Urinary cadmium concentration is associated with the severity and clinical outcomes of COVID-19: a bicenter observational cohort study.

BACKGROUND: Cadmium and nickel exposure can cause oxidative stress, induce inflammation, inhibit immune function, and therefore has significant impacts on the pathogenesis and severity of many diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can also provoke oxidative stress and the dysregulation of inflammatory and immune responses. This study aimed to assess the potential associations of cadmium and nickel exposure with the severity and clinical outcomes of patients with coronavirus disease 2019 (COVID-19). METHODS: We performed a retrospective, observational, bicenter cohort analysis of patients with SARS-CoV-2 infection in Taiwan between June 2022 and July 2023. Cadmium and nickel concentrations in blood and urine were measured within 3 days of the diagnosis of acute SARS-CoV-2 infection, and the severity and clinical outcomes of patients with COVID-19 were analyzed. RESULTS: A total of 574 patients were analyzed and divided into a severe COVID-19 group (hospitalized patients) (n = 252; 43.9%), and non-severe COVID-19 group (n = 322; 56.1%). The overall in-hospital mortality rate was 11.8% (n = 68). The severe COVID-19 patients were older, had significantly more comorbidities, and significantly higher neutrophil/lymphocyte ratio, C-reactive protein, and interleukin-6 than the non-severe COVID-19 patients (all p < 0.05). Blood and urine cadmium and urine nickel concentrations were significantly higher in the severe COVID-19 patients than in the non-severe COVID-19 patients. Among the severe COVID-19 patients, those in higher urine cadmium/creatinine quartiles had a significantly higher risk of organ failure (i.e., higher APACHE II and SOFA scores), higher neutrophil/lymphocyte ratio, lower PaO2/FiO2 requiring higher invasive mechanical ventilation support, higher risk of acute respiratory distress syndrome, and higher 60-, 90-day, and all-cause hospital mortality (all p < 0.05). Multivariable logistic regression models revealed that urine cadmium/creatinine was independently associated with severe COVID-19 (adjusted OR 1.643 [95% CI 1.060-2.547], p = 0.026), and that a urine cadmium/creatinine value > 2.05 µg/g had the highest predictive value (adjusted OR 5.349, [95% CI 1.118-25.580], p = 0.036). CONCLUSIONS: Urine cadmium concentration in the early course of COVID-19 could predict the severity and clinical outcomes of patients and was independently associated with the risk of severe COVID-19.

Influence of chronic obstructive pulmonary disease on long-term hospitalization and mortality in patients with heart failure with reduced ejection fraction.

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to survey the influence of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients. METHODS: We retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis. RESULTS: Of the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. Lower left ventricular ejection fraction was found in the HF and COPD comorbidity group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently associated with a beneficial effect on survival in HF patients with COPD. Oral corticosteroid uses and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode. CONCLUSION: In HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use might relate to a beneficial effect on survival in HF patients with COPD. The use of maintenance oral corticosteroid in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.

A high neutrophil to lymphocyte ratio is associated with poor nutritional status in chronic kidney disease patients.

We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and nutritional parameters in chronic kidney disease (CKD) patients. In this cross-sectional study, 187 non-dialysis CKD patients were enrolled. Daily dietary energy intake (DEI) and daily dietary protein intake (DPI) were assessed by 3-d dietary records. Protein-energy wasting (PEW) was defined as Subjective Global Assessment (SGA) class B and C. Spearman correlation analysis, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. The median NLR was 2·51 (1·83, 3·83). Patients with CKD stage 5 had the highest NLR level. A total of 19·3 % (n 36) of patients suffered from PEW. The NLR was positively correlated with SGA and serum P, and the NLR was negatively correlated with BMI, waist and hip circumference, triceps skinfold thickness, mid-arm muscle circumference, DPI and Hb. Multivariate logistic regression analysis adjusted for DPI, DEI, serum creatinine, blood urea nitrogen, uric acid and Hb showed that a high NLR was an independent risk factor for PEW (OR = 1·393, 95 % CI 1·078, 1·800, P = 0·011). ROC analysis showed that an NLR ≥ 2·62 had the ability to identify PEW among CKD patients, with a sensitivity of 77·8 %, a specificity of 62·3 % and an AUC of 0·71 (95 % CI 0·63, 0·81, P < 0·001). The NLR was closely associated with nutritional status. NLR may be an indicator of PEW in CKD patients.

