of the city varied significantly, indicating that atmospheric air quality remains unstable. Areas with the highest and lowest risk values were identified.

CONCLUSIONS

The environmental state of atmospheric air in Kyiv requires greater attention and additional research to identify the causes of air pollution, along with implementation of measures to improve air quality.

COMPETING INTERESTS

The authors declare no competing financial interests.

Advantages of everolimus therapeutic drug monitoring in oncology when drug-drug interaction is suspected: A case report

INTRODUCTION

Drug interactions involving everolimus are fairly well known because of its common use, primarily as an immunosuppressant. Several recommendations regarding therapeutic drug monitoring are also available for the use of everolimus-based immunosuppression regimens. However, everolimus use in oncology differs substantially, particularly because of the high doses involved. Therapeutic drug monitoring, although sometimes necessary, is not recommended as a routine in oncology. Thus, it was deemed inapplicable due to the lack of clear recommendations.

CASE REPORT

Here, we present a case where a patient was prescribed everolimus for renal cell carcinoma. The patient benefitted from a pharmaceutical consultation prior to treatment initiation, and a drug interaction with verapamil was suspected.Management and outcome: Therapeutic drug monitoring of everolimus was proposed. Based on the everolimus values reported in the literature, trough plasma concentration in the patient was greatly increased. The patient was then diagnosed with grade 4 oral mucositis, thereby requiring temporary suspension of everolimus treatment. Management of adverse effects was performed through multiple medicated mouthwashes.

DISCUSSION

Therapeutic drug monitoring for everolimus is important for potential drug interactions or the occurrence of severe adverse events. In such cases, dose adjustments should be managed according to everolimus plasma concentrations. Clear oncological recommendations regarding plasma everolimus thresholds are required for a successful follow-up of the patient's condition and to ensure adequate response to treatment.

Drug-Induced Liver Injury in the Setting of Chronic Liver Disease

Drug-induced liver injury (DILI) is an uncommon but significant cause of liver injury and need for liver transplant. DILI in the setting of chronic liver disease (CLD) is poorly understood. Clinical features of patients presenting with DILI in the setting of CLD are similar to those without CLD with the exception of a higher incidence of diabetes among those with CLD and DILI. Diagnosis of DILI in CLD is difficult because there are no objective biomarkers and current causality assessments have not been studied in this population. Differentiating DILI from exacerbation of underlying liver disease is even more challenging.

Off-label use of tacrolimus in children with glomerular disease: Effectiveness, safety and pharmacokinetics

Glomerular diseases are leading causes of end-stage renal disease in children. Tacrolimus is frequently used off-label in the treatment of glomerular diseases. The effectiveness, safety and pharmacokinetic data of tacrolimus in the treatment of glomerular diseases in children are reviewed in this paper to provide evidence to support its rational use in clinical practice. The remission rates in previously published studies were different. In 19 clinical trials on children with nephrotic syndrome, the overall remission rate was 52.6-97.6%. In four clinical trials on children with lupus nephritis, the overall remission rate was 81.8-89.5%. In a pilot study with paediatric Henoch-Schönlein purpura nephritis patients, the overall remission rate was 100.0%. Infection, nephrotoxicity, gastrointestinal symptoms and hypertension are the most common adverse events. Body weight, age, CYP3A5 genotype, cystatin-C and daily dose of tacrolimus may have significant effects on the pharmacokinetics of tacrolimus in children with glomerular disease. More prospective controlled trials with long follow-up are needed to demonstrate definitely the effectiveness, safety and pharmacokinetics of tacrolimus in children with glomerular diseases.

Airborne particulate matter accumulation on common green wall plants

In order to better design greening systems for effective particulate matter (PM) removal, it is important to understand the impact leaf traits have on PM deposition. There are however, inconsistences amongst the leaf traits that have previously been correlated with PM accumulation. The aim of this paper was to identify vegetation characteristics of green wall plants that were associated with the accumulation of particulate matter. To determine patterns associated with different leaf morphologies, eleven common ornamental plant species were sampled across 15 sites, over a 6 month duration. PM deposition was determined gravimetrically and its associated size fractions determined microscopically. Linear mixed models were used to identify statistical patterns relating to differences in PM deposition across plant species. PM deposition and the relative frequencies of particle size fractions were found to be statistically different among species, sites and months. Green wall plants were shown to be effective at PM accumulation as all of the assessed plant species had equivalent PM removal efficiency, with minimal evidence of influential leaf characteristics that could enhance PM removal.

Patients With Chronic Liver Disease Suggestive of Nonalcoholic Fatty Liver Disease May Be at Higher Risk for Drug-Induced Liver Injury

To date, there have been no studies that systematically examined if individuals with nonalcoholic fatty liver disease (NAFLD) have an increased risk of drug-induced liver injury (DILI). We conducted a study to test if the frequency of suspected DILI from prescription agents is higher in individuals with chronic liver disease (CLD) suggestive of NAFLD.

Size-Resolved Single-Particle Fluorescence Spectrometer for Real-Time Analysis of Bioaerosols: Laboratory Evaluation and Atmospheric Measurements

Characteristic particle size, fluorescence intensity, and fluorescence spectra are important features to detect and categorize bioaerosols. A prototype size-resolved single-particle fluorescence spectrometer (S2FS) was developed to simultaneously measure aerodynamic diameters and fluorescence spectra. Emission spectra are dispersed in 512 channels from 370 to 610 nm, where a major portion of biological fluorescence emission occurs. The S2FS consists of an aerodynamic particle sizer and a fluorescence spectrometer with a 355 nm laser excitation source and an intensified charge-coupled device as the detector. Highly fluorescent particles, such as Ambrosia artemisiifolia pollen and Olea europaea pollen, can be distinguished by the S2FS on a single-particle level. For weakly fluorescent particles, fluorescence spectra can only be obtained by averaging multiple particles (between 100 and 3000) of the same kind. Preliminary ambient measurements in Mainz (Germany, central Europe) show that an emission peak at ∼440 nm was frequently observed for fluorescent fine particles (0.5-1 μm). Fluorescent fine particles accounted for 2.8% on average based on the number fraction in the fine mode. Fluorescent coarse particles (>1 μm) accounted for 8.9% on average based on the number fraction, with strongest occurrence observed during a thunderstorm and in the morning.

