Biochar derived from tobacco waste significantly reduces the accumulations of cadmium and copper in edible parts of two vegetables: an in-situ field study

Biochar, as a soil amendment, can be applied to remediate heavy metal (HM) contaminated farmland. However, there is little research on the effect of tobacco biochar (TB) derived from tobacco waste on HM controlling in edible parts of vegetables. In this study, the impact of two TB levels on the plant growth, copper (Cu) and cadmium (Cd) accumulation in the edible parts of lettuce and chrysanthemum, and on Cu and Cd bioavailability of rhizosphere soil was investigated through in-situ field experiments. The results showed that TB has rich oxygen containing functional groups, high porosity, high nitrogen adsorption capacity. The addition of 5 t ha-1 and 10 t ha-1 TB significantly increased the shoot biomass of chrysanthemum, but had no effect on the growth of lettuce. Two levels of TB significantly increased the pH value, but decreased the available Cu and Cd concentrations of rhizosphere soil, thereby reducing the Cu and Cd accumulations in the edible parts of lettuce and chrysanthemum. The findings provided effective evidences that TB derived from tobacco waste is an efficient strategy for controlling Cu and Cd accumulation in the edible parts of vegetables to ensure agri-product safety production in HM-polluted farmland.

Ectomycorrhizal fungi, two species of Laccaria, differentially block the migration and accumulation of cadmium and copper in Pinus densiflora

The root tips of host plant species can establish ectomycorrhizae with their fungal partners, thereby altering the responses of the host plants to heavy metal (HM) toxicity. Here, two species of Laccaria, L. bicolor and L. japonica, were investigated in symbiosis with Pinus densiflora to study their potential for promotion of phytoremediation of HM-contaminated soils in pot experiments. The results showed that L. japonica had significantly higher dry biomass than L. bicolor in mycelia grown on modified Melin-Norkrans medium containing elevated levels of cadmium (Cd) or copper (Cu). Meanwhile, the accumulations of Cd or Cu in L. bicolor mycelia were much higher than that in L. japonica at the same level of Cd or Cu. Therefore, L. japonica displayed a stronger tolerance to HM toxicity than L. bicolor in situ. Compared with non-mycorrhizal P. densiflora seedlings, inoculation with two Laccaria species significantly increased the growth of P. densiflora seedlings in absence or presence of HM. The mantle of host roots blocked the uptake and migration of HM, which led to the decrease of Cd and Cu accumulation in the P. densiflora shoots and roots, except for the root Cd accumulation of L. bicolor-mycorrhizal plants when 25 mg kg^-1 Cd exposure. Furthermore, HM distribution in mycelia showed Cd and Cu are mainly retained in the cell walls of mycelia. These results provide strong evidence that the two species of Laccaria in this system may have different strategies to assist host tree against HM toxicity.

The impact of sitagliptin in palmitic acid-induced insulin resistance in human HepG2 cells through the suppressor of cytokine signaling 3/phosphoinositide 3-kinase/protein kinase B pathway

Patients with type 2 diabetes respond differently to sitagliptin, an oral anti-hyperglycemic medication. Patients whose blood sugar levels were effectively managed while using sitagliptin had significantly lower levels of a protein called suppressor of cytokine signaling 3 (SOCS3), according to our earlier research. In this study, we established an in vitro insulin resistance cell model for human HepG2 cells to investigate the possible mechanism of the effect of sitagliptin on glucose metabolism via the SOCS3/phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) pathway. Since insulin resistance first develops in the liver, palmitic acid was used to generate an insulin resistance cell model in human HepG2 cells, after which small interfering ribonucleic acid (siRNA)-SOCS3 and sitagliptin were used to intervene. We then examined the changes in cell viability and biochemical indices in the insulin resistance cell model. SOCS3, Akt, and glycogen synthase kinase 3beta (GSK-3β) gene expression levels were quantified using reverse transcription-polymerase chain reaction, and the protein expression levels of SOCS3, Akt, phosphorylated Akt (p-Akt), GSK-3β, and phosphorylated GSK-3β (p-GSK-3β) were quantified using Western blot. In results: the expression of the SOCS3 gene was considerably raised in both the insulin resistance model group and the insulin resistance model + siRNA-negative control group, but decreased following treatment with sitagliptin. After sitagliptin intervention, the protein expression of Akt, p-Akt, and p-GSK-3β were dramatically decreased in the model group, while SOCS3 was significantly decreased. We conclude that sitagliptin can reduce insulin resistance by downregulating SOCS3 and regulating glucose metabolism in a hypoglycemic manner.

Beneficial effects of arbuscular mycorrhizae on Cu detoxification in Mimosa pudica L. grown in Cu-polluted soils

Arbuscular mycorrhizal (AM) fungi are known to have beneficial effects on host plants growing on contaminated soils. The present study aimed at investigating the influence of two different AM fungi (Rhizophagus intraradices and Funneliformis mosseae) on the growth of plants and Cu uptake by Mimosa pudica L. grown in polluted soils containing various levels of Cu (Control, 400, 500, or 600 mg kg^-l soil) in pot experiments. Mycorrhizal colonisation rates by the two AM fungi decreased markedly with the increasing Cu levels in soils. This inhibition was more pronounced to F. mosseae than R. intraradices, indicating that R. intraradices was more tolerant to Cu than F. mosseae. Compared with non-mycorrhizal plants, R. intraradices inoculation increased plant growth (including shoot height, numbers of compound leaves and leaflets, and dry biomass) and P concentrations in the shoots and roots of M. pudica at all levels of Cu. Meanwhile, F. mosseae displayed a capability of growth promotion to M. pudica much later and lower than R. intraradices. F. mosseae and R. intraradices markedly decreased Cu concentration in shoots at 400-600 mg kg^-1 Cu levels. However, R. intraradices was more efficient than F. mosseae in decreasing the shoot Cu concentrations. As for the increasing Cu tolerance by R. intraradices, possibly it was reached though the improvement of phosphorus nutrition and the decline of Cu transport from roots to shoots of M. pudica. R. intraradices showed a good potential for improving medicinal plants growth and declining toxic effects in Cu-contaminated soils.