Comparison of Clinical Characteristics and Outcomes of Hospitalized Patients Infected with the D614G Strain or Alpha Variant of COVID-19 in Taiwan: A Multi-Center Cohort Study.

Objective: Direct comparison of the clinical traits of coronavirus disease 2019 (COVID-19) in strain D614G, which originated from Wuhan, China, and the Alpha variant, which contains 17 mutations, infected patients could help physicians distinguish between strains and make clinical decisions accordingly. This study sought to compare the clinical characteristics and outcomes of the D614G strain and Alpha variant of SARS-COV-2 and identify the predictors for viral RNA clearance and in-hospital mortality in patients with COVID-19. Methods: This study recruited consecutive patients from four hospitals between March 1, 2020, and July 31, 2021. Demographic characteristics, laboratory results, and clinical outcomes were determined. Results: Among the 239 enrolled patients, 11.2% (27/239) were infected with strain D614G and 88.7% (212/239) were infected with the Alpha variant. There were no significant differences in disease progression, rate of respiratory failure, subsequent development of acute respiratory distress syndrome (ARDS), acute kidney injury, cardiac injury, duration of stay in the intensive care unit or hospital, discharge rate, mortality rate, or viral RNA clearance time between the two groups. Multivariate Cox regression revealed that antibiotic therapy reduced the risk of delayed viral RNA clearance (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.13-0.55), while autoimmune disease increased the risk of delayed viral RNA clearance (HR, 3.98; 95% CI, 1.21-13.04). Elderly patients (age > 65 years) and patients with a history of cerebrovascular accident (CVA) were at increased risk of in-hospital mortality (HR, 5.14; 95% CI, 1.06-24.72 and HR, 3.62; 95% CI, 1.25-10.42, respectively). Conclusions: There were no significant differences between the D614G strain and Alpha variant of COVID-19 in terms of clinical characteristics and outcomes. However, factors affecting viral RNA clearance and the risk of in-hospital mortality were identified. These results could help to inform the future prioritization of resource allocation and identify patients in need of intense monitoring.

Clinical outcomes and prognostic factors for prolonged mechanical ventilation in patients with acute stroke and brain trauma.

BACKGROUND/PURPOSE: Neurological dysfunction is a common condition necessitating prolonged mechanical ventilation (PMV). We investigated the clinical features and outcomes of patients with acute neurological diseases requiring PMV. METHODS: This retrospective observational study was conducted at the Respiratory Care Center (RCC) of Chang Gung Memorial Hospital, Taiwan, between January 2011 and January 2014. The main outcome was weaning success, defined as successful withdrawal from mechanical ventilator support for more than 5 days. RESULTS: The study included 103 patients with acute stroke and brain trauma receiving PMV. Weaning success was reported in 63 (61%) patients and weaning failure was reported in 40 (39%) patients. Patients in the weaning failure group were older and had a lower RCC Glasgow Coma Scale (GCS) score (6.0 vs 7.9, p = 0.005), lower albumin level (2.8 vs 3.1, p = 0.015), longer RCC stay (28.7 vs 21.3 days, p = 0.017), and higher in-hospital mortality rate (47% vs 9%, p < 0.01). Multivariate analysis revealed that reduced RCC GCS score is an independent prognostic factor for weaning failure (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.05-1.46, p = 0.016) and that per unit increase of RCC GCS score is associated with a lower risk of in-hospital mortality (OR = 0.83, 95% CI = 0.70-0.96, p = 0.019). CONCLUSION: Reduced RCC GCS score is an independent prognostic factor for weaning failure, and is associated with increased in-hospital mortality rates in patients with acute stroke and brain trauma requiring PMV.

