Multivitamin use and all-cause and cause-specific mortality in cancer survivors

BACKGROUND

Despite no sufficient evidence on benefits and harms of multivitamin use, cancer survivors use multivitamins as a self-care strategy to improve or maintain health. We examined if multivitamin use was associated with mortality in cancer survivors.

METHODS

15,936 male and 7026 female cancer survivors in the NIH-AARP Diet and Health Study were included in the analysis. Types and frequency of multivitamin use at on average 4.6 years after cancer diagnosis were assessed. Multivariable-adjusted relative risks (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression models.

RESULTS

Multivitamin use was not associated with lower all-cause mortality risk in all female (RR = 0.94, 95% CI:0.87-1.01 daily vs. no use) or male cancer survivors (RR = 0.96, 95% CI:0.91-1.00); however, a modest inverse association for CVD mortality was observed in female survivors of reproductive cancers (RR = 0.75, 95% CI:0.61-0.92) and male survivors of non-reproductive cancers (RR = 0.81, 95% CI:0.70-0.94). Multivitamin use was also associated with a lower risk of cancer-specific mortality in survivors of skin (RR = 0.65, 95% CI:0.48-0.88) and breast (RR = 0.79, 95% CI:0.65-0.95) cancer.

DISCUSSION

Multivitamin use may provide a modest survival benefit to some cancer survivors. Cancer care providers should talk with cancer survivors about potential benefits and harms of multivitamin use.

Antioxidant and Antiproliferative Activities of Several Garlic Forms

It is hypothesized that garlic, Allium sativum, might protect against oxidative stress that causes damage to cells and tissues leading to the development of various health conditions including cancer. However, it is not known whether garlic's potential anticancer benefits differ by form of garlic consumed. This study aimed to quantify and compare the in vitro antioxidant and antiproliferative activity of several garlic forms in water and alcohol extracts including fresh garlic, fresh garlic set aside, heated garlic, heated garlic set aside, garlic powder, black garlic, two commercially available garlic supplements. Antioxidant activity of different garlic forms were measured using three assays: DPPH (2,2-diphenyl-1-picryl-hydrazyl-hydrate) assay, superoxide assay, and hydroxyl assay. In vitro effects of garlic extracts were investigated against the most common lung cancer subtypes: H520, H1975, and A549 cell lines using the sulforhodamine B (SRB) assay. Among free radical scavenging assays, Garlicin®, a commercially available supplement, displayed high antioxidant activity in water and alcohol extracts (DPPH assay: 2.02 mg AAE (mg ascorbic acid equivalent)/g garlic and 3.53 mg AAE/g garlic, respectively; superoxide assay: 6.73 mg AAE/g garlic and 7.13 mg AAE/g garlic, respectively). In the hydroxyl assay, water extract of fresh garlic crushed and set aside for 10 min showed the highest antioxidant activity. Garlicin® alcohol extract and fresh garlic water extracts strongly inhibited the proliferation of H1975, A549 and H520 cells. Other forms of garlic including garlic powder and black garlic exhibited low antioxidant and antiproliferative activity. Our results demonstrate that the preparation and processing methods of garlic may lead to different antioxidant benefits.

Characteristics of Cancer Epidemiology Studies That Employ Metabolomics: A Scoping Review

An increasing number of cancer epidemiology studies use metabolomics assays. This scoping review characterizes trends in the literature in terms of study design, population characteristics, and metabolomics approaches and identifies opportunities for future growth and improvement. We searched PubMed/MEDLINE, Embase, Scopus, and Web of Science: Core Collection databases and included research articles that used metabolomics to primarily study cancer, contained a minimum of 100 cases in each main analysis stratum, used an epidemiologic study design, and were published in English from 1998 to June 2021. A total of 2,048 articles were screened, of which 314 full texts were further assessed resulting in 77 included articles. The most well-studied cancers were colorectal (19.5%), prostate (19.5%), and breast (19.5%). Most studies used a nested case-control design to estimate associations between individual metabolites and cancer risk and a liquid chromatography-tandem mass spectrometry untargeted or semi-targeted approach to measure metabolites in blood. Studies were geographically diverse, including countries in Asia, Europe, and North America; 27.3% of studies reported on participant race, the majority reporting White participants. Most studies (70.2%) included fewer than 300 cancer cases in their main analysis. This scoping review identified key areas for improvement, including needs for standardized race and ethnicity reporting, more diverse study populations, and larger studies.