Ma Xing Shi Gan Decoction Attenuates PM2.5 Induced Lung Injury via Inhibiting HMGB1/TLR4/NFκB Signal Pathway in Rat

Ma Xing Shi Gan Decoction (MXD), a classical traditional Chinese medicine prescription, is widely used for the treatment of upper respiratory tract infection. However, the effect of MXD against particulate matters with diameter of less than 2.5 μm (PM2.5) induced lung injury remains to be elucidated. In this study, rats were stimulated with PM2.5 to induce lung injury. MXD was given orally once daily for five days. Lung tissues were harvested to assess pathological changes and edema. Myeloperoxidase (MPO) activity and malonaldehyde (MDA) content in lung were determined to evaluate the degree of injury. To assess the barrier disruption, the bronchoalveolar lavage fluid (BALF) was collected to determine the total protein content and count the number of neutrophils and macrophages. For evaluating the activation of macrophage in lung tissue, CD68 was detected using immunohistochemistry (IHC). The levels of inflammatory factors including tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), and interleukin-6 (IL-6) in BALF and serum were measured. In vitro, a PM2.5-activated RAW 264.7 macrophages inflammatory model was introduced. To evaluate the protective effect of MXD-medicated serum, the cell viability and the release of inflammatory factors were measured. The effects of MXD on the High mobility group box-1/Toll-like receptor 4/Nuclear factor-kappa B (HMGB1/TLR4/NFκB) pathway in lung tissue and RAW 264.7 cells were assessed by Western blot. For further confirming the protective effect of MXD was mediated by inhibiting the HMGB1/TLR4/NFκB pathway, RAW 264.7 cells were incubated with MXD-medicated serum alone or MXD-medicated serum plus recombinant HMGB1 (rHMGB1). MXD significantly ameliorated the lung injury in rats, as evidenced by decreases in the pathological score, lung edema, MPO activity, MDA content, CD68 positive macrophages number, disruption of alveolar capillary barrier and the levels of inflammatory factors. In vitro, MXD-medicated serum increased cell viability and inhibited the release of inflammatory cytokines. Furthermore, MXD treatment was found to inhibit HMGB1/TLR4/NFκB signal pathway both in vivo and in vitro. Moreover, the protection of MXD could be reversed by rHMGB1 in RAW 264.7. Taken together, these results suggest MXD protects rats from PM2.5 induced acute lung injury, possibly through the modulation of HMGB1/TLR4/NFκB pathway and inflammatory responses.

Spatio-Temporal Variation Characteristics of PM2.5 in the Beijing-Tianjin-Hebei Region, China, from 2013 to 2018

Air pollution, including particulate matter (PM_2.5) pollution, is extremely harmful to the environment as well as human health. The Beijing–Tianjin–Hebei (BTH) Region has experienced heavy PM_2.5 pollution within China. In this study, a six-year time series (January 2013–December 2018) of PM_2.5 mass concentration data from 102 air quality monitoring stations were studied to understand the spatio-temporal variation characteristics of the BTH region. The average annual PM_2.5 mass concentration in the BTH region decreased from 98.9 μg/m³ in 2013 to 64.9 μg/m³ in 2017. Therefore, China has achieved its Air Pollution Prevention and Control Plan goal of reducing the concentration of fine particulate matter in the BTH region by 25% by 2017. The PM_2.5 pollution in BTH plain areas showed a more significant change than mountains areas, with the highest PM_2.5 mass concentration in winter and the lowest in summer. The results of spatial autocorrelation and cluster analyses showed that the PM_2.5 mass concentration in the BTH region from 2013–2018 showed a significant spatial agglomeration, and that spatial distribution characteristics were high in the south and low in the north. Changes in PM_2.5 mass concentration in the BTH region were affected by both socio-economic factors and meteorological factors. Our results can provide a point of reference for making PM_2.5 pollution control decisions.

Parathyroid hormone related protein (PTHrP)-mediated hypercalcemia in malignancy associated with anti-PD-1 immune checkpoint inhibitor treatment and related inflammatory reactions

Over the last decade, the breakthrough of immune checkpoint inhibitors has revolutionized cancer therapeutics, an enterprise not devoid of a novel constellation of unique immune-related adverse events. In this article, we present the first two patients, one with metastatic urothelial bladder cancer and another one with inoperable non-small squamous cell lung carcinoma, with immune-related parathyroid hormone related protein (PTHrP)-mediated hypercalcemia concurrent with immune-related pneumonitis following administration of anti-PD-1 monoclonal antibody nivolumab. The second patient present immune-related colitis as well. In both patients the hypercalcemia developed when cancer was in remission, rendering unlikely the diagnosis of humoral hypercalcemia of malignancy. The time of onset of PTHrP-mediated hypercalcemia-11 weeks and 15 weeks after initiation of nivolumab for the first and second patient respectively- insinuated the immune-related origin of PTHrP. The concurrent immune-related pneumonitis raised the question of whether the immune-related inflammatory milieu in the context of pneumonitis could be the source of the immune-related PTHrP. In conclusion, increased awareness of nivolumab-related hypercalcemia -an extremely rare immune-related adverse event- could enable the identification of immune-related elevation of PTHrP. Moreover, our cases provide the rationale for further research in pursuit of not only the source of immune-related PTHrP expression, but also of a causative link connecting the inflammatory milieu of immune-related pneumonitis and/or immune-related colitis with PTHrP-mediated hypercalcemia. Finally, the correlation of immune-related adverse events observed herein with response to nivolumab is in line with previous reports, necessitating further consolidation.

The impact of polar fraction of the fine particulate matter on redox responses in different rat tissues

Particulate matter (PM) contains different chemical substances that have been associated with health effects and an increased risk of mortality due to their toxicity. In this study, fine particulate matter (PM_2.5) samples were collected in a region with rural characteristics (Seropédica (Se)) and another with some industries (Duque de Caxias (DC)) (Brazil, RJ). Rats were exposed to PM_2.5 extracts daily for 25 days at different dilutions: 10×, 5×, and a concentrated solution (CS). Biochemical analyses were investigated for total antioxidant capacity (ACAP), lipid peroxidation (LPO) levels, reduced glutathione (GSH) concentration, activity of glutamate cysteine ligase (GCL), and activity of glutathione S-transferase (GST). The liver showed a significant increase in GCL (DC-5×, DC-CS and Se-CS) and GST activities (DC-CS and Se-CS) in both regions when compared to the control group. In the renal cortex, GCL activity decreased in most of the tested groups while GST activity increased only in the 5× groups of both regions (DC and Se). In the renal medulla, GCL activity decreased for Se-10× and DC-CS but increased for Se-5×, and GST activity increased in the Se-10×, DC-5×, and DC-CS groups. Lung GCL increased in all groups for both regions. Moreover, this organ also showed an increase in GST activity when higher metal concentrations were present (5× and CS). TBARS levels were increased for all tissues in most tested concentrations. These data indicate that soluble compounds (e.g., metals) from PM_2.5 sampled in areas with different pollution indexes can change the redox status and cause damage to different tissues.

