Two cases of MPO-ANCA-positive hypertrophic pachymeningitis mimicking as intracranial infection.

Hypertrophic pachymeningitis (HP) is a rare disorder marked by thickening of the dura mater due to diverse etiologies. MPO-ANCA-positive HP represents a variant of AAV confined to the central nervous system, distinguished by the presence of serum MPO antibodies. Distinguishing HP triggered by MPO-ANCA from other causes can be challenging.In this study, we present two cases of MPO-ANCA-positive HP initially misdiagnosed as intracranial infections. Case 1 underwent surgery for chronic suppurative otitis media, with histopathological findings revealing inflammatory changes without definitive suppuration. He was presumed to have a secondary intracranial infection resulting from the surgery. However, his condition deteriorated despite two weeks of antibiotic and antiviral treatment. Case 2 presented with headache and was initially suspected of having intracranial Brucellosis given his serum Brucella positivity. Despite treatment for brucellosis, his symptoms persisted, and he developed visual and hearing impairments. Both patients were ultimately diagnosed with MPO-ANCA-positive HP, exhibiting serum MPO antibody positivity. Their symptoms showed improvement with glucocorticoid and immunosuppressive therapy.Based on these observations, we propose that MPO-ANCA-positive HP may initially present as intracranial infection. For HP patients presenting with headache, mastoiditis, otitis media, and visual loss, it is imperative to conduct ANCA antibody-related tests to enhance diagnostic precision.

Internal exposure risk based on urinary metabolites of PAHs of occupation and non-occupation populations around a non-ferrous metal smelting plant.

The emission of various metals from non-ferrous metal smelting activities is well known. However, relative investigations on potential occupational exposure of organic pollutants are still limited. Herein, total of 619 human urine samples were collected from workers engaged in smelting activities and residents living near and/or far from the smelting sites, and ten mono-hydroxylated metabolites of polycyclic aromatic hydrocarbons (OH-PAHs) in human urine were determined. The median levels of Σ10OH-PAHs in smelting workers (25.6 ng/mL) were significantly higher (p < 0.01) than that of surrounding residents (9.00 ng/mL) and rural residents as the control (8.17 ng/mL), indicating an increase in occupational PAH exposure in non-ferrous metal smelting activities. The composition profiles of OH-PAH congeners were similar in three groups, in which naphthalene metabolites accounted for 76-82% of the total. The effects of smoking, drinking, gender, BMI, and occupational categories on urinary OH-PAHs were considered. The partial correlation analysis showed an insignificant effect of non-ferrous metal smelting activities on PAH exposure for surrounding residents. In the health risk assessments, almost all smelting workers had cancer risks exceeded the acceptable level of 10-6. This study provides a reference to occupational PAH exposure and reinforce the necessary of health monitoring among smelting workers.

Handwipes as indicators to assess organophosphate flame retardants exposure and thyroid hormone effects in e-waste dismantlers.

Dermal exposure is increasingly recognized as an important pathway for organic pollutant exposure. However, data on dermal exposure are limited, particularly with respect to the health effects. This study evaluated association between organophosphorus flame retardants (OPFRs) in handwipes and internal body burden on workers and adult residents in an electronic waste (e-waste) dismantling area. The impact of dermal exposure to OPFRs on thyroid hormones (THs) served as a biomarker for early effects. Triphenyl phosphate (TPhP) was the most detected compound in handwipes, with median levels of 1180, 200, and 24.0 ng in people identified as e-waste bakers, e-waste dismantlers, and adult residents. Among e-waste dismantlers, TPhP levels in handwipes were positively correlated with paired serum TPhP and urinary diphenyl phosphate (DPhP) levels. In multiple linear regression models controlling for sex, age and smoking, TPhP levels in handwipes of e-waste dismantlers were significantly negatively correlated with three THs used to evaluate thyroid function: serum reverse 3,3',5-triiodo-L-thyronine (rT3), 3,3'-diiodo-L-thyronine (3,3'-T2), and 3,5-diiodo-L-thyronine (3,5-T2). These findings suggest that handwipes can act as non-invasive exposure indicators to assess body burden of dermal exposure to TPhP and health effects on THs of e-waste dismantlers. This study highlights importance of OPFR effect on human THs through dermal exposure.