Citric Acid and Poly-glutamic Acid Promote the Phytoextraction of Cadmium and Lead in Solanum nigrum L. Grown in Compound Cd-Pb Contaminated Soils

Phytoextraction is an efficient strategy for remediating heavy metal-contaminated soil. Chelators can improve the bioavailability of heavy metals and increase phytoextraction efficiency. However, traditional chelators have gradually been replaced due to secondary pollution. In this study, a typical organic acid (citric acid, CA) and a novel biodegradable chelator (poly-glutamic acid, PGA), were investigated using pot experiments to compare the phytoextraction efficiency of Solanum nigrum L. (a Cd (hyper)accumulator) for cadmium (Cd) and lead (Pb) in contaminated soil. The results showed CA and PGA significantly improved plant growth, and total Cd and Pb amounts of S. nigrum, both CA and PGA significantly increased the shoot Cd and Pb concentrations. However, only PGA significantly increased the root Pb concentration. CA and PGA application promoted the bioavailability of Cd and Pb in rhizosphere soils and their translocations from roots to shoots in S. nigrum. Both CA and PGA increased the phytoextraction efficiency of Cd and Pb in S. nigrum plants, and the PGA for Cd and Pb phytoextraction was more effective than CA. Our findings demonstrate that the biodegradable chelator PGA has great potential for enhancing phytoextraction from compound Cd-Pb contaminated soils, suggesting that biodegradable chelator-assisted phytoextraction with (hyper)accumulator is strongly recommended in severely contaminated sites.

Integrated Bacteria-Fungi Diversity Analysis Reveals the Gut Microbial Changes in Buffalo With Mastitis

The gut microbial community is closely related to mastitis, but studies regarding the influences of mastitis on gut microbiota in buffalo remain scarce. Herein, we characterized the differences in gut bacterial and fungal communities between mastitis-affected and healthy buffalos. Interestingly, although mastitis had no effect on gut bacterial and fungal diversities in the buffalos, some bacterial and fungal taxa were significantly altered. Bacterial and fungal taxonomic analysis showed that the preponderant bacterial phyla (Firmicutes and Bacteroidetes) and fungal phyla (Ascomycota and Basidiomycota) in buffalo were the same regardless of health status. At the level of genus, the changes in some gut bacterial and fungal abundances between both groups were gradually observed. Compared with healthy buffalos, the proportions of 3 bacterial genera (uncultured_bacterium_f_Muribaculaceae, Eubacterium_nodatum_group, and Lachnoclostridium_10) and 1 fungal genus (Pichia) in the mastitis-affected buffalo were significantly increased, whereas 4 bacterial genera (Ruminococcus_2, Candidatus_Stoquefichus, Turicibacter, and Cellulosilyticum) and 4 fungal genera (Cladosporium, Thermothelomyces, Ganoderma and Aspergillus) were significantly decreased. Taken together, this research revealed that there was significant difference in the compositions of the gut microbial community between the healthy and mastitis-affected buffalos. To our knowledge, this is the first insight into the characteristics of the gut microbiota in buffalos with mastitis, which is beneficial to understand the gut microbial information of buffalo in different health states and elucidate the pathogenesis of mastitis from the gut microbial perspective.

Long-term hexavalent chromium exposure disturbs the gut microbial homeostasis of chickens

Industrial production, ore smelting and sewage disposal plant can discharge large amounts of heavy metals every year, which may contaminate soil, water and air, posing a great threat to ecological environment and animal production. Hexavalent chromium [Cr (VI)], a recognized metallic contaminant, has been shown to impair kidney, liver and gastrointestinal tract of many species, but little is known about the gut microbial characteristics of chickens exposed to Cr (VI). Herein, this study characterized the gut microbial alternations of chickens exposed to Cr (VI). Results indicated that the gut microbial alpha-diversity in chickens exposed to Cr (VI) decreased significantly, accompanied by a distinct shifts in taxonomic composition. Microbial taxonomic analysis demonstrated that the preponderant phyla (Firmicutes, Bacteroidetes, Proteobacteria and Epsilonbacteraeota) were the same in both groups, but different in types and relative abundances of dominant genera. Moreover, some bacterial taxa including 2 phyla and 47 genera significantly decreased, whereas 3 phyla and 17 genera significantly increased during Cr (VI) exposure. Among decreased taxa, 9 genera (Coprobacter, Ruminococcus_1, Faecalicoccus, Eubacterium_nodatum_group, Parasutterella, Slackia, Barnesiella, Family_XIII_UCG-001 and Collinsella) even cannot be detected. In conclusion, this study revealed that Cr (VI) exposure dramatically decrased the gut microbial diversity and altered microbial composition of chickens. Additionally, this study also provided a theoretical basis for relieving Cr (VI) poisoning from the perspective of gut microbiota.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery

Abstract

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

Promotion of Zinc Tolerance, Acquisition and Translocation of Phosphorus in Mimosa pudica L. Mediated by Arbuscular Mycorrhizal Fungi

Heavy metal contamination of soil is of increasing concern because of its potential risk to human health. In this study, two AMFs (Rhizophagus intraradices and Funneliformis mosseae) substantially increased the biomass of bashfulgrass in Zn-contaminated soil, even at Zn levels of up to 600 mg kg^-1. Zn uptake in R. intraradices- and F. mosseae-mycorrhizal bashfulgrass was increased by 40-fold and 7-fold, respectively, when plants grown in Zn-contaminated (400 mg kg^-1) soil. Elemental analysis showed that neither AMF had an effect on Zn concentration in plant tissues, including the roots and shoots. However, a significant increase of phosphorus (P) concentration was observed, suggesting the increased is from the improved use efficiency of soil nutrients by AMFs. Comparing the two AMFs, better growth performance with more biomass occurred with R. intraradices-inoculated bashfulgrass in Zn-contaminated soil. This is consistent with R. intraradices being more tolerant to Zn than F. mosseae, indicated by a higher colonization percentage in bashfulgrass roots. Taken together, our data indicate that AMFs possibly improve acquisition and translocation of P to promote increased biomass. Moreover, mycorrhiza did not enhance Zn accumulation in shoots and roots of bashfulgrass at the same Zn level. In the future, developing AMF (especially R. intraradices) inoculation of plants might be a desirable means of safe production of ornamental plants in metal-polluted soil.