Selective inhibition of mTORC1/2 or PI3K/mTORC1/2 signaling does not prevent or modify epilepsy in the intrahippocampal kainate mouse model

Dysregulation of the PI3K/Akt/mTOR pathway has been implicated in several brain disorders, including epilepsy. Rapamycin and similar compounds inhibit mTOR. complex 1 and have been reported to decrease seizures, delay seizure development, or prevent epileptogenesis in different animal models of genetic or acquired epilepsies. However, data for acquired epilepsy are inconsistent, which, at least in part, may be due to the poor brain penetration and long brain persistence of rapamycin and the fact that it blocks only one of the two cellular mTOR complexes. Here we examined the antiepileptogenic or disease-modifying effects of two novel, brain-permeable and well tolerated 1,3,5-triazine derivatives, the ATP-competitive mTORC1/2 inhibitor PQR620 and the dual pan-PI3K/mTORC1/2 inhibitor PQR530 in the intrahippocampal kainate mouse model, in which spontaneous seizures develop after status epilepticus (SE). Following kainate injection, the two compounds were administered over 2 weeks at doses previously been shown to block mTORC1/2 or PI3K/mTORC1/2 in the mouse brain. When spontaneous seizures were recorded by continuous (24/7) video-EEG recording starting 6 weeks after termination of treatment, no effects on incidence or frequency of seizures were observed. Drug treatment suppressed the epilepsy-induced activation of the PI3K/Akt/mTOR pathway in the hippocampus, but granule cell dispersion in the dentate gyrus was not prevented. When epilepsy-associated behavioral alterations were determined 12-14 weeks after kainate, mice pretreated with PQR620 or PQR530 exhibited reduced anxiety-related behavior in the light-dark box, indicating a disease-modifying effect. Overall, the data indicate that mTORC1/C2 or PI3K/mTORC1/C2 inhibition may not be an antiepileptogenic strategy for SE-induced epilepsy.

The short-term effects of air pollutants on influenza-like illness in Jinan, China

Background

There is valid evidence that air pollution is associated with respiratory disease. However, few studies have quantified the short-term effects of six air pollutants on influenza-like illness (ILI). This study explores the potential relationship between air pollutants and ILI in Jinan, China.

Methods

Daily data on the concentration of particulate matters < 2.5 μm (PM 2.5), particulate matters < 10 μm (PM10), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) and ILI counts from 2016 to 2017 were retrieved. The wavelet coherence analysis and generalized poisson additive regression model were employed to qualify the relationship between air pollutants and ILI risk. The effects of air pollutants on different age groups were investigated.

Results

A total of 81,459 ILI counts were collected, and the average concentrations of PM2.5, PM10, O₃, CO, SO₂ and NO₂ were 67.8 μg/m³, 131.76 μg/ m³, 109.85 μg/ m³, 1133 μg/ m³, 33.06 μg/ m³ and 44.38 μg/ m³, respectively. A 10 μg/ m³ increase in concentration of PM2.5, PM10, CO at lag0 and SO₂ at lag01, was positively associated with a 1.0137 (95% confidence interval (CI): 1.0083–1.0192), 1.0074 (95% CI: 1.0041–1.0107), 1.0288 (95% CI: 1.0127–1.0451), and 1.0008 (95% CI: 1.0003–1.0012) of the relative risk (RR) of ILI, respectively. While, O3 (lag5) was negatively associated with ILI (RR 0.9863; 95%CI: 0.9787–0.9939), and no significant association was observed with NO₂, which can increase the incidence of ILI in the two-pollutant model. A short-term delayed impact of PM2.5, PM10, SO2 at lag02 and CO, O3 at lag05 was also observed. People aged 25–59, 5–14 and 0–4 were found to be significantly susceptible to PM2.5, PM10, CO; and all age groups were significantly susceptible to SO₂; People aged ≥60 year, 5–14 and 0–4 were found to be significantly negative associations with O₃.

Conclusion

Air pollutants, especially PM2.5, PM10, CO and SO₂, can increase the risk of ILI in Jinan. The government should create regulatory policies to reduce the level of air pollutants and remind people to practice preventative and control measures to decrease the incidence of ILI on pollution days.

Fraction distribution of arsenic in different-sized atmospheric particulate matters

The sequential extraction method was used to determine the fraction of arsenic (As) in different-sized particulate matters (PMs) (i.e., PM_2.5, PM₁₀, and total suspended particles (TSP)). Samples were collected from Baoding, a typical medium-sized city with the serious haze pollution in China. The bioavailabilities of As in the samples were estimated based on the fraction results. A large percentage of fine particles were detected in TSP, with the average PM_2.5/PM₁₀ and PM₁₀/TSP ratios all above 0.69. The total concentrations of As in PM_2.5, PM₁₀, and TSP samples were in the range of 4.5-296.4, 14.1-708.0, and 32.8-798.0 ng m^-3, respectively. The mass percentages of As in PM_2.5, PM_2.5-10, and PM_10-100 were calculated; the results indicated that As tended to concentrate in fine particles. PM-bound As mainly presented in the nonspecifically sorbed fraction (F1) during all of the sampling periods. The percentages of F1-As and bioavailability of As were higher in PM_2.5, followed by PM₁₀ and TSP. By contrast, the residual fraction (F5-As) contents declined in the order of TSP > PM₁₀ > PM_2.5. Significant differences in the speciation and bioavailability of As in different-sized PMs were found, and the influence of particle size on the speciation and bioavailability of As in PMs was verified. Fine particles adsorbed more As with higher bioavailability, and potentially led to more serious adverse effects on human health than the larger ones.

Generics in transplantation medicine: Randomized comparison of innovator and substitution products containing mycophenolate mofetil

Objective: Mycophenolate mofetil (MMF) is widely used as an immunosuppressant for the prophylaxis of acute organ rejection in recipients of solid organ transplants. Materials and methods: We have compared, in healthy subjects, the pharmacokinetics of mycophenolic acid when MMF was administered in the form of the innovator product CellCept (F. Hoffmann-La Roche Ltd.) or one of three commercially available generics, Renodapt (Biocon Ltd.), Mycept (Panacea Biotec), or Cellmune (Cipla Ltd.). The study was powered to detect a 20% difference in mean formulation performance measures, but not to formally evaluate bioequivalence. Geometric mean ratios of maximum concentrations (C_max) and areas under plasma concentration-time curves were calculated. Results: Comparing generics against each other, the differences in point estimates of the geometric mean ratios of C_max of two of the comparisons were either borderline within (Renodapt/Cellmune) or clearly outside (Mycept/Cellmune) a region of 80 – 125% around the reference mean, indicating that bioequivalence between these generics may be difficult to show. Conclusion: Physicians in the field of transplantation should be aware of the potential risk of altering the therapeutic outcome when switching from one preparation of MMF to another. ClinicalTrials.gov identifier: NCT02981290.

