Acute respiratory distress syndrome due to inhalation of acryloyl chloride.

BACKGROUND: Acryloyl chloride is a highly toxic volatile liquid that can cause pulmonary edema. However, no sufficient treatment reports have been published to date. Here, we report a case of acute respiratory distress syndrome (ARDS) caused by acryloyl chloride inhalation. CASE PRESENTATION: The patient was a 36-year-old man with accidental exposure to acryloyl chloride. The patient had dyspnea and wet cough, with approximately 88% percutaneous oxygen saturation at room air. He was diagnosed with ARDS and admitted to the intensive care unit. Initially, he was treated with a high-flow nasal cannula and sivelestat sodium. However, due to the possibility of delayed exacerbation, the patient was switched to methylprednisolone. Oxygenation gradually improved, and the patient was discharged on the day 8 of hospitalization. CONCLUSION: We report the case of a patient who developed ARDS with delayed exacerbation after the inhalation of acryloyl chloride, which was treated without endotracheal intubation.

Detoxification of hydroxylated polychlorobiphenyls by Sphingomonas sp. strain N-9 isolated from forest soil.

To examine the biodegradation of hydroxylated polychlorobiphenyls (OH-PCBs), we isolated Sphingomonas sp. strain N-9 from forest soil using mineral salt medium containing 4-hydroxy-3-chlorobiphenyl (4OH-3CB) at the concentration of 10 mg/L. Following incubation with strain N-9, the concentration of 4OH-3CB decreased in inverse proportion to strain N-9 proliferation, and it was converted to 3-chloro-4-hydroxybenzoic acid (4OH-3CBA) after 1 day. We observed that strain N-9 efficiently degraded lowly chlorinated OH-PCBs (1-4 Cl), while highly chlorinated OH-PCBs (5-6 Cl) were less efficiently transformed. Additionally, strain N-9 degraded PCBs and OH-PCBs with similar efficiencies, and the efficiency of OH-PCB degradation was dependent upon the positional relationships between OH-PCB hydroxyl groups and chlorinated rings. OH-PCB biodegradation may result in highly toxic products, therefore, we evaluated the cytotoxicity of two OH-PCBs [4OH-3CB and 4-hydroxy-3,5-dichlorobiphenyl (4OH-3,5CB)] and their metabolites [4OH-3CBA and 3,5-chloro-4-hydroxybenzoic acid (4OH-3,5CBA)] using PC12 rat pheochromocytoma cells. Our results revealed that both OH-PCBs induced cell membrane damage and caused neuron-like elongations in a dose-dependent manner, while similar results were not observed for their metabolites. These results indicated that strain N-9 can convert OH-PCBs into chloro-hydroxybenzoic acids having lower toxicity.

Pulmonary and pleural inflammation after intratracheal instillation of short single-walled and multi-walled carbon nanotubes.

Relationships between the physical properties of carbon nanotubes (CNTs) and their toxicities have been studied. However, little research has been conducted to investigate the pulmonary and pleural inflammation caused by short-fiber single-walled CNTs (SWCNTs) and multi-walled CNTs (MWCNTs). This study was performed to characterize differences in rat pulmonary and pleural inflammation caused by intratracheal instillation with doses of 0.15 or 1.5mg/kg of either short-sized SWCNTs or MWCNTs. Data from bronchoalveolar lavage fluid analysis, histopathological findings, and transcriptional profiling of rat lungs obtained over a 90-day period indicated that short SWCNTs caused persistent pulmonary inflammation. In addition, the short MWCNTs markedly impacted alveoli immediately after instillation, with the levels of pulmonary inflammation following MWCNT instillation being reduced in a time-dependent manner. MWCNT instillation induced greater levels of pleural inflammation than did short SWCNTs. SWCNTs and MWCNTs translocated in mediastinal lymph nodes were observed, suggesting that SWCNTs and MWCNTs underwent lymphatic drainage to the mediastinal lymph nodes after pleural penetration. Our results suggest that short SWCNTs and MWCNTs induced pulmonary and pleural inflammation and that they might be transported throughout the body after intratracheal instillation. The extent of changes in inflammation differed following SWCNT and MWCNT instillation in a time-dependent manner.