Association of ambient fine particulate matter exposure with gestational diabetes mellitus and blood glucose levels during pregnancy

BACKGROUND

Previous studies have examined the associations between ambient fine particulate matter (PM_2.5) exposure and gestational diabetes mellitus (GDM). However, limited studies explored the relationships between PM_2.5 exposure and blood glucose levels during pregnancy, especially in highly polluted areas.

OBJECTIVES

To examine the associations of prenatal ambient PM_2.5 exposure with GDM and blood glucose levels, and to identify the sensitive exposure windows in a highly air-polluted area.

METHODS

From July 2016 to October 2017, a birth cohort study was conducted in Beijing, China. Participants were interviewed in each trimester regarding demographics, lifestyle, living and working environment, and medical conditions. Participant's daily ambient PM_2.5 levels from 3 m before last menstrual period (LMP) to the third trimester was estimated by a hybrid spatiotemporal model. Indoor air quality index was calculated based on environmental tobacco smoke, ventilation, cooking, painting, pesticide, and herbicide use. Distributed lag non-linear model was applied to explore the sensitive weeks of PM_2.5 exposure.

RESULTS

Of 165 pregnant women, 23 (13.94%) developed GDM. After adjusting for potential confounders, PM_2.5 exposure during the 1^st trimester was associated with higher odds of GDM (10 μg/m³ increase: OR = 1.89, 95% CI: 1.04-3.49). Each 10 μg/m³ increase in PM_2.5 during the 2^nd trimester was associated with 17.70% (2.21-33.20), 15.99% (2.96-29.01), 18.82% (4.11-33.52), and 17.10% (3.28-30.92) increase in 1-h, 2-h, Δ1h-fasting (1-h minus fasting), and Δ2h-fasting (2-h minus fasting) blood glucose levels, respectively. PM_2.5 exposure at 24^th-27^th weeks after LMP was associated with increased GDM risk. We identified sensitive exposure windows of 21^st-24^th weeks for higher 1-h and 2-h blood glucose levels and of 20^th-22^nd weeks for increased Δ1h-fasting and Δ2h-fasting.

CONCLUSIONS

Ambient PM_2.5 exposure during the second trimester was associated with higher odds of GDM and higher blood glucose levels. Avoiding exposure to high air pollution levels during the sensitive windows might prevent women from developing GDM.

Abstract 2385: A prospective investigation of serum bile acids with risk of liver cancer, fatal liver disease, and biliary cancer

Abstract Background: Laboratory and emerging epidemiologic data suggest that bile acids (BAs), major regulators of the gut microbiota, play an important role in liver disease and cancer etiology. However, few epidemiologic studies have comprehensively examined associations between BAs and either liver endpoints or biliary cancer.

Methods: In the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, we designed 1:1 matched nested case-control studies of primary liver cancer (n=247 cases), fatal liver disease (n=261 cases), and primary biliary cancer (n=92 cases). Using baseline serum collected ≤30 years prior to diagnosis or death, we measured concentrations of 15 BAs with liquid chromatography tandem mass spectrometry. We used multivariable conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between BAs and each endpoint, accounting for multiple comparisons.

Results: Comparing the highest to the lowest quartile, ten BAs were positively associated with liver cancer risk, including taurocholic (OR =4.70, 95% CI=2.51-8.78; Q-trend<0.0001), taurochenodeoxycholic (OR =4.61, 95% CI=2.38-8.91; Q-trend<0.0001), and glycocholic acid OR =4.11, 95% CI=2.11-7.99; Q-trend<0.0001), and 11 were positively associated with fatal liver disease risk, including taurochenodeoxycholic acid (OR =9.65, 95% CI=4.41-21.14; Q-trend<0.0001), taurocholic OR =7.45, 95% CI=3.70-14.97; Q-trend<0.0001), taurochenodeoxycholic (OR =9.05, 95% CI=4.04-20.32; Q-trend<0.0001), and glycocholic acid OR=6.12, 95% CI=2.84-13.77; Q-trend<0.0001). No significant associations were observed between BAs and biliary cancer though ORs were consistently >1.