Differential effects of three amendments on the immobilisation of cadmium and lead for Triticum aestivum grown on polluted soil

Conventional chemical soil amendments and novel material biochars have been widely reported for the immobilisation of cadmium (Cd) and lead (Pb) in polluted soil. However, information regarding their comparative effectiveness is poor. In the present study, rice husk biochar (RHB) was compared with two chemical soil amendments including hydroxyapatite (HAP) and hydrated lime (HDL) for their effectiveness to enhance plant growth and the reduction of Cd uptake and translocation by Triticum aestivum L. grown in heavy-metal-polluted soil. Compared with control and two chemical soil amendments, RHB rapidly improved wheat growth. The HAP, HDL, and RHB treated plants retained Cd and Pb in roots and restricted their translocation. The RHB treatment had the best effect on growth, yield promotion and the reduction of Cd and Pb in wheat grain. Furthermore, the soils treated with RHB and HAP showed lower DTPA-extracted Cd concentrations, and the maximum reduction was observed in HAP-amended soil. However, the DTPA-extracted Pb concentration was not significantly decreased after the application of two chemical soil amendments for 40 days; the maximum reduction was found in soil treated with RHB for 80 days. In all treatments, Cd in post-harvest soil was mainly present in exchangeable, carbonate bound, and Fe-Mn oxide Cd, while the dominant chemical form of Pb was Fe-Mn oxide Pb. Three soil amendments application decreased exchangeable and organic bound- Cd and Pb levels. HAP and RHB displayed significantly immobilisation for soil Cd and reduced translocation of heavy metal as well as its availability in soil, but the HAP had significant inhibition on growth of wheat in contaminated soil. Therefore, RHB shows a promising potential for the reduction of Cd and Pb bioaccumulation in grains from wheat grown on heavy-metal-polluted soils.

Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics

BACKGROUND

Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA.

METHODS

Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes.

RESULTS

Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics.

CONCLUSIONS

Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.

Three novel microRNAs based on microRNA signatures for gastric mucosa-associated lymphoid tissue lymphoma

This study aimed to identify novel microRNAs (miRNAs) that play crucial regulatory roles in the pathogenesis of mucosa-associated lymphoid tissue (MALT) lymphoma by retrieving and analyzing the miRNA expression profile GSE23877. Differentially expressed miRNAs between gastric MALT lymphoma samples and human tonsil tissue samples as well as their target genes were identified. The transcriptional regulatory relationships between miRNAs and target genes were analyzed, and the regulatory network between them was constructed. Target genes annotated as transcription factors (TFs) were screened, and an miRNA-target gene regulatory network was established. Moreover, the expression levels of miRNAs and target genes as well as the correlation between them were verified. In total, 53 upregulated and 25 downregulated miRNAs were obtained, for which 35 and 25 experimentally validated miRNA-target interactions, respectively, were screened. Some miRNAs were significantly enriched in certain pathways; for example, miR-320a was enriched in systemic lupus erythematosus and ribosome, miR-622 in the p53 signaling pathway and chronic myeloid leukemia, and miR-429 in cancer-related pathways. In addition, upregulated miRNAs, including miR-320a, miR-940, and miR-622, and downregulated miRNAs, including miR-331-3p and miR-429, were hub nodes in the miRNA-target gene regulatory network, and the TF MYC was a co-target of miR-320a, miR-622, and miR-429. The expression trends of miR-320a and miR-429 as well as of some of their target genes were consistent with those in the results of microarray analysis. In conclusion, miR-320a, miR-622, and miR-429 are possibly novel miRNAs participating in the pathomechanism of gastric MALT lymphoma.

Strategy of the Causes of Death of Dependents

Abstract

Objective To discuss the methods and strategies to identify the causes of dependents' deaths, as well as provide the experiences that can be used for reference and scientific basis for the forensic identification of the potentially growing deaths of the same kind in the future. Methods The 13 cases concerning death of dependents accepted by Sun Yat-sen University Forensic Center were collected, and the basic information of the dependents were statistically described. The nutritional status, environmental condition and medical care condition were evaluated according to dietary energy, living space, environment and medical treatment condition. Results Among the 13 dependents, there were 11 males and 2 females, with the oldest 74 and the youngest 9 and dwelling time was from 0.4 to 5.6 years. Forensic pathological examination showed that 13 dependents had infectious diseases and 11 were severely dystrophic. There were no fatal mechanical injuries or poisoning in dependents. Molecular pathological screening of 4 cases revealed no pathogenic variants of sudden death susceptible genes. The poor status of the diet, nutrition, living environment and medical care of these dependents were discovered. The direct cause of death of all 13 dependents was identified to be disease. The lack of nutrition, poor living environment and lack of medical care were thought to play a dominant role in causing the deaths of 12 dependants. Conclusion The death identification should follow the judicial procedure. In identification of the causes of death and analysis of the proportion of the affecting factors resulting in death, all factors, including nutrition,environment, medical care, injury and diseases, need to be considered.

