Carbon monoxide intoxication: an updated review

Spectrum of delayed post-hypoxic leukoencephalopathy syndrome: A systematic review

BACKGROUND

Delayed post hypoxic leukoencephalopathy syndrome (DPHLS), also known as Grinker’s myelinopathy, is a rare but significant neurological condition that manifests days to weeks after a hypoxic event. Characterized by delayed onset of neurological and cognitive deficits, DPHLS presents substantial diagnostic and therapeutic challenges.

AIM

To consolidate current knowledge on pathophysiology, clinical features, diagnostic approaches, and management strategies for DPHLS, providing a comprehensive overview and highlighting gaps for future research.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines, we systematically searched PubMed, ScienceDirect and Hinari databases using terms related to delayed post-hypoxic leukoencephalopathy. Inclusion criteria were original research articles, case reports, and case series involving human subjects with detailed clinical, neuroimaging, or pathological data on DPHLS. Data were extracted on study characteristics, participant demographics, clinical features, neuroimaging findings, pathological findings, treatment, and outcomes. The quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist.

RESULTS

A total of 73 cases were reviewed. Common comorbidities included schizoaffective disorder, bipolar disorder, hypertension, and substance use disorder. The primary causes of hypoxia were benzodiazepine overdose, opioid overdose, polysubstance overdose, and carbon monoxide (CO) poisoning. Symptoms frequently include decreased level of consciousness, psychomotor agitation, cognitive decline, parkinsonism, and encephalopathy. Neuroimaging commonly revealed diffuse T2 hyperintensities in cerebral white matter, sometimes involving the basal ganglia and the globus pallidus. Magnetic resonance spectroscopy often showed decreased N-acetylaspartate, elevated choline, choline-to-creatinine ratio, and normal or elevated lactate. Treatment is often supportive, including amantadine, an antioxidant cocktail, and steroids. Hyperbaric oxygen therapy may be beneficial in those with CO poisoning. Parkinsonism was often treated with levodopa. Most of the patients had substantial recovery over the course of months and many cases had some residual neurocognitive deficits.

CONCLUSION

DPHLS remains a complex and multifaceted condition with various etiologies and clinical manifestations. Early recognition and appropriate management are crucial to improving patient outcomes. Future research should focus on standardizing diagnostic criteria, using advanced imaging techniques, and exploring therapeutic interventions to improve understanding and treatment of DPHLS. Conducting prospective cohort studies and developing biomarkers for early diagnosis and monitoring will be essential to advance patient care.

Effects of acute carbon monoxide poisoning on liver damage and comparisons of related oxygen therapies in a rat model

Acute carbon monoxide (CO) poisoning may cause liver damage and liver dysfunction. Therefore, in this study, we aimed to compare the efficiency of normobaric oxygen (NBO) and high-flow nasal cannula oxygen (HFNCO) treatments on liver injury. For that purpose, 28 male Wistar albino rats were divided into four groups (Control, CO, CO + NBO, and CO + HFNCO). The control group was allowed to breath room air for 30 min. Acute CO poisoning in CO, CO + NBO, CO + HFNCO was induced by CO exposure for 30 min. Thereafter, NBO group received 100% NBO with reservoir mask for 30 min. HFNCO group received high-flow oxygen through nasal cannula for 30 min. At the end of the experiment, all animals were sacrificed by cardiac puncture under anesthesia. Serum liver function tests were measured. Liver tissue total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels, tissue histomorphology and immunoexpression levels of Bax, Caspase 3, TNF-α, IL-1β, and NF-κB were also examined. Our observations indicated that acute CO poisoning caused significant increases in blood COHb, serum aminotransferase (AST), alanine aminotransferase (ALT0, alkaline phosphatase (ALP), total protein, albumin, and globulin levels but a decrease in albumin to globulin ratio (all, p < 0.05). Furthermore, acute CO poisoning significantly increased the OSI value, and the immunoexpresssion of Bax, Caspase 3, TNF-α, IL-1β, and NF-κB in liver tissue (all, p < 0.05). These pathological changes in serum and liver tissue were alleviated through both of the treatment methods. In conclusion, both the NBO and HFNCO treatments were beneficial to alleviate the acute CO poisoning associated with liver injury and dysfunction.

Study on the Gas-Chromic Character of Pd/TiO2 for Fast Room-Temperature CO Detection

As a widely used support, TiO2 has often been combined with Pd to form highly sensitive gas-chromic materials. Herein, we prepared a series of Pd/TiO2 catalysts with different Pd content (from 0.1 to 5 wt.%) by the impregnation method for their utilization in fast room-temperature CO detection. The detection was simply based on visible color change when the Pd/TiO2 was exposed to CO. The sample with 1 wt.% Pd/TiO2 presented an excellent CO gasochromic character, associated with a maximum chromatic aberration value of 90 before and after CO exposure. Systematic catalyst characterizations of XPS, FT-IR, CO-TPD, and N2 adsorption-desorption and density functional theory calculations for the CO adsorption and charge transfer over the Pd and PdO surfaces were further carried out. It was found that the interaction between CO and the Pd surface was strong, associated with a large adsorption energy of -1.99 eV and charge transfer of 0.196 e. The color change was caused by a reduction in Pd2+ to metallic Pd0 over the Pd/TiO2 surface after CO exposure.

Carbon monoxide-related fatalities: A fifteen-year single institution experience

Introduction

The winter climate in Delhi is severe, with temperatures dropping below 10°C. As a result, individuals often resort to utilizing diverse heat sources such as electrical heating appliances, coal and gas geysers. Unfortunately, these sources are commonly associated with the emission of carbon monoxide (CO) which can accumulate in inadequately ventilated spaces. Exposure to this noxious gas can lead to acute lethargy and debilitation, leaving individuals in a state of helpless distress.

Materials and Methods

The present study utilized a retrospective descriptive analysis to examine cases of fatal carbon monoxide exposure retrieved from the Department of Forensic Medicine archives at the esteemed All India Institute of Medical Sciences, New Delhi. Autopsy records were thoroughly examined with respect to various parameters including age, gender, seasonality of the incident, circumstances surrounding the death, source of carbon monoxide generation, post mortem observations, as well as toxicological analysis reports.

Results and Discussion

This study entailed an analysis of 56 individuals who fell victim to carbon monoxide poisoning, with a staggering 95% of fatalities occurring during the winter season. The majority of the individuals affected belonged to the age bracket of 21-30 years. The most common sources of carbon monoxide exposure were linked to the use of coal-burning earthen or iron vessels for room heating, as well as structural fires. With the exception of one case, all incidents were accidental in nature. Additionally, nearly all of the victims were discovered in enclosed spaces with heating equipment in close proximity, and evidence of a struggle was noted on the crime scene or with the deceased.

Conclusion

The findings of this study indicate that the principal contributor to the inadvertent build-up of lethal concentrations of carbon monoxide gas is the utilization of heating appliances within inadequately ventilated, enclosed spaces. Due to the scentless and non-irritating properties of this gas, individuals who are asleep may be unable to detect its presence in their surroundings, thereby leading to a silent death. To mitigate such risks, the installation of carbon monoxide detectors is crucial. Additionally, it is of utmost importance to raise public awareness regarding the perils associated with using fire pots, coal burning and electrical heating appliances in areas with insufficient ventilation.

Practical Recommendations for the Evaluation and Management of Cardiac Injury Due to Carbon Monoxide Poisoning

Carbon monoxide (CO) is a relatively frequent cause of poisoning evaluated in emergency departments. The risk of neurologic injuries, such as cognitive, psychological, vestibular, and motor deficits, is 25% to 50%. However, the risk of cardiac injuries should also be considered. Among patients with CO poisoning, the mortality in patients with myocardial injury is approximately 3 times greater than that in patients without myocardial injury. In large-scale studies, up to 69.2% of patients with acute CO poisoning exhibiting elevated troponin I levels and no underlying cardiovascular illnesses had late gadolinium enhancement on cardiac magnetic resonance, suggesting covert CO-induced myocardial fibrosis. Myocardial damage can be evaluated using electrocardiography, echocardiography, computed tomography, and cardiac magnetic resonance. This paper offers recommendations for cardiac evaluations based on our collective experience of managing >2,000 cases of acute CO poisoning with supporting information taken from peer-reviewed published reports on CO poisoning.

