Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016

BACKGROUND

Exposure of toxic metals from e-cigarette use is a cause for public health concern because youth, young adults, and non-smokers are the target population rapidly adopting e-cigarette use. The purpose of this research is to determine the association of the body burden of heavy metals with e-cigarette use using NHANES (U.S.) 2015-2016 data.

METHODS

Blood lead (N = 1899) and urinary cadmium, barium, and antimony (N = 1302) data were extracted from NHANES, 2015-2016; geometric means were calculated and bivariate and multivariable linear regression analyses were conducted. Participants were categorized as having neither e-cigarette nor cigarette use; smoking history (including dual use with e-cigarettes); and only e-cigarette (current or former).

RESULTS

In multivariable analyses adjusted for sex, race/ethnicity, age, and poverty levels, current or former e-cigarette use failed to reach a statistical significance in the association with metals. However, participants with a smoking history were more likely to have higher blood lead and urinary cadmium than participants who neither used e-cigarettes nor cigarettes.

CONCLUSION

Blood lead levels, and urinary cadmium, barium, and antimony levels were similar between participants who used e-cigarettes and participants who did not.

Binding and leakage of barium in alginate microbeads

Microbeads of alginate crosslinked with Ca(2+) and/or Ba(2+) are popular matrices in cell-based therapy. The aim of this study was to quantify the binding of barium in alginate microbeads and its leakage under in vitro and accumulation under in vivo conditions. Low concentrations of barium (1 mM) in combination with calcium (50 mM) and high concentrations of barium (20 mM) in gelling solutions were used for preparation of microbeads made of high-G and high-M alginates. High-G microbeads accumulated barium from gelling solution and contained higher concentrations of divalent ions for both low- and high-Ba exposure compared with high-G microbeads exposed to calcium solely and to high-M microbeads for all gelling conditions. Although most of the unbound divalent ions were removed during the wash and culture steps, leakage of barium was still detected during storage. Barium accumulation in blood and femur bone of mice implanted with high-G beads was found to be dose-dependent. Estimated barium leakage relevant to transplantation to diabetic patients with islets in alginate microbeads showed that the leakage was 2.5 times lower than the tolerable intake value given by WHO for high-G microbeads made using low barium concentration. The similar estimate gave 1.5 times higher than is the tolerable intake value for the high-G microbeads made using high barium concentration. To reduce the risk of barium accumulation that may be of safety concern, the microbeads made of high-G alginate gelled with a combination of calcium and low concentration of barium ions is recommended for islet transplantation.

Ensemble modeling coupled with six element concentrations in human blood for cancer diagnosis

Six important metal contents (i.e., zinc, barium, magnesium, calcium, copper, and selenium) in blood samples coupled with an ensemble classification algorithm have been used for the classification of normal people and cancer patients. A dataset containing 42 healthy samples and 32 cancer samples was used for experiment. The prediction results from this method outperformed those from the newly developed support vector machine, i.e., a sensitivity of 100%, a specificity of 95.2%, and an overall accuracy of 98.6%. It seems that ELDA coupled with blood element analysis can serve as a valuable tool for diagnosing cancer in clinical practice.

Trace elements in obese Turkish children

The quality of the diet of obese children is poor. Eating habits may alter micronutrient status in obese patients. In this study, we determined the serum levels of selenium, zinc, vanadium, molybdenum, iron, copper, beryllium, boron, chromium, manganese, cobalt, silver, barium, aluminum, nickel, cadmium, mercury, and lead in obese Turkish children. Thirty-four obese and 33 healthy control subjects were enrolled in the study. Serum vanadium and cobalt levels of obese children were significantly lower than those of the control group (0.244 ± 0.0179 vs. 0.261 ± 0.012 μg/l, p < 0.001, and 0.14 ± 0.13 vs. 0.24 ± 0.15 μg/l, p = 0.011, respectively). There was no significant difference between groups regarding the other serum trace element levels. In conclusion, there may be alterations in the serum levels of trace elements in obese children and these alterations may have a role in the pathogenesis of obesity.