Magnetic graphene enabled tunable microwave absorber via thermal control

By synthesizing nitrogen-doped graphene (NG) via a facile thermal annealing method, a fine control of the amount and location of doped nitrogen as well as the oxygen-containing functional groups is achieved with varying annealing temperature. The favorable magnetic properties have been achieved for N-doped rGO samples obtained at two temperatures of all NG samples, i.e., 500 °C and 900 °C with saturation magnetization of 0.63 emu g^-1 and 0.67 emu g^-1 at 2 K, respectively. This is attributed to the optimized competition of the N-doping and reduction process at 500 °C and the dominated reduction process at 900 °C. NG obtained at 300 °C affords the best overall absorbing performance: when the absorber thickness is 3.0 mm, the maximum absorption was -24.6 dB at 8.51 GHz, and the absorption bandwidth was 4.89 GHz (7.55-12.44 GHz) below -10 dB. It owes its large absorbing intensity to the good impedance match and significant dielectric loss. The broad absorption bandwidth benefits from local fluctuations of dielectric responses contributed by competing mechanisms. Despite the significant contribution from materials loss to the absorption, the one quarter-wavelength model is found to be responsible for the reflection loss peak positions. Of particular significance is that an appropriate set of electromagnetic parameters associated with reasonable reduction is readily accessible by convenient control of annealing temperature to modulate the microwave absorbing features of graphene. Thus, NG prepared by thermal annealing promises to be a highly efficient microwave absorbent.

[Correlation between Genetic Variants and Polymorphism of Caveolin and Sudden Unexplained Death]

OBJECTIVES

To explore the genetic variation sites of caveolin （CAV） and their correlation with sudden unexplained death （SUD）.

METHODS

The blood samples were collected from SUD group （71 cases）, coronary artery disease （CAD） group （62 cases） and control group （60 cases）, respectively. The genome DNA were extracted and sequencing was performed directly by amplifying gene coding region and exon-intron splicing region of CAV1 and CAV3 using PCR. The type of heritable variation of CVA was confirmed and statistical analysis was performed.

RESULTS

A total of 4 variation sites that maybe significative were identified in SUD group, and two were newfound which were CAV1： c.45C>T （T15T） and CAV1：c.512G>A （R171H）, and two were SNP loci which were CAV1：c.246C>T （rs35242077） and CAV3：c.99C>T （rs1008642） and had significant difference （P<0.05） in allele and genotype frequencies between SUD and control groups. Forementioned variation sites were not found in CAD group.

CONCLUSIONS

The variants of CAV1 and CAV3 may be correlated with a part of SUD group.

[Research Progress of the Correlation between Caveolin and Unexpected Sudden Cardiac Death]

Due to the negative autopsy and without cardiac structural abnormalities, unexpected sudden cardiac death （USCD） is always a tough issue for forensic pathological expertise. USCD may be associated with parts of fatal arrhythmic diseases. These arrhythmic diseases may be caused by disorders of cardiac ion channels or channel-related proteins. Caveolin can combine with multiple myocardial ion channel proteins through its scaffolding regions and plays an important role in maintaining the depolarization and repolarization of cardiac action potential. When the structure and function of caveolin are affected by gene mutations or abnormal protein expression, the functions of the regulated ion channels are correspondingly impaired, which leads to the occurrence of multiple channelopathies, arrhythmia or even sudden cardiac death. It is important to study the effects of caveolin on the functions of ion channels for exploring the mechanisms of malignant arrhythmia and sudden cardiac death.

Relative 3D Reconstruction Using Multiple Uncalibrated Images

In this article we show how relative 3D reconstruction from point correspondences of multiple uncalibrated images can be achieved through reference points. The original contributions with respect to related works in the field are mainly a direct global method for relative 3D reconstruction and a geometric method to select a correct set of reference points among all im age points. Experimental results from both simulated and real image sequences are presented, and robustness of the method and reconstruction precision of the results are discussed.

Identification of potential therapeutic targets for melanoma using gene expression analysis

Metastatic melanoma represents a significant cause of death in patients with melanoma and the frequency is increasing. The aim of this study was to identify potential therapeutic targets for metastatic melanoma. Gene expression profile GSE44660 was downloaded from Gene Expression Omnibus database. A total of 22 samples were analyzed in our study, including 3 specimens of normal melanocytes, 12 specimens of melanoma LNM (lymph node metastasis) and 7 specimens of MBM (melanoma brain metastasis). DEGs (differentially expressed genes) in LNM and MBM were identified respectively using Limma package. GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways analyses of common DEGs between two comparison groups were performed using DAVID, followed by cancer-related genes and transcription factor analysis. PPI (protein-protein interaction) network was constructed by STRING, and significant key genes were selected. Totally, 401 common DEGs were identified. Disease analysis showed that ICAM1 (intercellular adhesion molecule 1) and NBN (nibrin) were related to melanoma. In the PPI network, BIRC5 (baculoviral IAP repeat containing 5), BUB1 (BUB1 mitotic checkpoint serine/threonine kinase), GMNN (geminin, DNA replication inhibitor), AURKA (aurora kinase A), TOP2A (topoisomerase (DNA) II alpha) and BUB1B (BUB1 mitotic checkpoint serine/threonine kinase B) were with higher degree more than 50. ICAM1, NBN, BIRC5, BUB1, BUB1B, GMNN, AURKA and TOP2A may play key roles in the progression and development of melanoma. They may be used as specific therapeutic targets in the treatment of metastatic melanoma. However, further experiments are still needed to confirm our results.