Forensic utility of carboxyhemoglobin levels in postmortem spleen specimens in South Korea

In order to determine whether CO poisoning was the definitive cause of death, the concentration of carboxyhemoglobin (COHb) in spleen specimens was analyzed using a gas chromatography-thermal conductivity detector. 125 cases of forensic autopsy reports containing COHb analysis requests were analyzed and subdivided into two groups, improbable and highly probable of CO intoxication. In the first group which consists of 100 cases, the results of COHb analysis were negative, and the circumstances of death, as well as the postmortem findings could not validate the exposure to CO. In the second group which consists of 25 cases, the results of COHb were positive, and both postmortem findings and circumstances of death confirmed the exposure to CO. In the cases of indoors and vehicle fires or those including the use of briquettes, COHb levels reached 43.1-97.5 %, whereas in individuals without any feature of CO poisoning had COHb level high as 29.8 %. However, certain cases without any connection to fire nor CO exposure also contained significant amount of CO based on post-mortem analysis. This study focuses on cases without any relationship to fire or CO and proves that COHb levels below 30 % may be considered as a contributing factor to but not exclusively as the cause of death.

Phylogenetic diversity of putative nickel-containing carbon monoxide dehydrogenase-encoding prokaryotes in the human gut microbiome

Although the production of carbon monoxide (CO) within the human body has been detected, only two CO-utilizing prokaryotes (CO utilizers) have been reported in the human gut. Therefore, the phylogenetic diversity of the human gut CO-utilizing prokaryotes remains unclear. Here, we unveiled more than a thousand representative genomes containing genes for putative nickel-containing CO dehydrogenase (pCODH), an essential enzyme for CO utilization. The taxonomy of genomes encoding pCODH was expanded to include 8 phyla, comprising 82 genera and 248 species. In contrast, putative molybdenum-containing CODH genes were not detected in the human gut microbial genomes. pCODH transcripts were detected in 97.3 % (n=110) of public metatranscriptome datasets derived from healthy human faeces, suggesting the ubiquitous presence of prokaryotes bearing transcriptionally active pCODH genes in the human gut. More than half of the pCODH-encoding genomes contain a set of genes for the autotrophic Wood-Ljungdahl pathway (WLP). However, 79 % of these genomes commonly lack a key gene for the WLP, which encodes the enzyme that synthesizes formate from CO2, suggesting that potential human gut CO-utilizing prokaryotes share a degenerated gene set for WLP. In the other half of the pCODH-encoding genomes, seven genes, including putative genes for flavin adenine dinucleotide-dependent NAD(P) oxidoreductase (FNOR), ABC transporter and Fe-hydrogenase, were found adjacent to the pCODH gene. None of the putative genes associated with CO-oxidizing respiratory machinery, such as energy-converting hydrogenase genes, were found in pCODH-encoding genomes. This suggests that the human gut CO utilization is not for CO removal, but potentially for fixation and/or biosynthesis, consistent with the harmless yet continuous production of CO in the human gut. Our findings reveal the diversity and distribution of prokaryotes with pCODH in the human gut microbiome, suggesting their potential contribution to microbial ecosystems in human gut environments.

Association of carbon monoxide poisoning with cardiovascular disease risk: A systematic review and meta-analysis

Objective

This study aims to provide an updated overview of the relationship between carbon monoxide poisoning (COP) and cardiovascular disease.

Methods

A systematic literature search was conducted in PubMed, Embase, Cochrane, and Web of Science databases up to September 2023. The association between COP patients and cardiovascular adverse events was examined and summarized. The outcomes included arrhythmia, coronary heart disease, heart failure, myocardial infarction, major adverse cardiovascular events (MACE), carboxyhaemoglobin percent (COHB%), Pondus Hydrogenii (PH) electrocardiography (ECG) parameters.

Results

Eight eligible articles, involving a total of 251,971 patients, were included for evidence synthesis. The analysis revealed a heightened incidence of MACE in patients with COP. Additionally, COP exhibited an impact on specific ECG parameters. The incidence of MACE after COP was found to be similar in Korean and Chinese populations, and there was no significant effect of gender or underlying diseases on MACE incidence following COP. The incidence of MACE after COP did not differ significantly in individuals aged 50 years and older.

Conclusions

Considering the observed heterogeneity and potential biases in the selected studies, emergency physicians should be aware of the increased likelihood of cardiovascular events in patients diagnosed with COP.

Effects of major air pollutants on angina hospitalizations: a correlation study

BACKGROUND

Angina is a crucial risk signal for cardiovascular disease. However, few studies have evaluated the effects of ambient air pollution exposure on angina.

OBJECTIVE

We aimed to explore the short-term effects of air pollution on hospitalization for angina and its lag effects.

METHODS

We collected data on air pollutant concentrations and angina hospitalizations from 2013 to 2020. Distributed lag nonlinear model (DLNM) was used to evaluate the short-term effects of air pollutants on angina hospitalization under different lag structures. Stratified analysis by sex, age and season was obtained.

RESULTS

A total of 39,110 cases of angina hospitalization were included in the study. The results showed a significant positive correlation between PM2.5, SO2, NO2, and CO and angina hospitalization. Their maximum harmful effects were observed at lag0-7 (RR = 1.042; 95% CI: 1.017, 1.068), lag0-3 (RR = 1.067; 95% CI: 1.005, 1.133), lag0-6 (RR = 1.078; 95% CI: 1.041, 1.117), and lag0-6 (RR = 1.244; 95% CI: 1.109, 1.397), respectively. PM10 did not have an overall risk effect on angina hospitalization, but it did have a risk effect on women and the elderly. O3 was significantly negatively correlated with angina hospitalization, with the most pronounced effect observed at lag0-6 (RR = 0.960; 95% CI: 0.940, 0.982). Stratified analysis results showed that women and the elderly were more susceptible to pollutants, and the adverse effects of pollutants were stronger in the cold season.

CONCLUSION

Short-term exposure to PM2.5, SO2, NO2, and CO increases the risk of hospitalization for angina.

Understanding the CO capture reaction through electronic structure analysis of four-membered-ring group-13/N- and B/group-15-based Lewis acid-base pairs

Incomplete combustion yields a significant byproduct, known for its high toxicity to humans: gas phase carbon monoxide (CO). This study utilized several advanced theoretical methods to examine the factors contributing to the activation energy involved in CO capture by a frustrated Lewis pair (FLP) and to forecast the potential success of the CO capture reaction. The current theoretical findings indicate that among the four-membered-ring Group-13/N-FLP and B/Group-15-FLP molecules, only the B/N-based FLP-type molecule effectively captures CO, considering both thermodynamics and kinetics. According to the results obtained through energy decomposition analysis-natural orbitals for chemical valence (EDA-NOCV), it can be concluded that the donor-acceptor (singlet-singlet) model, rather than the electron-sharing (triplet-triplet) model, effectively characterizes the electronic structures in the CO trapping reaction involving four-membered-ring G13/G15-FLPs. Theoretical findings, derived from EDA-NOCV and frontier molecular orbital theory, demonstrate that the CO capture reaction by G13/G15-FLP involves two distinct bonding interactions. The first interaction is characterized by FLP-to-CO forward bonding, with the lone pair of G15 (G13/G15-FLP) donating to the empty p-π* orbital of carbon (CO), which predominates. The second interaction involves CO-to-FLP backward bonding, where the empty σ* orbital of G13 (G13/G15-FLP) accepts the lone pair of carbon (CO), albeit to a lesser extent. In summary, our theoretical findings indicate that the G13-C and G15-C bonds in the G15/G15-TS species with a four-membered ring can be classified as two dative single bonds. The importance of the interaction between Lewis bases and CO surpasses that of the interaction between Lewis acids and CO. Theoretical evidences in this study demonstrate a linear connection between the G13-G15 bond length within the four-membered-ring G13/G15-FLP and the activation barrier linked to CO capture. The activation strain model analysis in this study suggests that the activation energy required for bond formation primarily depends on the geometric deformation energy of G13/G15-FLP in capturing CO. Our DFT investigation shows that Hammond's postulate is obeyed by the CO catching reaction of the four-membered-ring G13/N-FLP, meaning that an earlier transition state is associated with a lower activation barrier, but not with the CO catching reaction of the four-membered-ring B/G15-FLP.

