Impacts of ship emissions and sea-land breeze on urban air quality using chemical characterization, source contribution and dispersion model simulation of PM2.5 at Asian seaport

Fine particulate matter (PM2.5) emitted from marine transportation, bulk materials handling at the docks, and dust dispersion has garnered increased attention, particularly in the interface between port and urban areas. This study explored the inter-transport of PM2.5 between Kaohsiung Harbor and neighboring Metro Kaohsiung. Chemical analyses of PM2.5 samples from four sites include water-soluble ions, metallic elements, carbons, anhydrosugars, and organic acids to establish PM2.5's chemical fingerprints. The CALPUFF air dispersion model is employed to simulate the spatiotemporal distribution of PM2.5 in Kaohsiung Harbor and adjacent urban areas. A clear seasonal and diurnal variation of PM2.5 concentrations and chemical composition was observed in both harbor and urban areas. The high correlation of nighttime PM2.5 levels between the port and urban areas suggests inter-transport phenomena. Sea salt spray, ship emissions, secondary aerosols, and heavy fuel-oil boilers exhibit higher levels in the port area than in the urban area. In Metro Kaohsiung, mobile sources, fugitive dust, and waste incinerators emerge as major PM2.5 contributors. Furthermore, sea breeze significantly influences PM2.5 dispersion from Kaohsiung Harbor to Metro Kaohsiung, particularly in the afternoon. The average contribution of PM2.5 from ships' main engines in Kaohsiung Harbor ranges from 2.9% to 5.3%, while auxiliary engines contribute 3.8%-8.3% of PM2.5 in Metro Kaohsiung.

Spatiotemporal variation and inter-transport of atmospheric speciated mercury between Kaohsiung Harbor and neighboring urban areas

This study investigated the spatiotemporal variation, gas-particle partition, and source resolution of atmospheric speciation mercury (ASM) in Kaohsiung Harbor and neighboring Metro Kaohsiung. Four sampling sites were selected to determine the pollution characteristics and inter-transport of ASM between the port and urban areas. The yearly average GEM, GOM, and PBM concentrations were 7.13 ± 2.2 ng/m3, 331 ± 190 pg/m3, and 532 ± 301 pg/m3, respectively. Notably, GEM emerged as the predominant ASM species (85-94%), primarily originating from anthropogenic emissions from the harbor area and nearby industrial complex. The study revealed a distinct seasonal variation in ASM concentrations in the Kaohsiung Area in the following order: winter > fall > spring > summer. Concerning spatial distribution, ASM concentrations in the port areas were generally higher than those in the urban areas. This disparity was chiefly attributed to the influence of the prevailing winds, local sources, and atmospheric dispersion. Backward trajectory simulation revealed that polluted air masses blown from the northeast in winter and spring, moving along the western in-land part of Taiwan Island, were likely influenced by local sources and long-range transport (LRT). In summer, air pollutants originating from the south were likely transported from the coastal industrial sources. During fall, air masses blown from the western offshore waters transported air pollutants from Kaohsiung Harbor to neighboring Metro Kaohsiung. The results obtained from principle component analysis (PCA) indicated that primary sources in the port areas included ship emissions, vehicular exhausts, and nearby industrial complex, which align with the primary source factors identified by positive matrix factorization (PMF), which were mobile sources and coal-fired industrial boilers. Meanwhile, mobile sources and sulfur-containing fuel/waste combustion were identified as the primary sources in the urban areas.

The Applications and Pitfalls of Cone-Beam Computed Tomography-Based Synthetic Computed Tomography for Adaptive Evaluation in Pencil-Beam Scanning Proton Therapy

PURPOSE

The study evaluates the efficacy of cone-beam computed tomography (CBCT)-based synthetic CTs (sCT) as a potential alternative to verification CT (vCT) for enhanced treatment monitoring and early adaptation in proton therapy.

METHODS

Seven common treatment sites were studied. Two sets of sCT per case were generated: direct-deformed (DD) sCT and image-correction (IC) sCT. The image qualities and dosimetric impact of the sCT were compared to the same-day vCT.

RESULTS

The sCT agreed with vCT in regions of homogeneous tissues such as the brain and breast; however, notable discrepancies were observed in the thorax and abdomen. The sCT outliers existed for DD sCT when there was an anatomy change and for IC sCT in low-density regions. The target coverage exhibited less than a 5% variance in most DD and IC sCT cases when compared to vCT. The Dmax of serial organ-at-risk (OAR) in sCT plans shows greater deviation from vCT than small-volume dose metrics (D0.1cc). The parallel OAR volumetric and mean doses remained consistent, with average deviations below 1.5%.

CONCLUSION

The use of sCT enables precise treatment and prompt early adaptation for proton therapy. The quality assurance of sCT is mandatory in the early stage of clinical implementation.

Association of exposure to environmental vanadium and manganese with lung function among young children: A population-based study

Exposure to environmental metals has been associated with health outcomes including respiratory health. Little is known about the impact of exposure to environmental metals on lung function among young children in general population. This study aimed to investigate the associations of exposure to metals with lung function among young children in a population-based cohort. A total of 1488 children aged 5-8 years attended a follow-up visit as part of the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort. We measured urinary samples of vanadium (median: 1.21 ng/mL; interquartile range (IQR): 0.73-1.98), manganese (median: 0.23 ng/mL; IQR: 0.13-0.47), arsenic (median: 40.51 ng/mL; IQR: 21.66-70.49), nickel (median: 1.09 ng/mL; IQR: 0.31-3.60), and cadmium (median: 0.26 ng/mL; IQR: 0.11-0.43) and performed lung function tests. Urinary vanadium concentrations were inversely associated with FVC (β coefficient for the highest quartile versus the other quartiles: -33.40, p = 0.001), FEV1 (β: -41.31, p < 0.001), FEV1/FVC ratio (β: -1.00, p = 0.009), PEF (β: -92.12, p = 0.004), and FEF25-75 (β: -82.85, p < 0.001), after adjusting for relevant confounders. Urinary manganese concentrations were inversely associated with FVC (β: -26.60, p = 0.007), FEV1 (β: -31.62, p = 0.001), PEF (β: -84.86, p = 0.009), and FEF25-75 (β: -69.21, p = 0.002). Stratification analyses found inverse associations of urinary vanadium and manganese concentrations with lung function parameters predominantly among children exposed to environmental tobacco smoke. We did not find significant associations of urinary arsenic, nickel, and cadmium concentrations with lung function parameters. In conclusion, this study adds new evidence showing inverse associations of vanadium and manganese exposure with lung function among young children in the general population. Children with environmental tobacco smoke exposure are particularly vulnerable to adverse impact of vanadium and manganese exposure on lung function.

Chemical characteristics and spatiotemporal variation of marine fine particles for clustered channels of air masses transporting toward remote background sites in East Asia

This study investigated the chemical characteristics, spatiotemporal distribution, and source apportionment of marine fine particles (PM_2.5) for clustered transport channels/routes of air masses moving toward three remote sites in East Asia. Six transport routes in three channels were clustered based on backward trajectory simulation (BTS) in the order of: West Channel > East Channel > South Channel. Air masses transported toward Dongsha Island (DS) came mainly from the West Channel, while those transported toward Green Island (GR) and Kenting Peninsula (KT) came mostly from the East Channel. High PM_2.5 commonly occurred from late fall to early spring during the periods of Asian Northeastern Monsoons (ANMs). Marine PM_2.5 was dominated by water-soluble ions (WSIs) which were predominated by secondary inorganic aerosols (SIAs). Although the metallic content of PM_2.5 was predominated by crustal elements (Ca, K, Mg, Fe, and Al), enrichment factor clearly showed that trace metals (Ti, Cr, Mn, Ni, Cu, and Zn) came mainly from anthropogenic sources. Organic carbon (OC) was superior to elemental carbon (EC), while OC/EC and SOC/OC ratios in winter and spring were higher than those in other two seasons. Similar trends were observed for levoglucosan and organic acids. The mass ratio of malonic acid and succinic acid (M/S) was commonly higher than unity, showing the influences of biomass burning (BB) and secondary organic aerosols (SOAs) on marine PM_2.5. We resolved that the main sources of PM_2.5 were sea salts, fugitive dust, boiler combustion, and SIAs. Boiler combustion and fishing boat emissions at DS had higher contribution than those at GR and KT. The highest/lowest contribution ratios of cross-boundary transport (CBT) were 84.9/29.6% in winter and summer, respectively.

