Adiponectin blood levels and autism spectrum disorders: a systematic review

OBJECTIVE

To review the relationship between adiponectin levels and autism spectrum disorders (ASDs) in children.

BACKGROUND

ASDs are associated with pervasive social interaction and communication abnormalities. Researchers have studied various pathophysiological mechanisms underlying ASDs to identify predictors for an early diagnosis to optimize treatment outcomes. Immune dysfunction, perhaps mediated by a decrease in anti-inflammatory adipokine, adiponectin, along with changes in other adipokines, may play a central role in increasing the risk for ASDs. However, other factors, such as low maternal vitamin D levels, atherosclerosis, diabetes, obesity, cardio-metabolic diseases, preterm delivery, and oxytocin gene polymorphism may also contribute to increased risk for ASDs.

METHODS

Searches on the database; PubMed, Google Scholar, and Cochrane using keywords; adiponectin, adipokines, ASD, autism, autistic disorder, included English-language studies published till September 2022. Data were extracted on mean differences between adiponectin levels in children with and without ASDs.

RESULTS

The search yielded six studies providing data on adiponectin levels in young patients with ASDs. As can be seen from Table 1, four of the six studies were positive for an inverse correlation between ASD and adiponectin levels. In addition, two of the four positive and one negative studies found low adiponectin levels associated with and the severity of autistic symptoms. However, results from one reviewed study were insignificant.

CONCLUSION

Most studies reviewed yielded lower adiponectin levels in children with ASDs as well as the severity of autistic symptoms.

Levels, distributions and influential factors of residential airborne culturable bacteria in 12 Chinese cities: Multicenter on-site survey among dwellings

Residential airborne culturable bacteria (RAB) are commonly used to assess indoor microbial loads, which is a very effective and recognized indicator of public concern about residential air quality. Many countries and organizations have set exposure limits for residential bacteria. Nevertheless, few studies have been conducted in multicenter cities about the distribution and influencing factors of RAB. It is a challenge to investigate the distribution of RAB and identify the association between indoor influencing variables and RAB in China. The current finding implied the comparative results from a one-year on-site survey of 12 cities in China. The concentration of RAB ranged from 0 CFU/m³ to 18,078 CFU/m³, with an arithmetic median of 350 CFU/m³. RAB concentrations were more in the warm season than those in the cold season, and were more in the bedrooms than those in the living rooms. Indoor environmental indicators (including PM_2.5 and PM₁₀) showed the mediating role in the process of temperature and relative humidity effects on RAB. . Influential factors including family-related information (income), architectural characteristics (house type, building history, living floor, the layers of window glass, and decoration) and lifestyle behaviors (heating, new furniture, incense-burned, insecticides-used, air condition-used, and plants-growed) were related with the concentration of RAB. This study presents essential data on the distribution of RAB in some Chinese cities, and reveals the residential influential factors that might minimize health risk from RAB.

Assessment of the level and distribution of health system responsiveness in Oyo State, Nigeria

Background

Health systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State.

Methods

The study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%.

Results

The overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35–5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28–3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23–2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11–2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13–2.53).

Conclusions

The overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08276-9.

Arsenic speciation in shellfish from South China Sea: Levels, estimated daily intake and health risk assessment

The purposes of this study were to measure the concentrations of arsenic speciation in shellfish from South China Sea and evaluate the health risk by local residents through shellfish consumption. The median concentrations (in wet weight) of arsenic speciation in shellfish samples were in the following order: AsB (16.0 mg·kg^-1) > DMA (1.30 mg·kg^-1) > AsV (0.23 mg·kg^-1) > AsC (0.08 mg·kg^-1) > AsIII (0.05 mg·kg^-1) > MMA (0.01 mg·kg^-1). Among shellfish species, Mactra mera and Babylonia areolata were found to accumulate iAs and AsB, respectively. The target hazard quotient values of iAs (THQ_iAs) in all shellfish samples were lower than 1. However, the carcinogenic risk values of iAs (CR_iAs) in the Mactra mera, Mytilus galloprovincialis and Pinctada margaritifera were beyond the acceptable range, implying that continuous exposure to iAs pollution via the consumption of these shellfish would pose a potential cancer risk to local consumers.

Survey of legacy and emerging per- and polyfluorinated alkyl substances in Mediterranean seafood from a North African ecosystem

Despite the ubiquity of per- and polyfluorinated alkyl substances (PFAS) in all environmental compartments, little is known about the pollution they cause on the African continent, neither on levels, nor effects. Here we examined the occurrence and levels of 21 legacy and emerging PFAS in 9 marine species (3 fish, 2 crustaceans and 4 mollusks) collected from Bizerte lagoon, Northern Tunisia. Furthermore, assessment of potential human health risks through consumption of contaminated seafood was examined. This is the first study assessing PFAS in Mediterranean coastal areas of North Africa. Twelve out of the 21 targeted PFAS were detected, evidencing the occurrence of PFAS in seafood from North Africa, albeit at low levels. The Ʃ₂₁PFAS concentrations in all seafood samples ranged from 0.202 ng g^-1 dry weight (dw) to 2.89 ng g^-1 dw, with a mean value of 1.10 ± 0.89 ng g^-1 dw. The profiles of PFAS varied significantly among different species, which might be related to their different trophic level, protein content, feeding behaviour and metabolism. Generally, current exposure to PFAS through seafood consumption indicates that it should not be of concern to the local consumers, at least for those PFAS for which information is available.

Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016

BACKGROUND

Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa.

METHODS

We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15-49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05.

RESULTS

The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15-95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45⁺ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14-1.69). The uptake of Pap smear test was also higher among women aged 35-44 years.

CONCLUSIONS

The prevalence of cervical cancer uptake is substantially low among women aged 15-24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.

Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification

BACKGROUND

The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections.

METHODS

Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed.

RESULTS

Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis.

CONCLUSION

Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge. This study has uncovered a potential role for the use of additional serial sections in the morphological reappraisal of small hyperplastic polyps, especially when proximally located.

Levels Propagation Approach to Image Segmentation: Application to Breast MR Images

Accurate segmentation of a breast tumor region is fundamental for treatment. Magnetic resonance imaging (MRI) is a widely used diagnostic tool. In this paper, a new semi-automatic segmentation approach for MRI breast tumor segmentation called Levels Propagation Approach (LPA) is introduced. The introduced segmentation approach takes inspiration from tumor propagation and relies on a finite set of nested and non-overlapped levels. LPA has several features: it is highly suitable to parallelization and offers a simple and dynamic possibility to automate the threshold selection. Furthermore, it allows stopping of the segmentation at any desired limit. Particularly, it allows to avoid to reach the breast skin-line region which is known as a significant issue that reduces the precision and the effectiveness of the breast tumor segmentation. The proposed approach have been tested on two clinical datasets, namely RIDER breast tumor dataset and CMH-LIMED breast tumor dataset. The experimental evaluations have shown that LPA has produced competitive results to some state-of-the-art methods and has acceptable computation complexity.

Cadmium Contamination in Breast Milk of Moroccan Lactating Women and the Associated Factors: CONTAMILK Study

The objectives of this study were to assess levels of contamination of breast milk (BM) by cadmium (Cd) among lactating mothers from Rabat, Morocco, and to investigate its association with several maternal habits, parameters, and factors. In addition, to estimate the daily intake of the newborns. Cd concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS) in 70 human milk samples collected between the 2nd and 5th day postpartum. Accuracy of the analysis was checked by various methods including the use of reference material. A structured questionnaire was filled during the collection of milk reporting data concerning anthropometric, sociodemographic parameters, dietary and cosmetic habits, etc. The median (range) of Cd in human milk was 0.49 μg/L (range 0.013-95.19 μg/L) respectively. In 21 (30%) of 70 samples, Cd levels were higher than the normal reported by the World Health Organization (WHO) in BM (< 1 μg/L). Indeed, several factors affect significantly Cd levels in BM of the mothers such as low maternal education level, preterm delivery, cesarean delivery, and area of residence. Also, the frequency of consumption of milk and dairy products as well dried fruits and wheat bread and the frequency of use of cosmetic powders. However, the daily intake of cadmium by the newborns was lower than tolerable daily intake of the WHO for 97% of them. Our results revealed low cadmium concentrations in human milk samples from Moroccan lactating mothers living in Rabat, also the association of some factors with the levels of contamination found in this population.

Treating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir

The administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. However, many questions remain regarding the optimal dosing regimens and plasma concentrations, timing of administration, and adverse effects of vitamin C and thiamine. These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis.

Systematic Review of the Literature of Factors Affecting the Exposure and the Levels of Lead in Human Breast Milk

Human milk may sometimes contain chemical contaminants, which could have adverse effects on neonates or nursing infants. Lead (Pb) is of considerable interest due to its toxicity and occurrence. Furthermore, it has been suggested that human milk is a significant potential source of lead exposure to nursing infants. A systematic literature search in PubMed, Science Direct, and Google Scholar databases was performed to identify relevant studies, published in English until 2017, that investigated and explored common factors affecting the level of lead in human milk among lactating women around the world. Forty-nine papers were rated and explored the effect of one or several factors on the level of lead in human milk from 28 countries and carried out over a wide time frame from 1983 to 2017 and through Europe, Asia, America, and Africa, reviewing more than 5,000 subjects. Place of residence, maternal age, stage of lactation, smoking habits, maternal dietary intakes, and parity were the mostly assessed factors among the studies and considered as the main factors affecting Pb levels in BM. Other factors were not studied well enough and considered minor because few surveys evaluated their impacts. However, the literature findings are very controversial.

What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review

Objectives

Impairment of cardiac function and arrhythmias often coexist in patients with liver diseases. Many studies have proved this coexistence and put forward various theories toward its pathophysiology. This narrative review tries to find the answers with supporting evidence on five main questions:

Materials and methods

Clinical evidence was obtained by using search engines, namely, Cochrane Library, PubMed, and Google Scholar. Studies published in journals in the English language, between January 1969 and December 2019, which mentioned the relationship between cardiac arrhythmia and liver disease, were included. We used the keywords: jaundice, bilirubin, arrhythmia, ECG, QTc interval, QT dispersion, liver, and cirrhosis. Relevant animal or human studies answering the five main questions were extracted and reviewed.

Conclusion

The evidence included in our review sheds light on the fact that approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy (CC) and there has been an association between liver abnormalities and cardiac pathology. The present review also supports that there exists a strong association between high levels of serum bilirubin levels and cardiac arrhythmias, QTc value can be relied upon as a risk factor for predicting imminent arrhythmias, and that it is associated with mortality. Its basic pathophysiology can be explained by the potential action of bile acids in prolonging the QT interval. It also causes cardiac hypertrophy and apoptosis of cardiomyocytes leading to cardiac dysfunction.