A Field Study of Carbon Monoxide Levels in Snow Caves During Short-Term Stove Use

INTRODUCTION

While the use of camping stoves in poorly ventilated areas is discouraged, the need to address dehydration challenges in harsh arctic conditions has led to their unconventional use inside snow caves for snow melting, subjecting occupants to unknown carbon monoxide (CO) levels. This study, located at sea level in northeastern Greenland, aimed to assess CO levels and dynamics during short cooking sessions in newly constructed emergency snow caves.

METHODS

In 5 snow caves, constructed according to the same design principles by 4 different individuals, a single MSR Whisperlite multifuel burner, primed with ethanol and burning white gas, was used to melt snow. CO concentrations were monitored every minute until all the snow in a 5-L pot was converted to water and CO levels returned to below 10 ppm.

RESULTS

A total of 16 experiments conducted showed that the priming phase generated the highest CO peaks, with a maximum of 120 ppm. Time-weighted averages ranged from 14 ppm to 67 ppm, with trial durations of 15 to 21 min. A single trial with a dirty burner resulted in up to a 10-fold increase in CO levels.

CONCLUSIONS

While single, short cooking sessions of less than 10 min burn time in newly constructed snow caves may be tolerated under specific conditions, the study highlighted substantial variation between caves and the importance of using clean burners, emphasizing the need for further research to gain a comprehensive understanding of CO exposure dynamics in snow caves.

Hyperbaric oxygen treatment reveals spatiotemporal OXPHOS plasticity in the porcine heart

Cardiomyocytes meet their high ATP demand almost exclusively by oxidative phosphorylation (OXPHOS). Adequate oxygen supply is an essential prerequisite to keep OXPHOS operational. At least two spatially distinct mitochondrial subpopulations facilitate OXPHOS in cardiomyocytes, i.e. subsarcolemmal (SSM) and interfibrillar mitochondria (IFM). Their intracellular localization below the sarcolemma or buried deep between the sarcomeres suggests different oxygen availability. Here, we studied SSM and IFM isolated from piglet hearts and found significantly lower activities of electron transport chain enzymes and F1FO-ATP synthase in IFM, indicative for compromised energy metabolism. To test the contribution of oxygen availability to this outcome, we ventilated piglets under hyperbaric hyperoxic (HBO) conditions for 240 min. HBO treatment raised OXPHOS enzyme activities in IFM to the level of SSM. Complexome profiling analysis revealed that a high proportion of the F1FO-ATP synthase in the IFM was in a disassembled state prior to the HBO treatment. Upon increased oxygen availability, the enzyme was found to be largely assembled, which may account for the observed increase in OXPHOS complex activities. Although HBO also induced transcription of genes involved in mitochondrial biogenesis, a full proteome analysis revealed only minimal alterations, meaning that HBO-mediated tissue remodeling is an unlikely cause for the observed differences in OXPHOS. We conclude that a previously unrecognized oxygen-regulated mechanism endows cardiac OXPHOS with spatiotemporal plasticity that may underlie the enormous metabolic and contractile adaptability of the heart.

Delayed encephalopathy after acute carbon monoxide poisoning: a case study

Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a relatively rare inflammatory-associated neurometabolic complication. In this article, we present a case report of a 50-year-old male patient with a history of carbon monoxide poisoning. This acute poisoning, although successfully controlled during a stay in the intensive care unit of a local hospital, later led to persistent neurological symptoms. The patient was then treated in the inpatient unit of the rehabilitation clinic, where cognitive deterioration began to develop 20 days after admission. Subsequent examination using EEG and magnetic resonance imaging confirmed severe encephalopathy later complicated by SARS-CoV-2 infection with fatal consequences due to bronchopneumonia. Because currently there are no approved guidelines for the management of DEACMP, we briefly discuss the existing challenges for future studies, especially the application of rational immunosuppressive therapy already in the acute treatment phase of CO poisoning, which could prevent the development of a severe form of DEACMP.

The role of carbon monoxide in aerotoxic syndrome

Chronic low-level exposure to toxic compounds in airplane cabin air may result in Aerotoxic Syndrome (AS). Aetiologic agents are organophosphates and numerous volatile organic hydrocarbons originating from leaks of engine oil and hydraulic fluids. Despite a documented history spanning decades, the role of carbon monoxide remains controversial. What evidence exists that carbon monoxide (CO), present in the cocktail of toxic compounds in bleed air, contributes to the AS? We selected 22 publications encompassing 888 flights with 18 different aircraft types. In one study of 100 flights, fume events were confirmed in 38. Four studies were initialized after air quality incidents. The cabin CO concentrations could be categorized in three levels, 1) low (<5 ppm), without health implications, 2) moderate (5-10 ppm) with probably health implications in case of chronic exposure, and 3) high > 10 ppm, with health effects in case of acute and chronic exposure. These levels were recorded in 12, 6 and 4 studies respectively. In the six studies in category 2, max CO concentrations ranged from 5.8-9.4 ppm. The four studies with CO > 10 ppm comprised 376 of the 888 flights (42%) with six aircraft types. Toxic CO levels ranging between 13-60 ppm were identified in at least 129 of 888 (14.5%) flights. In one study with high CO levels four flight attendants were diagnosed with CO poisoning with elevated HbCO levels. Max CO levels in aviation are either the same or higher than current occupational exposure limits (OEL) for ground-based workplace exposures or levels for urban street transport environments. Specific aspects of aviation should be taken into consideration: the effect of low(er) air pressure at high altitudes increasing the toxicity of CO, and the binding of CO to CYP enzymes, leading to impaired organophosphate detoxification. We conclude that CO must be considered an important factor in the lubrication derived cocktail of airborne toxic compounds causing AS. In line with the WHO advice, a reduction of the OEL to 5 ppm over 8 hr time weighted average (TWA) for aircrew is strongly recommended. And we advocate continuous monitoring during all phases of flight and installation of CO detectors in the air supply ducts to the aircraft cabin.

Spatial adjustment of bioenergetics, a possible determinant of contractile adaptation and development of contractile failure

Cardiomyocytes depend on mitochondrial oxidative phosphorylation (OXPHOS) for energy metabolism, which is facilitated by the mitochondrial electron transfer system (ETS). In a series of thermogenic redox reactions, electrons are shuttled through the ETS to oxygen as the final electron acceptor. This electron transfer is coupled to proton translocation across the inner mitochondrial membrane, which itself is the main driving force for ATP production. Oxygen availability is thus a prerequisite for ATP production and consequently contractility. Notably, cardiomyocytes are exceptionally large cells and densely packed with contractile structures, which constrains intracellular oxygen distribution. Moreover, oxygen must pass through layers of actively respiring mitochondria to reach the ones located in the innermost contractile compartment. Indeed, uneven oxygen distribution was observed in cardiomyocytes, suggesting that local ATP supply may also vary according to oxygen availability. Here, we discuss how spatial adjustment of bioenergetics to intracellular oxygen fluctuations may underlie cardiac contractile adaptation and how this adaptation may pose a risk for the development of contractile failure.

Hyperbaric oxygen treatment in carbon monoxide poisoning - Does it really matter?

Carbon monoxide (CO) is an odorless and colorless gas that can lead to fulminant and life-threatening intoxications. Besides an early diagnosis, an appropriate treatment of the intoxication is important. In this context the reduction of CO concentration in blood and tissues is crucial revealing hyperbaric oxygen treatment (HBO) as a highly promising tool. However, the benefit of HBO in CO intoxications is still considered controversial. In this review, we discuss the evidence of the role of HBO treatment in isolated CO intoxication.