[SVM-aided cancer diagnosis based on the concentration of the macroelement and microelement in human blood]

Support vector machine (SVM) has shown its excellent learning and generalization ability for the binary classification of real problems and has been extensively employed in many areas. In this paper, SVM, K-Nearest Neighbor, Decision Tree C4.5 and Artificial Neural Network were applied to identify cancer patients and normal individuals using the concentrations of 6 elements including macroelements (Ca, Mg) and microelements (Ba, Cu, Se, Zn) in human blood. It was demonstrated, by using the normalized features instead of the original features, the classification performances can be improved from 91.89% to 95.95%, from 83.78% to 93.24%, and from 90.54% to 94.59% for SVM, K-NN and ANN respectively, whereas that of C4.5 keeps unchangeable. The best average accuracy of SVM with linear dot kernel by using 5-fold cross validation reaches 95.95%, and is superior to those of other classifiers based on K-NN (93.24%), C4.5 (79.73%), and ANN (94.59%). The study suggests that support vector machine is capable of being used as a potential application methodology for SVM-aided clinical cancer diagnosis.

Acute barium nitrate intoxication treated by hemodialysis

A 22-year-old male was admitted to hospital with diarrhea and vomiting, cardiac arrhythmias, severe hypokalemia and gradual onset of muscular weakness. A potassium infusion was started, but for several hours serum potassium remained low. Evidence of toxic ingestion was initially lacking. When it became clear -- after a considerable delay -- that the patient had ingested barium nitrate, hemodialysis was started. This resulted in rapid clinical improvement with correction of hypokalemia and restored muscular function. Intoxication with barium causes hypokalemia, arrhythmias, muscular weakness and paralysis, often requiring respiratory support. This patient presented with symptoms typical of severe barium intoxication, non-responsive to potassium supplementation. There are few published reports on the use of hemodialysis in barium poisoning. This case confirms the possible benefit of hemodialysis in severe cases, where potassium supplementation alone is insufficient.

Acute barium intoxication and hemodiafiltration

We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.

[Determination of trace barium in biological samples by Zeeman graphite AAS with coated graphite tube]

Using a tungstate-coated graphite tube, trace barium in biological samples was determined by Zeeman graphite AAS. The sensitivity of Ba can be significantly improved. The precision and the lifetime of graphite tube have been improved by adding matrix modifier. The method is simple. The recovery and precision are satisfactory.

Complex regulation of human neutrophil activation by actin filaments: dihydrocytochalasin B and botulinum C2 toxin uncover the existence of multiple cation entry pathways

In human neutrophils, the chemotactic peptide, N-formyl-L-methionyl-L-leucyl-L-phenalalanine (fMLP), the Ca(2+)-ATPase inhibitor, thapsigargin, and the lectins, concanavalin A (Con A) and mistletoe lectin I (ML I), stimulate the entry of Ca2+ and Na+ with subsequent activation of exocytosis and superoxide anion (O2-) formation. We studied the role of actin in neutrophil activation. The actin filament-disrupting substances, dihydrocytochalasin B (dhCB) and botulinum C2 toxin (C2 toxin) potentiated fMLP- and lectin-stimulated Ca(2+)- and Na+ entry. Lectin-induced Mn2+ entry was enhanced by actin disruption, whereas fMLP-triggered Mn2+ entry was unaffected. dhCB and C2 toxin inhibited fMLP- and lectin-stimulated Ba2+ influx. The actin disrupters also inhibited fMLP- and ML I-induced Sr2+ influx, whereas Con A-stimulated Sr2+ entry was not influenced by dhCB and C2 toxin. Thapsigargin-stimulated cation entry was not altered by actin disruption. DhCB and botulinum C2 toxin potentiated lysozyme release induced by all four stimuli. Con A and ML I per se activated O2- formation only in the presence and not in the absence of dhCB. Con A potentiated the stimulatory effects of ML I on O2- formation in the presence of dhCB and primed neutrophils to respond to ML I in the absence of dhCB. Our data indicate the following: (1) dhCB and C2 toxin uncover the existence of multiple cation entry pathways in neutrophils; (2) actin disruption facilitates exocytosis and O2- formation by enhancement of Ca(2+)- and Na+ entry and by altering the function of proteins involved in activation of secretion and O2- formation; and (3) Con A and ML I, which possess different sugar specificities, activate different signaling pathways in neutrophils.

Concanavalin A and mistletoe lectin I differentially activate cation entry and exocytosis in human neutrophils: lectins may activate multiple subtypes of cation channels