The Clinical Experience of Mycobacterial Culture Yield of Pleural Tissue by Pleuroscopic Pleural Biopsy among Tuberculous Pleurisy Patients.

Background and Objectives: Tuberculous pleurisy is a common extrapulmonary TB that poses a health threat. However, diagnosis of TB pleurisy is challenging because of the low positivity rate of pleural effusion mycobacterial culture and difficulty in retrieval of optimal pleural tissue. This study aimed to investigate the efficacy of mycobacterial culture from pleural tissue, obtained by forceps biopsy through medical pleuroscopy, in the diagnosis of TB pleurisy. Materials and Methods: This study retrospectively enrolled 68 TB pleurisy patients. Among them, 46 patients received semi-rigid pleuroscopy from April 2016 to March 2021 in a tertiary hospital. We analyzed the mycobacterial culture from pleural tissue obtained by forceps biopsy. Results: The average age of the study participants was 62.8 years, and 64.7% of them were men. In the pleuroscopic group, the sensitivity of positive Mycobacterium tuberculosis (M. TB) cultures for sputum, pleural effusion, and pleural tissue were 35.7% (15/42), 34.8% (16/46), and 78.3% (18/23), respectively. High sensitivities of M. TB culture from pleural tissue were up to 94.4% and 91.7% when pleural characteristic patterns showed adhesion lesions and both adhesion lesions and presence of micronodules, respectively. Conclusions: M. TB culture from pleural tissue should be considered a routine test when facing unknown pleural effusion during pleuroscopic examination.

Fine particulate matter (PM2.5/PM1.0) in Beijing, China: Variations and chemical compositions as well as sources.

Particulate matter (i.e., PM1.0 and PM2.5), considered as the key atmospheric pollutants, exerts negative effects on visibility, global climate, and human health by associated chemical compositions. However, our understanding of PM and its chemical compositions in Beijing under the current atmospheric environment is still not complete after witnessing marked alleviation during 2013-2017. Continuous measurements can be crucial for further air quality improvement by better characterizing PM pollution and chemical compositions in Beijing. Here, we conducted simultaneous measurements on PM in Beijing during 2018-2019. Results indicate that annual mean PM1.0 and PM2.5 concentrations were 35.49 ± 18.61 µg/m3 and 66.58 ± 60.17 µg/m3, showing a positive response to emission controls. The contribution of sulfate, nitrate, and ammonium (SNA) played an enhanced role with elevated PM loading and acted as the main contributors to pollution episodes. Discrepancies observed among chemical species between PM1.0 and PM2.5 in spring suggest that sand particles trend to accumulate in the range of 1-2.5 µm. Pollution episodes occurred accompanied with southerly clusters and high formation of SNA by heterogeneous reactions in summer and winter, respectively. Results from positive matrix factorization (PMF) combined with potential source contribution function (PSCF) models showed that potential areas were seasonal dependent, secondary and vehicular sources became much more important compared with previous studies in Beijing. Our study presented a continuous investigation on PM and sources origins in Beijing, which provides a better understanding for further emission control as well as a reference for other cities in developing countries.

Recent advances in porous organic frameworks for sample pretreatment of pesticide and veterinary drug residues: a review.

Rapid and accurate detection of pesticide and veterinary drug residues is a continuing challenge because of the complex matrix effects. Thus, appropriate sample pretreatment is a crucial step for the effective extraction of the analytes and removal of the interferences. Recently, the development of nanomaterial adsorbents has greatly promoted the innovation of food sample pretreatment approaches. Porous organic frameworks (POFs), including polymers of intrinsic microporosity, covalent organic frameworks, hyper crosslinked polymers, conjugated microporous polymers, and porous aromatic frameworks, have been widely utilized due to their tailorable skeletons and pores as well as fascinating features. This review summarizes the recent advances for POFs to be utilized in adsorption and sample preparation of pesticide and veterinary drug residues. In addition, future prospects and challenges are discussed, hoping to offer a reference for further study on POFs in sample pretreatment.