Using neural networks and remote sensing for spatio-temporal prediction of air pollution during the COVID-19 pandemic

The study aims to monitor air pollution in Iranian metropolises using remote sensing, specifically focusing on pollutants such as O3, CH4, NO2, CO2, SO2, CO, and suspended particles (aerosols) in 2001 and 2019. Sentinel 5 satellite images are utilized to prepare maps of each pollutant. The relationship between these pollutants and land surface temperature (LST) is determined using linear regression analysis. Additionally, the study estimates air pollution levels in 2040 using Markov and Cellular Automata (CA)-Markov chains. Furthermore, three neural network models, namely multilayer perceptron (MLP), radial basis function (RBF), and long short-term memory (LSTM), are employed for predicting contamination levels. The results of the research indicate an increase in pollution levels from 2010 to 2019. It is observed that temperature has a strong correlation with contamination levels (R2 = 0.87). The neural network models, particularly RBF and LSTM, demonstrate higher accuracy in predicting pollution with an R2 value of 0.90. The findings highlight the significance of managing industrial towns to minimize pollution, as these areas exhibit both high pollution levels and temperatures. So, the study emphasizes the importance of monitoring air pollution and its correlation with temperature. Remote sensing techniques and advanced prediction models can provide valuable insights for effective pollution management and decision-making processes.

Association Between Air Pollution and Coronary Heart Disease Hospitalizations in Lanzhou City, 2013-2020: a Time Series Analysis

Coronary heart disease (CHD) is one of the most serious public health problems. However, few studies have focused on the effects of exposure to particulate matter and gaseous air pollutants on CHD. This study aimed to explore the relationship between air pollutants and the number of hospitalized patients with CHD in Lanzhou, and we collected daily data on the number of hospitalized patients with CHD, daily air pollutants, and meteorological factors from 2013 to 2020. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson regression model was applied to evaluate the relationship between air pollutants and the number of hospitalized patients with CHD. The results indicated that the hysteresis effect of all pollutants except O38h reached its maximum at lag3, and the relative risk of coronary heart disease admission was 1.0014 (95%CI: 1.0004, 1.0023), 1.0003 (95%CI: 1.0000, 1.0006), 1.0020 (95%CI: 1.0004, 1.0035), and 1.0053 (95%CI: 1.0026, 1.0080) when PM2.5, PM10, NO2, and SO2 concentrations were increased by 10 μg/m3, respectively. Each 1 mg/m3 increase in CO concentration was associated with a relative risk of coronary heart disease; hospitalization risk was 1.1076 (95%CI: 1.0530, 1.1650). We observed a relative risk of 0.9991 (95%CI: 0.9986, 0.9999) for each 10 μg/m3 increase in O38h for coronary heart disease admission at lag1. Women and elderly were more susceptible to the impact of air pollution, and the impact was greater during cold seasons. Our results indicate that air pollution increased the risk of hospitalization for CHD in a short term. The research findings can provide strategic insights into the impact of current and future air pollution on CHD.

Diagnostic accuracy of carboxyhemoglobin saturation with pulse CO-oximetry in patients with carbon monoxide poisoning

Objective

Carboxyhemoglobin saturation (SpCO)with pulse CO-oximetry is an alternative method in CO poisoning; however, the correlation of it with blood carboxyhemoglobin level (COHb) is still debated.The study aimed to evaluate the correlation between SpCO and venous COHb level and factors associated with the diagnostic accuracy of SpCO.

Material and methods

SpCO and venous COHb levels of patients with CO poisoning, according to a COHb level was 3%, were evaluated. The sensitivity, specificity, 95% CI (confidence interval), and the cut-off value of SpCO were calculated using ROC analysis at a 10% threshold for COHb. Agreement levels were calculated with Bland-Altman analysis. Risk factors affecting diagnostic accuracy were analyzed using logistic regression analysis.

Results

If the 10% threshold of COHb was accepted as the diagnostic threshold for CO poisoning, the sensitivity and specificity of SpCO were 98.4% and 100% (95% CI: 0.996-1.000) at the 6.85 cut-off point of SpCO. The scatter plot of COHb and SpCO showed a strong positive relationship at values of presentation and discharge (r = .979, p<0.001; r = .969, p<0.001). With a bias of 3.1% for the mean difference between-COHb and SpCO, the limits of agreement from Bland- Altman analysis were -0.7 to 7.1. For the 10% threshold, age and male gender have significantly increased false negativity rates (B = .074, p = 0.010, and B = 0.252, p = 0.011, respectively).

Conclusion

SpCO is a reliable method with high sensitivity and specificity; therefore, a lower cut-off points of SpCO compared to COHb level may be accepted to diagnose and follow-up CO poisoning.

Performance and Emissions of a CI-ICE Fuelled with Jatropha Biodiesel Blends and Economic and Environment Assessment for Power Generation in Non-Interconnected Areas

An experimental investigation into the effects of Jatropha biodiesel (JB) blends on the performance and emissions of a diesel engine was performed, and an economic and environmental assessment of the Jatropha curcas L. (JCL) crop for JB production and its use was also presented. The results revealed that when the engine operates with JB blends in proportions of up to 10%, the brake-specific fuel consumption (BSFC) increases to 37.5% at full engine load, and the engine’s thermal efficiency is reduced by 10% regarding diesel operation. A reduction in the specific emissions of carbon monoxide, unburned hydrocarbons, and particulate matter with JB blends of up to 75% of the engine load was found. On the other hand, specific carbon dioxide and nitrogen oxide emissions, with regard to diesel, increased by 21.8 and more than 100%, respectively. The lower heating value (LHV) was the property that most influenced the engine’s performance and emissions fuelled with JB blends, because JB has a lower value of LHV than diesel. Finally, the economic and environmental assessment showed that Colombian soil is well-suited to JCL crops. The use of JB instead of palm biodiesel could mean a decrease of 27,730 USD/day and 1588 kg/day of CO2 emissions.

The emergence and advancement of Tsuji-Trost reaction triggered carbon monoxide recognition and bioimaging

Considering that carbon monoxide is both a vital gasotransmitter and an obnoxious gas, tremendous efforts have been dedicated toward its recognition through various methods. However, the fluorescent light-up approach through the exploration of optical markers remains one of the most convenient methods owing to its several advantages. Amongst the different approaches towards the development of CO responsive optically active molecular markers, the Tsuji-Trost reaction-based CO recognition strategy has remained one of the most significant areas of interest across researchers working in this field. However, there have been no attempts to exclusively summarize the commendable work done in this area yet. The current review, therefore, attempts to summarize the developments of various optical probes following this reaction strategy until the year 2022. This review provides detailed mechanistic insights into the Tsuji-Trost mediated CO detection strategy. Besides, discussions on the strategic development and employment of probes based on various allyl derivatives - allyl carbamate/carbonate/ethers - will provide a thorough understanding of the detection method. The significant advancements of the Tsuji-Trost reaction as an interesting strategy that is accepted and extensively explored for monitoring CO in various media including air, aqueous solutions and living systems have been elaborately discussed. Various potential applications and utilization of these developed fluorogenic probes for tracing CO in different living systems have been examined systematically. Moreover, monitoring of exogenous/endogenous CO levels, modulation of intracellular CO concentration under various induced conditions and bioimaging of CO in in vivo models have also been detailed here. Briefly, this review summarizes the current prospects of this detection method and the future directions in related fields.

Carboxyhemoglobin (COHb): Unavoidable Bystander or Protective Player?

Carbon monoxide (CO) is a cytoprotective endogenous gas that is ubiquitously produced by the stress response enzyme heme-oxygenase. Being a gas, CO rapidly diffuses through tissues and binds to hemoglobin (Hb) increasing carboxyhemoglobin (COHb) levels. COHb can be formed in erythrocytes or in plasma from cell-free Hb. Herein, it is discussed as to whether endogenous COHb is an innocuous and inevitable metabolic waste product or not, and it is hypothesized that COHb has a biological role. In the present review, literature data are presented to support this hypothesis based on two main premises: (i) there is no direct correlation between COHb levels and CO toxicity, and (ii) COHb seems to have a direct cytoprotective and antioxidant role in erythrocytes and in hemorrhagic models in vivo. Moreover, CO is also an antioxidant by generating COHb, which protects against the pro-oxidant damaging effects of cell-free Hb. Up to now, COHb has been considered as a sink for both exogenous and endogenous CO generated during CO intoxication or heme metabolism, respectively. Hallmarking COHb as an important molecule with a biological (and eventually beneficial) role is a turning point in CO biology research, namely in CO intoxication and CO cytoprotection.

