Effect of cortisol and glycosylated-hemoglobin levels on mortality in intensive care unit.

OBJECTIVES: To research the effects of blood cortisol and hemoglobinA1c (HBA1C) levels on mortality in patients admitted to the intensive care unit (ICU) and whether these factors could be used as reliable indicators for mortality risk assessment in these patients. METHODS: After receiving approval from the ethics committee, 79 patients admitted to ICU were included in the study. From patient files, we collected data on demographics (age, gender), presence of diabetes mellitus, and levels of cortisol, HbA1C, glucose, and lactate measured during hospitalization, along with acute physiology and chronic health evaluation (APACHE) II scores calculated within the first 24 hours. In our study, we planned to investigate the relationship between patients' cortisol and HbA1C levels and mortality. RESULTS: A total of 79 patients were included in the study. The mortality rate of the patients included in the study was 65.8%. In the model established with all variables, only cortisol level (p=0.017) and APACHE II score (p=0.005) were defined to affect mortality. CONCLUSION: Cortisol levels at the time of admission to the ICU were found to affect mortality and can be considered a predictive factor, while HBA1C levels showed no such effect. Our findings indicate that neither cortisol nor HBA1C levels had an impact on the duration of mechanical ventilation or length of stay in the ICU.

Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during prone position.

BACKGROUND: Prone position during general anesthesia for special surgical operations may be related with increased airway pressure, decreased pulmonary and thoracic compliance that may be explained by restriction of chest expansion and compression of abdomen. The optimum ventilation mode for anesthetized patients on prone position was not described and studies comparing volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) during prone position are limited. We hypothesized that PCV instead of VCV during prone position could achieve lower airway pressures and reduce the systemic stress response. In this study, we aimed to compare the effects of PCV and VCV modes during prone position on respiratory mechanics, oxygenation, and hemodynamics, as well as blood cortisol and insulin levels, which has not been investigated before. METHODS: Fifty-four ASA I-II patients, 18-70 years of age, who underwent percutaneous nephrolithotomy on prone position, were randomly selected to receive either the PCV (Group PC, n = 27) or VCV (Group VC, n = 27) under general anesthesia with sevoflurane and fentanyl. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O PEEP. Respiratory parameters were recorded during supine and prone position. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated during surgery and 60 min after extubation. RESULTS: P-peak and P-plateau levels during supine and prone positions were significantly higher and P-mean and compliance levels during prone position were significantly lower in Group VC when compared with Group PC. Postoperative PaO2 level was significantly higher in Group PC compared with Group VC. Cortisol levels were increased with surgery in both groups (p < 0.05) and decreased to baseline levels in Group PC while remained high in Group VC in the early postoperative period. Cortisol levels were significantly higher in Group VC during surgery and in the early postoperative period compared with Group PC. CONCLUSION: When compared with VCV mode, PCV mode is associated with lower P-peak and P-plateau levels during both supine and prone positions, better oxygenation postoperatively, lower blood cortisol levels during surgery in prone position and in the early postoperative period. We concluded that PCV mode might be more appropriate in prone position during anesthesia.

Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.

Pressure-controlled ventilation (PCV) is less frequently employed in general anesthesia. With its high and decelerating inspiratory flow, PCV has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus volume-controlled ventilation (VCV), will result in a lower peak airway pressure and reduced risk of barotrauma. We hypothesized that PCV instead of VCV during laparoscopic surgery could achieve lower airway pressures and reduce the systemic stress response. Forty ASA I-II patients were randomly selected to receive either the PCV (Group PC, n = 20) or VCV (Group VC, n = 20) during laparoscopic cholecystectomy. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. General anesthesia with sevoflurane and fentanyl was employed to all patients. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O positive-end expiratory pressure (PEEP). Respiratory parameters were recorded before and 30 min after pneumoperitonium. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated 30 min after pneumoperitonium and 60 min after extubation. The P-peak levels observed before (18.9 ± 3.8 versus 15 ± 2.2 cmH2O) and during (23.3 ± 3.8 versus 20.1 ± 2.9 cmH2O) pneumoperitoneum in Group VC were significantly higher. Postoperative partial arterial oxygen pressure (PaO2) values are higher (98 ± 12 versus 86 ± 11 mmHg) in Group PC. Arterial carbon dioxide pressure (PaCO2) values (41.8 ± 5.4 versus 36.7 ± 3.5 mmHg) during pneumoperitonium and post-operative mean cortisol and insulin levels were higher in Group VC. When compared to VCV mode, PCV mode may improve compliance during pneumoperitoneum, improve oxygenation and reduce stress response postoperatively and may be more appropriate in patients having laparoscopic surgery.