Atmospheric Vanadium Emission Inventory from Both Anthropogenic and Natural Sources in China.

Vanadium is a strategically important metal in the world, although sustained exposure under high vanadium levels may lead to notable adverse impact on health. Here, we leverage a bottom-up approach to quantitatively evaluate vanadium emissions from both anthropogenic and natural sources during 1949-2017 in China for the first time. The results show that vanadium emissions increased by 86% from 1949 to 2005 to a historical peak value and then gradually decreased to 12.9 kt in 2017. With the effective implementation of air pollution control measures, vanadium emissions from anthropogenic sources decreased sharply after 2011. During 2011-2017, about half of vanadium emissions came from coal and oil combustion. In addition, industrial processes and natural sources also cannot be ignored, with the total contributions of more than 24%. The high levels of vanadium emissions were mainly distributed throughout the North China Plain and the eastern and coastal regions, especially in several urban agglomerations. Furthermore, the comprehensive evaluation by incorporating contrastive analysis, Monte Carlo approach, and GEOS-Chem simulation shows that vanadium emissions estimated in this study were reasonable and acceptable. The findings of our study provide not only a scientific foundation for investigating the health effects of vanadium but also useful information for formulating mitigation strategies.

Significant but Spatiotemporal-Heterogeneous Health Risks Caused by Airborne Exposure to Multiple Toxic Trace Elements in China.

Airborne trace elements (TEs) pose a notable threat to human health due to their toxicity and carcinogenicity, whereas their exposures and associated health risks in China remain unclear. Here, we present the first nationwide assessment of spatiotemporal exposure to 11 TEs in China by coupling a bottom-up emission inventory with a modified CMAQ model capable of TE simulation. Associated health risks of 11 TEs are then evaluated using a set of risk assessment models. Our results show that the CMAQ model could reasonably reproduce the spatiotemporal variations of 11 TEs in China compared to observations. We find significant but spatiotemporal-heterogeneous cancer risks associated with high-level exposure of TEs in China. Gridded cell concentrations of hexavalent chromium, arsenic, and nickel in eastern and central China usually exceed China's air quality standard limits, resulting in significant cancer risks that affected over 85% of the entire population in China in 2015. National annual mean population-weighted concentrations of 11 TEs decrease by 9.8-35.6% from 2012 to 2015, largely attributed to emission reduction from coal combustion. Our study provides critical insights for policymakers to implement stricter measures to alleviate health burdens and benefit relevant epidemiological research on airborne TEs.

Cardiorespiratory coupling is associated with exercise capacity in patients with chronic obstructive pulmonary disease.

BACKGROUND: The interaction between the pulmonary function and cardiovascular mechanics is a crucial issue, particularly when treating patients with chronic obstructive pulmonary disease (COPD). Synchrogram index is a new parameter that can quantify this interaction and has the potential to apply in COPD patients. Our objective in this study was to characterize cardiorespiratory interactions in terms of cardiorespiratory coupling (CRC) using the synchrogram index of the heart rate and respiratory flow signals in patients with chronic obstructive pulmonary disease. METHODS: This is a cross-sectional and preliminary data from a prospective study, which examines 55 COPD patients. K-means clustering analysis was applied to cluster COPD patients based on the synchrogram index. Linear regression and multivariable regression analysis were used to determine the correlation between the synchrogram index and the exercise capacity assessed by a six-minute walking test (6MWT). RESULTS: The 55 COPD patients were separated into a synchronized group (median 0.89 (0.64-0.97), n = 43) and a desynchronized group (median 0.23 (0.02-0.51), n = 12) based on K-means clustering analysis. Synchrogram index was correlated significantly with six minutes walking distance (r = 0.42, p = 0.001) and distance saturation product (r = 0.41, p = 0.001) assessed by 6MWT, and still was an independent variable by multivariable regression analysis. CONCLUSION: This is the first result studying the heart-lung interaction in terms of cardiorespiratory coupling in COPD patients by the synchrogram index, and COPD patients are clustered into synchronized and desynchronized groups. Cardiorespiratory coupling is associated with exercise capacity in patients with COPD.