Residual effects of EDDS leachates on plants during EDDS-assisted phytoremediation of copper contaminated soil

In this study, a novel experimental setup (one pot placed above another) was used to investigate the residual effects of EDDS application on plant growth and metal uptake. Two plant species, garland chrysanthemum and ryegrass, were grown in the upper pots (mimicking the upper soil layers) and were harvested 7 days after EDDS application. During this period the upper pots were watered twice. The lower pots (mimicking the subsoil under the upper soil layers) served as leachate collectors. Thereafter, the two pots were separated, and the same plants were grown in the upper and lower pots in two continuous croppings. Results showed that EDDS application restrained the growth of the first crop and resulted in a dramatic enhancement of Cu accumulation in plants grown in the upper pots. However, no negative growth effects were identified for the second and third crops, which were harvested 81 and 204 days after the EDDS application, respectively. In the lower pots, the leachate from the upper pots after EDDS application exhibited the increased total and CaCl(2)-extractable Cu concentrations in the soil. However, the growth of garland chrysanthemum and ryegrass, and their shoot Cu concentrations were unaffected. These data suggest that the residual risk associated with EDDS application was limited, and that subsoil to which EDDS leachate was applied may exhibit reduced Cu bioavailability for plants due to the biodegradation of EDDS.

Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States Coast Guard data

OBJECTIVE

To estimate the association between wearing a personal floatation device (PFD) and death by drowning among recreational boaters.

DESIGN

Matched cohort study analysis of Coast Guard data.

SETTING

United States.

SUBJECTS

Recreational boaters during 2000-2006.

MAIN OUTCOME MEASURES

Risk ratio (RR) for drowning death comparing boaters wearing a PFD with boaters not wearing a PFD.

RESULTS

Approximately 4915 boater records from 1809 vessels may have been eligible for our study, but because of missing records and other problems, the analysis was restricted to 1597 boaters in 625 vessels with 878 drowning deaths. The adjusted RR was 0.51 (95% CI 0.35 to 0.74).

CONCLUSIONS

If the estimated association is causal, wearing a PFD may potentially prevent one in two drowning deaths among recreational boaters. However, this estimate may be biased because many vessels had to be excluded from the analysis.

Treatment of chromoblastomycosis with terbinafine: A report of four cases

This report is about four cases of chromoblastomycosis confirmed by direct examination, histopathology and cultures. The duration of disease infection varied from 5 to 12 years. By culture, Cladosporium carrionii was isolated in two cases and Fonsecaea pedrosoi in the other two cases. Terbinafine 0.25 g twice daily for 1 month and 0.25 g once daily for maintenance therapy were given to three patients. Terbinafine 0.25 g once daily was given to one patient. After 4-8 months of therapy, all cases were cured without relapse when followed up for 6 months. The total dosage of terbinafine was 37.5-60 g. No relevant side effects showed during treatment.

Beliefs and practices to prevent drowning among Vietnamese-American adolescents and parents

OBJECTIVE

To determine the beliefs, attitudes and practices regarding water safety among Vietnamese-Americans through focus group interviews.

PARTICIPANTS

15 teenagers (aged 15-19 years) and 20 parents participated, and reported similar attitudes, beliefs and practices regarding water activities. Participants identified a lack of familiarity with water activities and few swimming skills, noting that these activities are not perceived as recreational sports among the Vietnamese. They reported recreating at open water sites because they are free and available, and attributed drowning to fate. Vietnamese youth swim unsupervised, responding to peer pressure despite lack of skills. Participants had negative attitudes toward life jackets using, swimming pools and lessons, because of the costs, but would attend lessons in Vietnamese. They identified schools and Vietnamese media as means of delivering injury-prevention messages.

CONCLUSIONS

Decreasing drowning among Vietnamese-Americans requires changing the knowledge, attitudes and safety practices with programs and messages in Vietnamese, as well as targeting the dominant culture.

Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

OBJECTIVE

To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills.

METHODS

We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003-04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0-100%.

RESULTS

For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students' positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months.

CONCLUSIONS

We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.

Tissue microarray analysis of human FRAT1 expression and its correlation with the subcellular localisation of beta-catenin in ovarian tumours

The mechanisms involved in the pathogenesis of ovarian cancer are poorly understood, but evidence suggests that aberrant activation of Wnt/beta-catenin signalling pathway plays a significant role in this malignancy. However, the molecular defects that contribute to the activation of this pathway have not been elucidated. Frequently rearranged in advanced T-cell lymphomas-1 (FRAT1) is a candidate for the regulation of cytoplasmic beta-catenin. In this study, we developed in situ hybridisation probes to evaluate the presence of FRAT1 and used an anti-beta-catenin antibody to evaluate by immunohistochemistry the expression levels and subcellular localisation of beta-catenin in ovarian cancer tissue microarrays. Expression of FRAT1 was found in some human normal tissues and 47% of ovarian adenocarcinomas. A total of 46% of ovarian serous adenocarcinomas were positive for FRAT1 expression. Accumulation of beta-catenin in the nucleus and/or cytoplasm was observed in 55% ovarian adenocarcinomas and in 59% of serous adenocarcinomas. A significant association was observed in ovarian serous adenocarcinomas between FRAT1 and beta-catenin expression (P<0.01). These findings support that Wnt/beta-catenin signalling may be aberrantly activated through FRAT1 overexpression in ovarian serous adenocarcinomas. The mechanism behind the overexpression of FRAT1 in ovarian serous adenocarcinomas and its significance is yet to be investigated.

The PPARgamma ligand, rosiglitazone, reduces airways hyperresponsiveness in a murine model of allergen-induced inflammation

There is considerable interest in the role of peroxisome proliferator activated receptors (PPARs) as ligand-activated transcription factors in the airways. This study examines the effects of a potent synthetic PPARgamma ligand, rosiglitazone (RG), in a murine model of allergen-induced inflammation, to explore its potential regulation of airways inflammation, structure and function. C57BL/6 mice were sensitised with ovalbumin (OVA, 50 microg i.p., days 0, 12) and challenged with aerosolized OVA (1% w v(-1), 30 min day(-1)) for 7 days (days 20-26). Mice were treated with RG (5 mg kg(-1) i.p.) or vehicle during the challenge period. The OVA challenge induced increases in leukocyte number and MMP-2 activity in bronchoalveolar lavage fluid and in goblet cell number in lung tissue obtained on Day 27. RG failed to inhibit inflammatory cell infiltration, MMP-2 activity or goblet cell hyperplasia. Respiratory resistance in response to methacholine (MCh i.v.) was greater in OVA-challenged mice than saline-challenged mice and this airways hyperresponsiveness (AHR) was reduced by RG. However, RG did not affect MCh-induced contraction in isolated guinea-pig tracheal rings, nor did it influence the airway obstruction induced by MCh in saline-challenged mice, so a direct effect on airway obstruction is unlikely. These data suggest that RG modulates AHR in this model, by a mechanism that is also potentially independent of an anti-inflammatory action.