A Turn-On Quinazolinone-Based Fluorescence Probe for Selective Detection of Carbon Monoxide

Carbon monoxide (CO) is a toxic, hazardous gas that has a colorless and odorless nature. On the other hand, CO possesses some physiological roles as a signaling molecule that regulates neurotransmitters in addition to its hazardous effects. Because of the dual nature of CO, there is a need to develop a sensitive, selective, and rapid method for its detection. Herein, we designed and synthesized a turn-on fluorescence probe, 2-(2'-nitrophenyl)-4(3H)-quinazolinone (NPQ), for the detection of CO. NPQ provided a turn-on fluorescence response to CO and the fluorescence intensity at 500 nm was increased with increasing the concentration of CO. This fluorescence enhancement could be attributed to the conversion of the nitro group of NPQ to an amino group by the reducing ability of CO. The fluorescence assay for CO using NPQ as a reagent was confirmed to have a good linear relationship in the range of 1.0 to 50 µM with an excellent correlation coefficient (r) of 0.997 and good sensitivity down to a limit of detection at 0.73 µM (20 ppb) defined as mean blank+3SD. Finally, we successfully applied NPQ to the preparation of a test paper that can detect CO generated from charcoal combustion.

A mitochondria-targeted fluorescent probe for imaging of endogenous carbon monoxide in living cells

Carbon monoxide (CO), a vital gasotransmitter, plays critical functions in many physiological processes. Mitochondrial CO is closely related to mitochondrial respiration, thus the detection and imaging of mitochondrial CO in living cells is very important and has attracted much attention recently. In this paper, we developed a hemicyanine-based off-on fluorescent probe, CO-H1, which was used for monitoring endogenous mitochondrial CO levels in living cells. After reacted with CO in the presence of PdCl₂, the fluorescence of CO-H1 was enhanced notably, accompanied by a significant red shift of absorption. CO-H1 exhibits low cytotoxicity, high sensitivity (detection limit of 0.048 μM), and good selectivity for CO. When incubated with living cells, probe CO-H1 mainly entered the mitochondria. CO-H1 was successfully applied to imaging the exogenous/endogenous mitochondrial CO in living cells, suggesting its potential application for further studying the biological functions of mitochondrial CO in living cells.

Nanomaterials as catalysts for CO2 transformation into value-added products: A review

Carbon dioxide (CO₂₎ is the most important greenhouse gas (GHG), accounting for 76% of all GHG emissions. The atmospheric CO₂ concentration has increased from 280 ppm in the pre-industrial era to about 418 ppm, and is projected to reach 570 ppm by the end of the 21^st century. In addition to reducing CO₂ emissions from anthropogenic activities, strategies to adequately address climate change must include CO₂ capture. To promote circular economy, captured CO₂ should be converted to value-added materials such as fuels and other chemical feedstock. Due to their tunable chemistry (which allows them to be selective) and high surface area (which allows them to be efficient), engineered nanomaterials are promising for CO₂ capturing and/or transformation. This work critically reviewed the application of nanomaterials for the transformation of CO₂ into various fuels, like formic acid, carbon monoxide, methanol, and ethanol. We discussed the literature on the use of metal-based nanomaterials, inorganic/organic nanocomposites, as well as other routes suitable for CO₂ conversion such as the electrochemical, non-thermal plasma, and hydrogenation routes. The characteristics, steps, mechanisms, and challenges associated with the different transformation technologies were also discussed. Finally, we presented a section on the outlook of the field, which includes recommendations for how to continue to advance the use of nanotechnology for conversion of CO₂ to fuels.

Lighting up trace carbon monoxide and residual palladium species by a low cytotoxic mitochondria targetable red fluorescent probe: Its large scaled applications

High levels of residual palladium can lead to serious negative health effects. Carbon monoxide (CO) is a significant gasotransmitter in transporting intermolecular and intramolecular signals to balance several physiological processes. Therefore, there is a need for rapid detection of CO and palladium residue. To address these issues, we have designed a novel light-up fluorescent probe for the detection of Pd and CO. It can not only detect Pd and CO selectively with a remarkable chromogenic and red fluorescent response over other metal ions allowing detection with naked eyes but also discriminate Pd⁰ and Pd²⁺/Pd⁴⁺ species. The detection reaction is confirmed by HPLC analysis. The probe demonstrates biocompatibility and mitochondrial target ability for potential biological applications. The practical applications based on drug residue and soil analysis, and smartphone have been successfully performed. Bioimaging of the concentration change of Pd and CO in HeLa cells using the probe is successfully applied. Therefore, the present approach can provide early diagnosis of Pd and CO with low detection limit, low cytotoxicity, high selectivity, and sensitivity.

Dexamethasone therapy prevents delayed neuropsychiatric sequelae after carbon monoxide poisoning: a prospective registry-based study

BACKGROUND

Delayed neuropsychiatric sequelae are major complications of carbon monoxide poisoning; carbon monoxide triggers brain oxidation and inflammation. Corticosteroids such as dexamethasone modulate neurological damage after carbon monoxide poisoning through anti-inflammatory actions and immune response inhibition. However, it is not known whether corticosteroids prevent delayed neuropsychiatric sequelae. We thus studied whether dexamethasone reduced the incidence of delayed neuropsychiatric sequelae.

METHODS

This registry-based study enrolled patients with carbon monoxide poisoning treated in a Korean tertiary care hospital from March 1^st, 2020 to November 30^th, 2021. Data of patients were prospectively collected during the study period, and retrospectively analyzed. One group received intravenous dexamethasone. We performed multivariable logistic regression analysis to identify factors associated with delayed neuropsychiatric sequelae.

RESULTS

A total of 128 patients were enrolled, of which 99 patients received dexamethasone therapy and 29 patients did not. The incidences of delayed neuropsychiatric sequelae in the dexamethasone and non-dexamethasone groups were 16.2% and 37.9%, respectively. Multivariable logistic regression analysis revealed that dexamethasone use (odds ratio = 0.122, 95% confidence interval 0.031-0.489) and a higher Glasgow Coma Scale (odds ratio = 0.818, 95% confidence interval 0.682-0.981) was associated with a lower incidence of delayed neuropsychiatric sequelae.

CONCLUSION

Early dexamethasone treatment was significantly associated with a decreased incidence of delayed neuropsychiatric sequelae. A higher Glasgow Coma Scale at presentation also was associated with a lower incidence of delayed neuropsychiatric sequelae.

A pilot study of neuroprotective effect of granulocyte colony-stimulating factor (G-CSF) in patients with carbon monoxide poisoning: a double-blind, randomized, placebo-controlled trial

Although neuroprotective effects of granulocyte colony-stimulating factor (G-CSF) have been shown in rats exposed to carbon monoxide (CO), this pilot clinical trial was performed to assess the feasibility of treatment with G-CSF in patients with acute CO poisoning. A double-blind, randomized, placebo-controlled pilot clinical trial was conducted on twenty-six patients with acute CO poisoning. G-CSF (90 μg/kg) was administered intravenously for 72 h. Demographic data, routine laboratory tests, differential blood counts, venous blood gas, and adverse reactions were recorded. The primary endpoint was brain ischemia improvement based on CT findings and the secondary endpoints examined improvements in the modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index as well as S-100β concentrations. Fourteen patients received G-CSF, and 12 received a placebo. Twenty-six were followed for 30 days and no one in both groups died during follow-up. Neurological complications, brain ischemic changes, Barthel, and mRS were compared between the two groups on determined days after the onset of therapeutic intervention, and no significant differences were observed between the two groups. Favorable results were achieved for treated patients by different measures; NIHSS was decreased 72 h after treatment (p = 0.046), and S-100β levels were significantly higher in the G-CSF group than in the control group, 12 h and 72 h after the treatment. G-CSF appears to have potential effects on several clinical parameters in patients with acute CO poisoning. The trial was registered at the Iranian Registry of Clinical Trials with the ID: (IRCT201607232083N7).

