[Pollution Characterization, Source Identification, and Health Risks of Atmospheric Particle-Bound Heavy Metals in PM2.5 in Zhengzhou City: Based on High-resolution Data].

In order to study the pollution characteristics and sources of heavy metals in urban atmospheric PM2.5, 21 elements in atmospheric PM2.5 in Zhengzhou City were detected using an online metal analyzer during July and October 2017 and January and April 2018, and the changes in heavy metal concentrations were analyzed. Heavy metals were traced by enrichment factors, principal component analysis, and potential source function. The US EPA risk assessment model was used to assess their health risks. The results showed that:the concentrations of K, Zn, Mn, Pb, Cu, As, Cr, and Se increased with the increase in pollution level. The results of enrichment factors and principal component analysis showed that the main sources of heavy metals were crust, mixed combustion, industry, and motor vehicles. The characteristic radar charts showed that the pollution dominated by crustal sources mainly occurred in spring and winter, whereas the pollution dominated by mixed combustion sources mainly occurred in winter. Pb, As, and Ni were greatly affected by the transport of a fen nutrient-laden plain, Beijing-Tianjin-Hebei, and southern Henan, whereas Cd was greatly affected by the northwest region of the sampling site. As presented a significant carcinogenic risk in both adults and children, whereas Pb and Sb presented a significant non-carcinogenic risk in children.

Computed tomography for the diagnosis of solitary thin-walled cavity lung cancer.

BACKGROUND AND AIM: Lung cancer is the most commonly diagnosed neoplasm and the leading cause of cancer-related death worldwide. Despite the high incidence of lung cancer, the diagnosis of solitary thin-walled cavity lung cancer is rare. The aim of this review is to explore the potentials of computed tomography (CT) as diagnostic tool for solitary thin-walled cavity lung cancer. METHOD: The literature search was made in electronic databases including PudMed, Ovid SP, Embase, Web of Sciences, EBSCO and Wiley online by using relevant key terms. Because of the rarity of the subject, no precise exclusion or inclusion criteria were used for article selection and the outcome dissemination was decided to be more descriptive rather than quantitative. RESULTS: The detection of cavitation in lungs is frequently done utilizing chest radiographs CT scans. However, the diagnostic challenge remains the accurate detection of solitary thin-walled cavity lung cancer among the prevalence of cavitary lung lesions in multiple thoracic disorders including benign disorders, infectious disease and malignant tumors. Moreover, an accurate diagnosis of solitary thin-walled cavity lung cancer is further complicated by its subjective classification within the literature. In order to facilitate early diagnosis of this disease and circumvent the need for more invasive tests that may not be warranted, the overarching goal is to establish definitive radiological features of lung cavities that are indicative of malignancy. Herein, we describe the benefits of using CT to identify and diagnose solitary thin-walled cavity lung cancer, as well as explore the underlying mechanisms that contribute to thin-walled cavity formation in oncology patients. CONCLUSION: CT is the best modality for the noninvasive differentiation between malignant and nonmalignant cavities as it provides reliable information regarding the morphology and density of lesions. Besides, CT densitometry can efficiently detect the calcifications in lesions.

Dynamic assessment of the changing geometry of the mitral apparatus in 3D could stratify abnormalities in functional mitral regurgitation and potentially guide therapy.

INTRODUCTION: In functional mitral regurgitation (FMR), effective regurgitant orifice area (EROA) displays a dynamic pattern. The impact of dynamic changes of annulus dysfunction and leaflets tenting on phasic EROA was explored with real-time three-dimensional transesophageal echocardiography (RT3D-TEE). METHODS: RT3D-TEE was performed in 52 FMR patients and 30 controls. Mitral annulus dimensions and leaflets tenting were measured throughout systole (TomTec, Germany). Phasic EROA was measured by proximal isovelocity surface area (PISA) method. RESULTS: Mitral annulus had the minimal area and an oval shape with saddle configuration during early systole in controls, which enlarged and became round and flattened towards mid and late systole (P<0.05). In contrast, annulus in FMR was significantly larger, rounder and flatter (P<0.001), which further dilated and became more flattened at late systole (P<0.05 vs control). Leaflet tenting height in FMR decreased in mid systole and remains unchanged towards late systole. The leaflet tenting volume peaked at early and late systole with a mid-systolic trough in both FMR and controls. But tenting volume of patients with FMR was significantly larger than that of controls (all P<0.001 vs control in whole systole). Further analysis demonstrated that early tenting volume (ß value=0.053, P<0.05) was a predictor of early EROA, whereas late tenting volume (ß value=0.031, P<0.05) and late annular displacement velocity were predictors of late EROA. CONCLUSIONS: The early and late peak EROAs of FMR was primarily contributed by tenting volume at early systole and late systole respectively. These findings would be of value to consider in interventions aimed at reducing the severity of FMR.