Atmospheric occurrences of nitrated and hydroxylated polycyclic aromatic hydrocarbons from typical e-waste dismantling sites.

Primitive electronic waste (e-waste) dismantling activities have been shown to be an important emissions source for a variety of toxic organic compounds, including carcinogenic polycyclic aromatic hydrocarbons (PAHs). Previous studies have found that some nitrated PAHs (NPAHs) are more toxic than their parent PAHs, however, little attention has been paid to the formation of PAH derivatives during e-waste processing and there is a lack of comprehensive data from field observations. In this study, the spatial distribution, temporal trends and atmospheric fate of NPAHs and hydroxylated PAHs (OH-PAHs) were investigated at typical e-waste dismantling sites, with monitoring data collected over three consecutive years. Compared to background levels, higher levels of NPAHs and OH-PAHs were found in air samples from an e-waste dismantling industrial park, with their seasonal and annual changes shown to be affected by e-waste dismantling activities. Atmospheric PM2.5 particles were found to have high relative abundances of NPAHs (76.9%-95.1%) and OH-PAHs (73.3%-91.6%), with particle-bound concentrations ranging from 20.1 to 88.8 and 37.1 to 107 pg m-3, respectively. The most abundant NPAH isomers were found to be 9-Nitroanthracene and 2-Nitrofluoranthene, while OH-PAH isomers containing 2-4 rings were predominant. Source identification was performed based on the specific diagnostic ratios of NPAH isomers, confirming that NPAH and OH-PAH emissions have multiple sources, including emissions related to the e-waste dismantling process, atmospheric photochemical reactions and traffic emissions. Further research on the fate of such derivatives and their potential use as markers for source identification, is urgently required.

Liquid-liquid extraction combined with online cleanup for the simultaneous determination of PAHs by GC-MS/MS and their hydroxylated metabolites by LC-MS/MS in human fingernails.

A method was developed for the simultaneous determination of polycyclic aromatic hydrocarbons (PAHs) and their hydroxylated metabolites (OH-PAHs) in human fingernails using liquid-liquid extraction and online purification. After surface decontamination by rinsing with acetone, the fingernails were digested with sodium hydroxide and subjected to liquid-liquid extraction with a mixture of n-hexane and methyl tertbutyl ether. The organic extract was then fractionated using a silica-based solid-phase extraction (SPE) cartridge to obtain a PAH fraction eluted with n-hexane/dichloromethane (v/v, 95:5) and an OH-PAH fraction eluted with dichloromethane/ethyl acetate (v/v, 50:50). The PAH fraction was directly injected into an online gel permeation chromatography-gas chromatography-triple quadrupole tandem mass spectrometry (GPC-GC-MS/MS) system, enabling rapid determination of 16 PAHs. A parallel online SPE liquid chromatography tandem mass spectrometry (LC-MS/MS) method was used to determine 12 OH-PAHs. Validation experiments showed that the recovery of PAH and OH-PAH were within range of 67.4%-105.1% (RSD ≤ 10.1%) and 72.8%-102.3% (RSD ≤ 10.9%), respectively, with limits of quantitation (LOQ) of 0.06-0.8 ng/g and 0.15-3.1 ng/g, respectively. Forty-two human fingernail samples from residents of Southern China were analyzed to establish background PAH and OH-PAH levels in this region. Several PAHs and OH-PAHs were detected, at concentrations of 97.5 to 3,687 ng/g for PAHs and 24.2 to 767 ng/g for OH-PAHs. The dominant homologues were two- and three-ring PAH isomers, notably naphthalene (Nap), fluorene (Flu), and phenanthrene (Phe), as well as the corresponding hydroxylated metabolites 2-OH-Nap, OH-Flu, and OH-Phe. Smoking, consuming barbecued food, and age had no significant effects on PAH exposure, but a larger sample would be required to confirm this finding. The online purification strategy presented here expedites cleanup and purification during analysis of human fingernails and should facilitate non-invasive biomonitoring of PAHs in humans, particularly when analyzing large numbers of samples.