The mannose-specific lectin, concanavalin A (ConA), activates Ca2+ entry in human neutrophils by an as yet poorly defined mechanism. The question of whether the sugar specificity of lectins influences signal transduction is unresolved too. Therefore, we studied the effects of ConA in comparison to those of the beta-galactoside-specific lectin, mistletoe lectin I (MLI), on cation entry and exocytosis in human neutrophils. ConA- and MLI-activated influx of Ca2+, Mn2+, Ba2+, Sr2+, and Na+. Lectin-induced cation influxes were inhibited by 1-(beta-[3-(4-methoxyphenyl)propoxy]-4-methoxy-phenethyl) -1H-imidazole hydrochloride (SK&F 96365) and Gd3+. There were differences in the effectiveness of lectins to activate cation entry and of SK&F 96365, Gd3+, and modulators of protein phosphorylation to block entry. MLI but not ConA inhibited thapsigargin-induced Ca2+ entry. Under whole-cell voltage-clamp conditions, MLI activated an inward current that was substantially reduced by removal of extracellular Na+. ConA and MLI synergistically activated Ca2+ entry and lysozyme release. SK&F 96365 and removal of extracellular Ca2+ and Na+ partially inhibited exocytosis. Our data show the following: (1) ConA and MLI activate monovalent and divalent cation entry in human neutrophils by a SK&F 96365- and Gd3+-sensitive pathway, presumably nonselective cation channels. (2) Ca2+ and Na+ entry are involved in the activation of exocytosis by lectins. (3) The differential and/or synergistic effects of ConA and MLI on cation entry and exocytosis may be attributable to mannose- and beta-galactoside-specific activation of signal transduction pathways, i.e., activation of multiple and differentially regulated subtypes of nonselective cation channels.

Rapid ADP-evoked currents in human platelets recorded with the nystatin permeabilized patch technique

"Whole-cell" patch recordings using nystatin permeabilization were made from single human platelets during application of agonists from a "puffer" pipette. In platelets clamped near the resting potential and bathed in Na+ saline, 40 microM ADP activated a transient inward current within tens of milliseconds. At -73 mV the current lasted between 0.1 and 1 s and had a peak of between 13 and 31 pA in different cells. Ion substitution experiments indicated that the channel is permeable to Na+,K+, and Ba2+ and presumably also to Ca2+, but is not permeable to Cl-. The single channel conductance was 15 pS (near the resting potential) in nominally Ca(2+)-free saline and 11 picosiemens in BaCl2 saline. Thrombin, at 1 unit/ml, did not elicit detectable currents during a 3-s application in platelets bathed in 1 mM Ca2+, Na+ saline. Under the same conditions, in fura-2-loaded cells, thrombin-evoked Ca2+ entry (monitored by Mn2+ quench) was detectable after a delay of 1.4 s. This suggests that early thrombin-evoked Ca2+ entry occurs via small conductance channels, below the resolution of the patch clamp technique, or by an electroneutral pathway. The ADP-evoked channel has the requisite speed of activation to account for the rapid Ca2+ influx observed during stopped-flow studies of agonist-evoked changes in [Ca2+]i.

Biliary excretion of barium in the rat

Biliary excretion of barium was studied in Sprague-Dawley bile-duct-cannulated rats injected intravenously with 1.8 micrograms Ba/rat as 133Ba-labeled barium chloride. Approximately 0.5% of the barium dose was excreted into bile within 2 h. The time-course profile of biliary excretion of the radiotracer closely reflected that of plasma concentrations. Biliary barium levels reached their peak in the first 15-min period after administration and rapidly declined thereafter. The plasma-to-bile barium-concentration ratio was approx 1 at 2 h after injection. There was no tendency of barium to concentrate in liver, and the 133Ba levels in stomach and small intestine largely exceeded hepatic levels. There is evidence indicating that barium is predominantly excreted with feces following parenteral administration in rats and humans. The results of this study suggest that biliary excretion is of little quantitative importance and that physiological routes other than bile contribute to elimination of barium by the digestive tract.

The essential role of a poison center in handling an outbreak of barium carbonate poisoning

Acute barium salt poisoning may cause acute hypokalemia and result in respiratory paralysis and ventricular tachyarrhythmias. The early nonspecific gastrointestinal symptoms of barium poisoning due to food contamination could be confused with other benign food poisonings. Early diagnosis and initiation of intensive supportive care is essential. We report an outbreak of acute barium carbonate poisoning, occurring at a family reunion party, which resulted in 9 hospital admissions. All of the victims initially developed nausea, vomiting, abdominal colic, dizziness and watery diarrhea followed by numbness of the face and distal extremities 1-2 h after ingesting fried flour-coated sweet potatoes. The flour was later confirmed to be contaminated with barium carbonate. One person died in the emergency room with a serum potassium level of 0.8 mEq/L. Two other victims developed ventricular tachycardia and respiratory paralysis but completely recovered with the treatment advice provided by the poison center. The poison center was successful in helping to make the correct diagnosis in a timely manner, immediately distribute the treatment protocol, and coordinate the laboratory confirmation of barium carbonate poisoning.