An urgent health problem of indoor air pollution: results from a 15-years carbon monoxide poisoning observed study in Jinan City

Carbon monoxide (CO) poisoning is a public health concern in developing countries especially in China with a high disease burden. We aimed to focus on non-occupational CO poisoning caused by household coal heating secular trends based on registry data in Jinan, China, and we aim to provide further evidence and suggestions for public health policy. We analyzed the occurrence and development trend and assess the spatial-temporal epidemiological characteristics of non-occupational CO poisoning caused by household coal heating in Jinan between 2007 and 2021. Among total of 6588 CO poisoning, 5616 cases (85.25%) and 180 deaths caused by household coal heating was identified during study period. The cumulative incidence rate was 5.78 per 100,000 person-years and the mortality rate was 0.19 per 100,000 person-years. The incidence in urban areas (6.55 per 100,000 person-years) was higher than rural areas (5.04 per 100,000 person-years), and there was a statistical difference between urban and rural (P < 0.001) (P < 0.001). The poisoning time point mainly occurs in the sleep stage. In Jinan, socioeconomic status, accessibility to health services and rural status are determinants for CO poisoning incidence and mortality. Implementation of urban and rural central heating renovation is an effective way to further reduce the disease burden of CO poisoning in the future.

Effect of carbon monoxide administration using haemoglobin-vesicles on the hippocampal tissue

Carbon monoxide (CO) is a toxic gas that causes neuropathy. However, CO is endogenously produced in small amounts showing various beneficial effects. We hypothesized that CO-bound haemoglobin-vesicle (HbV) administration would reduce cerebral ischaemia-reperfusion injury without causing neuropathy. Three experiments were conducted. First, rats were exposed to CO inhalation to create a CO-poisoning group, and they were sacrificed on 0, 7, 14, and 21 days after CO exposure. Histopathologically, hippocampal damage was prominent at 14 days. Second, the rats were administered with CO-HbV equivalent to 50 or 25% of circulating blood volume (CO-HbV50 or CO-HbV25 group). Rats were sacrificed 14 days after administration. Third, rats put into haemorrhagic shock by 50% of circulating blood withdrawal were resuscitated using saline, autologous blood, and CO-HbV. They were sacrificed 14 days after resuscitation. Hippocampal damage assessment clarified that almost no necrotic cells were observed in the CO-HbV50 group. Necrotic cells in the CO-HbV25 group were comparable to those found for the control group. In rats resuscitated from haemorrhagic shock, the hippocampal damage in the group using CO-HbV was the mildest. Administration of CO-HbV did not lead to marked hippocampal damage. Furthermore, CO-HbV was effective at preventing cerebral ischaemia-reperfusion injury after haemorrhagic shock.

Short-Term Exposure to Ambient Air Pollution and Hospital Admissions for Sequelae of Stroke in Chinese Older Adults

Extensive evidence suggests that ambient air pollution contributes to a higher risk of hospital admissions for cerebrovascular diseases; however, its association with admissions for sequelae of stroke remains unclear. A time-stratified case-crossover study was conducted among 31,810 older adults who were admitted to hospital for sequelae of stroke in Guangzhou, China during 2016-2019. For each subject, daily residential exposure to fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) was extracted from a validated grid data set. Conditional logistic regression models were used for exposure-response analyses. In single-pollutant models, each interquartile range (IQR) increase of lag 04-day exposure to CO (IQR: 0.25 mg/m3) and lag 3-day exposure to O3 (69.6 μg/m3) was significantly associated with a 4.53% (95% confidence interval: 1.67%, 7.47%) and 5.63% (1.92%, 9.48%) increase in odds of hospital admissions for sequelae of stroke, respectively. These associations did not significantly vary across age or sex. With further adjustment for each of the other pollutants in 2-pollutant models, the association for CO did not change significantly, while the association for O3 disappeared. We estimated that 7.72% of the hospital admissions were attributable to CO exposures. No significant or consistent association was observed for exposure to PM2.5, PM10, SO2, or NO2. In conclusion, short-term exposure to ambient CO, even at levels below the WHO air quality guideline, was significantly associated with an increased odds of hospital admissions for sequelae of stroke, which may lead to considerable excess hospital admissions.

Health effects of exposure to sulfur dioxide, nitrogen dioxide, ozone, and carbon monoxide between 1980 and 2019: A systematic review and meta-analysis

The burden of disease attributed to the indoor exposure to sulfur dioxide (SO₂ ), nitrogen dioxide (NO₂ ), ozone (O₃ ), and carbon monoxide (CO) is not clear, and the quantitative concentration-response relationship is a prerequisite. This is a systematic review to summarize the quantitative concentration-response relationships by screening and analyzing the polled effects of population-based epidemiological studies. After collecting literature published between 1980 and 2019, a total of 19 health outcomes in 101 studies with 182 health risk estimates were recruited. By meta-analysis, the leave-one-out sensitivity analysis and Egger's test for publication bias, the robust and reliable effects were found for SO₂ (per 10 μg/m³ ) with chronic obstructive pulmonary diseases (COPD) (pooled relative risks [RRs] 1.016, 95% CI: 1.012-1.021) and cardiovascular diseases (CVD) (RR 1.012, 95%CI: 007-1.018), respectively. NO₂ (per 10 μg/m³ ) had the pooled RRs for childhood asthma, preterm birth, lung cancer, diabetes, and COPD by 1.134 (1.084-1.186), 1.079 (1.007-1.157), 1.055 (1.010-1.101), 1.019 (1.009-1.029), and 1.016 (1.012-1.120), respectively. CO (per 1 mg/m³ ) was significantly associated with Parkinson's disease (RR 1.574, 95% CI: 1.069-2.317) and CVD (RR 1.024, 95% CI: 1.011-1.038). No robust effects were observed for O₃ . This study provided evidence and basis for further estimation of the health burden attributable to the four gaseous pollutants.

Examination of central nervous system by functional observation battery after massive intravenous infusion of carbon monoxide-bound and oxygen-bound hemoglobin vesicles in rats

Carbon monoxide (CO) is known as a toxic gas inducing "CO poisoning", which acutely affects the central nervous system (CNS) and which persistently affects brain functions depending on the exposure time and CO concentration. By contrast, in pathological rodent models, intravenous infusion of CO-bound hemoglobin vesicles (CO-HbV) has shown various beneficial effects such as anti-oxidative and anti-inflammatory reactions. This study assessed effects of CO-HbV infusion on CNS using a functional observation battery, sensory reflexes, grip strength, and landing foot splay measurements. The test fluids were CO-HbV and O₂-bound HbV (O₂-HbV) suspended in saline ([Hb] ​= ​10 ​g/dL), and saline alone for comparison. The rats received either 16 or 32 ​mL/kg of fluid intravenously at 1.5 ​mL/min/kg. Observations were made before infusion, and at 5 ​min, 4, 8, 24, 48 and 72 ​h after infusion. Massive doses of 16 and 32 ​mL/kg respectively corresponded to about 29 and 57% of the whole circulating blood volume (56 ​mL/kg). No toxicological effect was observed in any measurement item for any group in comparison to the control saline infusion group. Histopathological examination of hippocampal tissue at 14 days after infusion showed the number of necrotic cells to be minimal. Results obtained from rats in this experiment suggest that the massive intravenous infusion of CO-HbV yields beneficial anti-oxidative and anti-inflammatory effects without showing CO-poisoning-related symptoms of CNS damage.