A quasi-dense approach to surface reconstruction from uncalibrated images

This paper proposes a quasi-dense approach to 3D surface model acquisition from uncalibrated images. First, correspondence information and geometry are computed based on new quasi-dense point features that are resampled subpixel points from a disparity map. The quasi-dense approach gives more robust and accurate geometry estimations than the standard sparse approach. The robustness is measured as the success rate of full automatic geometry estimation with all involved parameters fixed. The accuracy is measured by a fast gauge-free uncertainty estimation algorithm. The quasi-dense approach also works for more largely separated images than the sparse approach, therefore, it requires fewer images for modeling. More importantly, the quasidense approach delivers a high density of reconstructed 3D points on which a surface representation can be reconstructed. This fills the gap of insufficiency of the sparse approach for surface reconstruction, essential for modeling and visualization applications. Second, surface reconstruction methods from the given quasi-dense geometry are also developed. The algorithm optimizes new unified functionals integrating both 3D quasi-dense points and 2D image information, including silhouettes. Combining both 3D data and 2D images is more robust than the existing methods using only 2D information or only 3D data. An efficient bounded regularization method is proposed to implement the surface evolution by level-set methods. Its properties are discussed and proven for some cases. As a whole, a complete automatic and practical system of 3D modeling from raw images captured by hand-held cameras to surface representation is proposed. Extensive experiments demonstrate the superior performance of the quasi-dense approach with respect to the standard sparse approach in robustness, accuracy, and applicability.

Pathology of experimental disuse muscular atrophy in rats

The relationship between structural changes and hyaluronic acid (HA) content in muscular atrophy is unknown. The objective of our study was to conduct multifaceted evaluations of the change in muscle extensibility in muscular atrophy, in terms of morphological aspects as well as from a biochemical viewpoint, including changes in intercellular substances. Using a muscular atrophy model of the soleus muscle in the cast-fixed limbs of Wistar rats, we examined changes in HA accompanying muscular atrophy. Compared with controls, the cast-fixed limbs showed histological evidence of muscular atrophy and electron microscopy indicated destruction of the fasciae. Measurement of the HA level in muscle tissue from cast-fixed rats indicated a reduction in concentration per unit of weight. In contrast, serum HA concentrations increased in the cast-fixed group compared with the control group, suggesting that HA present in the fasciae was released into the blood stream during muscular atrophy.

Characteristics of drowning by different age groups

CONTEXT

While it is known that the risk of unintentional drowning varies with age, the manner in which drowning episode characteristics vary by age has not been well described. Such information might be useful for prevention.

OBJECTIVE

To describe characteristics of drowning by age group.

DESIGN

Retrospective review of the characteristics of drowning victims and their drowning incidents obtained from death certificates, medical examiner, pre-hospital, emergency department, and hospital records.

SETTING

Three counties in Western Washington state.

SUBJECTS

Residents who died (n=709) of unintentional drowning within the study region during 1980 through 1995.

OUTCOMES

Age specific counts, proportions, and rates per million person years were estimated for and compared among six age groups.

RESULTS

Rates varied by age group: 0-4 (30.5), 5-14 (11.6), 15-19 (29.9), 20-34 (21.5), 35-64 (12.5), and 65 years or older (21.2). Among those 0-4 years, the proportions that drowned in pools, bathtubs, and open water were nearly equal. But from age 5-64 years, over 69% of deaths were in open water. Among those 65 years and older, the deaths were almost evenly divided between bathtub and open water; bathtub drowning rates were highest in this age group, 10.9. Pre-drowning activities were divided into boating, swimming, car passenger, bathing, and fell in while doing something else. Most (64/89, 76%) victims aged 0-4 years drowned while bathing or after falling in. Among those 15-19 years, most occurred while swimming (24/79, 34%) or boating (22/79, 31%). The drowning event was least often witnessed among those 0-4 years (10/36, 28%), and most often witnessed (44/58, 76%) among those 15-19 years. Medical care (pre-hospital, emergency department, or hospital) was most often involved in drownings of those 0-4 years (70/89, 79%) and least among those over 65 years (11/86, 13%).

CONCLUSION

The characteristics of drowning episodes vary greatly by age. Different prevention strategies may be needed for different age groups.

Intranuclear ubiquitin immunoreactivity in the pigmented neurons of the substantia nigra in fire fatalities

To evaluate the significance of immunohistochemical staining of ubiquitin (heat shock protein) in the midbrain for medico-legal investigation of death in fires, we examined forensic autopsy cases of fire fatalities (n = 35) in comparison with controls (n = 27; brain stem injury, acute myocardial infarction and carbon monoxide poisoning other than fire fatality). There were two intranuclear staining patterns in the nuclei of pigmented substantia nigra neurons: a type of inclusion (possible Marinesco bodies) and a diffuse staining. Percentage of nuclear ubiquitin positivity (Ub-positive %) in fire fatalities (2.7-44.7%; mean, 18.5%) was significantly higher than in brain stem injury (n = 9; 0-10.4%; mean, 4.5%) and myocardial infarction (n = 14; 1.5-14.6%; mean, 6.9%), independently of blood carboxyhemoglobin (COHb) levels. Age-dependent increase in Ub-positive % was observed in lower COHb (< 60%) cases. The intranuclear diffuse ubiquitin staining was not observed in cases of high blood cyanide level (> 1.0 microg/ml). These observations showed that intranuclear ubiquitin immunoreactivity of the pigmented substantia nigra neurons in the midbrain was induced by severe stress in fires.