Trace element concentrations in surface estuarine and marine sediments along the Mississippi Gulf Coast following Hurricane Katrina.

Hurricanes are relatively frequent ecological disturbances that may cause potentially long-term impacts to the coastal environment. Hurricane Katrina hit the Mississippi Gulf Coast in August 2005, and caused a storm surge with the potential to change the trace element content of coastal surface sediments. In this study, surface estuarine and marine sediments were collected monthly following the storm from ten sites along the Mississippi Gulf Coast (Mobile Bay, Grand Bay Bayous Heron and Cumbest, Pascagoula, Ocean Springs, Biloxi Gulf, Back Biloxi Bay, Gulfport Gulf, Gulfport Courthouse Rd, and Gulfport Marina). Concentrations of V, Cr, Mn, Fe, Co, Ni, Zn, As, Cd, and Pb were measured by inductively coupled plasma-mass spectrometry to evaluate their temporal and spatial variations in the year following Hurricane Katrina. Sediments were characterized by pH, particle size distribution and total carbon and nitrogen content. Trace element contents of the sediments were determined in both <2 mm and <63 µm grain size fractions. Results revealed no significant temporal and spatial variability in trace element concentrations, in either size fraction. Potential ecological risk of the sediments was assessed by using NOAA SQuiRTs' guideline values; most concentrations remained below probable adverse effects guidelines to marine organisms suggesting that trace elements redistributed by Hurricane Katrina would not cause an adverse impact on resident organisms. Instead, the concentrations of trace elements were site-dependent, with specific contaminants relating to the use of the area prior to Hurricane Katrina.

Determination of total and partially extractable solid-bound element concentrations using collision/reaction cell inductively coupled plasma-mass spectrometry and their significance in environmental studies.

Determination of solid-bound element concentrations is an important initial step in environmental studies especially for assessment of contamination level, and of origin, relative mobility, and fate of contaminants. This study revealed that a relatively new collision/reaction cell inductively coupled plasma-mass spectrometry is a potent tool for determining total and partially extractable solid-bound element (V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, and Pb) concentrations in a complex matrix solution containing HF and/or HCl. Six different extraction methods commonly used for environmental monitoring studies were tested for their bias and variability using estuarine and marine standard reference materials. Microwave-assisted methods based on concentrated [HNO3] or [HNO3 + HF (4:1)] and [HNO3 + HF + HCl (10:3:2)] were applied for determining pseudo-total and total element concentrations, respectively. Dilute-acids (1 M HNO3, 1 M HCl, and 0.5 M HCl) were utilized in single-step partial extraction protocols. Except the 0.5 M HCl cold-extraction method which was performed at room temperature, other partial extraction protocols used microwave-digestion. This study demonstrated that the use of microwave-assisted methods in studies aimed at determining the non-residual, non-specific extractable fractions of elements in solid environmental samples may result in overestimation, and thus needs to be re-examined. We believe that the cold extraction method will play a significant role in future environmental monitoring studies. Nevertheless, results of the cold extraction method not accompanied with total element concentrations have limited value, as the amount of extraction may vary significantly with the nature (origin) of the elements, and with the types of the samples. Therefore, we suggest combining microwave-assisted total digestion and 0.5 M HCl cold-extraction methods as a relatively cost- and time-effective, environmentally sound screening procedure for routine environmental monitoring programs involving a large number of samples from diverse geological and anthropogenic settings.

Quantitative determination of multiple elements in botanicals and dietary supplements using ICP-MS.

A method was developed and validated for the analysis of 21 elements in various botanicals and dietary supplements using ICP-MS. Closed-vessel microwave digestion of botanicals and dietary products was assisted by various different procedures. The samples digested with concentrated nitric and hydrochloric acid (8:2) revealed the best recoveries (91-106%) using the reference certified materials (SRM 3280, SRM 1566b). The method was validated for linearity, precision, accuracy, LOD, and LOQ. The LOD was found to be in the range from 0.005 to 1.09 ng/mL with the exception of potassium. Eleven botanicals and 21 dietary supplements were analyzed. Among the analyzed elements, K was the most abundant followed by Na, Mg, Al, Ca, Mn, and Fe, whereas V, Cr, Co, Ni, Se, Cd, Hg, and Pb were present in low concentrations in most of the samples. The results showed that the ICP-MS method is a simple, fast, and reliable for the multielement determination in dietary supplements and botanicals.