Exogenous pulmonary surfactant for acute respiratory distress syndrome in adults: A systematic review and meta-analysis.

Acute respiratory distress syndrome (ARDS) is often characterized by reduced lung compliance, which suggests dysfunction of the endogenous surfactant system. The effectiveness of exogenous surfactants as replacements for the endogenous system in the treatment of ARDS in adults was assessed. Randomized controlled trials from Medline (1950-2011), Embase (1989-2011), the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (1994-2011) were analyzed. Two reviewers identified trials for inclusion and the results of included trials were quantitatively pooled with a fixed-effects model. Seven trials (2,144 patients) with good methodological quality were included in the analysis. Pulmonary surfactant treatment was not associated with reduced mortality [relative risk (RR), 1.00; 95% confidence interval (CI) 0.89-1.12]. Subgroup analysis revealed no reduced mortality for various surfactant types. Heterogeneity was not significant in the primary outcome analysis (I(2)=0%). There was no evidence of publication bias. Oxygenation, ventilation-free days, duration of ventilation and APACHE II scores did not undergo pooled analysis due to insufficient data. Exogenous surfactant did not reduce mortality in adults with ARDS in our meta-analysis, and we cannot accurately define whether exogenous surfactant has an effect on oxygenation from the included studies.

Right-sided free wall accessory pathway refractory to conventional catheter ablation: lessons from 3-dimensional electroanatomic mapping.

INTRODUCTION: the aim of this study was to delineate the electroanatomic substrates of right-sided free wall (RFW) accessory pathways (APs) that were refractory to conventional catheter ablation utilizing 3-dimensional (3-D) mapping. METHODS AND RESULTS: eleven patients with RFW APs that failed initial conventional catheter ablation(s) by a mean of 1.9 ± 0.5 attempts were enrolled in the study. Electroanatomic mapping of the right atrium was performed during orthodromic reciprocating tachycardia in 3 patients and right ventricular pacing in 8 patients. The earliest atrial activation site, which represented the atrial insertion of the AP, was separated from the tricuspid annulus by an average of 14.3 ± 3.9 mm, and the local activation time was 27.8 ± 17.0 ms earlier than that of the corresponding annular point. One patient exhibited an AP with wide branching on the atrial side. RF ablation with an irrigated catheter successfully interrupted AP conduction in all patients without complications. CONCLUSIONS: RFW APs resistant to conventional catheter ablation might be due to unique anatomic AP features such as more epicardial course at the annulus level with atrial insertion distant from the tricuspid annulus. Electroanatomic mapping is helpful to accurately localize the atrial insertion sites of these APs and facilitates catheter ablation.

ERK-MAPK signaling opposes rho-kinase to reduce cardiomyocyte apoptosis in heart ischemic preconditioning.

We and others have reported that Rho-kinase plays an important role in the pathogenesis of heart ischemia/reperfusion (I/R) injury. Studies have also demonstrated that the activation of Rho-kinase is reversed in ischemic preconditioning (IPC). However, the mechanisms by which Rho-kinase is increased in I/R and reversed in IPC are not thoroughly understood. In female Wistar rats, we created I/R by ligating the left anterior-descending branch of the coronary artery (LAD) for 30 min and releasing the ligature for 180 min. IPC rats underwent IPC (two cycles of 5-min ligation of the LAD and 5-min reflow) before I/R. IPC caused a significant increase in extracellular signal-regulated kinase (ERK)1/2 activity and reduced Rho-kinase activity and cardiomyocyte apoptosis (P<0.05 versus I/R). Administration of PD98059, an inhibitor of ERK-mitogen-activated protein kinase (MAPK), increased cardiomyocyte apoptosis, Caspase-3 activity and myocardial infarction size (P<0.05 versus IPC). Western-blot analysis showed that administration of PD98059 increased Rho-kinase activity. Treatment with fasudil, an inhibitor of Rho-kinase, reversed cell apoptosis caused by treatment with PD98059 in IPC. In addition, ROCK1 (Rho-kinase 1) may be the major Rho-kinase isoform that is opposed by ERK-MAPK signaling in IPC. These results indicate that ERK-MAPK signaling is required in IPC to oppose Rho-kinase activity in cardiomyocyte apoptosis in vivo.