Chemical fingerprints and source resolution of atmospheric fine particles in an industrial harbor based on one-year intermittent field sampling data

This study investigated the spatiotemporal variation, chemical characteristics, and source resolution of PM_2.5 in an East Asian seaport adjacent to industrial complex and urban area. Three representative harbor sites were selected to simultaneously sample 24-h PM_2.5 once every 13 days in four seasons. A significant seasonal variation was observed with the highest and the lowest PM_2.5 concentration in February (winter) and May (summer), respectively. High contribution of secondary inorganic aerosols (SIAs) showed that SO₂ and NO_x emitted from neighboring combustion sources burning coal and heavy fuel oil (HFO) were the major precursors forming secondary inorganic PM_2.5. High ratios of V/Ni and V/Cu were observed in summer (June~August) since the prevailing west and southwest winds from outer port carried ship emissions to inter port. The correlation of chemical fingerprints (V, Ni, V/Ni, Zn, nss-SO₄^2-, OC) and the number of ships were high at the Zhung-He Site and moderate at the Qi-Ho Site. The Cl^-, Na⁺, V, Ni, nss-SO₄^2-, OC, and V/Ni of PM_2.5 were co-influenced by ship missions and oceanic spray in the Kaohsiung Harbor. The influences were relatively higher for winds blown from the harbor areas than those blown from the industrial areas. Oppositely, the Fe, Mn, Cr, Cu, Ca, Zn, and Al in PM_2.5 were higher for winds blown from the industrial areas than those from the harbor areas. The CMB receptor modelling resolved that the major sources of PM_2.5 were industrial missions, secondary aerosols, mobile sources, ship emissions, oceanic spray, fugitive dust, biomass burning, and organic carbon. Similar to Busan (South Korea), Brindisi (Italy), Lampedusa (Italy), and Barcelona (Spain), the contributions of ship emissions in the Kaohsiung Harbor were in the range of 7.4-7.8 %. Meanwhile, Kaohsiung Harbor was highly influenced by emissions from industrial areas and urban areas.

Traditional chinese god image dataset: A glimpse of chinese culture

This data article describes a dataset of images of common Chinese deities. The dataset is divided into five categories according to the types of deities, and a total of 1314 original images were captured by smart phones from Chinese temples and through Google search engine. Each category were split into training, validation and test subsets in a ratio of 70:20:10. We rotated the pictures by 30°, 60°, 90°, 120°, 150°, and 180°; and zoomed in and out to augment the images for training and validation sets. After data enhancement, the total number of images reaches 10,786. Two models, EfficientNet-B0 and MobileNetV2, are used to identify five kinds of god images. After data augmentation, the accuracy, precision, recall, specificity and F1-score of EfficientNet-B0 were 96.15%, 96.44%, 96.18%, 96.16% and 97.60%, respectively; the accuracy, precision recall, specificity and F1-score of MobileNetV2 were 92.31%, 92.89%, 92.37%, 92.33% and 95.19%, respectively. This dataset can be used as a reference for traditional Chinese god statue images, and can also be used for object detection and image classification through machine learning and deep learning methods.

Inter-comparison of chemical fingerprint and source apportionment of marine fine particles at two islands through the west and east passages of the Taiwan Island

In this study, the concentrations of marine fine particles (PM_2.5) and their chemical fingerprints were inter-compared at two islands located aside from the west and east waters of Taiwan Island and the variability of west and east passages (i.e., Routes A1 and A2) were explored. Marine PM_2.5 was simultaneously sampled at the Green and Dongsha Islands and five chemical components (i.e., water-soluble ions, metallic elements, carbonaceous content, anhydrosugars, and organic acids) were further analyzed in PM_2.5 to characterize their chemical fingerprints. The highest concentrations of chemical composition and PM_2.5 were commonly observed during the Asian Northeastern Monsoons (ANMs) via long-range transport (LRT). Water-soluble ions (WSIs) were dominated by secondary inorganic aerosols (SIAs), and followed by oceanic spray. The major metallic content of PM_2.5 was crustal elements, while trace metals originated from anthropogenic sources with an enrichment factor (EF) > 10. In terms of carbonaceous content in PM_2.5, organic carbon (OC) was superior to elemental carbon (EC). High levoglucosan concentrations were also observed during the periods of ANMs. Secondary organic aerosols (SOAs) were formed by atmospheric chemical reactions during the LRT procedure. The PM_2.5 concentration of Route A1 was 37.51 % higher than that of Route A2, and trace metals (V, Mn, Ni, Pb, Cr, and Cu) increased significantly by 96.16-325.83 %. Positive matrix factorization (PMF) results revealed that the dominant factor of PM_2.5 for Route A1 was shipping emissions and vehicular exhausts (41.2 %), while that for Route A2 was oceanic spray (30.2 %). Route A1 was mainly attributed to highly industrialized regions, densely populated urbanized areas, and ship-intensive traffics in East Asia.

Kidney damage induced by repeated fine particulate matter exposure: Effects of different components

BACKGROUND

Exposure to fine particulate matter with an aerodynamic diameter of ≤2.5 μm (PM_2.5) is associated with adverse health effects. This study aimed to evaluate the toxic effects of the constituents of PM_2.5 on mouse kidneys.

METHODS

We collected PM_2.5 near an industrial complex located in southern Kaohsiung, Taiwan, that was divided into water extract and insoluble particles. Male C57BL/6 mice were divided into five groups: control, low- and high-dose insoluble particle exposure, and low- and high-dose water extract exposure. Biochemical analysis, Western blot analysis, histological examination, and immunohistochemistry were performed to evaluate the impact of PM_2.5 constituents on mice kidneys.

RESULTS

PM_2.5 was collected from January 1, 2021, to February 8, 2021, from an industrial complex in Kaohsiung, Taiwan. Metallic element analysis showed that Pb, Ni, V, and Ti were non-essential metals with enrichment factors >10. Polycyclic aromatic hydrocarbon and nitrate polycyclic aromatic hydrocarbon analyses revealed that the toxic equivalents are, in the order, benzo(a)pyrene (BaP), indeno(1,2,3-cd) pyrene (IP), dibenzo(a,h)anthracene (DBA), and benzo(b)fluoranthene (BbF), which are potential carcinogens. Both water extract and insoluble particle exposure induced inflammatory cytokine upregulation, inflammatory cell infiltration, antioxidant activity downregulation, and elevation of kidney injury molecule 1 (KIM-1) level in mouse kidneys. A dose-dependent effect of PM_2.5 water extract and insoluble particle exposure on angiotensin converter enzyme 2 downregulation in mouse kidneys was observed.

CONCLUSION

We found that water-soluble extract and insoluble particles of PM_2.5 could induce oxidative stress and inflammatory reactions, influence the regulation of renin-angiotensin system (RAS), and lead to kidney injury marker level elevation in mouse kidneys. The lowest-observed-adverse-effect level for renal toxicity in mice was 40 μg water-soluble extract/insoluble particle inhalation per week, which was approximately equal to the ambient PM_2.5 concentration of 44 μg/m³ for mice.

Efficacy of oral nystatin treatment for patients with oral mucosal dysesthesia but without objective oral mucosal manifestations and necessity of Candida culture test before oral nystatin treatment

Background/purpose

Materials and methods

Results

Conclusion

Association between Ambient Air Pollution and Emergency Room Visits for Pediatric Respiratory Diseases: The Impact of COVID-19 Pandemic

The level and composition of air pollution have changed during the coronavirus disease 2019 (COVID-19) pandemic. However, the association between air pollution and pediatric respiratory disease emergency department (ED) visits during the COVID-19 pandemic remains unclear. The study was retrospectively conducted between 2017 and 2020 in Kaohsiung, Taiwan, from 1 January 2020 to 1 May 2020, defined as the period of the COVID-19 pandemic, and 1 January 2017 to 31 May 2019, defined as the pre-COVID-19 pandemic period. We enrolled patients under 17 years old who visited the ED in a medical center and were diagnosed with respiratory diseases such as pneumonia, asthma, bronchitis, and acute pharyngitis. Measurements of particulate matter (PM) with aerodynamic diameters of <10 μm (PM10) and < 2.5 μm (PM2.5), nitrogen dioxide (NO2), and Ozone (O3) were collected. During the COVID-19 pandemic, an increase in the interquartile range of PM2.5, PM10, and NO2 levels was associated with increases of 72.5% (95% confidence interval [CI], 50.5−97.7%), 98.0% (95% CI, 70.7−129.6%), and 54.7% (95% CI, 38.7−72.6%), respectively, in the risk of pediatric respiratory disease ED visits on lag 1, which were greater than those in the pre-COVID-19 pandemic period. After adjusting for temperature and humidity, the risk of pediatric respiratory diseases after exposure to PM2.5 (inter p = 0.001) and PM10 (inter p < 0.001) was higher during the COVID-19 pandemic. PM2.5, PM10, and NO2 may play important roles in pediatric respiratory events in Kaohsiung, Taiwan. Compared with the pre-COVID-19 pandemic period, the levels of PM2.5 and PM10 were lower; however, the levels were related to a greater increase in ED during the COVID-19 pandemic.

Seasonal variation and source identification of atmospheric speciated mercury in an industrial harbor area in East Asia

In this study, the pollution characteristics, spatiotemporal variation, and potential sources of atmospheric speciated mercury (ASM) in an industrial harbor area were explored. Gaseous elemental mercury (GEM), gaseous oxidized mercury (GOM), and particle-bound mercury (PBM) were sampled by a self-designed manual system at three harbor sites in four seasons. The yearly average concentrations of GEM, GOM, and PBM were 6.7 ± 2.0 ng/m³, 244 ± 70 pg/m³, and 410 ± 105 pg/m³, respectively. The seasonal average ASM concentration was in the order of: winter > fall > spring > summer. In terms of species, GEM dominated ASM, while reactive mercury (RM = GOM + PBM) accounted for 6.0-15.7%of ASM, implying that ASM was governed by anthropogenic sources in the harbor area. The highest ASM concentrations were observed at Site Zhonghe (ZH), which is mainly influenced by both ship exhausts and industrial emissions, and positively correlated with CO, NO_x, and SO₂. In particular, GOM was positively correlated with O₃, and negatively correlated with air temperature and relative humidity, showing high impact from atmospheric photochemical reactions. Air masses transporting westerly in spring were mainly from ship exhausts. In summer, air masses transporting from the south were from utility power plants and machinery exhausts. In fall and winter, air masses were transported mainly from the north, blowing by the long-range transport of polluted air masses originated from the north. Both principal component analysis and positive matrix factorization results indicate that coal burning, industrial emissions, and vehicular exhausts are the main contributors to ASM. Site Zhongdao (ZD) was close to the bulk carrier loading and unloading zones and was highly influenced by mobile sources, while Site ZH was mainly influenced by the neighboring industrial complex.