How to cite this article

Arya S, Kumar P, Tiwari B, Belwal S, Saxena S, Abbas H. What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review. Indian J Crit Care Med 2020;24(12):1251–1255.

Evaluation of a modified vancomycin nomogram for obese adults

PURPOSE

The purpose of this study was to compare therapeutic vancomycin trough levels in obese adults when using an original nomogram (phase I) versus a modified nomogram (phase II).

METHODS

This study compared a vancomycin nomogram with a modified vancomycin nomogram for obese adults over 100 kg. The primary endpoint compared the percentage of sub-therapeutic, therapeutic, and supra-therapeutic vancomycin trough concentrations between the nomograms. Patients were included if they were at least 18 years of age, had a total body weight of 100-299 kg, and had an initial vancomycin trough level collected. Patients were excluded if they had end-stage renal disease or were on continuous renal replacement therapy.

RESULTS

Therapeutic trough levels occurred in 85 out of 171 patients (50%) in phase I and 98 out of 149 patients (66%) in phase II. The incidence of both sub-therapeutic and supra-therapeutic troughs was less in phase II (p = 0.013). In the subgroup of adults aged 18 to 49 with a normalized creatinine clearance of greater than 90 mL/min, there was a trend in more therapeutic levels with the modified nomogram and less chance of sub-therapeutic levels (p = 0.088). In the subgroup of adults with a normalized creatinine clearance of 60-90 mL/min, there was significant improvement in therapeutic levels and a decrease in supra-therapeutic levels without increasing the percent of sub-therapeutic levels (p = 0.001).

CONCLUSION

The modified vancomycin nomogram at Cone Health showed significant improvement in therapeutic trough concentrations while reducing the rates of under and over dosing obese adults. The Cone Health-modified vancomycin nomogram could be a useful tool for initial dosing of vancomycin in the obese population.

Perfluoroalkyl substances (PFASs) in the marine environment: Spatial distribution and temporal profile shifts in shellfish from French coasts

Perfluoroalkyl substances (PFASs) were investigated in filter-feeding shellfish collected from 2013 to 2017 along the English Channel, Atlantic and Mediterranean coasts of France. PFOS (perfluorooctane sulfonate), PFTrDA (perfluorotridecanoic acid), PFTeDA (perfluorotetradecanoic acid), PFDoDA (perfluorododecanoic acid) and PFUnDA (perfluoroundecanoic acid) were detected in more than 80% of samples, thus indicating widespread contamination of the French coastal environment by these chemicals. The distribution of PFAS concentrations showed differences according to sampling locations and years. PFOS was the predominant PFAS in most samples collected from English Channel and Atlantic coasts until 2014, but the opposite was observed in 2015, 2016 and 2017, while perfluoroalkyl carboxylic acids (PFCAs) prevailed in Mediterranean samples in all study years. Among PFCAs, PFTrDA showed the highest maximum (1.36 ng g^-1 ww) and median (0.077 ng g^-1 ww) concentrations in 2016-2017. Other PFAS median concentrations were within the 0.014 (PFNA) - 0.055 (PFTeDA) ng g^-1 ww range. The profiles determined each year in most Mediterranean samples suggest distinctive sources. PFOS median concentrations showed a significant decrease over the study years, from 0.118 to 0.126 ng g^-1 ww in 2013-2015 to 0.066 ng g^-1 ww in 2016 and 2017. ∑PFCAs showed no trends in concentration ranges over the same years. The shift in PFAS profiles from PFOS to long-chain PFCAs over the study period reflects PFOS production phase-out, combined with continuous inputs of PFCAs into the marine environment. These results provide reference data for future studies of the occurrence of contaminants of emerging concern on European coasts.

Immunochemical and Physical Quantitation of Grass and Olive Pollen Allergens: Correlation With Asthma Admissions in Cáceres, Spain

BACKGROUND AND OBJECTIVES

The association between pollen counts and allergen levels in the air is controversial. Objectives: The aims of the study were to quantify total and major allergen levels of Phleum pratense and Olea europaea and to analyze their correlation with grass and olive pollen counts and the number of asthma attacks attended at Complejo Hospitalario Universitario, Cáceres, Spain.

MATERIAL AND METHODS

A volumetric air sampler and a Burkard spore trap were used for pollen and aeroallergen collection during April- June 2011. Filters were extracted, and major allergens were quantified using enzyme-linked immunosorbent assay.

RESULTS

May was the main grass pollination period, with a maximum peak of 1362 grains/m3 (May 13). The main pollination period for olive was April 30-May 20, with a maximum peak of 851 grains/m3 (May 11). A moderate correlation was observed between asthma exacerbations and grass pollen counts or Phleum total allergen levels; this became stronger when a 3-day offset was introduced. A significant association was observed between asthma exacerbations and total olive allergen or olive pollen grain levels when a 1-day offset was introduced. The maximum correlation (moderate-high) was observed 4 days and 6 days away from the maximum olive pollen peak and the maximum Ole e 1 peak level, respectively.

CONCLUSIONS

This study reveals a significant correlation between grass and olive pollination and an increase in the number of visits to the emergency room for asthma attacks. The aerobiological pattern of allergen levels in the air is similar to that of pollen counts during the grass and olive pollination periods.