Conclusion: Conjugated BAs were strongly associated with increased risk of liver cancer and fatal liver disease, suggesting mechanistic links between the gut microbiota, BA signaling pathways, and liver cancer or death from liver disease.

Citation Format: Zeinab Farhat, Neal D. Freedman, Joshua N. Sampson, Roni T. Falk, Jill Koshiol, Stephanie J. Weinstein, Demetrius Albanes, Rashmi Sinha, Erikka Loftfield. A prospective investigation of serum bile acids with risk of liver cancer, fatal liver disease, and biliary cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2385.

Postdiagnosis Multivitamin and Individual Vitamin Supplement Use and Mortality Among Patients With Colorectal Cancer in the NIH–AARP Diet and Health Study

Objectives

We aimed to evaluate the association of postdiagnostic multivitamin and individual vitamin supplement use with total and cancer-specific mortality among colorectal cancer (CRC) survivors.

Methods

In the National Institutes of Health (NIH)–AARP Diet and Health Study, we estimated the associations between vitamin use and total mortality and cancer-specific mortality risk among 2,136 CRC survivors. Use of multivitamin and individual vitamins (vitamin A, vitamin C, vitamin E, beta-carotene, and calcium) were assessed by a food-frequency questionnaire at baseline in 1995–1996 and follow-up questionnaire in 2004–2005. Participants reported frequency of use as never, < 1 time per week, 1–3 times per week, 4–6 times per week, or every day and categories were assigned a corresponding value (never = 0, < 1 time per week = 0.5, 1–3 times per week = 2, 4–6 times per week = 5, and every day = 7). Based on the sum of these values, participants were assigned to one of the following groups: never use (0 times/week), casual use (>0 to 6 times/week), consistent use (7 times/week), or heavy use (>7 times/week). Vital status was ascertained annually by linkage to the Social Security Administration Death Master File and the National Death Index Plus through December 31, 2019. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models with age as the underlying time metric and adjusting for potential confounders.

Results

Postdiagnosis multivitamin use was not associated with all-cause mortality or CRC-specific mortality, but consistent, as compared with never, postdiagnosis vitamin A use was associated with a 12% lower risk of total mortality (HR: 0.88, 95% CI: 0.78–1.00). Consistent, as compared with never, postdiagnosis vitamin C and calcium use were also associated with lower risk of total mortality (HR: 0.86, 95% CI: 0.75–0.99 and HR: 0.84 95% CI: 0.73–0.97, respectively). Use of vitamin E or beta-carotene supplements were not associated with total mortality or CRC-specific mortality.

Conclusions

In the NIH-AARP cohort, consistent use of vitamin A, vitamin C, and calcium but not multivitamins was associated with lower total mortality and CRC-specific mortality among CRC cancer survivors.

Funding Sources

This work was supported by the NCI Intramural Research Program.

A prospective investigation of serum bile acids with risk of liver cancer, fatal liver disease, and biliary tract cancer

Bile acids (BAs), major regulators of the gut microbiota, may play an important role in hepatobiliary cancer etiology. However, few epidemiologic studies have comprehensively examined associations between BAs and liver or biliary tract cancer. In the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) study, we designed 1:1 matched, nested, case-control studies of primary liver cancer (n = 201 cases), fatal liver disease (n = 261 cases), and primary biliary tract cancer (n = 138 cases). Using baseline serum collected ≤30 years before diagnosis or death, we measured concentrations of 15 BAs with liquid chromatography-tandem mass spectrometry. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable conditional logistic regression models, adjusted for age, education, diabetes status, smoking, alcohol intake, and body mass index. We accounted for multiple comparisons using a false discovery rate (FDR) correction. Comparing the highest to the lowest quartile, seven BAs were positively associated with liver cancer risk, including taurocholic acid (TCA) (OR, 5.62; 95% CI, 2.74-11.52; Q trend < 0.0001), taurochenodeoxycholic acid (TCDCA) (OR, 4.77; 95% CI, 2.26-10.08; Q trend < 0.0001), and glycocholic acid (GCA) OR, 5.30; 95% CI, 2.41-11.66; Q trend < 0.0001), and 11 were positively associated with fatal liver disease risk, including TCDCA (OR, 9.65; 95% CI, 4.41-21.14; Q trend < 0.0001), TCA (OR, 7.45; 95% CI, 3.70-14.97; Q trend < 0.0001), and GCA (OR, 6.98; 95% CI, 3.32-14.68; Q trend < 0.0001). For biliary tract cancer, associations were generally >1 but not significant after FDR correction. Conjugated BAs were strongly associated with increased risk of liver cancer and fatal liver disease, suggesting mechanistic links between BA metabolism and liver cancer or death from liver disease.