[A Case of Neuroleptic Malignant Syndrome Associated with Undiagnosed Dementia with Lewy Bodies].

A 78-year-old woman was transferred to our hospital for clouded consciousness and a high fever. She had been diagnosed with Parkinsonian syndrome, which was controlled with amantadine. Hallucination appeared a week prior to the transfer and she was treated with haloperidol. Suspecting neuroleptic malignant syndrome, dantrolene sodium was administered along with symptomatic treatment with mechanical ventilation and cooling. Her symptoms were reversed and she was transferred to another hospital for neurological evaluation. Magnetic resonance imaging revealed dementia with Lewy bodies (DLB). The high drug sensitivity of DLB was considered the cause of neuroleptic malignant syndrome induced by haloperidol. DLB should be considered in neurological emergencies in patients with Parkinsonism.

Size effects of single-walled carbon nanotubes on in vivo and in vitro pulmonary toxicity.

To elucidate the effect of size on the pulmonary toxicity of single-wall carbon nanotubes (SWCNTs), we prepared two types of dispersed SWCNTs, namely relatively thin bundles with short linear shapes (CNT-1) and thick bundles with long linear shapes (CNT-2), and conducted rat intratracheal instillation tests and in vitro cell-based assays using NR8383 rat alveolar macrophages. Total protein levels, MIP-1α expression, cell counts in BALF, and histopathological examinations revealed that CNT-1 caused pulmonary inflammation and slower recovery and that CNT-2 elicited acute lung inflammation shortly after their instillation. Comprehensive gene expression analysis confirmed that CNT-1-induced genes were strongly associated with inflammatory responses, cell proliferation, and immune system processes at 7 or 30 d post-instillation. Numerous genes were significantly upregulated or downregulated by CNT-2 at 1 d post-instillation. In vitro assays demonstrated that CNT-1 and CNT-2 SWCNTs were phagocytized by NR8383 cells. CNT-2 treatment induced cell growth inhibition, reactive oxygen species production, MIP-1α expression, and several genes involved in response to stimulus, whereas CNT-1 treatment did not exert a significant impact in these regards. These results suggest that SWCNTs formed as relatively thin bundles with short linear shapes elicited delayed pulmonary inflammation with slower recovery. In contrast, SWCNTs with a relatively thick bundle and long linear shapes sensitively induced cellular responses in alveolar macrophages and elicited acute lung inflammation shortly after inhalation. We conclude that the pulmonary toxicity of SWCNTs is closely associated with the size of the bundles. These physical parameters are useful for risk assessment and management of SWCNTs.

Intratracheal instillation of single-wall carbon nanotubes in the rat lung induces time-dependent changes in gene expression.

The use of carbon nanotubes in the industry has grown; however, little is known about their toxicological mechanism of action. Single-wall carbon nanotube (SWCNT) suspensions were administered by single intratracheal instillation in rats. Persistence of alveolar macrophage-containing granuloma was observed around the sites of SWCNT aggregation at 90 days post-instillation in 0.2-mg- or 0.4-mg-injected doses per rat. Meanwhile, gene expression profiling revealed that a large number of genes involved in the inflammatory response were markedly upregulated until 90 days or 180 days post-instillation. Subsequently, gene expression patterns were dramatically altered at 365 days post-instillation, and the number of upregulated genes involved in the inflammatory response was reduced. These results suggested that alveolar macrophage-containing granuloma reflected a characteristic of the histopathological transition period from the acute-phase to the subchronic-phase of inflammation, as well as pulmonary acute phase response persistence up to 90 or 180 days after intratracheal instillation in this experimental setting. The expression levels of the genes Ctsk, Gcgr, Gpnmb, Lilrb4, Marco, Mreg, Mt3, Padi1, Slc26a4, Spp1, Tnfsf4 and Trem2 were persistently upregulated in a dose-dependent manner until 365 days post-instillation. In addition, the expression levels of Atp6v0d2, Lpo, Mmp7, Mmp12 and Rnase9 were significantly upregulated until 754 days post-instillation. We propose that these persistently upregulated genes in the chronic-phase response following the acute-phase response act as potential biomarkers in lung tissue after SWCNT instillation. This study provides further insight into the time-dependent changes in genomic expression associated with the pulmonary toxicity of SWCNTs.