Responses of serum chemokines to dramatic changes of air pollution levels, a panel study

Background: Despite the in vitro and in vivo evidence, studies are limited in evaluating whether chemokines are potential inflammatory mediators in response to air pollution exposure in humans. Methods: We conducted a panel study coinciding with the Beijing Olympics, when temporary air pollution controls were implemented. We measured a suite of serum chemokines among healthy adults before, during and after the Olympics, respectively. Linear mixed-effect models were used to evaluate changes in chemokine levels over the three time periods. Results: In response to the 50% drop in air pollution levels during the games, levels of RANTES, MCP-2, and TARC decreased by 25.8%, 20.9% and 35.3%, respectively (p < 0.001) from pre-Olympics, and then increased by 45.8%, 34.9% and 61.5%, respectively (p < 0.001) after the games when air pollution levels went up again. Similar patterns were observed in subgroup analyses by sex, age, smoking and body mass index. GRO-α and IL-8 decreased significantly during the games (22.5% and 30.4%), and increased non-significantly after the games. Eotaxin-1 only increased significantly from during- to post-games. Conclusions: The strongest associations with air pollution levels were observed among RANTES, TARC and MCP-2. Those chemokines may play important roles in the air pollution-induced inflammatory pathway.

Methodology for Estimating the Lifelong Exposure to PM2.5 and NO2—The Application to European Population Subgroups

Health impacts of air pollutants, especially fine particles (PM2.5) and NO2, have been documented worldwide by epidemiological studies. Most of the existing studies utilised the concentration measured at the ambient stations to represent the pollutant inhaled by individuals. However, these measurement data are in fact not able to reflect the real concentration a person is exposed to since people spend most of their time indoors and are also affected by indoor sources. The authors developed a probabilistic methodology framework to simulate the lifelong exposure to PM2.5 and NO2 simultaneously for population subgroups that are characterised by a number of indicators such as age, gender and socio-economic status. The methodology framework incorporates the methods for simulating the long-term outdoor air quality, the pollutant concentration in different micro-environments, the time-activity pattern of population subgroups and the retrospective life course trajectories. This approach was applied to the population in the EU27 countries plus Norway and Switzerland and validated with the measurement data from European multi-centre study, EXPOLIS. Results show that the annual average exposure to PM2.5 and NO2 at European level kept increasing from the 1950s to a peak between the 1980s and the 1990s and showed a decrease until 2015 due to the implementation of a series of directives. It is also revealed that the exposure to both pollutants was affected by geographical location, gender and income level. The average annual exposure over the lifetime of an 80-year-old European to PM2.5 and NO2 amounted to 23.86 (95% CI: 2.95–81.86) and 13.49 (95% CI: 1.36–43.84) µg/m3. The application of this methodology provides valuable insights and novel tools for exposure modelling and environmental studies.

Metabolic Comorbidities and Risk of Development and Severity of Drug-Induced Liver Injury

The incidence and rates of diagnosis of drug-induced liver injury (DILI) have been increasing in recent years as findings from basic research and the examination of clinical databases reveal information about the clinical course, etiology, and prognosis of this complex disease. The prevalence of metabolic comorbidities (e.g., diabetes mellitus, fatty liver, obesity, and metabolic syndrome (MetS)) has been increasing during the same period. The results of preclinical and clinical research studies indicate that characteristics of metabolic comorbidities are also factors that affect DILI phenotype and progression. The objective of this review is to present the evidence for DILI and hepatotoxicity mechanisms, incidence, and outcomes in patients with MetS and nonalcoholic fatty liver disease. Moreover, we also summarize the relationships between drugs used to treat metabolic comorbidities and DILI.

Contribution of transregional transport to particle pollution and health effects in Shanghai during 2013-2017

Transregional transport plays an important role in air pollution. This study investigated the impact of transregional transport on particle pollution in Shanghai from 2013 to 2017. A conditional potential source contribution function (CPSCF) method with high time resolution (1 h) PM_2.5 and PM₁₀ data was used to quantify the contribution of transregional transport. The corresponding health impact was also assessed. The average annual contribution of transregional transport to PM_2.5 (PM_{2.5_CTRT}) and PM₁₀ (PM_{10_CTRT}) was 22 and 30 μg/m³, 18 and 24 μg/m³, 19 and 24 μg/m³, 14 and 19 μg/m³, and 14 and 19 μg/m³, for 2013 to 2017, respectively, thus accounting for 31-37% of total PM_2.5 and PM₁₀. As PM_{2.5_CTRT} is a dominant component of PM_{10_CTRT}, the health effects related to PM_{2.5_CTRT} were assessed to avoid double counting. The number of annual deaths associated with PM_{2.5_CTRT} in Shanghai during the study period ranged from 636 (95% confidence intervals: 350, 936) to 1039 (573, 1530), among which cardiovascular disease and respiratory disease accounted for 62.8-67.6% and 16.6-19.5% of mortality, respectively. PM_{2.5_CTRT}-related deaths accounted for 5.3-8.2‰ of the total mortality in Shanghai during the study period. Between 9764 (9251, 10,277) and 12,190 (11,549, 12,830) cases of all-cause hospital admissions were attributable to PM_{2.5_CTRT} in Shanghai in one year, among which cardiovascular disease and respiratory disease hospital admissions accounted for 15.9-20.0% and 7.9-9.2%, respectively. Internal medicine and pediatrics outpatient visits related to PM_{2.5_CTRT} ranged from 70,684 (39,009, 100,829) to 97,380 (53,788, 138,793) cases and 23,185 (8302, 37,173) to 32,702 (11,726, 52,361) cases, respectively. The current work provides scientific evidence of the impact of transregional transport on air pollution and its health burden in Shanghai.

Microfluidic and Micromachined/MEMS Devices for Separation, Discrimination and Detection of Airborne Particles for Pollution Monitoring

Most of the microfluidics-related literature describes devices handling liquids, with only a small part dealing with gas-based applications, and a much smaller number of papers are devoted to the separation and/or detection of airborne inorganic particles. This review is dedicated to this rather less known field which has become increasingly important in the last years due to the growing attention devoted to pollution monitoring and air quality assessment. After a brief introduction summarizing the main particulate matter (PM) classes and the need for their study, the paper reviews miniaturized devices and/or systems for separation, detection and quantitative assessment of PM concentration in air with portable and easy-to-use platforms. The PM separation methods are described first, followed by the key detection methods, namely optical (scattering) and electrical. The most important miniaturized reported realizations are analyzed, with special attention given to microfluidic and micromachined or micro-electro-mechanical systems (MEMS) chip-based implementations due to their inherent capability of being integrated in lab-on-chip (LOC) type of smart microsystems with increased functionalities that can be portable and are easy to use. The operating principles and (when available) key performance parameters of such devices are presented and compared, also highlighting their advantages and disadvantages. Finally, the most relevant conclusions are discussed in the last section.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the 'Golden Therapeutic Window', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

Recent Topics on The Mechanisms of Immunosuppressive Therapy-Related Neurotoxicities