Fe@χ3-borophene as a promising catalyst for CO oxidation reaction: A first-principles study

A novel single-atom catalyst of Fe adsorbed on χ₃-borophene has been proposed as a potential catalyst for CO oxidation reaction (COOR). Quantitative pictures have been provided of both the stability of Fe@χ₃-borophene and various kinetic reaction pathways using first-principles calculations. Strong adsorption energy of -3.19 eV and large diffusion potential of 3.51 eV indicates that Fe@χ₃-borophene is highly stable. By exploring reaction mechanisms for COOR, both Eley-Ridel (E-R) and trimolecule E-R (TER) were identified as possible reaction paths. Low reaction barriers with 0.49 eV of E-R and 0.57 eV of TER suggest that Fe@χ₃-borophene is a very promising catalyst for COOR. Charge transfer between the χ₃-borophene and CO, O₂ and CO₂ gas molecules plays a key role in lowering the energy barrier during the reactions. Our results propose that Fe@χ₃-borophene can be a good candidate of single-atom catalyst for COOR with both high stability and catalytic activity.

Long-term air pollution levels modify the relationships between short-term exposure to meteorological factors, air pollution and the incidence of hand, foot and mouth disease in children: a DLNM-based multicity time series study in Sichuan Province, China

BACKGROUND

Epidemiological studies have investigated the short-term effects of meteorological factors and air pollution on the incidence of hand, foot, and mouth disease (HFMD). Several meteorological indicators, such as relative humidity and the diurnal temperature range (DTR), significantly modify the relationship between short-term exposure to temperature and HFMD incidence. However, it remains unclear whether (and how) long-term air pollution levels modify the short-term relationships of HFMD incidence with meteorological factors and air pollution.

METHODS

We obtained daily data on meteorological factors, air pollutants, and HFMD counts in children from 21 prefecture-level cities in Sichuan Province in Southwest China from 2015 to 2017. First, we constructed a distributed lag nonlinear model (DLNM) at each prefecture-level site to evaluate the short-term impacts of meteorological variables and air pollutants on HFMD incidence. Then, we assessed the pooled effects of the exposures and incorporated long-term city-specific air pollutant indicators as meta-predictors to examine their potential modification effects by performing multivariate meta-regression models.

RESULTS

We found that long-term SO₂ and CO concentrations significantly modified the short-term relationships between climatic variables and HFMD incidence. Specifically, high concentrations of CO (P = 0.027) and SO₂ (P = 0.039) reduced the risk of HFMD at low temperatures. The relationship between relative humidity and HFMD incidence was weakened at high SO₂ concentrations (P = 0.024), especially when the relative humidity was below the median level. When the minimum relative humidity (32%) was compared to the median relative humidity (77%), the risk ratio (RR) was 0.77 (95% CI: 0.51-1.17) in the 90^th percentile of SO₂ (19.6 μg/m³) and 0.41 (95% CI: 0.27-0.64) in the 10^th percentile of SO₂ (10.6 μg/m³).

CONCLUSION

Our results indicated that long-term SO₂ and CO levels modified the short-term associations between HFMD incidence in children and meteorological variables. These findings may inform health authorities to optimize targeted public health policies including reducing ambient air pollution and reinforcing self-protective actions to weaken the adverse health impacts of environmental factors on HFMD incidence.

Effects of inhalation frequency on inhalation/exposure dose of hazardous nanoparticles and toxic gases during cigarette smoking

In this study, we measured the pollutants generations during cigarette smoking under various inhalation frequency experiment scenarios by a self-developed smoking machine. Some concepts, the effective inhaled amount and exposure amount were proposed to quantitatively estimate emission rates. Important findings include: For interval 1 s, 2 s, 3 s, 4 s and 9 s (called from 1 s to 9 s herein), effective inhaled nano-scale PN (particle number) per cigarette was 8.43E+09 #, 7.24E+09 #, 5.74E+ 09 #, 3.82E+09 # and 1.15E+09 #, it decreased linearly with interval time; exposure amount of PN in side stream smoke was 1.06E+10 #, 1.2E+10 #, 1.48E+10 #, 1.84E+10 # and 8.74E+10 #, it increased with interval time. For toxic gases, all pollutants decreased with interval time in main stream smoke. In side stream smoke, NOx and CO firstly increased with interval time and then decreased (with the highest value at 3 s interval time), while HC always increased with interval time. So, this study is useful to understand the relationship between pollution and smoking habit.

Carbon Monoxide Signaling: Examining Its Engagement with Various Molecular Targets in the Context of Binding Affinity, Concentration, and Biologic Response

Carbon monoxide (CO) has been firmly established as an endogenous signaling molecule with a variety of pathophysiological and pharmacological functions, including immunomodulation, organ protection, and circadian clock regulation, among many others. In terms of its molecular mechanism(s) of action, CO is known to bind to a large number of hemoproteins with at least 25 identified targets, including hemoglobin, myoglobin, neuroglobin, cytochrome c oxidase, cytochrome P450, soluble guanylyl cyclase, myeloperoxidase, and some ion channels with dissociation constant values spanning the range of sub-nM to high μM. Although CO's binding affinity with a large number of targets has been extensively studied and firmly established, there is a pressing need to incorporate such binding information into the analysis of CO's biologic response in the context of affinity and dosage. Especially important is to understand the reservoir role of hemoglobin in CO storage, transport, distribution, and transfer. We critically review the literature and inject a sense of quantitative assessment into our analyses of the various relationships among binding affinity, CO concentration, target occupancy level, and anticipated pharmacological actions. We hope that this review presents a picture of the overall landscape of CO's engagement with various targets, stimulates additional research, and helps to move the CO field in the direction of examining individual targets in the context of all of the targets and the concentration of available CO. We believe that such work will help the further understanding of the relationship of CO concentration and its pathophysiological functions and the eventual development of CO-based therapeutics. SIGNIFICANCE STATEMENT: The further development of carbon monoxide (CO) as a therapeutic agent will significantly rely on the understanding of CO's engagement with therapeutically relevant targets of varying affinity. This review critically examines the literature by quantitatively analyzing the intricate relationships among targets, target affinity for CO, CO level, and the affinity state of carboxyhemoglobin and provide a holistic approach to examining the molecular mechanism(s) of action for CO.

Ambient carbon monoxide correlates with mortality risk of hemodialysis patients: comparing results of control selection in the case-crossover designs

Background

Growing evidence suggests that environmental air pollution adversely affects kidney health. To date, the association between carbon monoxide (CO) and mortality in patients with end-stage renal disease (ESRD) has not been examined.

Methods

Among 134,478 dialysis patients in the Korean ESRD cohort between 2001 and 2014, 8,130 deceased hemodialysis patients were enrolled, and data were analyzed using bidirectional, unidirectional, and time-stratified case-crossover design. We examined the association between short-term CO concentration and mortality in patients with ESRD. We used a two-pollutant model, adjusted for temperature as a climate factor and for nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and particulate matter less than 10 μm in diameter as air pollution variables other than CO.

Results

Characteristics of the study population included age (66.2 ± 12.1 years), sex (male, 59.1%; female, 40.9%), and comorbidities (diabetes, 55.6%; hypertension, 14.4%). Concentration of CO was significantly associated with all-cause mortality in the three case-crossover designs using the two-pollutant model adjusted for SO₂. Patients with diabetes or age older than 75 years had a higher risk of mortality than patients without diabetes or those younger than 75 years.

Conclusion

Findings presented here suggest that higher CO concentration is correlated with increased all-cause mortality in hemodialysis patients, especially in older high-risk patients.

Design of a Surface Plasmon Resonance CO Sensor

Carbon monoxide (CO) is a highly toxic gas, which can cause death if it is inhaled in small quantities for a long time or in large quantities for a short time. Since this gas can be lethal, it is essential to detect it from minute to large concentrations. Our study consists of the design of a superficial plasmonic resonance (SPR) CO sensor of tiny dimensions which is capable of giving an immediate response at different concentrations. It is designed to work at different heights above sea level since the refractive index of this gas depends on a mixture with air and the air pressure. Due to its low weight and tiny dimensions, it is ideal for space travel or on airplanes. The results show a high resolution and sensitivity (~10^-5 RIU of resolution and a sensitivity of 13.51-81.26 RIU^-1).