Transport route-based cluster analysis of chemical fingerprints and source origins of marine fine particles (PM2.5) in South China Sea

The fingerprints and source origins of marine PM_2.5 at two background islands in the South China Sea were clustered via trajectory analysis and positive matrix factorization. High PM_2.5 concentrations at the Dongsha Islands occurred for the north routes, while Nansha Islands had similar PM_2.5 concentrations amongst the transport routes. However, the chemical characteristics of PM_2.5 varied with the transport routes. Secondary inorganic aerosols (NO₃^-, SO₄^2-, and NH₄⁺) were abundant in water-soluble ions which dominated PM_2.5. Crustal metals were the abundant metals in PM_2.5, while trace metals were primarily originated from man-made sources. Organic carbon was superior to elemental carbon, and high concentrations of levoglucosan and organic acids were observed for the north routes. Overall, marine PM_2.5 at the Dongsha Islands was highly influenced by long-range transport of Asian continental outflows, while particulate air quality at the Nansha Islands was mainly governed by clean air parcels blown from the SCS.

Inter-comparison of chemical characteristics and source apportionment of PM2.5 at two harbors in the Philippines and Taiwan

This study inter-compared the concentration and chemical characteristics of PM_2.5 at two harbors in East Asia, and identified the potential sources of PM_2.5 and their contribution. Two sites located at the Kaohsiung (Taiwan) and Manila (the Philippines) Harbors were selected for simultaneous sampling of PM_2.5 in four seasons. The sampling of 24-h PM_2.5 was conducted for continuous seven days in each season. Water-soluble ions, metallic elements, carbonaceous content, anhydrosugars, and organic acids in PM_2.5 were analyzed to characterize their chemical fingerprints. Receptor modeling and trajectory simulation were further applied to resolve the source apportionment of PM_2.5. The results indicated that the Kaohsiung Harbor was highly influenced by long-range transport (LRT) of polluted air masses from Northeast Asia, while the Manila Harbor was mainly influenced by local emissions. Secondary inorganic aerosols were the most abundant ions in PM_2.5. Crustal elements dominated the metallic content of PM_2.5, but trace elements were mainly originated from anthropogenic sources. Higher concentrations of organic carbon (OC) than elemental carbon (EC) was found in PM_2.5, with secondary OC (SOC) dominant to the former. Levoglucosan in PM_2.5 at the Manila Harbor were superior to those at the Kaohsiung Harbor due to biomass burning surrounding the Manila Harbor. Additionally, high mass ratios of malonic and succinic acids (M/S) in PM_2.5 indicated the formation of SOAs. Overall, the ambient air quality of Manila Harbor was more polluted than Kaohsiung Harbor. The Kaohsiung Harbor was more severely affected by LRT of polluted air masses from Northeast Asia, while those toward the Manila Harbor came from the oceans. The major sources resolved by CMB and PMF models at the Kaohsiung Harbor were secondary aerosols, ironworks, incinerators, oceanic spray, and ship emissions, while those at the Manila Harbor were secondary aerosols, soil dust, biomass burning, ship emissions, and oceanic spray.

Repeated exposure to fine particulate matter constituents lead to liver inflammation and proliferative response in mice

BACKGROUND

Fine particulate matter (particulate matter with aerodynamic diameter of ≦2.5 µm, PM2.5) exposure cause adverse health effects, including lung inflammation. Through intra-tracheal instillation of PM2.5 components, the study aimed to evaluate the inflammatory and proliferative effects on mice liver. PM2.5 samples were collected near an industrial complex at southern Taiwan. Mice were exposed to water extracts or insoluble particles by intra-tracheal instillation. Male C57BL/6 mice were divided into five groups: control, low dose insoluble particle exposure (LP), high dose insoluble particle exposure (HP), low dose water extract exposure (LW), and high dose water extract exposure (HW). Biochemical analysis, western blotting, histological examination, and immunohistochemistry were employed to evaluate the results.

RESULT

Enrichment factor (EF) of metallic elements showed that the EFs of trace elements (Ti, V, Ni, Zn, Pb, Cr, and Cu) in PM2.5 were above 10. Hematoxylin and Eosin (H&E) staining of the liver tissue showed inflammatory infiltration in particle exposure group; hepatocyte ballooning degeneration and karyomegaly were seen in the water extract exposure group. Upregulation of inflammatory signaling, p65 and p50, and caspase-3 (an important effector involved in apoptosis) positive hepatocytes was significantly increased in the HP group, followed by an elevation in protein levels of growth arrest and DNA damage-inducible protein 153 (GADD153). Increased protein expression of proliferating cell nuclear antigen (PCNA) was noted in the LW and HW groups. An increase in phosphorylation of regulators of cell proliferation, Akt and extracellular signal-regulated kinase (ERK) 1/2, were detected in the LW and HW groups.

CONCLUSION

The present study shows that the insoluble particle composition of PM2.5 induced inflammatory signaling and cytokines upregulation in the liver, accompanied with inflammatory cell and macrophage infiltration and an abnormal liver function. Exposure of water extract to PM2.5 induced signals of upregulated cellular proliferation, elevated markers of cell proliferation in liver, hepatocyte ballooning degeneration and karyomegaly.

Metabolomic differences of exhaled breath condensate among children with and without asthma

BACKGROUND

There remains an unmet need in objective tests for diagnosing asthma in children. The objective of this study was to investigate the potential of metabolomic profiles of exhaled breath condensate (EBC) to discriminate stable asthma in Asian children in the community.

METHODS

One hundred and sixty-five Asian children (92 stable asthma and 73 non-asthmatic controls) participating in a population-based cohort were enrolled and divided into training and validation sets. Nuclear magnetic resonance-based metabolomic profiles of EBC samples were analyzed by using orthogonal partial least squares discriminant analysis.

RESULTS

EBC metabolomic signature (lactate, formate, butyrate, and isobutyrate) had an area under the receiver operator characteristic curve (AUC) of 0.826 in discriminating children with and without asthma in the training set, which significantly outperformed FeNO (AUC = 0.574; P < .001) and FEV₁ /FVC % predicted (AUC = 0.569; P < .001). The AUC for EBC metabolomic signature was 0.745 in the validation set, which was slightly but not significantly lower than in the testing set (P = .282). We further extrapolated two potentially involved metabolic pathways, including pyruvate (P = 1.67 × 10^-3 ; impact: 0.14) and methane (P = 1.89 × 10^-3 ; impact: 0.15), as the most likely divergent metabolisms between children with and without asthma.

CONCLUSION

This study provided evidence supporting the role of EBC metabolomic signature to discriminate stable asthma in Asian children in the community, with a discriminative property outperforming conventional clinical tests such as FeNO or spirometry.

Micromolar concentrations of citalopram or escitalopram inhibit glycoprotein VI-mediated and integrin αIIbβ3-mediated signaling in human platelets

Collagen and convulxin induce platelet aggregation through glycoprotein VI (GPVI)-FcRγ-Syk signaling pathway. In addition, fibrinogen induces platelet activation through integrin αIIbβ3-FcγRIIa-Syk signaling pathway. We previously reported that high concentrations of selective serotonin reuptake inhibitors (SSRI) reduce platelet aggregation induced by collagen. We further investigated the effects of SSRI on GPVI- and αIIbβ3-mediated signaling pathway. Citalopram and escitalopram, two relatively pure SSRI, were used in this study. Both citalopram and escitalopram concentration-dependently inhibited convulxin-induced platelet aggregation, serotonin (5-HT) release and the activation of αIIbβ3. 5-HT concentration in washed platelets was unchanged after short-term treatment with citalopram. The additional 5-HT failed to fully rescue the inhibitory effect of citalopram on convulxin-induced aggregation. Convulxin-induced phosphorylation of Syk, LAT, and Akt was inhibited by citalopram and escitalopram. Citalopram inhibited the interaction between FcRγ and Syk, whereas the phosphorylation of FcRγ in response to convulxin remained unaltered. Further, citalopram inhibited the increase of the interaction between serotonin transporter and Syk induced by convulxin. In the presence of Mn²⁺, escitalopram inhibited the formation of lamellipodia on immobilized fibrinogen. Escitalopram did not influence the binding of fibrinogen to platelets. It inhibited the phosphorylation of Syk and PAK triggered by the adhesion on fibrinogen. Our data demonstrate that micromolar concentrations of citalopram and escitalopram inhibit GPVI- and αIIbβ3-mediated platelet functions. The mechanism of the inhibitory effect of citalopram or escitalopram is not the influence on the activation of GPVI or the interaction between fibrinogen and αIIbβ3, but the interaction between Syk and its upstream molecules.