Although transplantation procedures have been developed for patients with end-stage hepatic insufficiency or other diseases, allograft rejection still threatens patient health and lifespan. Over the last few decades, the emergence of immunosuppressive agents such as calcineurin inhibitors (CNIs) and mammalian target of rapamycin (mTOR) inhibitors have strikingly increased graft survival. Unfortunately, immunosuppressive agent-related neurotoxicity commonly occurs in clinical practice, with the majority of neurotoxicity cases caused by CNIs. The possible mechanisms through which CNIs cause neurotoxicity include increasing the permeability or injury of the blood–brain barrier, alterations of mitochondrial function, and alterations in the electrophysiological state. Other immunosuppressants can also induce neuropsychiatric complications. For example, mTOR inhibitors induce seizures, mycophenolate mofetil induces depression and headaches, methotrexate affects the central nervous system, the mouse monoclonal immunoglobulin G2 antibody (used against the cluster of differentiation 3) also induces headaches, and patients using corticosteroids usually experience cognitive alteration. Therapeutic drug monitoring, individual therapy based on pharmacogenetics, and early recognition of symptoms help reduce neurotoxic events considerably. Once neurotoxicity occurs, a reduction in the drug dosage, switching to other immunosuppressants, combination therapy with drugs used to treat the neuropsychiatric manifestation, or blood purification therapy have proven to be effective against neurotoxicity. In this review, we summarize recent topics on the mechanisms of immunosuppressive drug-related neurotoxicity. In addition, information about the neuroprotective effects of several immunosuppressants is also discussed.

Drug-Induced Acute-on-Chronic Liver Failure in Asian Patients

OBJECTIVES

Acute insults from viruses, infections, or alcohol are established causes of decompensation leading to acute-on-chronic liver failure (ACLF). Information regarding drugs as triggers of ACLF is lacking. We examined data regarding drugs producing ACLF and analyzed clinical features, laboratory characteristics, outcome, and predictors of mortality in patients with drug-induced ACLF.

METHODS

We identified drugs as precipitants of ACLF among prospective cohort of patients with ACLF from the Asian Pacific Association of Study of Liver (APASL) ACLF Research Consortium (AARC) database. Drugs were considered precipitants after exclusion of known causes together with a temporal association between exposure and decompensation. Outcome was defined as death from decompensation.

RESULTS

Of the 3,132 patients with ACLF, drugs were implicated as a cause in 329 (10.5%, mean age 47 years, 65% men) and other nondrug causes in 2,803 (89.5%) (group B). Complementary and alternative medications (71.7%) were the commonest insult, followed by combination antituberculosis therapy drugs (27.3%). Alcoholic liver disease (28.6%), cryptogenic liver disease (25.5%), and non-alcoholic steatohepatitis (NASH) (16.7%) were common causes of underlying liver diseases. Patients with drug-induced ACLF had jaundice (100%), ascites (88%), encephalopathy (46.5%), high Model for End-Stage Liver Disease (MELD) (30.2), and Child-Turcotte-Pugh score (12.1). The overall 90-day mortality was higher in drug-induced (46.5%) than in non-drug-induced ACLF (38.8%) (P = 0.007). The Cox regression model identified arterial lactate (P < 0.001) and total bilirubin (P = 0.008) as predictors of mortality.

DISCUSSION

Drugs are important identifiable causes of ACLF in Asia-Pacific countries, predominantly from complementary and alternative medications, followed by antituberculosis drugs. Encephalopathy, bilirubin, blood urea, lactate, and international normalized ratio (INR) predict mortality in drug-induced ACLF.

Biotransformation profiles from a cohort of chronic fatigue women in response to a hepatic detoxification challenge

Chronic fatigue, in its various manifestations, frequently co-occur with pain, sleep disturbances and depression and is a non-communicable condition which is rapidly becoming endemic worldwide. However, it is handicapped by a lack of objective definitions and diagnostic measures. This has prompted the World Health Organization to develop an international instrument whose intended purpose is to improve quality of life (QOL), with energy and fatigue as one domain of focus. To complement this objective, the interface between detoxification, the exposome, and xenobiotic-sensing by nuclear receptors that mediate induction of biotransformation-linked genes, is stimulating renewed attention to a rational development of strategies to identify the metabolic profiles in complex multifactorial conditions like fatigue. Here we present results from a seven-year study of a cohort of 576 female patients suffering from low to high levels of chronic fatigue, in which phase I and phase II biotransformation was assessed. The biotransformation profiles used were based on hepatic detoxification challenge tests through oral caffeine, acetaminophen and acetylsalicylic acid ingestion coupled with oxidative stress analyses. The interventions indicated normal phase I but increased phase II glucuronidation and glycination conjugation. Complementarity was indicated between a fatigue scale, medical symptoms and associated energy-related parameters by application of Chi-square Automatic Interaction Detector (CHAID) analysis. The presented study provides a cluster of data from which we propose that multidisciplinary inputs from the combination of a fatigue scale, medical symptoms and biotransformation profiles provide the rationale for the development of a comprehensive laboratory instrument for improved diagnostics and personalized interventions in patients with chronic fatigue with a view to improving their QOL.

Drug-induced liver steatosis in patients with HIV infection

Drug-induced liver injury (DILI) due to the use of prescription and non-prescription medication by HIV-positive and HIV-negative patients is one of the main causes of acute liver failure and transplantation in Western countries and, although rare, has to be considered a serious problem because of its unforeseeable nature and possibly fatal course. Drug-induced steatosis (DIS) and steatohepatitis (DISH) are infrequent but well-documented types of DILI. Although a number of commonly used drugs are associated with steatosis, it is not always easy to identify them as causative agents because of the weak temporal relationship between the administration of the drug and the clinical event, the lack of a confirmatory re-challenge, and the high prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population, which often makes it difficult to make a differential diagnosis of DIS and DISH. The scenario is even more complex in HIV-positive patients not only because of the underlying disease, but also because the various anti-retroviral regimens have different effects on liver steatosis. Given the high prevalence of liver steatosis in HIV-positive patients and the increasing use of drugs associated with a potential steatotic risk, the identification of clinical signs suggesting liver damage should help to avoid the possible misdiagnosis of "primary" NAFLD in a patient with DIS or DISH. This review will therefore initially concentrate on the current diagnostic criteria for DIS/DISH and their differential diagnosis from NAFLD. Subsequently, it will consider the different clinical manifestations of iatrogenic liver steatosis in detail, with specific reference to HIV-positive patients. Finally, the last part of the review will be dedicated to the possible effects of liver steatosis on the bioavailability of antiretroviral and other drugs.

Dyslipidemia is a Risk Factor for the Incidence and Severity of Drug-Induced Liver Injury (DILI): A Retrospective Population-Based Study in China

Background

A Chinese population-based study aimed to investigate the risk factors for the incidence and severity of drug-induced liver injury (DILI) from Chinese herbal medicines and conventional Western medicines.