Prognostic Factors in Lung Adenocarcinoma with Bone Metastasis Treated with EGFR-TKIs.

Background and Objectives: Patients who have advanced lung cancer and bone metastasis (BM) often suffer from skeletal-related events (SREs) that lead to poor quality of life and poor prognosis. Our study aimed to investigate the prognostic factors in patients with BM from epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma. Materials and Methods: This retrospective study included 77 lung adenocarcinoma patients with synchronous BM. These patients had first-line EGFR tyrosine kinase inhibitors (EGFR-TKIs) between January 2017 and December 2019. Among them, 42 patients were treated with 120 mg of subcutaneous denosumab monthly. We investigated their baseline characteristics, cancer management, SREs, progression-free survival (PFS), and overall survival (OS). Results: The PFS in the patients treated with or without denosumab were 10.1 vs. 12.5 months (p = 0.971). The median OS was 26.9 vs. 29.5 months (p = 0.967) in no denosumab and denosumab groups, respectively. Univariate analyses showed benefit of afatinib in PFS and good performance status in OS. Conclusion: Those patients that took afatinib as first-line EGFR-TKIs had significantly longer PFS than those treated with other TKIs. Denosumab had no prognostic effect on PFS or OS.

Blood Cadmium Levels and Oxygen Desaturation during the 6-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease.

Background and Objectives: chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and a history of exposure to noxious stimuli. Cigarette smoking is the most important causal factor for developing COPD. Cadmium, a minor metallic element, is one of the main inorganic components in tobacco smoke. Inhaled cadmium was associated with a decline in lung function, gas exchange impairment, and the development of obstructive lung disease. Patients with COPD who had oxygen desaturation during the 6-min walk test (6MWT) had a significantly worse prognosis than non-desaturation in COPD patients. Nonetheless, few studies have addressed the influence of blood cadmium levels on exercise-induced oxygen desaturation in COPD patients. Our objective was to assess the potential impact of blood cadmium levels on oxygen desaturation during the 6MWT among COPD patients. Materials and Methods: we performed a retrospective analysis of patients with COPD who were examined for blood cadmium levels in a tertiary care referral center in Taiwan, between March 2020 and May 2021. The 6-min walk test was performed. Normal control subjects who had no evidence of COPD were also enrolled. Results: a total of 73 COPD patients were analyzed and stratified into the high-blood cadmium group (13 patients) and low-blood cadmium group (60 patients). A total of 50 normal control subjects without a diagnosis of COPD were enrolled. The high-blood cadmium group had a significantly higher extent of desaturation than the low-blood cadmium group. The frequency of desaturation during 6MWT revealed a stepwise-increasing trend with an increase in blood cadmium levels. A multivariable logistic regression model revealed that blood cadmium levels were independently associated with desaturation during the 6MWT (odds ratio 12.849 [95% CI 1.168-141.329]; p = 0.037). Conclusions: our findings indicate that blood cadmium levels, within the normal range, were significantly associated with desaturation during 6MWT in patients with COPD.

Non-Negligible Stack Emissions of Noncriteria Air Pollutants from Coal-Fired Power Plants in China: Condensable Particulate Matter and Sulfur Trioxide.