A review on organophosphate Ester (OPE) flame retardants and plasticizers in foodstuffs: Levels, distribution, human dietary exposure, and future directions

Given the ongoing studies on the adverse effects of organophosphate ester (OPE) flame retardants and plasticizers on human health, there is an increasing scientific interest in the risk of exposure to OPEs via dietary intake. Using peer-reviewed literature published up to 2018, this review surveyed and compiled the available and reported data on the concentrations and distributions of 30 OPEs based on their occurrence in various food samples from around the world. Regardless of sampling locations or food categories, 22 OPEs were detectable in at least one of analyzed sample, and there were clear variations in OPE levels among samples from different locations or food categories. For instance, cereals and fats/oils were the most contaminated by OPEs in China and Belgium, whereas fats/oils and desserts were the main polluted products in Sweden. In contrast, vegetables, fruits, fluid dairy products, and cereals were reported as the primary categories of food polluted by OPEs in Australia. Animal-based food categories such as eggs, fish and meat were the least contaminated, whereas the highest median OPE concentrations were found in meat and fish from the United State. The levels and distribution patterns of OPEs in foodstuffs demonstrated a tremendous difference even when collected from the same country and the same food item. Rice from China had the highest tris(2‑chloroethyl) phosphate (TCEP, mean: 29.8 ng/g dw) levels, whereas 2‑ethylhexyl‑diphenyl phosphate (EHDPP, mean: 4.17 ng/g ww), triphenyl phosphate (TPHP, mean: 26.14 ng/g ww), tris(2-chloroisopropyl) phosphate (TCIPP, mean: 0.87 ng/g ww) and tributyl phosphate (TNBP, median: 0.55 ng/g ww) concentrations were the highest in the same food category from Sweden, Belgium, Australia, and the United States, respectively. These discrepancies may be due to a variety of reasons such as differences in OPE physico-chemical properties, extent of usage, uptake, metabolic pathways, industrial food manufacturing processes, OPE level differences as a function of habitat, and accumulation and degradability of OPEs in different species. It is worth noting that, due to its worldwide usage in food packaging materials, EHDPP was more prominently found in processed food compared to non-processed food. Based on reported OPE levels in various foods, this review conducted a preliminary assessment of human exposure to OPEs through dietary intake, which suggested that the OPE estimated daily intake (EDI) for humans was around 880 ng/kg bw/day (95th percentile). This value was well below the corresponding OPE health reference dose given by the U.S. EPA (≥15,000 ng/kg bw/day). Even so, dietary exposure to OPEs via food intake may be not negligible based on some important factors such as dilution effects, cooking processes, and the contribution of as yet unknown means of OPE exposure. Overall, this review highlights several gaps in our understanding of OPEs in foodstuffs: 1) the investigation of contamination levels of OPEs in foodstuffs should be extended to other regions, especially North America and European countries, where OPEs are widely used and frequently detected in environmental samples, and 2) newly identified OPE derivatives/by-products, e.g., OP diesters and hydroxylated metabolites, which have been reported as end-products of OPE enzymatic metabolism or degradation through aqueous hydrolysis, and which may co-exist with parent OPEs, could also be screened with precursor OPEs in foodstuffs in future studies.

Atmospheric levels, variations, sources and health risk of PM2.5-bound polycyclic aromatic hydrocarbons during winter over the North China Plain

PM_2.5-bound polycyclic aromatic hydrocarbons (PAHs) during winter 2015 at three urban sites, including Beijing, Tianjin and Shijiazhuang, and one background site (Xinglong) over the North China Plain (NCP) were investigated. The spatial variations of PAHs showed the same trends with PM_2.5 mass concentrations, i.e. the highest PAHs concentrations was in Shijiazhuang, followed by Tianjin, Beijing and the lowest PAHs concentrations was in Xinglong. The diurnal variations of PAHs exhibited PAHs concentrations during nighttime were higher than those during daytime. The dominant species in PAHs were fluranthene and benzo[b + k]fluoranthene, indicating that diesel vehicle emission, coal combustion and biomass burning could be important and potential sources for PAHs over the NCP. There results were supported by diagnostic ratios analysis. But coefficient of divergence analysis showed that a high extent of spatial contrast among four sampling sites, except between Beijing and Tianjin. Analysis of toxicity equivalent quantities (TEQ) and the lifetime excess cancer risk (ECR) from inhalation exposure to PAHs showed that 818, 1517, 5129 and 182 cases per 100,000 people exposed in Beijing, Tianjin, Shijiazhuang and Xinglong, respectively, which were much higher than the threshold value suggested by US-EPA, i.e. 1 case per 100,000 people, and indicating that the NCP suffered from very serious health risk from PAHs, especially in Shijiazhuang.

Association between trace elements levels and asthma susceptibility

BACKGROUND

It is well-documented that the dysregulation of trace elements may be involved in the pathogenesis of asthma. However, the precise changes of trace elements levels in asthma cases remain elusive. We established whether trace elements levels were associated with asthma susceptibility by pooling case-control studies.

METHODS

34 studies were included. We extracted the standard mean differences (SMDs) and corresponding 95% confidence intervals (CIs). A pooled-analysis was performed.