Material/Methods

Liver biopsy and routine laboratory testing, including serum lipid measurements, was performed on 465 patients, including 168 patients with DILI and 297 patients without DILI. Histological grading of DILI used the METAVIR scoring system and the severity of DILI was graded as levels 0–5. Multivariate and univariate regression analysis were used to compare the two study groups, using a risk-adjusted odds ratio (AOR).

Results

There was no significant association between age, alcohol status, cardiovascular disease (CVD), hypertension, or type 2 diabetes mellitus and development of DILI. However, when compared with controls, patients with dyslipidemia (AOR, 2.173; 95% CI, 1.388–3.401; P=0.001) had an increased incidence of DILI, and men had a reduced incidence of DILI when compared with women (AOR, 0.276; 95% CI, 0.169–0.450; P<0.001). Risk factors for severe DILI (≥level 3) included drinking alcohol (AOR, 6.506; 95% CI, 2.184–19.384; P=0.001), and dyslipidemia (AOR, 3.095; 95% CI, 1.345–7.123; P=0.008). Patients with an increased duration of drug treatment of >1 year had a reduced risk of developing severe DILI compared with patients with a medication duration of ≤1 month (AOR, 0.259; 95% CI, 0.084–0.802).

Conclusions

Increased risk of the incidence of DILI was significantly associated with female gender and dyslipidemia, and the risk of developing severe DILI was associated with drinking alcohol and dyslipidemia.

Ambient PM2.5 and birth outcomes: Estimating the association and attributable risk using a birth cohort study in nine Chinese cities

BACKGROUND

Previous studies have reported that maternal exposure to particles with aerodynamic diameter <2.5 μm (PM_2.5) is associated with birth outcomes. However, a multicity birth cohort study has not been conducted in China, and the attributable fraction of adverse birth outcomes due to PM_2.5 exposure remains unknown.

METHODS

We examined associations in a birth cohort of 1,455,026 mother-and-live-birth pairs who were followed up from the first hospital visit for pregnancy until the birth of the baby during 2014-2017 in nine cites of the Pearl River Delta (PRD) region, China. The PM_2.5 exposures were estimated based on the air pollution concentrations of the nearby monitors. Cox proportional hazards regressions were employed to examine the associations.

RESULTS

We found 1% (HR = 1.01; 95% CI: 1.00, 1.02), 6% (HR = 1.06; 95% CI: 1.05, 1.07), and 7% (HR = 1.07; 95% CI: 1.06, 1.08) increases in risk of PTB and 20% (HR = 1.20; 95% CI: 1.18, 1.22), 18% (HR = 1.18; 95% CI: 1.15, 1.20), and 20% (HR = 1.20; 95% CI: 1.17, 1.23) increases in risk of LBW, with each 10 μg/m³ increase in PM_2.5 from trimester 1 to trimester 3, respectively. For PTB, highest HRs were observed during trimester 3, as for LBW, stronger effect were observed during trimester 1 and trimester 3. We further estimated that 7.84% (95% CI: 6.21%, 9.50%) of PTB and 14.85% (95% CI: 13.00%, 16.61%) of the LBW cases could be attributable to PM_2.5 exposure during the third trimester.

CONCLUSION

The results indicate that maternal PM_2.5 exposure is a risk factor for both LBW and PTB, and responsible for considerable burdens of PTB and LBW in the Pearl River Delta region.

Marine-Derived Natural Compounds for the Treatment of Parkinson's Disease

Parkinson’s disease (PD) is a neurodegenerative disorder caused by the loss of dopaminergic neurons, leading to the motor dysfunctions of patients. Although the etiology of PD is still unclear, the death of dopaminergic neurons during PD progress was revealed to be associated with the abnormal aggregation of α-synuclein, the elevation of oxidative stress, the dysfunction of mitochondrial functions, and the increase of neuroinflammation. However, current anti-PD therapies could only produce symptom-relieving effects, because they could not provide neuroprotective effects, stop or delay the degeneration of dopaminergic neurons. Marine-derived natural compounds, with their novel chemical structures and unique biological activities, may provide anti-PD neuroprotective effects. In this study, we have summarized anti-PD marine-derived natural products which have shown pharmacological activities by acting on various PD targets, such as α-synuclein, monoamine oxidase B, and reactive oxygen species. Moreover, marine-derived natural compounds currently evaluated in the clinical trials for the treatment of PD are also discussed.

Measurement of sirolimus concentrations in human blood using an automated electrochemiluminescence immunoassay (ECLIA): a multicenter evaluation

BACKGROUND

Therapeutic drug monitoring (TDM) of sirolimus is essential in transplant recipients. We evaluated the performance of a new electrochemiluminescence immunoassay (ECLIA) for measuring sirolimus concentrations in whole blood at five European laboratories.

METHODS

Study assessments included repeatability, intermediate precision and functional sensitivity (concentration at coefficient of variation [CV] of 20%) experiments. Method comparisons with liquid chromatography-tandem mass spectrometry (LC-MS/MS; reference method) and two immunoassays (chemiluminescent microparticle immunoassay [CMIA] and antibody-conjugated magnetic immunoassay [ACMIA]) were performed using native samples from patients with kidney transplants.

RESULTS

Imprecision testing CVs were ≤6.4% and ≤10.7% across the sirolimus concentration range for both repeatability and intermediate precision, respectively. The ECLIA showed excellent functional sensitivity: the CV did not reach 20%; the CV at the assay's limit of quantitation (1.5 μg/L) was 7.0%. Agreement between the ECLIA and LC-MS/MS using native kidney samples was close, with weighted Deming regression analysis yielding a slope of 1.05, an intercept of 0.154 μg/L and a Pearson's correlation coefficient (r) of 0.94, while Bland-Altman analysis showed a combined mean bias of 0.41 μg/L (±2 standard deviation [SD], -1.96 to 2.68). The ECLIA also showed good correlation with the two other immunoassays: the CMIA (slope=0.91, intercept=0.112 μg/L and r=0.89) and the ACMIA (slope=0.99, intercept=0.319 μg/L and r=0.97).

CONCLUSIONS

The ECLIA showed good precision, functional sensitivity and agreement with other methods of sirolimus measurement used in clinical practice, suggesting that the assay is suitable for TDM in transplant recipients and provides an alternative to LC-MS/MS.