Heavy metals concentrations of surface dust from e-waste recycling and its human health implications in southeast China.

The recycling of printed circuit boards in Guiyu, China, a village intensely involved in e-waste processing, may present a significant environmental and human health risk. To evaluate the extent of heavy metals (Cd, Co, Cr, Cu, Ni, Pb, Zn) contamination from printed circuit board recycling, surface dust samples were collected from recycling workshops, adjacent roads, a schoolyard, and an outdoor food market. ICP-OES analyses revealed elevated mean concentrations in workshop dust (Pb 110,000, Cu 8360, Zn 4420, and Ni 1500 mg/kg) and in dust of adjacent roads (Pb 22,600, Cu 6170, Zn 2370, and Ni 304 mg/kg). Lead and Cu in road dust were 330 and 106, and 371 and 155 times higher, respectively, than non e-waste sites located 8 and 30 km away. Levels at the schoolyard and food market showed that public places were adversely impacted. Risk assessment predicted that Pb and Cu originating from circuit board recycling have the potential to pose serious health risks to workers and local residents of Guiyu, especially children, and warrants an urgent investigation into heavy metal related health impacts. The potential environmental and human health consequences due to uncontrolled e-waste recycling in Guiyu serves as a case study for other countries involved in similar crude recycling activities.

Health effects of atmospheric particulates: a medical geology perspective.

In this review, atmospheric particulates as composite airborne earth materials often containing both natural and anthropogenic components were examined in the context of medical geology. Despite a vast number of both experimental and epidemiological studies confirming the direct and indirect links between atmospheric particulates and human health, the exact nature of mechanisms affecting the particulate-induced pathogenesis largely remains unexplored. Future in depth research on these areas would be most successful if potential mechanisms are examined with reference to the physical (e.g., size, shape and surface), chemical, mineralogical and source characteristics of particulate matters. The underlying goal of this review was to present the relevant terminology and processes proposed in the literature to explain the interfaces and interactions between atmospheric particles and human body within the framework of "atmospheric particle cycles." The complexities of the interactions were demonstrated through case studies focusing on particulate matter air pollution and malignant mesothelioma occurrences due to environmental exposure to erionite-a fibrous zeolite mineral. There is an urgent need for a standard protocol or speciation methods applicable to earth-materials to guide and streamline studies on etiology of mineral-induced diseases. This protocol or speciation methods should provide relevant procedures to determine the level and extent of physical, chemical and mineralogical heterogeneity of particulate matters as well as quantitative in-situ particulate characteristics.

Sources and characteristics of lead pollution in the urban environment of Guangzhou.

Guangzhou, the capital of the southeastern province of Guangdong, is one of the largest and most rapidly developing industrial cities in China. In recent years its rapid economic development has brought great prosperity to the Pearl River Delta (PRD) region, but has also given rise to a wide variety of environmental problems. The current level of lead (Pb) contamination (75-926 mg/kg) in the surface environment of Guangzhou remains a major concern, even though the use of leaded petrol in the city was banned in 1997. The Pb isotope ratios (206Pb/207Pb(min-max) : 1.1612-1.1961 and 208Pb/207Pb(min-max) : 2.4495-2.4838) of the urban dusts from unconfined (road dusts and gully sediments) and relatively confined (vehicular tunnel) settings in Guangzhou remains in a relatively narrow range, comparable with those of the regional natural and anthropogenic sources. This study highlights the inherent shortcomings of the Pb isotope fingerprinting technique for provenancing Pb sources, as both the target media (urban dusts) and potential sources have similar and highly radiogenic Pb isotope values. This could not only lead to an overestimation of the effectiveness of phasing-out of leaded petrol, but also an underestimation of the ever-increasing relative contributions from other potential sources of pollution, including coal combustion, industrial emissions of local Pb-ores and non-additive Pb contents of crude oils. Re-suspended Pb-bearing particulates deposited from early vehicular exhaust emission of leaded petrol with distinctly low Pb isotope compositions are still an important source of Pb pollution in the region.

Evidence of excessive releases of metals from primitive e-waste processing in Guiyu, China.