RESULTS

No marked difference (95% CI: -1.437-0.218, p = 0.149) of Se level between asthma and controls. Significant difference (95% CI: 0.112-1.032, p = 0.015; 95% CI: 0.376-1.331, p < 10^-4) of Cu level between asthma and controls was noted among overall populations and Asians. No marked difference of Zn level between asthma and controls was observed among overall populations, Asians, Caucasians and Africans. Significant difference (95% CI: -0.567 to -0.238, p < 10^-4) of Mg level between asthma and controls was noted among Asians. Marked difference (95% CI: 0.258-2.864, p = 0.019; 95% CI: 0.270-3.282, p = 0.021) of Fe level between asthma and controls was noted among overall populations and Asians. Age had no impact on the pooled SMDs of Se, Cu, Zn, Mg and Fe between asthma and controls. Sensitivity analyses did not change the overall results. No publication bias was noted for overall populations.

CONCLUSIONS

Alterations of Cu, Mg and Fe levels may be a biomarker of asthma risk among specific populations. Further studies should be performed to clarify the strength of these elements in asthma.

Distribution, bioaccumulation and trophic transfer of chlorinated polyfluoroalkyl ether sulfonic acids in the marine food web of Bohai, China

Chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs) caused great concerns recently as novel fluorinated alternatives. However, information on their bioconcentration, bioaccumulation and biomagnification in marine ecosystems is limited. In this study, 152 biological samples including invertebrates, fishes, seabirds and mammals collected from Bohai Sea of China were analyzed to investigate the residual level, spatial distribution, bioaccumulation and biomagnification of Cl-PFESAs. 6:2 Cl-PFESA was found in concentrations ranging from <MDL (method detection limit) to 3.84 ng/g ww and it is the dominant congener when compared with concentrations of 8:2 Cl-PFESA. Compared with other bays and regions, levels of 6:2 Cl-PFESA are relatively high in bivalves and fishes from Liaodong Bay. These levels were also found to tend to increase as compared with those in 2010-2014. Logarithm bioaccumulation factors (BAFs) for 6:2 Cl-PFESA ranged from 2.23 to 4.21, implying the bioaccumulation of this compound. The trophic magnification factor (BMF) for 6:2 Cl-PFESA was determined to be 3.37 in the marine food web, indicating biomagnification potential along the marine food chain.

The impact of vancomycin trough concentrations on outcomes in non-deep seated infections: a retrospective cohort study

Background

Guidelines recommending vancomycin trough concentrations > 10 mg/L in non-deep seated infections are based on expert opinion. The objective of this study was to evaluate patients with non-deep seated infections treated with short-course vancomycin to determine whether there were differences in outcomes with trough concentrations of ≤10 mg/L (low) versus > 10 mg/L (high).

Methods

A retrospective cohort study of patients hospitalized between March 10, 2010 and December 31, 2015 who received ≤14 days of vancomycin to treat a non-deep seated infection and had at least one steady state trough concentration was completed. Patient data for the low versus high trough cohorts were compared using appropriate statistical tests and binary logistic regression was used to identify factors associated with clinical outcome.

Results

Of 2098 patients screened, 103 (5%) met inclusion criteria. Baseline characteristics between cohorts were not different. Clinical cure was not different between the low (42/48 [88%]) and high trough (48/55 [87%]) cohorts (p > 0.99) and vancomycin trough concentration was not associated with clinical outcome (p = 0.973). More patients in the high trough group had dosing changes (7/48 [15%] vs. 22/55 [40%], p = 0.0046), with approximately three times more dose adjustments per patient (0.17 vs. 0.55, p = 0.0193). No signal for increased vancomycin resistance associated with vancomycin troughs was identified.

Conclusions:

No difference in clinical or microbiological outcomes based on vancomycin trough concentrations were observed in patients with non-deep seated infections treated with vancomycin for ≤14 days. Targeting higher vancomycin trough concentrations of > 10 mg/L may be associated with increased workload with no corresponding benefit in clinical or microbiological outcomes in these patients.

Elevated clozapine levels associated with infection: A systematic review

Clozapine is the most effective anti-psychotic medication for treatment refractory schizophrenia. A growing number of case reports have linked infection to high clozapine levels and associated adverse outcomes. We present a systematic review of published cases to clarify the relationship between infection and elevated clozapine levels. The case reports were located through PubMed and Embase. In addition, 8 new cases from two Australian states were included. Demographics, psychiatric diagnoses and medical morbidities, medications, clinical symptoms, clozapine levels, inflammatory markers and final clinical outcome were extracted. 40 cases were identified in 23 publications that demonstrated elevated clozapine levels associated with infection. Infections were commonly respiratory in origin. Adverse events, typically sedation, were associated with raised clozapine levels during infection. In many cases the signs of infection such as fever and white blood cell count were reduced. Severe adverse effects were uncommon, with one case each of seizure, myocarditis and neutropenia. The relationship between infection, clozapine levels and adverse events is complex and multi-factorial. Monitoring of clozapine levels is essential during hospitalisation for infection and consideration should be given to gradual dose reduction to minimise dose related side effects.