In this study, we investigated the emission characteristics of condensable particulate matter (CPM) and sulfur trioxide (SO3) simultaneously through ammonia-based/limestone-based wet flue gas desulfurization (WFGD) from four typical coal-fired power plants (CFPPs) by conducting field measurements. Stack emissions of filterable particulate matter (FPM) all meet the Chinese ultralow emission (ULE) standards, whereas CPM concentrations are prominent (even exceed 10 mg/Nm3 from two CFPPs). We find that NH4+ and Cl- increase markedly through the ammonia-based WFGD, and SO42- is generally the main ionic component, both in CPM and FPM. Notably, the occurrence of elemental Se in FPM and CPM is significantly affected by WFGD. Furthermore, the established chemical profiles in FPM and CPM show a distinct discrepancy. In CPM, the elemental S mainly exists as a sulfate, and the metallic elements of Na, K, Mg, and Ca mainly exist as ionic species. Our results may indicate that not all SO3 are included in CPM and they co-exist in stack plume. With the substantial reduction of sulfur dioxide (SO2), S distributed in SO3, CPM, and FPM becomes non-negligible. Finally, the emission factors of CPM and SO3 under typical ULE technical routes fall in the ranges of 74.33-167.83 and 48.76-86.30 g/(t of coal) accordingly.

Migration and Emission Characteristics of Ammonia/Ammonium through Flue Gas Cleaning Devices in Coal-Fired Power Plants of China.

To investigate the up-to-date migration and emission characteristics of NH3/NH4+ in coal-fired power plants (CFPPs) after implementing ultralow emission retrofitting, typical air pollution control devices (APCDs) in CFPPs, including flue gas denitrification, dust collectors, combined wet flue gas desulfurization (WFGD), and wet precipitators are involved in field measurements. The results show that most of the excessive injected and/or unreacted ammonia from the flue gas denitrification system, whether selective catalytic reduction (SCR) or selective noncatalytic reduction (SNCR), is converted into particle-bound NH4+ (>91%), and the rest (less than 9%) is carried by flue gas in the form of gaseous NH3, with a concentration value of 0.15-0.54 mg/(N m3) at the denitrification outlet. When passing through dust collectors, particle-bound NH4+ concentration decreases substantially along with the removal of particle matter. In WFGD, the dissolution and volatilization effects affect the gaseous ammonia concentration, which decreases when using limestone slurry and a 20% solution of ammonia as a desulfurization agent, while liquid ammonia solution with a high concentration (99.8%) may cause the flue gas NH3 concentration to increase considerably by 13 times. Particle-bound NH4+ concentration is mainly influenced by the relative strength of desulfurization slurry scouring and flue gas carrying effects and increases 2.84-116 times through ammonia-based WFGD. Furthermore, emission factors of NH3 for combinations of APCDs are discussed.

Fine particulate matter pollution in North China: Seasonal-spatial variations, source apportionment, sector and regional transport contributions.

Large areas of mainland China have been suffering frequently from heavy haze pollution during the past years, which feature high concentrations of fine particulate matter (PM2.5, particulate matters with aerodynamic diameters less than 2.5 µm) and low visibility. Moreover, these areas manifested strong regional complex pollution characteristics, particularly in North China including Beijing and the five surrounding provinces (BSFP). In this study, by using the localized comprehensive emission inventory of BSFP region in 2012 as an input, the Comprehensive Air Quality Model with Extensions-Particulate Matter Source Apportionment Technology (CAMx/PSAT) was used to assess the seasonal variations and source apportionment of PM2.5 in the highly polluted BSFP region, with a specific focus on the sectoral and sub-regional contributions to PM2.5 in Beijing during winter and summer. Results showed that the PM2.5 concentrations of BSFP region was higher in winter than that in summer. And the heavily polluted area in BSFP region shrinked noticeably in summer, compared with winter. As for source apportionment of PM2.5, residential and remaining industrial sectors constituted the top two sources of PM2.5 mass concentrations in Beijing. In addition, agricultural source represented a major contributor to ammonium, whereas transportation and power sectors constituted major sources to nitrates. In terms of contributions from sub-regions, the local sources ranked as the dominant contributors to PM2.5 in Beijing, while the main external contributions originated from the surrounding areas, such as Hebei and Shandong. Results of daily source apportionment to PM2.5 in Beijing showed that sub-regional long-distance transport became stronger when haze pollution was severe, in which contribution from remaining industrial sector would be higher than that of other periods. The results will allow for an improved understanding of the causes and origins of heavy regional PM2.5 pollution, and thus will benefit the development of effective joint control policies and identification of key polluting emission categories in North China and ultimately serve as references for other highly polluted megacities in the world.