Effects of a snake venom metalloproteinase, triflamp, on platelet aggregation, platelet-neutrophil and neutrophilneutrophil interactions: involvement of platelet GPIbα. and neutrophil PSGL-1

The biologically active components fromViperidae venoms specifically affect cell-matrix interactions, and have been utilized for developing anti-adhesive therapy as anti-thrombotic and antiangiogenic agents. Utilizing platelet aggregometry coupled with flow cytometry, we found that a metalloproteinase isolated from Trimeresurus flavoviridis, termed triflamp, inhibited heterotypic adhesion between platelets and neutrophils in whole blood samples. Triflamp is a monomeric glycoprotein with a molecular weight of ∼28 kDa. Triflamp has a N-terminal amino acid sequence homologous to other venom metalloproteinases isolated from T. flavoviridis. The enzymatic activity of triflamp was inhibited by EDTA and phenanthroline but not by PMSF. Moreover, triflamp is a pure α-fibrinogenase. Studies aimed at determining the nature of triflamp in affecting platelets or neutrophils revealed a selective inhibitory activity to glycoprotein (GP) Ibα.-dependent platelet aggregation and PSGL-1-dependent neutrophil homotypic aggregation, indicating that its effects are rather specific. As judged by Western blotting, GPIbα. on platelets and PSGL-1 on neutrophils are the substrates of triflamp. In conclusion, we suggest the novel role of venom metalloproteinase from Viperidae affecting the blood cell-cell interactions, thus offering a potential approach for further exploration of anti-inflammatory agents.

Triflamp, a snake venom metalloproteinase, reduces neutrophil-platelet adhesion through proteolysis of PSGL-1 but not glycoprotein Ibα

Triflamp, a metalloproteinase isolated from Trimeresurus flavoviridis, inhibits heterotypic adhesion between platelets and neutrophils. Coincubation studies demonstrate that direct interaction of triflamp with neutrophils is sufficient to inhibit the formation of neutrophil-platelet complexes. Its anti-adhesive effect is in a concentrationand incubation time-dependent manner. Triflamp reduces the expression of P-selectin glycoprotein ligand-1 (PSGL-1) on neutrophils and glycoprotein (GP) Ibα on platelets as probed by flow cytometry and Western blot. Moreover, triflamp disrupts P-selectin-mediated adhesion by cleaving PSGL-1 from the neutrophil surface.There are obvious differences regarding PSGL-1 proteolysis by triflamp and cathepsin G. Besides the NH2-terminus of PSGL-1, other sites are truncated by triflamp. The inhibitory effect of triflamp on PSGL-1 expression was prevented by pretreatment with a metalloproteinase inhibitor, phenanthroline. However, triflamptreated platelets fully keep the ability for binding to PAFor fMLP-stimulated neutrophils. Our results indicate that degradation of platelet GPIbα by triflamp does not interfere with neutrophil-platelet adhesion. Its effect on neutrophil PSGL-1 appears to be a critical factor for its inhibition on neutrophilplatelet interaction.

Obesity disproportionately impacts lung volumes, airflow and exhaled nitric oxide in children

Background

The current literature focusing on the effect of obesity and overweight on lung function and fraction of exhaled nitric oxide (FeNO) in children, particularly among healthy children of non-European descent, remains controversial. Furthermore, whether the relationship of obesity and overweight with lung function and FeNO in children is modified by atopy is unclear. The objective of this study was to examine the effect of excess weight on lung function parameters and FeNO among Asian children, with a particular focus on exploring the potential effect modification by atopy.

Methods

We investigated the effect of excess weight on lung function and FeNO in a population sample of 1,717 children aged 5 to 18 years and explored the potential modifying effect of atopy.

Results

There were positive associations of body mass index (BMI) z-score with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow (PEF), and forced expiratory flow at 25–75% (FEF_25-75) (all P<0.001), after controlling for confounders. The beta coefficient for FEV₁ (0.084) was smaller than that for FVC (0.111). In contrast, a negative association was found between BMI z-score and FEV₁/FVC ratio (P<0.001) and FeNO (P = 0.03). A consistent pattern of association for lung function variables was observed when stratifying by atopy. There was a negative association of BMI z-score with FeNO in atopic subjects (P = 0.006), but not in non-atopic subjects (P = 0.46).

Conclusions

Excess weight disproportionately impacts lung volumes and airflow in children from the general population, independent of atopic status. Excess weight inversely affects FeNO in atopic but not in non-atopic children.

Partially Defective Store Operated Calcium Entry and Hem(ITAM) Signaling in Platelets of Serotonin Transporter Deficient Mice

BACKGROUND

Serotonin (5-hydroxytryptamin, 5-HT) is an indolamine platelet agonist, biochemically derived from tryptophan. 5-HT is secreted from the enterochromaffin cells into the gastrointestinal tract and blood. Blood 5-HT has been proposed to regulate hemostasis by acting as a vasoconstrictor and by triggering platelet signaling through 5-HT receptor 2A (5HTR2A). Although platelets do not synthetize 5-HT, they take 5-HT up from the blood and store it in their dense granules which are secreted upon platelet activation.

OBJECTIVE

To identify the molecular composite of the 5-HT uptake system in platelets and elucidate the role of platelet released 5-HT in thrombosis and ischemic stroke.

METHODS

5-HT transporter knockout mice (5Htt-/-) were analyzed in different in vitro and in vivo assays and in a model of ischemic stroke.

RESULTS

In 5Htt-/- platelets, 5-HT uptake from the blood was completely abolished and agonist-induced Ca2+ influx through store operated Ca2+ entry (SOCE), integrin activation, degranulation and aggregation responses to glycoprotein VI (GPVI) and C-type lectin-like receptor 2 (CLEC-2) were reduced. These observed in vitro defects in 5Htt-/- platelets could be normalized by the addition of exogenous 5-HT. Moreover, reduced 5-HT levels in the plasma, an increased bleeding time and the formation of unstable thrombi were observed ex vivo under flow and in vivo in the abdominal aorta and carotid artery of 5Htt-/- mice. Surprisingly, in the transient middle cerebral artery occlusion (tMCAO) model of ischemic stroke 5Htt-/- mice showed nearly normal infarct volume and the neurological outcome was comparable to control mice.

CONCLUSION

Although secreted platelet 5-HT does not appear to play a crucial role in the development of reperfusion injury after stroke, it is essential to amplify the second phase of platelet activation through SOCE and plays an important role in thrombus stabilization.

Amniotic fluid induces platelet-neutrophil aggregation and neutrophil activation

OBJECTIVE

Amniotic fluid embolism syndrome is a fatal disease in pregnant women. The exact role of platelets and neutrophils in amniotic fluid embolism syndrome is not clear. We examined whether amniotic fluid could affect platelet-neutrophil aggregation and activation and the possible mechanisms.

STUDY DESIGN

Blood samples from the pregnant women were pretreated ex vivo with their own amniotic fluid. Flow cytometry was used to measure platelet-neutrophil aggregation and activation. Neutrophil-mediated activity of p38 mitogen-activated protein kinase and extracellular signal-regulated protein kinases 1 and 2 was analyzed by Western blotting.

RESULTS

Amniotic fluid significantly induced platelet-neutrophil aggregation, neutrophil CD11b expression, and reactive oxygen species production. Amniotic fluid induced minimal platelet P-selectin expression. The increase of intracellular calcium level of neutrophils and the activity of p38 mitogen-activated protein kinase were enhanced by amniotic fluid stimulation.

CONCLUSION

Amniotic fluid was able to induce neutrophil activation and platelet-neutrophil aggregation with minimal effect on platelet activation. These findings may provide a new insight in the understanding of the pathophysiologic condition of amniotic fluid embolism syndrome.

Selective serotonin reuptake inhibitors reduce P2Y12 receptor-mediated amplification of platelet aggregation

Selective serotonin reuptake inhibitors (SSRIs) have been reported to reduce platelet aggregation induced by ADP. ADP induces platelet aggregation through two purinergic receptors P2Y1 and P2Y12. We characterized the inhibitory properties of SSRIs on ADP-induced platelet aggregation and investigated the effects of SSRIs on the signaling pathways downstream of P2Y1 and P2Y12 receptors. Specific antagonists were used to evaluate which purinergic receptor-mediated aggregation was influenced by SSRIs. The primary phase of ADP-induced aggregation was not inhibited by citalopram. Citalopram failed to influence ADP-induced platelet shape change, intracellular calcium mobilization and the early phosphorylation of PKCα. Differently, citalopram inhibited the secondary phase of ADP-induced platelet aggregation in a concentration-dependent manner. Other SSRIs, including fluoxetine and sertraline, exhibited the same anti-platelet effects. Under P2Y1 blockade, citalopram inhibited platelet aggregation and integrin αIIbβ3 activation in response to ADP, indicating that citalopram inhibited P2Y12-mediated aggregation. Citalopram concentration-dependently inhibited the phosphorylation of Akt, GSK3β, p38 MAPK and Syk induced by ADP, but showed no effect on the decrease of cAMP and VASP phosphorylation. With integrin αIIbβ3 blockade, however, the phosphorylation of Akt triggered by ADP was unaltered by the addition of citalopram. Taken together, under the stimulation of ADP, SSRIs inhibit the amplification of platelet aggregation secondary to the activation of P2Y12 receptor, and subsequently reduce the activation of the downstream molecules of the outside-in signaling pathways.