Alzheimer and depressive cognitive-like behaviors in male and female rats: A new method for exposure to ambient air pollution

In the previous studies regarding the effects of exposure to ambient air pollution on biological markers and/or behavior of animals, the gaseous pollutants are not separated from the particulate matter (PM). Hence the synergetic effect of gaseous pollutants and PM was not considered. In this regard, current study was aimed to devolve a new method for separation of PM from gaseous pollutants. Also, the effect of exposure to fine particulate matter (PM_2.5) on the Alzheimer and depressive cognitive-like behaviors in rats after 3 and 6 months were investigated. Three chambers were designed including exposure group 1 (PM_2.5 plus gaseous pollutants alone), exposure group 2 (gaseous pollutants alone) and control group (clean air). Exposure time was 5 h per day (9.00 a.m.-2.00 p.m.) for 4 days per week. The concentration of PM_2.5 and gaseous pollutants (O₃, NO₂, and SO₂) were monitored in the exposure hours, continuously. Concentration of PM_2.5 by beta attenuation method and concentration of O₃, NO₂, and SO₂ by UV fluorescence was monitored. Also, the concentration of metals including Al, Cr, Mn, Pb, Cd, Ni, Fe, and Cu and 16-polycyclic aromatic hydrocarbons (PAHs) bound PM_2.5 by inductively coupled plasma mass spectrometry (ICP-MS) and gas chromatography-mass spectrometry (GC-MS) were analyzed, respectively. Cognitive-like behavior related to Alzheimer and depressive behaviors were determined by Y maze and Force swimming. The concentration of PM_2.5 in the 3 and 6 months exposure was higher than WHO guideline, significantly (p-value <0.05). The concentration of O₃, NO₂ and SO₂ in the 3 and 6 months exposure was lower than WHO guideline, significantly (p-value <0.05). The order of metals in the PM_2.5 according to mean concentration Al > Ca > Cu > Cd > Na > Fe > Cr > Ni > Mn > Pb. Also, the sum concentration of 16-PAHs in the PM_2.5 in the 3 and 6 months exposure was 45.7 ± 37.15 ng/m³ and 30.04 ± 25.27 ng/m³, respectively. Exposure to PM_2.5 cannot significantly increase Alzheimer and depressive cognitive-like behaviors in the rats. Also, a significant difference between male and female in Alzheimer and depressive cognitive-like behaviors not observed. •A new method for separation of PM_2.5 from other PM in the ambient air by ECO-PM sampler was presented.•A new method for separation of PM_2.5 from gaseous pollutants in the ambient air by HEPA filter and active carbon was presented.•Tow exposure groups including exposure 1: PM_2.5 plus gaseous pollutants and exposure 2: gaseous pollutants only were designed for increased accuracy of the in-vivo study.•Exposure to PM_2.5 cannot cause significant increased Alzheimer and depressive cognitive-like behaviors in the rats.

Application of the Public Health Exposome Framework to Estimate Phenotypes of Resilience in a Model Ohio African-American Women's Cohort

We report integration of the United States Environmental Protection Agency's (USEPA) United States Environmental Justice Screen (EJSCREEN) database with our Public Health Exposome dataset to interrogate 9232 census blocks to model the complexity of relationships among environmental and socio-demographic variables toward estimating adverse pregnancy outcomes [low birth weight (LBW) and pre-term birth (PTB)] in all Ohio counties. Using a hill-climbing algorithm in R software, we derived a Bayesian network that mapped all controlled associations among all variables available by applying a mapping algorithm. The results revealed 17 environmental and socio-demographic variables that were represented by nodes containing 69 links accounting for a network with 32.85% density and average degree of 9.2 showing the most connected nodes in the center of the model. The model predicts that the socio-economic variables low income, minority, and under age five populations are correlated and associated with the environmental variables; particulate matter (PM_2.5) level in air, proximity to risk management facilities, and proximity to direct discharges in water are linked to PTB and LBW in 88 Ohio counties. The methodology used to derive significant associations of chemical and non-chemical stressors linked to PTB and LBW from indices of geo-coded environmental neighborhood deprivation serves as a proxy for design of an African-American women's cohort to be recruited in Ohio counties from federally qualified community health centers within the 9232 census blocks. The results have implications for the development of severity scores for endo-phenotypes of resilience based on associations and linkages for different chemical and non-chemical stressors that have been shown to moderate cardio-metabolic disease within a population health context.

The emission of PM2.5 in respiratory zone from Chinese family cooking and its health effect

To investigate the PM_2.5 emission in the direct exposed area from Chinese family cooking, eleven kinds of Chinese ordinary family cooking dishes were designed including frying, quick-frying, stewing, deep-frying, boiling and steaming according to the results of questionnaire survey. The results showed that the intensity sequence for PM_2.5 emissions decreased as follows in general: deep-frying (0.709-2.731 mg/m³) > stir-frying (0.700-0.958 mg/m³) > stewing (~0.573 mg/m³) > quick-frying (0.140-0.433 mg/m³) > boiling (0.004-0.247 mg/m³) > steaming (0.011-0.088 mg/m³), most of them exceeded the national indoor air standard. The average concentration of PM_2.5 in the direct respiratory zone from family cooking was determined to be 0.599 mg/m³, which was about 8 times higher than the national indoor air standard of China and lower than that from commercial restaurants. The annual PM_2.5 inhalation exposure in the direct exposed area from family cooking for male and female was 346.30 mg/year and 309.59 mg/year, respectively. Although the annual PM_2.5 inhalation exposure of male operators in general ordinary family cooking was about 11.8% higher than that of females, the pregnant women, children and the elderly are not encouraged to prepare ordinary family cooking for a long time due to their sensitive to PM_2.5 emission. Selecting ventilator with high wind speed can reduce PM_2.5 emission more than 65% when compared to medium wind speed. Improvement of ventilator wind speed is considered to be an effect way to reduce PM_2.5 emission for cooking.

Consensus: guidelines: best practices for detection, assessment and management of suspected acute drug-induced liver injury during clinical trials in patients with nonalcoholic steatohepatitis

BACKGROUND

The last decade has seen a rapid growth in the number of clinical trials enrolling patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH). Due to the underlying chronic liver disease, patients with NASH often require different approaches to the assessment and management of suspected drug-induced liver injury (DILI) compared to patients with healthy livers. However, currently no regulatory guidelines or position papers systematically address best practices pertaining to DILI in NASH clinical trials.

AIMS

This publication focuses on best practices concerning the detection, monitoring, diagnosis and management of suspected acute DILI during clinical trials in patients with NASH.

METHODS

This is one of several papers developed by the IQ DILI Initiative, comprised of members from 15 pharmaceutical companies, in collaboration with DILI experts from academia and regulatory agencies. This paper is based on extensive literature review, and discussions between industry members with expertise in drug safety and DILI experts from outside industry to achieve consensus on common questions related to this topic.

RESULTS

Recommended best practices are outlined pertaining to hepatic inclusion and exclusion criteria, monitoring of liver tests, DILI detection, approach to a suspected DILI signal, causality assessment and hepatic discontinuation rules.

CONCLUSIONS

This paper provides a framework for the approach to assessment and management of suspected acute DILI during clinical trials in patients with NASH.