Endotypes of severe allergic asthma patients who clinically benefit from anti-IgE therapy.

BACKGROUND: Omalizumab, a recombinant monoclonal anti-IgE antibody, was developed for the treatment of severe allergic asthma. Not all these patients respond to omalizumab. OBJECTIVE: This study aimed to evaluate whether the proinflammatory cytokine profiles in the severe allergic asthma patients were different between who responded and nonresponded to omalizumab therapy. METHODS: A prospective study was conducted to examine type 2 cytokines and epithelium-derived cytokines in the bronchial tissues by immunohistochemistry, Western blot and PCR analysis among patients with severe allergic asthma before and after omalizumab therapy. RESULTS: Fourteen of 23 patients with unstable severe allergic asthma improved their asthma control after 4 months of omalizumab treatment (Responders), while nine failed to improve (Non-Responders). Most of Responders were type 2-high endotype (12/14) with upregulated expression of IL-33, IL-25 and TSLP in their bronchial tissues, while most of Non-Responders were type 2-low endotype (8/9). Repeated bronchoscopic biopsy was done in nine responders after omalizumab treatment and showed a decline in IL-13, IL-33, IL-25 and TSLP expression in the bronchial tissues. Among 14 Responders who continued omalizuamb treatments to a total 12 months, six patients achieved a well control of asthma (ACT ≥ 23), while eight patients required additional treatment for asthma symptoms and had more rhinosinusitis comorbidities and a mixed eosinophilic and neutrophilic inflammation in their bronchial tissues. CONCLUSION: Most of the severe allergic asthma patients who benefited from omalizumab treatment were IL-33, IL-25 and TSLP aggravated type 2-high endotype. Rhinosinusitis or with a mixed eosinophilic and neutrophilic airway inflammation should be evaluated in patients who partially responded to omalizumab treatment.

Factors affecting survival in patients with endobronchial malignant mass after flexible Bronchoscopic cryotherapy: a cohort study.

BACKGROUND: Malignant endobronchial mass (MEM) has poor prognosis, cryotherapy is reportedly to diagnose MEM, however, the therapeutic role of cryotherapy impacts on survival has not be well addressed. METHODS: Cohort data on post-cryotherapy MEM patients in a university-affiliated hospital between 2007 and 2012 were evaluated. Factors that impact survival of these subjects were analyzed using multivariate regression analysis. RESULTS: During study period, 67 patients (47 males), with median age was 63 years (range, 50-77 and median performance status of 2 (inter-quartile range [IQR], 2-3). Twenty-five had primary lung squamous cell carcinoma, 14 primary had lung adenocarcinoma, seven had metastatic colon adenocarcinoma, four had sarcoma, four had non-small cell lung cancer, four had small cell lung cancer, three had large cell carcinoma, two had lymphoma, one had muco-epidermoid carcinoma, two had esophageal squamous cell carcinoma, and one had metastatic renal cell carcinoma. MEM were observed as follows: 15 at the trachea, 14 at the left main bronchus, 12 at the right main bronchus, 12 at the right upper lobe bronchus, five at the right intermediate bronchus, three at the right lower lobe bronchus, three at the left upper lobe bronchus, two at the left lower lobe bronchus, and one at the right middle lobe bronchus Post-cryotherapy complications included minor bleeding (n = 14) and need for multiple procedures (n = 12); outcomes were relief of symptoms (n = 56), improved performance status (n = 49) and ability to receive chemotherapy (n = 43). After controlling for other variables, performance status improved after cryotherapy (odds ratio [OR] 3.7; p = 0.03; 95% confidence interval [CI] 1.2~10.7) and ability to receive chemotherapy (OR 4.3; p = 0.02; 95% CI 1.4~13.7) remained significant survival factor. Patients who received chemotherapy and cryotherapy had better survival than patients who received only cryotherapy (median, 472 vs. 169 days; log-rank test, p = 0.02; HR 0.37; 95% CI 0.16-0.89). CONCLUSION: Cryotherapy could be useful management of MEM by flexible bronchoscopy. The performance status after cryotherapy improved and caused further chemotherapy possible for the study patients and thereby, improved survival. However, the mechanism in detail of cryotherapy improve survival should be explored in the future.