Sudden death of an infant with 'an early epileptic encephalopathy'

This article reports an autopsy case of sudden death of an infant with an infrequent encephalopathy involving epileptic episodes. The infant was a 1-year and 10-month-old boy, who had a history of the first convulsive seizures in the third month after birth. The clinical diagnosis was described as 'an early infantile epileptic encephalopathy with suppression-bursts' (Ohtahara syndrome). On a winter day, he was collapsed following a high fever and was already dead on the arrival at a hospital. The body was small for the age and poorly nourished. The autopsy and postmortem magnetic resonance imaging scan (MRI) of formalin-fixed brain revealed advanced unsymmetric brain atrophy with cortical dysplasia, which were prominent in the left temporal and right occipital lobes, and sclerotic atrophy of the parahippocampal gyri, additionally showing a feature of the olivo-ponto-cerebellar atrophy. However, the cause of death was pathologically and microbiologically determined as bacterial bronchopneumonia following pulmonary infection of the influenza A virus. In sudden death cases of physically handicapped infants, the investigation of viral infection in consideration of an epidemiological survey is important even when the death can be pathomorphologically explained.

Use of Washington State newspapers for submersion injury surveillance

OBJECTIVES

To evaluate the usefulness of newspapers as a surveillance tool for submersion injury, the proportion of submersion events and important details reported in Washington State newspapers was determined. It was also determined whether a letter sent to newspaper editors to encourage reporting changed the proportion and content of reported submersion events.

METHODS

Newspaper articles regarding submersion were collected from 225 Washington newspapers from June 1993 through September 1998. Newspaper articles were linked to computerized state death and hospital records. Reporting during periods before and after a letter was sent encouraging more newspaper articles on submersion injury and preventative factors was compared.

RESULTS

A total of 1,874 submersion victims were identified in the three data sources. Of the 983 victims who had a death certificate, 52% were reported in at least one news article. Of the 471 persons in hospital discharge data, 25% were reported in a newspaper. Reporting of pediatric victims who died increased from 63% to 79% (p=0.008); reporting of hospitalized persons increased from 23% to 27% (p=0.3). There were increases in reporting of swimming ability (7% to 15%, p<0.001), supervision (82% to 91%, p<0.001), and alcohol use (7% to 24%, p<0.001). Reporting of life vest use decreased (35% to 23%, p<0.001).

CONCLUSIONS

Newspapers failed to report about one half of fatal submersions and three quarters of submersions that resulted in a hospitalization. An effort to improve reporting was associated with an increase in the proportion of pediatric drownings that were reported, but a consistent improvement in content was found. The usefulness of newspaper articles as a surveillance tool may be limited.

Evaluation of resuscitation skills in new residents before and after pediatric advanced life support course

OBJECTIVE

Acquisition of resuscitation skills taught in advanced resuscitation courses has not been evaluated. We sought to determine the interobserver reliability of a resuscitation performance skills checklist to assess resident performance of bag mask ventilation, intubation, defibrillation, and intraosseous vascular access, and to measure skill acquisition by entering residents after a pediatric advanced life support (PALS) course.

DESIGN

The resuscitation skills of all 39 pediatric R1's in 2 university-based training programs were assessed immediately before and after completion of a PALS course just before starting residency. Independent observers scored and timed resident performance of bag mask ventilation, endotracheal intubation, intraosseous access, and defibrillation. Scores before and after the PALS course were compared. Four independent observers scored 4 residents' videotaped skills performance. Observers' scores for each resident were compared.

RESULTS

Successful performance improved for bag mask ventilation from 62% to 97% after the PALS course; for successful endotracheal intubation, from 64% to 90%; for successful intraosseous needle placement, from 54% to 92%; and for successful defibrillation, from 77% to 97%. Interobserver reliability was high for continuous and noncontinuous variables.

CONCLUSIONS

New residents demonstrated significant acquisition of pediatric resuscitation skills immediately after completion of the PALS course. The skills performance checklist has excellent interobserver reliability and is a useful tool for evaluation of other training venues.

[Radiographic examination of skeletalized remains of an abandoned infant: a case report with special reference to odontological findings]

A homeless couple confessed that they had buried their baby, who died at the age of three months, in the graveyard two years earlier. The recovered infantile remains had been already completely skeletonized and dismembered. However, the maxilla and mandibula of the average matured infants, the age of the body was estimated to be 1 to 2.5 months old on the basis of the degree of calcification of deciduous teeth.

Cervical spine injuries among submersion victims

BACKGROUND

Submersion victims are frequently considered at high risk for cervical spine (C-spine) injury regardless of whether they sustain a traumatic injury. We hypothesized that C-spine injury is unlikely in submersion victims who do not sustain high-impact injuries.

METHODS

The study was a cohort study of all people who submerged between January 1974 and July 1996 and received medical care or were seen by the medical examiner in King, Pierce, and Snohomish counties in Washington State.

RESULTS

Eleven (0.5%) of 2,244 submersion victims had C-spine injuries. All 11 had submerged in open bodies of water; had clinical signs of serious injury; and had a history of diving, motorized vehicle crash, or fall from height. No C-spine injuries occurred in 880 low-impact submersions.

CONCLUSION

Submersion victims are at risk for C-spine injury only if they have also sustained a traumatic injury. Routine C-spine immobilization does not appear to be warranted solely on the basis of a history of submersion.