Cardiopulmonary arrest due to early hyperkalemia after liver injury.

Hyperkalemia due to crush syndrome after trauma is a well known fatal clinical condition, but early hyperkalemia with hemorrhage after trauma is a rare phenomenon. We report on a 5-year-old boy who bruised from the lumbers, had cardiopulmonary arrest caused by hyperkalemia, and underwent perihepatic packing twice before being discharged without any neurologic deficits. Clinicians should be vigilant for signs of hyperkalemia accompanying hemorrhagic shock, even in the early phase of trauma.

Physical properties of single-wall carbon nanotubes in cell culture and their dispersal due to alveolar epithelial cell response.

Concern over the influence of carbon nanotubes (CNTs) on human health has arisen due to advances; however, little is known about the potential toxicity of CNTs. In this study, impurity-free single-wall carbon nanotubes (SWCNTs), with different physical properties in cell culture medium, were prepared by a novel dispersion procedure. SWCNTs with small bundles (short linear shape) and SWCNTs with large bundles (long linear shape) did not cause a significant inhibition of cell proliferation, induction of apoptosis or arrest of cell cycle progression in A549 alveolar epithelial cells. Expression of many genes involved in the inflammatory response, apoptosis, response to oxidative stress and degradation of the extracellular matrix were not markedly upregulated or downregulated. However, SWCNTs with relatively large bundles significantly increased the level of intracellular reactive oxygen species (ROS) in a dose-dependent manner, and the levels of these ROS were higher than those of SWCNTs with relatively small bundles or commercial SWCNTs with residual metals. Transmission electron microscopy (TEM) revealed that impurity-free SWCNTs were observed in the cytoplasm and vacuoles of cells after 24 h. These results suggested that the physical properties, especially the size and length of the bundles of the SWCNTs dispersed in cell culture medium, contributed to a change in intracellular ROS generation, even for the same bulk SWCNTs. Additionally, the residual metals associated with the manufacturing of SWCNTs may not be a definitive parameter for intracellular ROS generation in A549 cells.

[Significance of comprehensive gene expression analysis for evaluation of biological effects of manufactured nanomaterials].

The industrial applications of manufactured nanomaterials (MNs) are expected to be extended to next-generation devices. On the other hand, concern over the effects of MNs on human health has risen owing to advances in the development of nanotechnology. Indeed, little is known about the mechanism of action of MNs. The New Energy and Industrial Technology Development Organization of Japan (NEDO) launched a new research project entitled "Evaluating risks associated with manufactured nanomaterials (P10024)" in 2006. The project demonstrated no adverse effects of MN inhalation exposure on the rat lungs, as determined by histopathological examination and bronchoalveolar lavage (BAL) fluid analysis. In parallel with this research, we have performed comparative gene expression analysis using DNA microarrays in rat lungs after inhalation exposure (4 weeks, 6 hours a day, 5 days a week) to single-wall nanotubes (SWCNTs), multiwall nanotubes (MWCNTs), C60 fullerene and ultrafine nickel oxide particles (Uf-NiO) as reference materials for the purpose of gaining insights into the molecular events following the exposure. In this review, we introduce an outline of the project, and discuss about the significance of comparative gene expression analysis for evaluation of the biological effects of MNs.

[Evaluation of 38 cases of employing aortic occlusion balloon catheter].

BACKGROUND: Aortic occlusion balloon catheter (AOBC), which occludes the descending aorta without thoracotomy, is expected to prevent further blood loss and raise blood pressure (BP). We investigated the effects of AOBC retrospectively. METHOD: AOBC was used in 38 patients for perioperative management only if the BP responded insufficiently despite rapid resuscitation due to massive hemorrhage below the diaphragm. There were 33 trauma cases, and five cases of ruptured abdominal aortic aneurysm. We inserted AOBC via the femoral artery or left common carotid artery in the emergency room(ER) or in the operating room (OR). RESULTS: BP increased for 38.7 +/- 33.9 mmHg following AOBC, with a survival rate of 36%. CONCLUSIONS: In our experience, AOBC was effective for raising BP in patients in hemorrhagic shock.