Synergistic effects of COMT and TPH2 on social cognition

Whether genetic factors affect social cognition, particularly emotion management, requires elucidation. This study investigates whether social cognition varies with genetic variations of COMT and tryptophan hydroxylase-2 (TPH2), which modulate dopamine and serotonin neurotransmissions respectively, and thereby emotion regulation. NIMH-recommended "managing emotions branch and 2 subtasks" of MSCEIT and six neurocognition domains, and genotypes of COMT Val158Met and TPH2 G703T were measured in 150 Han-Chinese healthy adults. Subjects carrying the M allele (M group) of COMT exceeded Val/Val homozygotes (V group) in managing emotions branch (p = 0.032) and emotional relation subtask (p = 0.037). TPH2 T/T homozygotes (T group) excelled those with the G allele (G group) in emotional management subtask (p = 0.025). Subjects with M+T variation surpassed the other 3 groups (M+G, V+T and V+G) in managing emotion branch (p = 0.002), emotional relation subtask (p = 0.023), and emotional management subtask (p = 0.002). The findings remained after control for gender, age, education, and neurocognitive functions. Synergistically, the effect size of COMT-TPH2 combination surmounted the sum of separate effect sizes of COMT and TPH2. The findings suggest that genetic variations of COMT and TPH2 have synergistic effects on social cognition in the general population.

A selective serotonin reuptake inhibitor, citalopram, inhibits collagen-induced platelet aggregation and activation

Clinical depression is a significant risk factor for cardiovascular diseases and confers an increased risk of mortality. Increased platelet reactivity may predispose depressed patients to cardiovascular diseases. The antidepressants selective serotonin reuptake inhibitors (SSRIs) have been found to have cardioprotective effects probably via the attenuation of platelet activation independently in addition to treatment of depression itself. However, the characters of the inhibitory effect of SSRIs on platelets remain largely unknown. Here we show that an SSRI, citalopram, specifically inhibited collagen-induced platelet aggregation. Citalopram, however, revealed only little inhibitory effect on platelet aggregation induced by thrombin, U46619, and ionomycin, and failed to inhibit reversible platelet aggregation induced by adenosine diphosphate with fibrinogen. Collagen-induced of αIIbβ3 integrin activation in platelets under a static condition was not influenced by citalopram. Citalopram inhibited convulxin-induced platelet aggregation and αIIbβ3 integrin activation. In the experiments with fibrinogen-induced aggregation in elastase-treated platelets, citalopram inhibited only collagen-induced αIIbβ3 activation but not the binding activities between activated αIIbβ3 integrin and fibrinogen. Moreover, citalopram inhibited α-granule and dense granule secretion from platelets in response to collagen, as determined by a reduced expression of P-selectin and adenosine triphosphate release, respectively. In addition, collagen-induced thromboxane A2 release in platelets was attenuated by citalopram pretreatment. These findings might specify the mechanisms of inhibitory effects of citalopram on collagen mediated platelet activation and aggregation, and further support the cardioprotective effect of SSRIs.

Episodic pain syndrome restricted cheiro-oral region associated with pontine lesion

Other than from the thalamus and sensory cortex, episodic pain is an extremely rare neurological manifestation in the central compartment. This study reports a middle-aged man who experienced an acute onset of episodic oscillatory burning pain restricted to the cheiro-oral region, who was found to have a singular infarct at the left tegmental pons. A close relationship between his pain attack and an elevation of arterial blood pressure was clearly observed. Blood adenohypophyseal hormones and electroencephalogram did not reveal an abnormality in the ictus. Neuroimaging and clinical studies did not support involvement of the thalamus, periaqueductal gray matter, hypothalamus or regional structure. Therefore, episodic pain may be an isolated manifestation with a pontine lesion. A relapsing expansion of focal cerebral oedema with fluid retention may have corresponded to the oscillation of his sensory deficit. This accumulating, devastating calamity by a repetitive and paroxysmal offense after a blood-brain barrier breakdown should be cautiously reviewed.

Lycopene binds PDGF-BB and inhibits PDGF-BB-induced intracellular signaling transduction pathway in rat smooth muscle cells

Cardiovascular diseases (CVDs) result from the sub-endothelial accumulation of inflammatory cells and smooth muscle cells (SMCs). Lycopene, a natural compound from tomato, has been suggested to play a role in CVD prevention. However, its action mechanism is still largely unknown. In this study, we examined the effect of lycopene on SMCs. We found that preincubation of PDGF-BB with lycopene resulted in a marked inhibition on PDGF-BB-induced PDGF receptor-beta (PDGFR-beta), PLCgamma, and ERK1/2 phosphorylation in rat A10 SMCs and primary cultured aortic SMCs. In striking contrast, lycopene did not influence EGF-induced ERK1/2 phosphorylation. Surprisingly, further analysis indicates that lycopene could directly bind PDGF-BB and inhibit PDGF-BB-SMC interaction, as determined by dot binding assay and Western blotting. In functional studies, lycopene inhibited PDGF-BB-induced SMC proliferation and migration toward gelatin and collagen at concentrations ranging from 2 to 10 microM. On the contrary, lycopene did not inhibit bFGF- and VEGF-induced endothelial cell migration. Gelatin zymography demonstrated that lycopene's effect on SMC migration was not due to the inhibition of matrix metalloproteinases (MMPs). Taken together, our results provide the first evidence showing that lycopene inhibits PDGF-BB-induced signaling, proliferation and migration in rat A10 and aortic SMCs. One of the action mechanisms is that lycopene is capable of binding PDGF-BB and inhibiting its interaction with SMC, which is quite different from those previously developed PDGFR-beta antagonists. The results presented here may help us to better understand the beneficial effects of lycopene in CVD prevention.

Detection and quantification of glucuro- and sulfoconjugated metabolites in human urine following oral administration of xenobiotic 19-norsteroids

Recently, the endogenous origin of nandrolone (19-nortestosterone) and other 19-norsteroids has been a focus of research in the field of drug testing in sport. In the present study, we investigated metabolites conjugated to a glucuronic acid and to a sulfuric acid in urine following administration of four xenobiotic 19-norsteroids. Adult male volunteers administered a single oral dose (10 mg) of each of four 19-norsteroids. Urinary samples collected from 0 to 120 h were subjected to methanolysis and beta-glucuronidase hydrolysis and were derivatized by N-methyl-N-trimethylsilyltrifluoroacetamide (MSTFA) before gas chromatography-mass spectrometry analysis. We confirmed that 19-norandrosterone (19-NA) and 19-noretiocholanolone (19-NE) were present in both glucuronide (g) and sulfate (s) conjugates and 19-norepiandrosterone (19-NEA) was excreted exclusively as a sulfate fraction in urine of all 19-norsteroids tested. The overall levels of the three metabolites can be ranked as follows: 19-NA(g+s)>19-NE(g+s)>19-NEA(s). The concentration profiles of these three metabolites in urine peaked between 2 to 12h post-administration and declined thereafter until approximately 72-96 h. 19-NA was most prominent throughout the first 24 h post-administration, except for a case in which an inverse relationship was found after 6h post-administration of nandrolone. Furthermore, we found that sulfate conjugates were present in both 19-NA and 19-NE metabolites in urine of all 19-norsteroids tested. The averaged total amounts of metabolites (i.e. 19-NA(s+g)+19-NE(s+g)+19-NEA(s)) excreted in urine were 38.6, 42.9, 48.3 and 21.6% for nandrolone, 19-nor-4-androsten-3,17-dione, 19-nor-4-androsten-3beta,17beta-diol and 19-nor-5-androstene-3beta,17beta-diol, respectively. Results from the excretion studies demonstrate significance of sulfate-conjugated metabolites on interpretation of misuse of the 19-norsteroids.

Rhodostomin, a disintegrin, inhibits adhesion of neutrophils to fibrinogen and attenuates superoxide production

Disintegrins are a group of Arg (or Lys)-Gly-Asp-containing snake venom proteins which inhibit platelet aggregation via the blockade of alpha(IIb)beta(3) integrin. Here, we studied the effect of rhodostomin, a disintegrin purified from the venom of Calloselasma rhodostoma, on the functions of neutrophils. By flow cytometric analysis of whole blood, we found that rhodostomin interacted with leukocytes of the myeloid and monocytic lineage as well as with platelets. The binding of rhodostomin to neutrophils could reach saturation in a dose-dependent manner, and its binding was increased in neutrophils stimulated with phorbol 12-myristate 13-acetate (PMA) and N-formyl-Met-Leu-Phe. EDTA did not inhibit the binding of rhodostomin. In addition, bound rhodostomin was not internalized. Soluble fibrinogen, a natural ligand of Mac-1 (CD11b/CD18, alpha(M)beta(2)), and the peptide, GRGDS, inhibited the binding of rhodostomin to PMA-activated neutrophils, while 7E3, a monoclonal antibody (mAb) raised against beta(3) integrin, or mAbs raised against alpha(M) and beta(2) integrin did not. Rhodostomin blocked the Mac-1-dependent adhesion of neutrophils to immobilized fibrinogen, in parallel with decreasing the production of superoxide from adherent neutrophils. Taken together, our results indicate that rhodostomin binds to activated neutrophils in an RGD-dependent manner, blocks the adhesion of activated neutrophils to fibrinogen and attenuates superoxide production, suggesting that rhodostomin may have anti-inflammatory properties.