Immunohistochemistry of pulmonary surfactant-associated protein A in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a fatal complication in severe traumas and diseases. Although the contribution of pulmonary surfactant abnormality to the pathogenesis of ARDS has been clinically fairly well investigated, the histopathological evidence has not been established. The aim of this study was to clarify the immunohistochemical distribution of surfactant-associated protein A (SP-A) for early diagnosis of ARDS with special regard to hyaline membrane (HM) formation. Two-hundred-and-ten autopsy cases of prolonged death from various traumas and diseases were investigated. ARDS were observed in 23 cases, showing speckled SP-A immunostaining. During the early, exudative phase of ARDS, characteristic SP-A distribution showed intense staining in the intra-alveolar massive aggregates and thick 'peeling'-like substances accompanied with a lot of granular staining. During the proliferative phase, localized accumulation of granular SP-A and macrophages containing dense granular SP-A became predominant. During the final fibrotic phase, SP-A staining in HMs became weak, and disseminated granular staining was observed in the alveolar spaces. These findings provide morphological evidence of the increase of SP-A during the early phase of ARDS, including some molecular alteration and its decrease during the late phase. Characteristic SP-A distribution in the exudative phase appeared to be especially useful for early histopathological diagnosis of respiratory distress, even prior to the appearance of typical HMs.

Intranuclear ubiquitin immunoreactivity of the pigmented neurons of the substantia nigra in fatal acute mechanical asphyxiation and drowning

To evaluate the significance of immunohistochemical staining of ubiquitin (heat shock protein) in the midbrain for the medico-legal diagnosis of fatal asphyxiation and drowning, we investigated forensic autopsy cases of fatal mechanical asphyxia (n = 18), manual/ligature strangulation (n = 9), hanging (n = 4), aspiration/choking (n = 5) and drowning (n = 16). These were compared to control groups (n = 30) consisting of fatalities from brainstem injury (n = 12) and acute myocardial infarction (n = 18). Ubiquitin was clearly demonstrated in the nuclei of pigmented substantia nigra neurons, showing two intranuclear staining patterns: a type of inclusion (possibly Marinesco bodies) and a diffuse staining. The diffuse staining was significantly more frequently observed in cases of drowning. The percentage of total ubiquitin positive neurons was frequently higher in strangulation (5.1-28.4%, mean 17.0%), aspiration/choking (5.3-32.0%, mean 17.6%) and drowning (7.0-34.1%, mean 19.8%), but relatively low in hanging (5.1-12.7%, mean 8.6%), brainstem injury (0-10.4%, mean 5.0%) and acute myocardial infarction (1.5-16.9%, mean 8.3%). These observations suggest that intranuclear ubiquitin immunoreactivity of the pigmented substantia nigra neurons in the midbrain was induced by a fatal severe stress on the central nervous system in asphyxiation and drowning.

Immunohistochemical investigation of pulmonary surfactant-associated protein A in fatal poisoning

To evaluate the immunohistochemical distribution of pulmonary surfactant-associated protein A (SP-A) in fatal poisoning in relation to the effects of drugs and poisons on respiratory function, 42 forensic autopsy cases were examined by scoring the staining intensity. The highest scores of SP-A staining, with dense granular deposits (aggregates) in the intra-alveolar space, were observed in fatalities from pancuronium bromide (muscle relaxant) injection and petroleum (butane) gas inhalation. Poisoning with organophosphate pesticides and arsenic (ingestion) showed a second grade SP-A score. However, The SP-A scores were relatively low in ethanol and sedative-hypnotic intoxication. Carbon monoxide intoxication showed a varied degree of SP-A score, and the aggregated SP-A score tended to be higher in cases of lower blood carboxyhemoglobin concentration. A varied SP-A score was also observed in methamphetamine fatalities, in which the score was relatively low in cases with a higher serum drug level. Increase of SP-A was not always associated with the intra-alveolar effusion or hemorrhages. The above-described observations suggested that the immunohistochemical score of SP-A may be a possible indication for intensity and duration of drug/poison-dependent respiratory distress.

Do parents value drowning prevention information at discharge from the emergency department?

STUDY OBJECTIVE

We determined parent recall and perceived usefulness of drowning prevention messages included in routine computer-generated discharge instructions.

METHODS

All pediatric emergency department patients' computerized discharge instructions included 3 prevention messages: wear a life vest, swim in safe areas, and do not drink alcohol while swimming or boating. Parents were telephoned 1 to 2 weeks after the visit and asked to recall the prevention messages and rate the usefulness of the instructions. Responses were linked with patient characteristics and ED visit variables (day and time of visit, duration of ED visit, severity of condition, diagnostic category, number of tests, and treatments).

RESULTS

Of 914 parents who were contacted, 795 were eligible. Of those, 619 (78%) completed the interview. Fifty percent of parents recalled receiving drowning prevention information; of these, 41% recalled unaided the life vest messages and 35% of 155 parents who did not own a life vest stated they would subsequently consider buying their child a life vest. Most (88%) rated the prevention information useful or very useful. No patient or visit variables were associated with usefulness ratings.

CONCLUSION

Written injury prevention messages with discharge instructions were well received by parents of children in a pediatric ED. The ED may be a setting where families could receive injury prevention education.

Immunohistochemical investigation of pulmonary surfactant-associated protein A in fire victims

To evaluate the forensic pathological significance of the immunohistochemical distribution of pulmonary surfactant-associated protein A (SP-A) in determining the cause of death in fires, 57 fire victims were examined by scoring the staining intensity. The highest SP-A score with dense granular deposits (aggregates) in the intra-alveolar space was frequently observed in cases with a lower blood carboxyhemoglobin (COHb) level (<60%). The SP-A score was relatively low in carbon monoxide intoxication due to causes other than fires. High SP-A scores showed a relation to the serum level and in part related to the bloody exudate in the lower airway. These observations suggested that the increase in SP-A in fire victims may be mainly related to pulmonary alveolar injury due to the inhalation of hot air and/or irritant gases rather than hypoxia.