Intelligent transportation systems to mitigate road traffic congestion

Intelligent transport systems have efficiently and effectively proved themselves in settling up the problem of traffic congestion around the world. The multi-agent based transportation system is one of the most important intelligent transport systems, which represents an interaction among the neighbouring vehicles, drivers, roads, infrastructure and vehicles. In this paper, two traffic management models have been created to mitigate congestion and to ensure that emergency vehicles arrive as quickly as possible. A tool-chain SUMO-JADE is employed to create a microscopic simulation symbolizing the interactions of traffic. The simulation model has showed a significant reduction of at least 50% in the average time delay and thus a real improvement in the entire journey time.

Changes in arachidonic acid (AA)- and linoleic acid (LA)-derived hydroxy metabolites and their interplay with inflammatory biomarkers in response to drastic changes in air pollution exposure

BACKGROUND

Untargeted metabolomics analyses have indicated that fatty acids and their hydroxy derivatives may be important metabolites in the mechanism through which air pollution potentiates diseases. This study aimed to use targeted analysis to investigate how metabolites in arachidonic acid (AA) and linoleic acid (LA) pathways respond to short-term changes in air pollution exposure. We further explored how they might interact with markers of antioxidant enzymes and systemic inflammation.

METHODS

This study included a subset of participants (n = 53) from the Beijing Olympics Air Pollution (BoaP) study in which blood samples were collected before, during, and after the Beijing Olympics. Hydroxy fatty acids were measured by liquid chromatography/mass spectrometry (LC/MS). Native total fatty acids were measured as fatty acid methyl esters (FAMEs) using gas chromatography. A set of chemokines were measured by ELISA-based chemiluminescent assay and antioxidant enzyme activities were analyzed by kinetic enzyme assays. Changes in levels of metabolites over the three time points were examined using linear mixed-effects models, adjusting for age, sex, body mass index (BMI), and smoking status. Pearson correlation and repeated measures correlation coefficients were calculated to explore the relationships of metabolites with levels of serum chemokines and antioxidant enzymes.

RESULTS

12-hydroxyeicosatetraenoic acid (12-HETE) decreased by 50.5% (95% CI: -66.5, -34.5; p < 0.0001) when air pollution dropped during the Olympics and increased by 119.4% (95% CI: 36.4, 202.3; p < 0.0001) when air pollution returned to high levels after the Olympics. In contrast, 13-hydroxyoctadecadienoic acid (13-HODE) elevated significantly (p = 0.023) during the Olympics and decreased nonsignificantly after the games (p = 0.104). Interleukin 8 (IL-8) correlated with 12-HETE (r = 0.399, BH-adjusted p = 0.004) and 13-HODE (r = 0.342, BH-adjusted p = 0.014) over the three points; it presented a positive and moderate correlation with 12-HETE during the Olympics (r = 0.583, BH-adjusted p = 0.002) and with 13-HODE before the Olympics (r = 0.543, BH-adjusted p = 0.008).

CONCLUSION

AA- and LA-derived hydroxy metabolites are associated with air pollution and might interact with systemic inflammation in response to air pollution exposure.

Reproducibility, Temporal Variability, and Concordance of Serum and Fecal Bile Acids and Short Chain Fatty Acids in a Population-Based Study

BACKGROUND

Bile acid (BA) and short chain fatty acid (SCFA) production is affected by diet and microbial metabolism. These metabolites may play important roles in human carcinogenesis.