Effects of Wet Flue Gas Desulfurization and Wet Electrostatic Precipitators on Emission Characteristics of Particulate Matter and Its Ionic Compositions from Four 300 MW Level Ultralow Coal-Fired Power Plants.

To achieve ultralow-emission (ULE) standards, wet electrostatic precipitators (WESP) installed downstream from wet flue gas desulfurization (WFGD) have been widely used in Chinese coal-fired power plants (CFPPs). We conducted a comprehensive field test study at four 300 MW level ULE CFPPs, to explore the impact of wet clean processing (WFGD and WESP) on emission characteristics of three size fractions of particulate matter (PM: PM2.5, PM10-2.5, and PM>10) and their ionic compositions. All these CFPPs are installed with limestone-based/magnesium-based WFGD and followed by WESP as the end control device. Our results indicate that particle size distribution, mass concentration of PM, and ionic compositions in flue gas change significantly after passing WFGD and WESP. PM mass concentrations through WFGD are significantly affected by the relative strength between desulfur slurry scouring and flue gas carrying effects. Concentrations of ions in PM increase greatly after passing WFGD; especially, SO42- in PM2.5, PM10-2.5, and PM>10 increase on average by about 1.4, 3.9, and 8.3 times, respectively. However, WESP before the stack can effectively reduce final PM emissions and their major ionic compositions. Furthermore, emission factors (kg/(t of coal)) of PM for different combinations of air pollution control devices are presented and discussed.

Obstructive sleep apnoea accelerates FEV1 decline in asthmatic patients.

BACKGROUND: Although the prevalence of both obstructive sleep apnoea (OSA) and asthma are both increasing, little is known about the impact of OSA on the natural history of lung function in asthmatic patients. METHODS: A total of 466 patients from our sleep laboratory were retrospectively enrolled. Of them, 77 patients (16.5%) had asthma with regular follow-up for more than 5 years. Their clinical characteristics, pulmonary function, emergency room visits, and results of polysomnography results were analysed. RESULTS: The patients were divided into three groups according to the severity of the apnoea-hypopnea index (AHI). The decline in FEV1 among asthma patients with severe OSA (AHI > 30/h) was 72.4 ± 61.7 ml/year (N = 34), as compared to 41.9 ± 45.3 ml/year (N = 33, P = 0.020) in those with mild to moderate OSA (5 < AHI ≤ 30) and 24.3 ± 27.5 ml/year (N = 10, P = 0.016) in those without OSA (AHI ≤ 5). For those patients with severe OSA, the decline of FEV1 significantly decreased after continuous positive airway pressure (CPAP) treatment. After multivariate stepwise linear regression analysis, only AHI was remained independent factor for the decline of FEV1 decline. CONCLUSIONS: Asthmatic patients with OSA had substantially greater declines in FEV1 than those without OSA. Moreover, CPAP treatment alleviated the decline of FEV1 in asthma patients with severe OSA.