Occurrence and seasonal variations of per- and polyfluoroalkyl substances (PFASs) including fluorinated alternatives in rivers, drain outlets and the receiving Bohai Sea of China

A simultaneous sampling campaign was undertaken to study the pollution by 21 per- and polyfluoroalkyl substances (PFASs) in rivers, drain outlets and their receiving Bohai Sea of China. Chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs) are being used as fluorinated alternatives and they were included in this study. In comparison with other regions and countries, high concentrations of ∑₂₁PFASs in seawater samples from the Bohai Sea, ranging from 5.03 to 41 700 ng/L (median: 64.8 ng/L), were observed. The spatial distribution of PFAS levels in this sea area was in the ranking of Laizhou Bay > Liaodong Bay > Bohai Bay > other sea areas. By comparing the levels and composition profiles of PFASs in the seawater and their sources (rivers and drain outlets), it was concluded that rivers and drain outlets are the primary sources of PFAS contamination to the Bohai Sea. These PFAS levels varied seasonally among the rivers and drain outlets, but statistically significant changes were not observed. Levels of 6:2 and 8:2 Cl-PFESAs in rivers, drain outlets and receiving sea were firstly reported in the present study. Relatively high concentrations of 6:2 Cl-PFESA were found in drain outlets, ranging from below method limits of quantification (MLQ) to 7600 ng/L, but 8:2 Cl-PFAES detection was infrequent and all median concentration below MLQ. Mass discharges to the sea of 6:2 Cl-PFESA from rivers and drain outlets to the sea were estimated to be 37 and 17 kg/y, respectively.

Modeling normativity in sustainability: a comparison of the sustainable development goals, the Paris agreement, and the papal encyclical

The idea of sustainability is intrinsically normative. Thus, understanding the role of normativity in sustainability discourses is crucial for further developing sustainability science. In this article, we analyze three important documents that aim to advance sustainability and explore how they organize norms in relation to sustainability. The three documents are: the Pope's Encyclical Laudato Si', the Sustainable Development Goals and the Paris Agreement. We show that understanding the role of different types of norms in the three documents can help understand normative features of both scientific and non-scientific sustainability discourses. We present the diverse system of norms in a model that interrelates three different levels: macro, meso, and micro. Our model highlights how several processes affect the normative orientation of nations and societies at the meso-level in different ways. For instance, individual ethical norms at the micro-level, such as personal responsibility, may help decelerate unsustainable consumerism at the aggregate meso-level. We also show that techno-scientific norms at the macro-level representing global indicators for sustainability may accelerate innovations. We suggest that our model can help better organize normative features of sustainability discourses and, therefore, to contribute to the further development of sustainability science.

Effect of RAGE gene polymorphisms and circulating sRAGE levels on susceptibility to gastric cancer: a case-control study

BACKGROUND

To investigate the influence of polymorphisms in the receptor for advanced glycation end products (RAGE) gene and circulating soluble RAGE (sRAGE) levels on susceptibility to gastric cancer, and identify whether these polymorphisms were correlated with serum sRAGE levels.

METHODS

We performed a hospital-based case-control study involving 200 gastric cancer patients and 207 cancer-free controls. Four well-characterized RAGE genetic polymorphisms, namely, rs1800624, rs1800625, rs184003, and rs2070600 were genotyped by PCR-RFLP.

RESULTS

The rs2070600 AG genotype might play a predominant role in the development of gastric cancer (adjusted OR 1.62, 95% CI 1.03-2.58). In contrast, the rs184003 GT genotype represented significantly reduced risk for gastric cancer (adjusted OR 0.62, 95% CI 0.39-0.99). Subgroup analysis demonstrated that rs2070600 AG variant genotype enhanced the gastric cancer risk among nonsmokers (OR 1.71, 95% CI 1.01-2.91), nondrinkers (OR 1.75, 95% CI 1.03-2.97), and patients with tumor stage III (OR 2.00, 95% CI 1.13-3.56). The average sRAGE levels in the gastric cancer patients were significantly decreased compared with those of the healthy controls. Subjects carrying the rs2070600 AG genotype had a decreased ability to produce sRAGE. Subjects carrying the rs184003 T variant allele had an increased ability to sRAGE.

CONCLUSIONS

These findings suggested that the variant genotypes of rs184003 and rs2070600 in the RAGE gene exhibit significant associations with gastric cancer risk and circulating sRAGE levels inverse change simultaneously, leading to a marked causal estimate between lowered sRAGE levels and increased gastric cancer risk.

Assessments of levels, potential ecological risk, and human health risk of heavy metals in the soils from a typical county in Shanxi Province, China

A total of 128 surface soil samples were collected, and eight heavy metals, including As, Cd, Cr, Cu, Pb, Ni, Zn, and Hg, were analyzed for their concentrations, potential ecological risks, and human health risks. The mean concentrations of these eight metals were lower than the soil environmental quality standards in China, while they were slightly higher than the background values in Shanxi Province. The enrichment factor, coefficient variation, and potential ecological risk index were used to assess the pollution and eco-risk level of heavy metals, among which, Cd and Hg showed higher pollution levels and potential risks than the others in the studied area. Moreover, multivariate geostatistical analysis suggested that Hg originated mainly from point sources such as industrial emissions, while agricultural activity is the predominant factor for Cd. The human health risk assessment indicated that non-carcinogenic values were below the threshold values. The total carcinogenic risks due to As, Cr, and Ni were within the acceptable range for adults, while for children, they were higher than the threshold value (1.0E-04), indicating that children are facing higher threat to heavy metals in soils. These results provide basic information on heavy metal pollution control and human health risk assessment management in the study regions.

Perceived and actual noise levels in critical care units

PURPOSE

To compare the noise levels perceived by critical care nurses in the Intensive Care Unit (ICU) to actual noise levels in the ICU.

METHODS

Following a pilot study (n=18) and revision of the survey tool, a random sample of nurses were surveyed twice in a 3-day period (n=108). Nurses perception of noise was compared to the actual sound pressure level using descriptive statistics.