Effect of Recombinant Human Brain Natriuretic Peptide on Acute Carbon Monoxide Poisoning Complicated with Heart Failure with Reduced Ejection Fraction

This paper aims to observe the effect of recombinant human brain natriuretic peptide (rhBNP) on treatment of acute carbon monoxide poisoning (ACMP) complicated with heart failure with reduced ejection fraction (HFREF).A total of 103 patients with ACMP complicated with HFREF admitted to our department from October 2016 to March 2020 were observed. Patients were divided into control group (50 cases) and experimental group (53 cases). The control group was given diuretic, vasodilator, and digitalis treatment, and the experimental group was supplemented with rhBNP treatment based on the control group. Patients' general information was collected. The levels of myocardial injury-associated indicators of patients were detected at and after admission.No significant differences were observed in the general data of patients compared with control group. The acute physiology and chronic health enquiry II score of patients was positively correlated with left ventricular ejection fraction (LVEF). At admission, the levels of myocardial injury indicators, N-terminal B-type brain natriuretic peptide, and cardiac ultrasound indexes had no significant difference between the control group and experimental group. However, after admission, the LVEF and stroke output levels were elevated, while the other indicators were all decreased compared with the control group.The rhBNP exerts a protective effect on ACMP-induced cardiomyocyte injury to improve cardiac function, shorten the length of hospital stay, and reduce the incidence and mortality of delayed encephalopathy after carbon monoxide poisoning.

Au-Decorated 1D SnO2 Nanowire/2D WS2 Nanosheet Composite for CO Gas Sensing at Room Temperature in Self-Heating Mode

We have designed a new ternary structure to enhance the sensing properties of WS2 nanosheet (NS)-based gas sensors at room temperature (RT) in self-heating mode. SnO2 nanowires (NWs, 10–30 wt%) were added to WS2 NSs and then Au nanoparticles (NPs) were deposited on the surface of the resulting composites by UV irradiation. The Au-decorated 10 wt% SnO2–WS2 composition showed the highest gas sensing properties. The presence of SnO2 NWs on the WS2 NSs effectively enhanced the diffusion and adsorption of gas species into deeper parts of the gas sensor. Furthermore, the chemical sensitization of Au (increase in oxygen ionosorption; spillover effect and catalytic effect towards CO) contributed to an enhanced response to CO gas. Gas sensing tests performed in the self-heating mode demonstrated the possibility of realizing a low-voltage, low-power-consumption CO gas sensor based on the Au-decorated 10 wt% SnO2–WS2. The sensor response under 60% relative humidity (RH) conditions was 84% of that under dry conditions, which shows that CO sensing is possible in wet environments at room temperature operation.

A Critical Review on Organic Small Fluorescent Probes for Monitoring Carbon Monoxide in Biology

Endogenous carbon monoxide (CO) is an important intracellular gas messenger that is intimately involved in many physiological and pathological processes. The abnormal concentration of CO in living organisms can cause many diseases. Therefore, it is of great significance to monitor CO in biological samples. Fluorescent probe technology provides an effective and convenient method for CO monitoring, with the advantages of high selectivity and sensitivity, fast response time and in situ fluorescence imaging in biological tissues, which is favored by the majority of researchers. In this paper, the research progress of CO fluorescent probes since 2018 is reviewed, and the design, detection mechanism and biological application of the related fluorescent probes are summarized. And the relationship between the structure and performance of the probes is discussed. Furthermore, the development trend and application prospect of CO fluorescent probes are prospected.

Impact of Hyperbaric Oxygen Therapy on Cognitive Functions: a Systematic Review

Hyperbaric oxygen therapy (HBOT) is a modality of treatment in which patients inhale 100% oxygen inside a hyperbaric chamber pressurised to greater than 1 atmosphere. The aim of this review is to discuss neuropsychological findings in various neurological disorders treated with HBOT and to open new perspectives for therapeutic improvement. A literature search was conducted in the MEDLINE (via PubMed) database from the inception up 10 May 2020. Eligibility criteria included original articles published in English. Case studies were excluded. Full-text articles were obtained from the selected studies and were reviewed on the following inclusion criteria (1) performed cognitive processes assessment (2) performed HBOT with described protocol. Two neuropsychologists independently reviewed titles, abstracts, full texts and extracted data. The initial search retrieved 1024 articles, and a total of 42 studies were finally included after applying inclusion and exclusion criteria. The search yielded controversial results with regard to the efficiency of HBOT in various neurological conditions with cognitive disturbance outcome. To the best of our knowledge this is the first state-of-the art, systematic review in the field. More objective and precise neuropsychological assessment methods are needed to exact evaluation of the efficacy of HBOT for neuropsychological deficits. Future studies should widen the assessment of HBOT effects on different cognitive domains because most of the existing studies have focussed on a single process. Finally, there is a need for further longitudinal studies.

Endogenous carbon monoxide due to hemolytic anemia: A forensic red herring

Carbon monoxide (CO) toxicity associated with exposure to an environmental, exogenous source, is routinely investigated in the field of forensics. Paramedics responded to the home of a 60-year-old woman who complained of persistent nausea, dizziness, and fatigue. Her initial carboxyhemoglobin (COHb) saturation was 25% as measured by paramedics in the field via pulse CO-oximetry (SpCO) and was, 2 hours later, confirmed by hospital laboratory spectrophotometric analysis to be 16% after initial treatment in the emergency department. The clinical presentation of environmental CO exposure and subsequent death notification to the North Carolina Office of the Chief Medical Examiner prompted an extensive investigation into the suspected residential source of CO, which ultimately ruled out all exogenous sources. The medicolegal death investigator later discovered an updated hematology consultation note, which determined the actual source of the CO to be endogenously produced from disease. Herein, we report an unusual fatality involving enhanced endogenous CO production caused by warm autoimmune hemolytic anemia. This unique case report and brief literature review of disease-related elevation of endogenous CO will shed light on this lesser-known phenomenon alerting the forensic community to its potential occurrence and need for consideration when sources of environmental exposure have been exhausted.

The emerging therapeutic role of some pharmacological antidotes in management of COVID-19

Background

A novel RNA coronavirus was identified in January 2020 as the cause of a pneumonia epidemic affecting the city of Wuhan; it rapidly spread across China.

Aim of the review

The aim is to discuss the potential efficacy of some pharmacologically known pharmacological antidotes (N-acetylcysteine; hyperbaric oxygen; deferoxamine; low-dose naloxone) for the management of COVID-19-associated symptoms and complications.

Method

An extensive search was accomplished in Medline, Embase, Scopus, Web of Science, and Central databases until the end of April, 2021. Four independent researchers completed the screening, and finally, the associated studies were involved.

Conclusion

The current proof hinders the experts for suggesting the proper pharmacological lines of treatment of COVID-19. Organizations, for example, WHO, should pursue more practical actions and design well-planned clinical trials so that their results may be used in the treatment of future outbreaks.

Proarrhythmic effects of carbon monoxide in human ventricular tissue: insights from computational modeling

Epidemiological studies have demonstrated that ambient air pollution has been closely associated with cardiovascular diseases. Carbon monoxide (CO) is a common ambient air pollutant that can cause adverse effects on the heart. CO is known to cause tissue ischemia, resulting in ventricular arrhythmias. However, accumulating biological studies showed that CO could exert effects on multiple cardiac ionic channels under normoxic conditions, which might indicate new proarrhythmic mechanisms other than ischemia-mediated electrophysiology changes. In this work, we evaluated the functional impacts of CO on human ventricles using a multi-scale model of human ventricular tissue. Experimental data regarding the effects of CO on different ion channels were incorporated into the cell model to explore the alterations of ventricular electrophysiology. Simulation results suggested that CO significantly prolonged the duration of ventricular action potentials, enhanced the transmural dispersion of repolarization, and reduced the adaptability of ventricular tissue to fast heart rates. In addition, simulated pseudo-ECGs showed consistent manifestations with the clinical observation that CO caused an apparent QT interval prolongation and T-wave widening, indicating that CO affected the heart's abnormal ventricular repolarization.