Triflamp, a snake venom metalloproteinase, reduces neutrophil-platelet adhesion through proteolysis of PSGL-1 but not glycoprotein Ib alpha

Triflamp, a metalloproteinase isolated from Trimeresurus flavo-viridis, inhibits heterotypic adhesion between platelets and neutrophils. Coincubation studies demonstrate that direct interaction of triflamp with neutrophils is sufficient to inhibit the formation of neutrophil-platelet complexes. Its anti-adhesive effect is in a concentration- and incubation time-dependent manner. Triflamp reduces the expression of P-selectin glycoprotein ligand-1 (PSGL-1) on neutrophils and glycoprotein (GP) Ibalpha on platelets as probed by flow cytometry and Western blot. Moreover, triflamp disrupts P-selectin-mediated adhesion by cleaving PSGL-1 from the neutrophil surface. There are obvious differences regarding PSGL-1 proteolysis by triflamp and cathepsin G. Besides the NH2-terminus of PSGL-1, other sites are truncated by triflamp. The inhibitory effect of triflamp on PSGL-1 expression was prevented by pretreatment with a metalloproteinase inhibitor, phenanthroline. However, triflamp-treated platelets fully keep the ability for binding to PAF- or fMLP-stimulated neutrophils. Our results indicate that degradation of platelet GPIb alpha by triflamp does not interfere with neutrophil-platelet adhesion. Its effect on neutrophil PSGL-1 appears to be a critical factor for its inhibition on neutrophil-platelet interaction.

Inhibitory effects of human α2-macroglobulin and mouse serum on the PSGL-1 and glycoprotein Ib proteolysis by a snake venom metalloproteinase, triflamp

Triflamp, a 28 kDa snake venom metalloproteinase purified from the venom of Trimeresurus flavoviridis, possesses the proteolytic activities toward P-selectin glycoprotein ligand-1 (PSGL-1), glycoprotein Ib (GPIb) and fibrinogen. In human whole blood preparation, however, triflamp (6 microg/ml) failed to cleave neutrophil PSGL-1 and platelet GPIb. Human alpha2-macroglobulin (alpha2M) was mainly responsible for the neutralization of the proteolytic effects of triflamp on PSGL-1, GPIb and fibrinogen. Human alpha2M neutralized triflamp at a stoichiometry about 1.1:1 (molar basis) determined by azocaseinolysis. SDS-PAGE analysis revealed that triflamp cleaved the bait-region of alpha2M. Western blot demonstrated that triflamp interacted with the C-terminal half-subunits of truncated alpha2M resulting in the formation of high-molecular-weight species of alpha2M-triflamp complexes. In the presence of competing nucleophile, 0.2 M methylamine, the proteolytic activity of triflamp was conserved. In vivo we found that mice neutrophils were resistant to the cleavage of PSGL-1 by triflamp. However, mouse PSGL-1 and GPIb were susceptible to be cleaved by triflamp in washed mouse neutrophil and platelet preparation, respectively. Similarly, mouse serum was also responsible for the inactivation of the proteolytic activity of triflamp. This study provides direct evidences for the reasonable explanation regarding the reduced proteolytic activity of triflamp toward its substrates in whole blood preparation and in vivo model.

Immunohistochemical analysis of epidermal growth factor receptor family members in stage I non-small cell lung cancer

BACKGROUND

To elucidate the relationship between the expression of epidermal growth factor receptor family members (ErbB-1, neu/ErbB-2, ErbB-3, and ErbB-4) and tumor recurrence.

METHODS

We used immunohistochemistry to examine the expression of four epidermal growth factor receptor family members in 73 patients with stage I non-small cell lung cancer.

RESULTS

Using Cox univariate analysis, we determined that angiolymphatic tumor emboli and non-well-differentiated tumor cells were two significant conventional pathologic predictors of tumor recurrence, and that ErbB-1 and ErbB-3 were also significant predictors. Co-expression of ErbB-1+, -3+, or expression of three or more epidermal growth factor receptor family members had a significant effect on lung cancer recurrence. A stepwise multivariate Cox proportional hazards regression analysis provided a predictive model for tumor recurrence.

CONCLUSIONS

The present study shows that in patients with a non-well-differentiated tumor, overexpression of ErbB-3 is a useful marker for predicting tumor recurrence. The present study also confirmed that ErbB-1 expression increased in proportion to the loss of tumor differentiation. The correlation between ErbB-3 and distant metastasis was good.

Phase I and pharmacokinetic study of a stable, polyethylene-glycolated liposomal doxorubicin in patients with solid tumors: the relation between pharmacokinetic property and toxicity

BACKGROUND

Compared with free drug, sterically stabilized liposomal drug has prolonged circulation time and, thereby, higher tumor selectivity and antitumor activity. The stability in plasma is an important consideration in the formulation of clinically useful liposomal drug. A Phase I study of a stable liposomal doxorubicin with polyethylene glycol (PEG) coating and phospholipid component of distearoyl phosphatidylcholine (DSPC) was performed to characterize its pharmacokinetic properties, toxicity profile, and maximal tolerated dose.

METHODS

The starting dose was 30 mg/m(2) every 3 weeks with an increment of 10 mg/m(2) for each level. A cohort of at least three patients was entered for each level. Dose escalation stopped when more than one-third of patients had dose limiting toxicity (DLT), which was equal to or more than Grade 3 nonhematologic toxicity. Blood was sampled immediately before and at 5 minutes, 2 hours, 4 hours, 10 hours, 24 hours, 48 hours, 72 hours, and 168 hours after the completion of PEGylated liposomal doxorubicin (PLD) infusion. Plasma level of doxorubicin was determined with fluorometry, and the pharmacokinetic properties were analyzed.

RESULTS

Twenty-six patients were entered, and 101 courses were studied. This DSPC PLD had a steady-state distribution volume (Vss) of 2.4 +/- 0.9 liters (mean +/- standard deviation), a clearance of 0.027 +/- 0.010 liters per hour, and a beta half-life of 65.0 +/- 17.8 per hour. These characteristics were dose independent, and the Vss and clearance were smaller than those of a well characterized PLD comprised of hydrogenated soybean phosphatidylcholine (HSPC). At the dose level of 50 mg/m(2), its plasma area under the concentration time curve was approximately twice that of HSPC PLD. Attenuation of acute toxicity, such as nausea, emesis, and alopecia, was noted in all dose levels. However, stomatitis was common from the dose level of 30 mg/m(2), and its incidence and severity increased with dosage and became dose limiting at 50 mg/m(2). A dose of 45 mg/m(2) every 3 weeks was then given in eight patients, and the side effects were acceptable. This dose was recommended for Phase II clinical trials. Fourteen of 17 patients with a dose level > or = 40 mg/m(2) were evaluable for response, but none achieved partial remission.

CONCLUSIONS

This DSPC PLD had the characteristics of second-generation liposomal drug pharmacokinetically and toxicologically. The incidence of severe stomatitis was higher than that of HSPC PLD, corresponding to the difference in pharmacokinetics. Only limited antitumor activity was observed, although defining its therapeutic application will need further Phase II studies. Further prolongation of plasma stability of PLD may not be clinically beneficial considering the increased stomatitis and the reduced achievable dose intensity.

Redoing reconstruction of the esophagus using remnants of the ileo-left colon aided by microvascular anastomosis

Theoretically, the jejunum, fasciocutaneous or myocutaneous flap is recommended as an esophageal substitute in redoing reconstruction of the esophagus after a second incidence of corrosive injury. However, other esophageal substitutes should also be considered. We present a case of a 42-year-old woman who underwent esophageal reconstruction using an ileocolon graft for corrosive esophageal stricture ten years before. The patient ingested caustic drain cleaner again and underwent resection of the ileocolon graft secondary to corrosive necrosis. Two and a half months after the second incidence of corrosive injury, reconstruction of the esophagus was again performed using a graft of remnant ileo-left colon aided by microvascular anastomosis. The patient was able to swallow a regular diet after the procedure. Remnant ileo-left colon is a good alternative esophageal substitute in cases of repeated corrosive injury.

Surgery for lung abscess in immunocompetent and immunocompromised children

PURPOSE

The aim of this study was to evaluate the surgical management results of lung abscess in immunocompetent and immunocompromised children.

METHODS

Surgery was performed on 30 children with lung abscess or necrotizing pneumonia refractory to medical treatment in a 12-year period. Of them, 23 were immunocompetent, and 7 were immunocompromised. Pulmonary resection was performed including unilateral lung in 28, bilateral in 2, and 2 lobes in 6. Concomitant decortication was performed in 18 (78.2%) immunocompetent patients.

RESULTS

Increased incidence of surgery for lung abscess was caused mainly by drug-resistant and fungal infection. Surgery was performed commonly for bacterial lung abscess on patients less than 5 years old and fungal lung abscess on adolescence. A multiple small abscess was the predominant type of abscess in immunocompetent patients, whereas 2-lobe involvement tended to occur in immunocompromised patients. Fungal lung abscess tended to occur on left lung and in female patients. Left lower lobe was involved most commonly in both groups of patients in which majority need lobectomy. Immunocompromised patients required a more extensive pulmonary resection. There were 3 postoperative complications (morbidity of 10.2%) with no postoperative mortality. Length of postoperative hospital stay ranged from 6 to 85 days with average of 18.4 days.