METHODS

We used a fully quantitative targeted LC-MS/MS system to measure serum and fecal BA and SCFA concentrations in 136 Costa Rican adults at study baseline and 6-months. We randomly selected 50 participants and measured their baseline samples in duplicate. Our objective was to evaluate: Technical reproducibility; 6-month temporal variability; and concordance between sample type collected from the same individual at approximately the same time.

RESULTS

Technical reproducibility was excellent, with intraclass correlation coefficients (ICC) ≥0.83 for all BAs except serum tauroursodeoxycholic acid (ICC = 0.72) and fecal glycolithocholic acid (ICC = 0.66) and ICCs ≥0.81 for all SCFAs except serum 2-methylbutyric acid (ICC = 0.56) and serum isobutyric acid (ICC = 0.64). Temporal variability ICCs were generally low, but several BAs (i.e., deoxycholic, glycoursodeoxycholic, lithocholic, taurocholic, and tauroursodeoxycholic acid) and SCFAs (i.e., 2-methylbutyric, butyric, propionic, and valeric acid) had 6-month ICCs ≥0.44. The highest degree of concordance was observed for secondary and tertiary BAs.

CONCLUSIONS

Serum and fecal BAs and SCFAs were reproducibly measured. However, 6-month ICCs were generally low, indicating that serial biospecimen collections would increase statistical power in etiologic studies. The low concordance for most serum and fecal metabolites suggests that consideration should be paid to treating these as proxies.

IMPACT

Our findings will inform the design and interpretation of future human studies on associations of BAs, SCFAs, and potentially other microbial metabolites, with disease risk.

Periodontal Disease and Breast Cancer Risk: Results from the Nurses' Health Study

BACKGROUND

While periodontal disease has been linked to increased cancer risk, studies regarding an association with breast cancer are limited.

METHODS

We examined the relationship between self-reported diagnosis of periodontal bone loss and incidence of breast cancer in a large, prospective cohort study, the Nurses' Health Study (1998-2014). We calculated HRs using Cox proportional hazards modeling, adjusting for risk factors common to both periodontal disease and breast cancer.

RESULTS

During 1,023,647 person-years of follow-up, 5,110 of breast cancer cases were reported. We observed no association between periodontal disease and overall breast cancer risk (HR, 1.02; 95% confidence interval: 0.94-1.10); the association was not modified by smoking status, or other breast cancer risk factors or by breast tumor subtypes.

CONCLUSIONS

We did not observe any association between periodontal disease and breast cancer risk.

IMPACT

Given inconsistent findings in the literature, further research with standardized clinical measures of periodontitis is warranted.

Types of garlic and their anticancer and antioxidant activity: a review of the epidemiologic and experimental evidence

Garlic, an Allium vegetable, contains rich flavonoids organosulfur compounds (OSCs) that have potent anticancer properties. The aim of the review is to provide an overview of the different types of garlic, their active compounds, and the potential anticancer benefits with a focus on antioxidant activity. Animal and cell line studies have provided convincing evidence that garlic and its organosulfur compounds inhibit carcinogenesis through a number of events including induction of apoptosis, inhibiting cellular proliferation, scavenging radical oxygen species (ROS), increasing the activities of enzymes such as glutathione S-transferase, and reducing tumor size. Epidemiological studies showed compelling evidence that garlic consumption is associated with decreased risk of colorectal cancer, but inconsistent evidence for stomach, breast, and prostate cancers. Studies also suggest that the presence and potency of garlic OSCs varies with respect to the preparation and form of garlic. Further epidemiological studies with information on garlic form consumed or preparation methods and molecular studies regarding its antioxidant mechanisms, such as increasing enzymatic and nonenzymatic antioxidants levels, are warranted.

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

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

Abstract 1609: Association between antioxidant levels and inhibition of lung cancer cell proliferation by various garlic extracts

Introduction:

Garlic is rich in organosulfur compounds that have potential chemopreventive properties. It contains a wide range of potent antioxidant compounds, which contribute by both radical scavenging activity and enhancing activity of enzymes. We aimed to investigate the antioxidant and antiproliferative activity of different garlic forms.