Post-stroke Anxiety Analysis via Machine Learning Methods.

Post-stroke anxiety (PSA) has caused wide public concern in recent years, and the study on risk factors analysis and prediction is still an open issue. With the deepening of the research, machine learning has been widely applied to various scenarios and make great achievements increasingly, which brings new approaches to this field. In this paper, 395 patients with acute ischemic stroke are collected and evaluated by anxiety scales (i.e., HADS-A, HAMA, and SAS), hence the patients are divided into anxiety group and non-anxiety group. Afterward, the results of demographic data and general laboratory examination between the two groups are compared to identify the risk factors with statistical differences accordingly. Then the factors with statistical differences are incorporated into a multivariate logistic regression to obtain risk factors and protective factors of PSA. Statistical analysis shows great differences in gender, age, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level between PSA group and non-anxiety group with HADS-A and HAMA evaluation. Meanwhile, as evaluated by SAS scale, gender, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level differ in the PSA group and the non-anxiety group. Multivariate logistic regression analysis of HADS-A, HAMA, and SAS scales suggest that hypertension, diabetes mellitus, drinking, high NIHSS score, and low serum HDL-C level are related to PSA. In other words, gender, age, disability, hypertension, diabetes mellitus, HDL-C, and drinking are closely related to anxiety during the acute stage of ischemic stroke. Hypertension, diabetes mellitus, drinking, and disability increased the risk of PSA, and higher serum HDL-C level decreased the risk of PSA. Several machine learning methods are employed to predict PSA according to HADS-A, HAMA, and SAS scores, respectively. The experimental results indicate that random forest outperforms the competitive methods in PSA prediction, which contributes to early intervention for clinical treatment.

Occurrence and distribution of typical semi-volatile organic chemicals (SVOCs) in paired indoor and outdoor atmospheric fine particle samples from cities in southern China.

Interest in the potential human health of semi-volatile organic chemicals (SVOCs) in indoor and outdoor environments has made the exposure assessment and source appointment a priority. In this study, paired indoor and outdoor atmospheric fine particle (PM2.5) samples were collected from 15 homes representing five typical urban cities in southern China. Four typical SVOCs, including 16 congeners of polycyclic aromatic hydrocarbons (PAHs), 13 congeners of organophosphorus flame retardants (OPFRs) and 8 congeners of polybrominated diphenyl ethers (PBDEs), as well as tetrabromobisphenol A (TBBPA) and its three debrominated congeners were analyzed. The highest total concentrations were found for OPFRs, followed by PAHs, PBDEs, and TBBPA. The indoor concentrations of two alkyl-OPFR isomers, tributylphosphate (TBP) and tris (2-butoxyethyl) phosphate (TBEP), were 4.3 and 11 times higher, respectively, than those of outdoors (p < 0.05). Additionally, the ratios of indoor to outdoor concentrations of alkyl-OPFR isomers varied greatly, suggesting that these compounds originated mainly from different household goods and products used in individual homes. The outdoor concentrations of PAHs and highly brominated PBDEs (BDE-209) typically exceeded the indoor concentrations. Significant correlations were also found between indoor and outdoor PM2.5 samples for PAHs and BDE-209, indicating that outdoor sources such as vehicle exhausts and industrial activities strongly influence their atmospheric occurrence. Additionally, the concentrations of debrominated TBBPA derivatives were higher than those of TBBPA in over 33% of both indoor and outdoor air particle samples. Nevertheless, our results indicated that inhalation exposure to typical SVOCs posed no non-carcinogenic risks to the human body. Although we observed notable differences in the sources, occurrences, and distributions of typical SVOC congeners, more studies using matched samples are still needed to unambiguously identify important indoor and outdoor sources in order to accurately assess the contributions of different sources and the associated human exposure risks.

Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses.