CONCLUSIONS

The incidence and pattern of lung abscess that required surgery between immunocompetent and immunocompromised children were different. A more aggressive, extensive surgical procedure is preferable for immunocompromised patients, and the surgical results were comparatively excellent to immunocompetent patients. However, the prognosis of immunocompromised children depends on their underlying disease process.

Intrathoracic muscle flap transposition in the treatment of fibrocavernous tuberculosis

BACKGROUND AND OBJECTIVE

Conventionally, pulmonary resection with thoracoplasty is used to treat fibrocavernous complication of pulmonary tuberculosis. This operation is usually bloody, time-consuming with complicated postoperative course. To prevent massive blood loss and preserved pulmonary function, a more simplified operative procedure, cavernostomy combined intrathoracic muscle flap transposition was used and the outcome was evaluated in this study.

DESIGN

Retrospective review.

METHODOLOGY

Between December 1989 and June 1996, a total of ten patients with fibrocavernous pulmonary tuberculosis were managed using cavernostomy combined with intrathoracic muscle flap transposition. Five of them had concomitant aspergilloma within the cavity while three had multiple drug resistant pulmonary tuberculosis. The muscle flap was used to plombage the cavity and reinforce the closure of bronchopleural fistula after cavernostomy.

RESULTS

Six postoperative complications occurred in five patients, including reformation of cavity (2), bronchopleurocutaneous fistulae (3), and postoperative bleeding (1). The success or failure of intrathoracic muscle flap transposition on patients with fibrocavernous tuberculosis was significantly correlated with the size of the cavity (194.0+/-11.2 vs. 283.0+/-44.6 cm(3), P=0.016) and the number of bronchopleural fistulae (1.6+/-0.4 vs. 4.0+/-0.4, P=0.008). There was no operative death and in long term follow-up, there was no recurrence of hemoptysis or deterioration of pulmonary function in the successful group of patients.

CONCLUSIONS

Cavernostomy combined with intrathoracic muscle flap transposition can be used to treat well-selected fibrocavernous pulmonary tuberculosis patients, except on patients with large size cavity, multiple bronchopleural fistulae or multiple drug resistance tuberculosis.

Pegylated liposomal doxorubicin in treating a case of advanced hepatocellular carcinoma with severe hepatic dysfunction and pharmacokinetic study

BACKGROUND

There is lack of effective and safe chemotherapy for advanced hepatocellular carcinoma. Polyethylene glycol-coated (pegylated) liposomal doxorubicin (PLD) has long circulation time and enhanced drug accumulation in the tumor tissues. It has significant activity in Kaposi's sarcoma, breast and ovarian cancers and the acute adverse effects of free drug are reduced.

PATIENTS AND METHODS

A patient with advanced hepatocellular carcinoma was treated with PLD and a pharmacokinetic study was performed. Initial serum total and direct bilirubin were 3.6 and 6.8 folds of upper normal, respectively, and an indocyanine green clearance test at 15 minutes was 26.3% (normal < 15%).

RESULTS

Compared to cases with normal liver function, increased volume of distribution of doxorubicin correlated with a large amount of ascites (P < 0.05). The clearance of drug was unexpectedly higher than in cases with normal liver function (P < 0.05). According to the pharmacokinetic studies, the disposition of PLD in this case has not been retarded even in the presence of severe liver dysfunction. Only minimal toxicities including grade 2 stomatitis and moderate leukopenia were observed. The tumor had a partial remission and the patient survived nine months after PLD treatment.

CONCLUSION

PLD could serve as a safe and effective treatment for hepatocellular carcinoma even in the presence of impaired liver function. Its role in treating advanced hepatocellular carcinoma is worthy of further study.

Direct comparison of liposomal doxorubicin with or without polyethylene glycol coating in C-26 tumor-bearing mice: is surface coating with polyethylene glycol beneficial?

Sterically stabilized liposome is characterized by a surface coating of polyethylene glycol (PEG) or other polymers that can reduce opsonization of the liposome by plasma proteins. It has a higher plasma area under the concentration-time curve (AUC), which is believed to correlate with better therapeutic efficacy. However, the presence of large molecules on the liposomal surface may reduce the interactions of liposomes with cells and hinder entry of liposomes into the tumor tissue. Using a stable liposomal system composed of distearoyl phosphatidylcholine/cholesterol, we examined the effect of PEG (Mr 2000) on the pharmacokinetics and on the efficacy of liposomal doxorubicin with C-26 syngeneic tumor model in BALB/c mice. The plasma AUC of liposomal doxorubicin with 6 mol-% PEG-modified distearoyl phosphatidylethanolamine (PEG-DSPE) was approximately twice that of liposomal doxorubicin without PEG at various dosages, regardless of whether the mice were tumor-bearing. Paradoxically, the group of mice treated with liposomal doxorubicin without PEG had higher tumor doxorubicin concentrations. The 72-h tumor AUC was 1.44 times that of liposomal doxorubicin with 6% PEG-DSPE. The tumor-accumulation efficiency (AUC(Tumor)/AUC(Plasma)) of liposomal doxorubicin without PEG was 0.87, and this was more than twice that of the liposomal doxorubicin with 6% PEG-DSPE (0.31). At a dose of 10 mg/kg, although both liposomal groups were better than the free drug group in terms of clinically relevant parameters, including toxicity, tumor shrinkage, and survival, there was no difference between the two liposomal drug groups. In this stable liposome system, surface coating with PEG offered no benefit for liposomal doxorubicin in the C-26 tumor model. To enhance the therapeutic index of liposomal doxorubicin, simply increasing plasma AUC by surface coating with PEG may not be satisfactory.

Sterically stabilized anti-idiotype immunoliposomes improve the therapeutic efficacy of doxorubicin in a murine B-cell lymphoma model

A liposome containing diverse synthetic lipid derivatives of polyethylene glycol (PEG) results in smaller distribution volume and longer circulation time in blood and, thus, may improve drug targeting. The characteristics and therapeutic efficacy of immunoliposomes with similar liposomal formulation have never been studied in lymphoma models. We have developed immunoliposomes conjugated with S5A8 monoclonal antibody, an anti-idiotype antibody to 38C13 murine B-cell lymphoma, and loaded them with doxorubicin using an ammonium sulfate gradient. Purified antibodies were covalently coupled to the termini of PEG on the surface of small unilamellar liposomes. Cell binding and internalization ability of these immunoliposomes were estimated by a fluorescence assay using a pH-sensitive fluorescent dye (HPTS). The in vitro cytotoxicity of doxorubicin encapsulated in immunoliposomes was greater for idiotype-positive 38C13 cells than for the idiotype-negative variant of this cell line. In syngeneic C3H/HeN mice, doxorubicin encapsulated in immunoliposomes exhibited a long circulation time and was more effective at prolonging survival of mice bearing 38C13 tumor than non-targeted liposomal doxorubicin or free doxorubicin plus empty immunoliposomes. Our results demonstrate the superiority of targeted therapy with these immunoliposomes and its potential in lymphoma treatment.

Giant intraluminal fibrovascular polyp of the esophagus

Giant polyps of the esophagus are relatively rare. Without previous history, the diagnosis of the disease is difficult to be made by esophagography and esophagoscopy. A case of giant intraluminal fibrovascular polyp (13x4x3.5 cm) of the esophagus is presented. The polyp was retrieved from the esophagus by a Foley's catheter and resected via the oral route.

Surgical results of 40 patients with malignant tracheobronchial lesions

The objective of this study was to evaluate the results of tracheobronchoplastyperformed on a variety of malignant diseases which involved the tracheobronchus. Between July 1988 and March 1996 tracheobronchial surgery was performed on 40 patients who had a variety of malignant diseases. The primary diseases were bronchogenic carcinoma (n=26), tracheobronchial tumour (n=5), thyroid cancer (n=6), and oesophageal cancer (n=3). Operative procedures that were performed on the tracheobronchus were sleeve lobectomy (n=22) or bilobectomies (n=5), sleeve pneumonectomy (n=3), sleeve resection of trachea (n=7) and bronchus (n=3). There was one postoperative death with a mortality rate of 2.5%. However, there were no significant postoperative complications apart from the one postoperative death; one patient developed a bronchopleural fistula and empyema. In lung cancer patients, the 2 year survival rate was 47.3%, and one (3.8%) local tumour recurrence. Four of five patients who had tracheobronchial tumours were alive and free from disease during 2-6 year follow-up period. One patient who had malignant fibrous histiocytoma died of brain metastasis 6 months after the operation. Among six patients whose thyroid cancer involved the trachea, one patient survived for 7 years, the other five patients were still alive and free from disease 2-5 years after the operation. Of the three patients whose oesophageal carcinoma involved the tracheobronchus, there was one operative death and the others died of tumour recurrence 1 and 2 years, respectively. We suggest that tracheobronchoplasty is a safe procedure with low morbidity and mortality rates in carefully selected patients with malignant diseases.