Methods:

Different types of garlic were obtained from a local Wegmans market in Buffalo, NY. Aqueous and methanol extracts of seven garlic forms including: raw garlic, raw garlic set aside for 10 minutes, garlic powder, cooked garlic, black garlic, and two garlic supplements (Garlicin and Kyolic) were investigated for their antioxidant and antiproliferative activity. Antioxidant activity was evaluated utilizing the 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) assay. The antioxidant activity of each sample was calculated in terms of gram equivalents of Trolox (TE) per gram of sample. Sulforhodamine B (SRB) assays were conducted to assess the antiproliferative effects after 48h of treatment with the extracts in cell lines selected to represent common cancer histologic and molecular lung cancer subtypes. Two-fold dilution concentrations of garlic extract were prepared ranging from 0.08% to 2.5% and the 50% inhibitory concentration (IC50) was calculated from dose-response curves. Each measurement of one sample was conducted in triplicate in order to average the antioxidant and antiproliferative measure for each garlic sample.

Results:

Among the different garlic forms, Garlicin supplement presented the highest antioxidant activity in both water and methanol extracts, 2.58 ± 0.43 and 3.45 ± 0.60 μmol trolox/g dry weight, respectively. Black garlic showed the next highest antioxidant activity in water and methanol extracts, 1.36 ± 0.53 and 0.19 ± 0.019 μmol trolox/g dry weight, respectively. Among lung cancer cells, different forms of garlic and different extraction methods resulted in varied percent inhibition. Garlicin alcohol extracts and fresh garlic water extracts resulted in a significant decrease in cell growth in H1975 cells and H520 cells, while other garlic forms showed lower levels of inhibition. Garlicin alcohol extracts and fresh garlic water extracts had the lowest IC50 values in H1975 EGFR mutant cells, 0.54% and 0.17% respectively. The same extracts were also potent in H520 squamous cells, 0.55% and 0.32%, respectively.

Conclusions:

In conclusion, Garlicin supplements and black garlic showed promising antioxidant activity, while Garlicin supplements and fresh garlic showed potent antiproliferative effects among lung cancer cells. Our results also indicate that the antioxidant and antiproliferative activity of different garlic forms are affected by different preparation and extraction methods. Further studies are needed to better understand the bioactive compounds present in garlic.

Citation Format: Zeinab Farhat, Pamela Hershberger, Diana Aga, Tyler Scheving, Ajay Myneni, Lina Mu. Association between antioxidant levels and inhibition of lung cancer cell proliferation by various garlic extracts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1609.

How do glutathione antioxidant enzymes and total antioxidant status respond to air pollution exposure?

This study aims to investigate how antioxidant enzyme activity and overall antioxidant capacity respond to short-term changes in exposure to air pollution. 201 participants were recruited before- and followed up during- and after- the 2008 Beijing Olympics. Serum levels of antioxidant enzymes including glutathione S-transferases (GST), glutathione peroxidase (GPx), glutathione reductase (GR), and total antioxidant status (TAS) were measured. We used linear mixed-effects models to compare changes in antioxidant enzymes across the three periods after adjusting for potential confounding factors. Among all participants, glutathione peroxidase (GPx) levels decreased by 12.0% when air pollution dropped by 50-60% during the Olympics and increased by 6.5% when air pollution levels rose after the Olympics. The magnitude of increase among males, smokers, and older individuals was relatively smaller compared to females, nonsmokers, and younger individuals. Among all participants, total antioxidant status (TAS) significantly decreased by 6.23% during the games and continued to decrease by 4.41% after the games. However, among females, nonsmokers, and younger participants, there was an increase in TAS response to the elevated air pollution levels. Our study observed strong responses in GPx and TAS levels to the short-term decrease and increase of air pollution levels and responses varied among subgroups.

Factor XI deficiency-related spontaneous primary intraventricular hemorrhage

Factor XI deficiency (plasma thromboplastin antecedent deficiency) is a rare autosomal-dominant disorder. Neurologic complications in factor XI deficiency are even rarer. We propose that the factor XI deficiency in our patient contributed to a primary intraventricular hemorrhage.