The Therapeutic Implications of the Gut Microbiome and Probiotics in Patients with NAFLD

Recent breakthrough in our understanding pertaining to the pathogenesis of nonalcoholic fatty liver disease (NAFLD) has pointed to dysregulation or derangement of the gut microbiome, also known as dysbiosis. This has led to growing interest in probiotic supplementation as a potential treatment method for NAFLD due to its ability to retard and/or reverse dysbiosis and restore normal gut flora. A thorough review of medical literature was completed from inception through July 10, 2018 on the PubMed database by searching for key terms such as NAFLD, probiotics, dysbiosis, synbiotics, and nonalcoholic steatohepatitis (NASH). All studies reviewed indicate that probiotics had a beneficial effect in patients with NAFLD and its subset NASH. Results varied between studies, but there was evidence demonstrating improvement in liver enzymes, hepatic inflammation, hepatic steatosis, and hepatic fibrosis. No major adverse effects were noted. Currently, there are no guidelines addressing the use of probiotics in the setting of NAFLD. In conclusion, probiotics appear to be a promising option in the treatment of NAFLD. Future research is necessary to assess the efficacy of probiotics in patients with NAFLD.

Drug-induced liver injury in obesity and nonalcoholic fatty liver disease

Obesity is commonly associated with nonalcoholic fatty liver (NAFL), a benign condition characterized by hepatic lipid accumulation. However, NAFL can progress in some patients to nonalcoholic steatohepatitis (NASH) and then to severe liver lesions including extensive fibrosis, cirrhosis and hepatocellular carcinoma. The entire spectrum of these hepatic lesions is referred to as nonalcoholic fatty liver disease (NAFLD). The transition of simple fatty liver to NASH seems to be favored by several genetic and environmental factors. Different experimental and clinical investigations showed or suggested that obesity and NAFLD are able to increase the risk of hepatotoxicity of different drugs. Some of these drugs may cause more severe and/or more frequent acute liver injury in obese individuals whereas others may trigger the transition of simple fatty liver to NASH or may worsen hepatic lipid accumulation, necroinflammation and fibrosis. This review presents the available information regarding drugs that may cause a specific risk in the context of obesity and NAFLD. These drugs, which belong to different pharmacological classes, include acetaminophen, halothane, methotrexate, rosiglitazone and tamoxifen. For some of these drugs, experimental investigations confirmed the clinical observations and unveiled different pathophysiological mechanisms which may explain why these pharmaceuticals are particularly hepatotoxic in obesity and NAFLD. Because obese people often take several drugs for the treatment of different obesity-related diseases, there is an urgent need to identify the main pharmaceuticals that may cause acute liver injury on a fatty liver background or that may enhance the risk of severe chronic liver disease.

Increasing risk of congenital anomalies associated with seasonal pattern of air pollution: Differences by maternal comorbidities

To interpret the relationship of the seasonal pattern of air pollution exposure associated with increased risk of congenital anomalies (CA) and the trimester-specific effects. In this work, 55,428 hospital records with 847 doctor-diagnosed CA from July 2013 to December 2016 were collected in Hohhot, China. Maternal exposure to critical air pollutants (SO₂, CO, PM₁₀, O₃, NO₂ and PM_2.5) were estimated using an inverse distance weighted (IDW) method on the basis of the ambient air quality monitoring stations. Logistic regression analysis was employed to determine the association of CA (in terms of odds ratio (OR) and 95% confidence interval (CI)) in three trimesters with heating/none heating season exposure. The results showed that CO exposure was found a significant association with ORs (95% CI) 1.58 (1.09, 2.27) changing from IQR2-3 and 1.40 (1.01, 1.93) changing from IQR3-IQR4 in 1st trimester and 1.51 (1.12, 2.04) changing from IQR2-3 in 2nd trimester, respectively. PM₁₀ also presented significant association with ORs (95% CI) 1.42(1.08, 1.86) changing from IQR3-4 in 2nd trimester. Exposure effects were found more obvious in heating season, i.e. CO exposure levels were associated with the risks of CA with IQR changing ORs (95% CI) of 5.21(2.02, 7.44), 2.24 (1.21, 4.15) and 1.84 (1.10, 3.11) in 1st trimester, respectively; PM_2.5 exposure levels were associated with the risks of CA with IQR changing ORs (95% CI) of 3.76 (1.48, 6.55), 2.45 (1.10, 5.44) and 3.30 (1.63, 6.67) in 2nd trimester, respectively. Our findings suggested some positive associations of pregnancy and CA with maternal exposure to ambient CO and PM_2.5 during the 1st and 2nd trimester after controlling for maternal comorbidities general covariates and other pollutants. PM₁₀ was also found significantly associated with increased risk of CA in 2_nd trimester besides seasons. There was no association found in 3rd trimester.

Chemical Characterization of PM2.5 at Rural and Urban Sites around the Metropolitan Area of Huancayo (Central Andes of Peru)

The purpose of this study was to determine PM2.5 mass concentration and the contents of trace elements and water-soluble ions in samples collected inside the Metropolitan area of Huancayo. Four monitoring stations were installed at three urban areas (UNCP, HYO, and CHI) and one rural (IGP). The sampling campaign was carried out from March 2017 to November 2017. The PM2.5 content was determined by gravimetric method, and fifteen trace elements (TE) and seven water-soluble ions were detected by inductively coupled plasma mass spectrometry (ICP–MS), and ion chromatography (IC), respectively. Datasets were assessed by one ANOVA test to detect significant differences among monitoring station. Hierarchical cluster analysis (HCA) and principal component analysis (PCA) were applied for source identification. The mean annual concentration of PM2.5 mass concentrations has ranged (average) from 3.4 to 36.8 µg/m3 (16.6 ± 6.8 µg/m3) for the monitoring stations under study. The annual World Health Organization thresholds and national air quality standards were exceeded. Significant differences (p < 0.05) were observed between most trace elements at urban and rural areas. PCA and HCA illustrated that the most important sources of traces element originated of natural origin (soil re-suspension) and vehicular sources (fuel combustion, abrasion of vehicles tires, wear car components).

Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: a critical review

The atypical antipsychotics (AAPs) have been used as first-line drugs in psychiatric practice for a wide range of psychotic disorders, including schizophrenia and bipolar mania. While effectively exerting therapeutic effects on positive and negative symptoms, as well as cognitive impairments in schizophrenia patients, these drugs are less likely to induce extrapyramidal symptoms compared to typical antipsychotics. However, the increasing application of them has raised questions on their tolerability and adverse effects over the endocrine, metabolic, and cardiovascular axes. Specifically, AAPs are associated to different extents, with weight gain, metabolic syndrome (MetS), and nonalcoholic fatty liver disease (NAFLD). This article summarized clinical evidence showing the metabolic side effects of AAPs in patients with schizophrenia, and experimental evidence of AAPs-induced metabolic side effects observed in animals and cell culture studies. In addition, it discussed potential mechanisms involved in the APPs-induced MetS and NAFLD.