Guiyu, China is infamous for its involvement in primitive e-waste processing and recycling activities. Freshwater samples were collected in and outside of Guiyu for dissolved metal analysis. It was found that dissolved metal concentrations were higher in Lianjiang and Nanyang River within Guiyu than the reservoir outside of Guiyu. Lianjiang was enriched with dissolved As, Cr, Li, Mo, Sb and Se, while Nanyang River had elevated dissolved Ag, Be, Cd, Co, Cu, Ni, Pb and Zn. Temporal distributions of the metals suggested recent discharges of metals attributable to a strong acid leaching operation of e-waste, where dissolved Ag, Cd, Cu and Ni (0.344+/-0.014, 0.547+/-0.074, 87.6+/-3.0 and 93.0+/-1.4 microg/L, respectively) were significantly elevated. Pb isotopic composition of dissolved Pb confirmed that more than one non-indigenous Pb were present in Lianjiang and Nanyang River. In summary, it was evident that the riverine environment of Guiyu was heavily impacted by e-waste related activities.

Trace metal contamination of sediments in an e-waste processing village in China.

This study examined trace metal contamination of sediments in Guiyu, China where primitive e-waste processing activities have been carried out. It was found that some river sediments in Guiyu were contaminated with Cd (n.d.-10.3mg/kg), Cu (17.0-4540mg/kg), Ni (12.4-543mg/kg), Pb (28.6-590mg/kg), and Zn (51.3-324mg/kg). The (206)Pb/(207)Pb and (208)Pb/(207)Pb ratios of the Pb-contaminated sediments of Lianjiang (1.1787+/-0.0057 and 2.4531+/-0.0095, respectively) were lower than those of Nanyang River (1.1996+/-0.0059 and 2.4855+/-0.0082, respectively), indicating a significant input of non-indigenous Pb with low (206)Pb/(207)Pb and (208)Pb/(207)Pb ratios. Copper, Pb and Zn in the non-residual fractions noticeably increased in the contaminated sediments compared to those in the uncontaminated sediments. A genuine concern is associated with potential transport of the contaminated sediments downstream and enhanced solubility and mobility of trace metals in the non-residual fractions.

Health effects of arsenic, fluorine, and selenium from indoor burning of Chinese coal.

China's economy has developed rapidly in the last two decades, leading to an increase in energy consumption and consequently emissions from energy generation. Coal is a primary energy source in China because of its abundance and will continue to be used in the future. The dominance of coal in energy production is expected to result in increasing levels of exposure to environmental pollution in China. Toxic trace elements emitted during coal combustion are the main sources of indoor air pollution. They are released into the atmosphere mainly in the forms of fine ash and vapors and have the potential to adversely affect human health. Those trace elements, which volatilize during combustion, are hazardous air pollutants (HAPs) and are particularly rich in Chinese coals. Among the HAPs, arsenic (As), fluorine (F), and selenium (Se) have already been identified as pollutants that can induce severe health problems. In this review, the geochemical characteristics of As, F, and Se, including their concentration, distribution, and mode of occurrences in Chinese coal, are documented and discussed. Our investigations have confirmed the current As- and F-induced epidemics in Guizhou (Southwest China) and Se epidemic in Hubei (Northeast China). In this study, diagnostic symptoms of arseniasis, fluorosis, and selenosis are also illustrated.

Sources and trends of environmental mercury emissions in Asia.

This paper focuses on environmental mercury emissions in Asia and elaborates its probable trend in the future and associated implications given the anticipated socioeconomic outlook and other macro-environmental factors. Among the various regions, Asia has become the largest contributor of anthropogenic atmospheric Hg, responsible for over half of the global emission. In the next few decades, a significant increase in anthropogenic Hg emissions in Asia is likely owing to rapid economic and industrial development, unless drastic measures are taken. In particular, the dominance of Asia in some Hg-emitting industries, such as coal combustion, steel production and gold mining, provokes a serious environmental concern over their potential contributions of incidental Hg in the region. Moreover, the increasing prevalence of electrical and electronic manufacturing industry as a user and a contributor of Hg in Asia is also worrying. Specifically, disposal of obsolete electrical and electronic wastes represents a phenomenon increasingly encountered in Asia. In addition to escalating anthropogenic Hg emissions in Asia, associated environmental and health implications may also exacerbate in the region for the probable effects of a unique combination of climatic (e.g. subtropical climate), environmental (e.g. acid rain) and socioeconomic factors (e.g. high population density). Hence, much effort is still needed to understand the role of Asia in global Hg cycle and associated environmental and health effects in the region.