Surgical results of 29 patients with benign tracheobronchial lesions

This study was carried out in order to evaluate the surgical results of benign tracheobronchial diseases. Between July 1988 and March 1996, tracheobronchial surgery was performed on 29 patients with a variety of benign diseases. The primary diseases were post intubation or post tracheostomy tracheal stenosis (n = 12), tuberculous stenosis (n = 7), congenital tracheal stenosis with or without vascular ring (n = 4), tracheobronchial tumour (n = 2), oesophageal tumour (n = 1), and miscellaneous conditions (n = 3). Thirty-one operative procedures included sleeve lobectomy (n = 7), sleeve resection of trachea (n = 17) and bronchus (n = 2), and plastic surgery of trachea (n = 4) and bronchus (n = 1). There was one operative death, which put the mortality rate at 3.4%. There were five postoperative complications in this series (17.2%), including anastomotic disruption of trachea (n = 1), bilateral vocal cord palsy (n = 1), prolonged endotracheal intubation (n = 1) and overgrowth of granulation (n = 2). The complication of anastomotic disruption of trachea was treated by insertion of a tracheal T-tube, and the granulation was treated by bronchoscopic excision. We suggest that tracheobronchoplasty is a safe procedure in carefully selected patients with benign diseases.

Surgical results of 23 patients with tracheobronchial injuries

The objective of this study was to evaluate the surgical results of tracheobronchial injuries. Between July 1988 and March 1996, tracheobronchial surgery was performed on 23 injured patients. According to the aetiology, the injuries were categorized as blunt injury (n = 13), cutting or penetrating injury (n = 5), and corrosive injury (n = 5). Blunt injuries included three complete laryngotracheal disruptions, one tracheal laceration, and eight bronchial ruptures. Cutting or penetration injuries included four laryngotracheal ruptures and one tracheal cutting wound. Corrosive injuries included one tracheal necrosis, one tracheal stenosis and three esophagorespiratory fistulae. Operative procedures that were performed on the tracheobronchus included tracheoplasty (n = 12), bronchoplasty (n = 7), sleeve resection of the trachea (n = 2) and bronchus (n = 2). Two hospital deaths were encountered, with a mortality rate of 8.7%. One patient with caustic injury died of bronchopleural fistula and empyema. The other patient died with multiple injuries from multiple organ failure which was unrelated to the bronchoplasty. One postoperative complication was restenosis of the trachea in a caustic injured patient, which was treated by a T-tube insertion. In conclusion, tracheobronchoplasty is an effective life-saving emergency procedure for the patients with tracheobronchial injuries.

Surgical treatment of pediatric lung abscess

Eight pediatric patients with lung abscesses underwent surgical intervention in our hospital during a 7-year period. All the abscesses were associated with severe sepsis or complicated by a bronchopleural fistula that did not respond to medical treatment and tube thoracostomy. Seven patients required unilateral thoracotomies, and one patient with bilateral lesions required simultaneous bilateral thoracotomies. One tension pneumatocele required a preceding pneumonostomy. All patients underwent decortication and at least one additional surgical procedure consisting of: lung debridement plus bronchial closure (n = 4); lobectomy (n = 2); bisegmentectomy (n = 3); and/or segmentectomy (n = 1). There were no operative deaths, but two patients had persistent air leakage that was treated by bronchial closure. The average hospital stay was 22 days (postoperative 10.1 days). All the patients recovered completely. For many pediatric lung abscesses that do not respond to medical treatment and simple drainage procedures, surgical intervention is indicated and can shorten the hospital stay.

Results of surgical treatment of 107 patients with complications of pulmonary tuberculosis

The objective of this study was to evaluate the results of surgical intervention performed on 107 patients with pulmonary tuberculosis complications. Between September 1988 and December 1995, 107 patients underwent a total of 126 operations for major complications of pulmonary tuberculosis. One hundred and twenty-six operations consisted of lobectomies only or plus other lung resections performed in 55 cases, pneumonectomies in 20 cases, segmentectomies in 18 cases, wedge resections in two cases, tracheobronchoplasties in four cases, decortications in two cases, cavernostomies with concomitant muscle transpositions in seven cases, thoracoplasties reserved for the previously failed operations or to be a supplement for pulmonary resections in 18 cases. The operative mortality rate was of 1.8%, and the major complication rate was of 16.8%. Twenty-eight (26.1%) patients with tuberculosis bacilli in sputum before operation have converted except one diabetic patient. In conclusion, surgery is indicated in pulmonary tuberculosis complications that are life-threatening or unresponsive to chemotherapy. Pulmonary resection is the procedure of choice for most cases that require surgery.

Functional evaluation of esophageal substitutes

BACKGROUND

The function of esophageal Substitutes is not comparable to the normal esophagus.

METHODS

To clarify the difference between esophageal substitutes and the normal esophagus, radionuclide scintigraphy and clinical assessment were used as study methods. The study was conducted in groups of substernal colon (n = 9), substernal ileocolon (n = 6), posterior mediastinal colon (n = 6) and posterior mediastinal gastric tube (n = 14). The control group consisted of normal volunteers (n = 8).

RESULTS

Patients with substernal ileocolon did not experience nocturnal regurgitation, which occurred often in other groups. All esophageal substitutes had a decreased clearance ability compared to the normal esophagus. Among these substitutes, the posterior mediastinal gastric tube had the shortest swallowing time, while the substernal ileocolon had the longest. The substernal colon had a significantly prolonged transit time. Among these study groups, neither differences of clearance ability nor those of alimentary reflux reached statistical significance.

CONCLUSIONS

From the view point of food transit, it is suggested that a posterior mediastinal gastric tube or posterior mediastinal colon is the first choice of esophageal substitute.

Transneuronal WGA-HRP: can it demonstrate development of ocular dominance patches and effects of monocular deprivation?

We have attempted to use intraocular injections of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) to label ocular dominance patches in developing layer 4 of cat visual cortex. The cortices of animals killed at 49 days or later showed normal ocular dominance patches similar to those seen in [3H]proline material. Animals killed at 42 days showed some patches, but also showed unsegregated regions. Animals killed younger were difficult to stain and did not have patches. We also examined the ability of the WGA-HRP technique to demonstrate the effects of monocular deprivation (MD). MD for the first 3 months of life produced expansion of the afferents from the nondeprived eye and retraction of the patches from the deprived eye. One week of MD at about 5 weeks of age produced an expansion of the patches innervated by the nondeprived eye, but did not obviously affect the patches innervated by the deprived eye. We conclude that WGA-HRP is useful for examining the effects of long-term MD on ocular dominance patches but not for following the development of segregation. Its advantages over the [3H]proline technique are that it does not require a delay of many weeks before the sections can be examined and is much less expensive.

The development of MK-801, kainate, AMPA, and muscimol binding sites in cat visual cortex

Previous work using homogenate binding has shown that the development of (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]-cyclohepten-5,10imin e maleate (MK-801) binding in cat visual cortex increases from 21 days to 42 days, the height of the plastic period, and decreases in adulthood. We have studied the generality of this finding by examining the development of NMDA binding sites in several brain regions and by examining the development of other binding sites in the visual cortex. After confirming the original finding, we extended it by showing that the sensitivity of MK-801 binding sites to glutamate and glycine decreases when the cat becomes an adult. We then examined the regional specificity of MK-801 binding. Retinal binding did not change significantly with age. Binding in both visual cortex and hippocampus increased significantly from 7 days to 42 days regardless of whether binding was measured per milligram wet weight or per milligram protein. The decline from 42 days to adulthood was less dramatic in the hippocampus than in the visual cortex and was statistically significant only when binding was measured per milligram protein. Saturation analyses also showed a difference in the two structures. Bmax in the visual cortex, but not in the hippocampus, decreased from 42 days to adulthood. To determine whether these developmental changes were specific to MK-801 binding sites, we compared the age-dependent binding of MK-801, kainate, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), and muscimol. Like MK-801, kainate binding increased from 7 days to 42 days and decreased from 42 days to adulthood. AMPA and muscimol binding showed a similar increase in binding from 7 days to 42 days but did not decrease significantly from 42 days to adulthood. Displacement experiments suggest that AMPA and kainate bind to separate sites. The 42-day peak in NMDA and kainate binding suggests that their associated receptors may have a role in determining the plastic period of visual cortex.

Bronchial rupture caused by blunt chest injury

We have surgically treated six patients with bronchial rupture caused by blunt chest injury in the past 5 years. All injuries resulted from traffic accidents, except in one patient who was hit by a crane. Clinical manifestations included chest pain (n = 6), subcutaneous emphysema (n = 4), and dyspnea (n = 6). Roentgenographic findings were tension (n = 3) or nontension (n = 3) pneumothorax, subcutaneous emphysema (n = 4), pneumomediastinum (n = 3), deep cervical emphysema (n = 5), and delayed collapse of the affected lung (n = 3). Three patients had associated injuries: right clavicle and rib fractures in the first; right humeral, scapular, and multiple rib fractures and left sternoclavicular joint dislocation in the second; and left clavicle fracture in the third. These six patients all underwent immediate tube thoracostomy and then bronchoplasty. Bronchoplasty was performed within 3 days in four patients and on days 16 and 30, respectively, in the other two patients. The affected lung demonstrated full expansion in all patients immediately after bronchoplasty. Follow-up bronchoscopy showed good patency of all bronchi.