Barium carbonate intoxication

A 22-year-old man attempted to commit suicide by swallowing an unknown amount of barium carbonate dissolved in hydrochloric acid. Shortly after ingestion, he developed crampy abdominal pain and generalized muscle weakness. About 2 h later, respiratory failure ensued necessitating orotracheal intubation and mechanical ventilation. Concomitantly, life-threatening arrhythmias including ventricular fibrillation occurred, and he had to be resuscitated for 45 min. After correction of severe hypokalemia (serum potassium 1.5 mmol/l), cardiac rhythm stabilized. In an attempt to accelerate removal of barium from the circulation hemodialysis was begun. During hemodialysis muscle strength returned. Pharmacokinetic analysis of serum barium levels suggest that hemodialysis shortened the serum half-life of barium. Subsequently, the patient made a complete and uneventful recovery. Our case demonstrates that severe barium poisoning can be survived provided that early aggressive therapeutic measures are undertaken. Hemodialysis seems to be efficacious in the therapy of barium intoxication.

Calcium channels in thrombin-activated human platelet membrane

Platelet-activating factor, 5-hydroxytryptamine, thromboxane A2, adenosine diphosphate and thrombin are known to activate platelets by stimulating calcium entry, but the nature of the entry pathways is unknown. We present the identification of single divalent cation channels from thrombin-activated human platelets. Membrane vesicles from unstimulated and thrombin-stimulated human platelets were incorporated in planar bilayers and unitary currents through single channels were measured. Divalent cation selective channels could only be demonstrated in thrombin-stimulated preparations. These channels share a number of properties in common with voltage-dependent calcium channels--a high degree of selectivity for divalent cations, a single channel conductance of about 10 pS (in 150 mM Ba2+) and sensitivity to blockade by inorganic calcium channel blockers such as Ni2+. In other respects, these channels are different as they are not voltage-dependent and are not blocked by 1,4-dihydropyridine calcium channel antagonists.

Acute poisoning by a barium chloride burn

A 62-year-old man sustained a barium chloride burn after his jackhammer penetrated a pocket of molten barium chloride. He subsequently developed signs of systemic barium poisoning including bigeminy and hypokalemia. Treatment consisted of early thorough debridement and intravenous potassium supplementation. Serum barium levels were determined. In a review of the literature these appeared to be the first toxic barium levels to be reported. The literature concerning barium poisoning and its complications is reviewed and related to the clinical presentation and treatment of this chemically burned patient.

Effects of divalent cation ionophore A23187 on potassium permeability of rat erythrocytes

A23187 transports calcium rapidly into rat erythrocytes, apparently by an electroneutral exchange for intracellular magnesium and protons. When red cells are incubated in the absence of any added divalent cations, A23187 transports internal magnesium out of the cells, in exchange for extracellular protons. Magnesium uptake into erythrocytes is produced by A23187, providing the extracellular concentration of this cation exceeds intracellular levels, and the ionophore also transports strontium, but not barium, into red cells. A23187 produces a rapid and extensive loss of intracellular potassium from erythrocytes during uptake of calcium or strontium, but not magnesium. When red cells are incubated in the absence of any exogenous divalent cations, A23187 still produces a potassium efflux and this is inhibited completely by small amounts of ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid and restored by the addition of calcium in excess of the chelator. Although EDTA enhances the extent of magnesium release from erythrocytes incubated with A23187, it prevents the potassium efflux. Dipyridamole and 4-acetamid-4'-isothiocyano-stilbene-2,5'-disulfonic acid, which decrease chloride premeability of erythrocytes, inhibit the A23187-induced potassium loss from red cells. Rutamycin, peliomycin, venturicidin, and A23668B also inhibit potassium efflux from intact cells incubated with A23187, but this effect is not correlated with their abilities to inhibit various ATPases in red cell membrane preparations. It is concluded that A23187 does not transport potassium directly across the erythrocyte plasma membrane, but permits small amounts of endogenous calcium to interact with some membrane component to enhance potassium permeability of the cell.

Barium-induced skeletal muscle paralysis in the rat, and its relationship to human familial periodic paralysis

An in vivo study of skeletal muscle paralysis induced by intravenous barium chloride has been made in curarized and non-curarized rats. The influence of potassium and calcium chlorides, propranolol, ouabain, and prior adrenalectomy on the paralysis has also been studied. Paralysis is found to be due to a direct effect on skeletal muscle, and to correlate well with the development of hypokalaemia. Possible mechanisms of action of barium are discussed, and attention is drawn to the similarity between barium poisoning and hypokalaemic familial periodic paralysis.