MAJOR RESULTS

Nurses perceived the ICUs to be noisier than the actual values. The ICU was louder than the recommended noise level for resotrative sleep. This finding raises the question of how we can assist nurses to reduce what they perceive to be a loud environment.

APPLICATION

Future work is needed to develop interventions specifically for nurses to raise awareness of noise in the ICU and to provide them with skills to assist in noise reduction.

Soil concentrations, occurrence, sources and estimation of air-soil exchange of polychlorinated biphenyls in Indian cities

Past studies have shown potentially increasing levels of polychlorinated biphenyls (PCBs) in the Indian environment. This is the first attempt to investigate the occurrence of PCBs in surface soil and estimate diffusive air-soil exchange, both on a regional scale as well as at local level within the metropolitan environment of India. From the north, New Delhi and Agra, east, Kolkata, west, Mumbai and Goa and Chennai and Bangalore in the southern India were selected for this study. 33 PCB congeners were quantified in surface soil and possible sources were derived using positive matrix factorization model. Net flux directions of PCBs were estimated in seven major metropolitan cities of India along urban-suburban-rural transects. Mean Σ33PCBs concentration in soil (12ng/g dry weight) was nearly twice the concentration found in global background soil, but in line with findings from Pakistan and urban sites of China. Higher abundance of the heavier congeners (6CB-8CB) was prevalent mostly in the urban centers. Cities like Chennai, Mumbai and Kolkata with evidence of ongoing PCB sources did not show significant correlation with soil organic carbon (SOC). This study provides evidence that soil is acting as sink for heavy weight PCB congeners and source for lighter congeners. Atmospheric transport is presumably a controlling factor for occurrence of PCBs in less polluted sites of India.

Cadmium Levels in Tissue and Plasma as a Risk Factor for Prostate Carcinoma: a Meta-Analysis

Cadmium is a heavy metal that has been suggested to be a carcinogen by evidence. A number of published studies have investigated the association between cadmium levels and prostate cancer, but the results were inconsistent. Thus, we conducted a meta-analysis to get a precise estimate of this subject. After a careful searching and screening, a total of 11 publications containing 14 separated studies were included. Based on a random-effect model, the pooled data showed that cadmium levels of prostate tissues (standard mean difference (SMD) = 3.17, 95 % confidence interval (CI) = 0.60-5.74, P < 0.05) and plasma (SMD = 4.07, 95 % CI = 2.01-6.13, P < 0.05) were significantly higher in prostate cancer patients than those in the healthy controls. No difference of hair and nail cadmium levels between the prostate cancer cases and the controls was found. The data suggested that cadmium exposure might exert an influence on the tumorigenesis of prostate tissues. Future investigations with large sample sizes are needed to verify the results.

Polysaccharides and lignin from oak wood used in cooperage: Composition, interest, assays: A review

It is widely accepted that alcoholic beverage quality depends on their ageing in premium quality oak wood. From the choice of wood to beverage ageing, through the different steps in cask manufacturing, many factors should be considered. One of the biggest challenge in cooperages is to take into account all these factors. Most of the studies are interested in phenolic compounds, extracted during ageing and especially involved in wine oxidation, colour, and sensory properties such as astringency and bitterness. Oak aroma volatile compounds have also been the subject of numerous studies. These compounds of interest are part of low molecular weight compounds which represent 2%-10% of oak wood composition. However, three polymers constitute the main part of oak wood: cellulose, hemicellulose and lignin. As far as we are aware, few studies concerning the role of these major macromolecules in oak wood have been published previously. This article reviews oak wood polysaccharides and lignin, their potential interest and different assays used to determine their content.

New steps forward in the neuroactive steroid field

Evidence accumulated in recent years suggests that the systemic treatment with neuroactive steroids, or the pharmacological modulation of its production by brain cells, represent therapeutic options to promote neuroprotection. However, new findings, which are reviewed in this paper, suggest that the factors to be considered for the design of possible therapies based on neuroactive steroids are more complex than previously thought. Thus, although as recently reported, the nervous system regulates neuroactive steroid synthesis and metabolism in adaptation to modifications in peripheral steroidogenesis, the neuroactive steroid levels in the brain do not fully reflect its levels in plasma. Even, in some cases, neuroactive steroid level modifications occurring in the nervous tissues, under physiological and pathological conditions, are in the opposite direction than in the periphery. This suggests that the systemic treatment with these molecules may have unexpected outcomes on neural steroid levels. In addition, the multiple metabolic pathways and signaling mechanisms of neuroactive steroids, which may change from one brain region to another, together with the existence of regional and sex differences in its neural levels are additional sources of complexity that should be clarified. This complexity in the levels and actions of these molecules may explain why in some cases these molecules have detrimental rather than beneficial actions for the nervous system. This article is part of a Special Issue entitled 'Steroid Perspectives'.

Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility

Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.

Towards a computational(ist) neurobiology of language: Correlational, integrated, and explanatory neurolinguistics

We outline what an integrated approach to language research that connects experimental, theoretical, and neurobiological domains of inquiry would look like, and ask to what extent unification is possible across domains. At the center of the program is the idea that computational/representational (CR) theories of language must be used to investigate its neurobiological (NB) foundations. We consider different ways in which CR and NB might be connected. These are (1) A Correlational way, in which NB computation is correlated with the CR theory; (2) An Integrated way, in which NB data provide crucial evidence for choosing among CR theories; and (3) an Explanatory way, in which properties of NB explain why a CR theory is the way it is. We examine various questions concerning the prospects for Explanatory connections in particular, including to what extent it makes sense to say that NB could be specialized for particular computations.

High levels of Zinc-α-2-Glycoprotein among Omani AIDS patients on combined antiretroviral therapy

OBJECTIVE

To investigate the levels of zinc-α-2-glycoprotein (ZAG) among Omani AIDS patients receiving combined antiretroviral therapy (cART).

METHODS

A total of 80 Omani AIDS patients (45 males and 35 females), average age of 36 years, who were receiving cART at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, were tested for the levels of ZAG. In addition, 80 healthy blood donors (46 males and 34 females), average age of 26 years, attending the SQUH Blood Bank, were tested in parallel as a control group. Measurement of the ZAG levels was performed using a competitive enzyme-linked immunosorbent assay and in accordance with the manufacturer's instructions.

RESULTS

The ZAG levels were found to be significantly higher among AIDS patients compared to the healthy individuals (P=0.033). A total of 56 (70%) of the AIDS patients were found to have higher levels of ZAG and 16 (20%) AIDS patients were found to have high ZAG levels, which are significantly (P>0.031) associated with weight loss.

CONCLUSIONS

ZAG levels are high among Omani AIDS patients on cART and this necessitates the measurement of ZAG on routine basis, as it is associated with weight loss.

Access to safe abortion: progress and challenges since the 1994 International Conference on Population and Development (ICPD)

BACKGROUND

The 1994 International Conference on Population and Development (ICPD) viewed access to safe abortion as imperative for public health.

PROGRESS SINCE ICPD

Globally, the number of induced abortions (safe and unsafe) per 1000 women aged 15-44 years declined from 35 in 1995 to 28 in 2008. The number of deaths due to unsafe abortion declined from 69,000 in 1990 to 47,000 in 2008, as safe and effective methods of abortion, including manual vacuum aspiration and medical abortion, became more widely available. During the same period, there was a slight increase in the number of countries where abortion is permitted on request, and 70 countries made grounds for abortion more liberal.

CHALLENGES

Since ICPD, the decline in unsafe abortion was slower than that in safe abortion, and unsafe-abortion-related mortality continued to be a problem. Nearly all unsafe abortions and mortality occur in developing countries.

RECOMMENDATIONS

While more must be done to ensure universal access to safe, acceptable and affordable contraception to reduce the need for abortion, this need will always exist. Information on grounds for safe abortion should be made widely available for women to access services to which they are legally entitled to. As recommended by ICPD, quality postabortion care including contraception counseling and provision should be available to all women, regardless of the legal grounds for abortion. The paper provides the evidence on unsafe abortion, a reproductive health issue that is entirely preventable but has been largely neglected or tarnished by emotional and contentious debates.

Does obesity interfere with anastrozole treatment? Positive association between body mass index and anastrozole plasma levels

INTRODUCTION

The efficacy of adjuvant endocrine treatment with aromatase inhibitors (AIs), inhibiting the conversion of androgens to estrogen in adipose tissue, might depend on the overall volume of adipose tissue. However, little evidence is available regarding the pharmacokinetic behavior of AIs in women with obesity. The aim of this study was to investigate the interaction between body mass index (BMI) and anastrozole treatment as well as estrogenic activity.

PATIENTS AND METHODS

A total of 216 postmenopausal patients with early-stage breast cancer who were receiving AI treatment with anastrozole constituted the final sample included in the analysis. During a regular 3-month after-care check-up, sociodemographic and clinical data and BMI were assessed. Blood samples were collected during routine blood testing. Measurement of AI plasma levels was performed by liquid chromatography-tandem mass spectrometry. Follicle stimulating hormone (FSH) and estradiol were measured within the routine blood examination.

RESULTS

A median anastrozole plasma concentration of 34.7 ng/mL (mean, 37.4), with a large interindividual variability, was observed (SD, 15.1; range, 5.4-86.5). After age adjustment, it was found that anastrozole plasma concentrations significantly increased with BMI (r = 0.241; P = .001). Anastrozole serum concentrations in women with obesity (BMI ≥ 30) exceeded those of women with normal weight (BMI ≤ 25) by 25%. Women with excess weight had lower mean FSH levels, indicating higher estrogenic activity, compared with women with normal weight.

CONCLUSION

This study indicates that BMI is a vital factor in anastrozole metabolism, as measured by anastrozole plasma concentration and FSH levels. Further research is mandatory to clarify results on the association of obesity and AI treatment efficacy to allow adapting AI treatment accordingly.

Populations and pigeons: prosaic pluralism about evolutionary causes

Walsh (2007, 2010) was correct to conclude that the way a biological population is described should affect conclusions about whether natural selection occurs, but wrong to conclude that natural selection is therefore not a cause. After providing a new argument that (Walsh, 2007) ignored crucial biological details, I give a biological illustration that motivates a fairly extreme dependence on description. I argue that contrary to an implication of (Otsuka, Turner, Allen, & Lloyd, 2011), biologists allow much flexibility in describing populations, as contemporary research on recent human evolution shows. Properly understood, such description-dependence is consistent with descriptions capturing different causal relations involving the same population. I thus show that Walsh's (2007) arguments fail for reasons that have not previously been understood; I argue that Walsh's (2010) more recent "Sure Thing" argument fails for similar reasons. The resulting view provides a new perspective on causation in evolutionary processes.