OBJECTIVES: Lesions limited to the bilateral middle cerebellar peduncles (MCPs) are uncommon. This retrospective study investigated diseases with a proclivity for the bilateral MCPs and explored the associations between their neuroimaging features and clinical findings for the differential diagnosis of such lesions. METHODS: We enrolled 26 patients who were admitted to our department between January 2016 and March 2019 with bilateral MCP abnormalities on magnetic resonance imaging (MRI). The demographic, clinical, and neuroimaging characteristics, and the biomarkers and diagnoses were evaluated. RESULTS: Although all patients exhibited symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted and fluid-attenuated inversion recovery imaging, they were diagnosed with different conditions. Diagnoses included acute cerebral infarction (ACI) (n = 9, 34.62%), Wallerian degeneration (WD) (n = 8, 30.77%), multiple system atrophy (MSA) (n = 6, 23.08%), neuromyelitis optica (NMO) (n = 1, 3.85%), heroin-induced leukoencephalopathy (n = 1, 3.85%), and primary central nervous system lymphoma (PCNSL) (n = 1, 3.85%). Patients with ACI exhibited bilateral MCP-restricted diffusion hyperintensities on diffusion-weighted imaging and corresponding stenosis or occlusion of the vertebrobasilar system. The initial MRI of patients with WD depicted pontine infarctions, while symmetrical MCP lesions were observed on follow-up MRI. Symmetrical MCP lesions, cruciform hyperintensity, and marked atrophy in the posterior fossa were characteristic manifestations of MSA. Longitudinally extensive myelitis affecting more than three vertebral segments on cervical MRI and positive serum AQP4-IgG may be indicative of NMO. Heroin-induced leukoencephalopathy was characterized by extra-symmetrical lesions in the posterior limbs of the internal capsules, while the anterior limbs were spared. PCNSL was indicated by a significant and characteristic "fist" sign on contrast-enhanced MRI. CONCLUSIONS: Bilateral MCP lesions were most frequently observed in cerebrovascular diseases, followed by neurodegenerative diseases, inflammatory diseases, toxic encephalopathies, and lymphomas. Our findings demonstrate that bilateral MCP signal abnormalities are more common in patients with ACI and WD, with fewer degenerative processes than previously believed. The high frequency of WD may be attributed to the specific awareness of this pathology. WD can also present with stage-related restricted diffusion and should not be mistaken for a new infarction. The symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted imaging often raise concern regarding a demyelinating process. Our findings emphasize that neurologists should consider the aforementioned conditions and correlate the specific neuroimaging characteristics and medical history before arriving at the final diagnosis.

Derivatization gas chromatography negative chemical ionization mass spectrometry for the analysis of trace organic pollutants and their metabolites in human biological samples.

Gas chromatography negative chemical ionization mass spectrometry (GC-NCI-MS) is a preferred instrumental approach for the trace and ultra-trace analysis of various toxic organics and their metabolites in human biological fluids. Specifically, the method has played an important role in the highly sensitive and specific quantitative detection of persistent highly halogenated compounds in environmental matrices and biota during the past few decades. However, for the analysis of toxic metabolites with active hydrogen atoms, such as acids, alcohols, and phenolic compounds, from biological matrixes or organics without electronegative atoms or groups, a derivatization step is often needed prior to GC analysis. Such derivatization aims to change the properties of targets to improve their separation, increase their volatility, and enhance the sensitivity of instrumental detection. This review summarizes three derivatization strategies commonly used for GC methods, i.e., alkylation, silylation, and acylation, together with their application combined with GC-NCI-MS for the high sensitivity analysis of toxic organic metabolites in the human body. The advantages and disadvantages of each derivatization method and potential directions for future applications are discussed. Given the broad variety of applications as well as the compound-specific sensitivity for the ultra-trace analysis of target xenobiotics in human biological fluids, subsequent studies are required to develop convenient, faster derivatization procedures and reagents better suited for routine analysis. Graphical abstract.

Insights into biomonitoring of human exposure to polycyclic aromatic hydrocarbons with hair analysis: A case study in e-waste recycling area.

In this study, 96 pairs of hair and urine samples were collected from e-waste (EW) dismantling workers of an industrial park, as well as residents living in surrounding areas. The concentrations of polycyclic aromatic hydrocarbons (PAHs) and hydroxylated PAH metabolites (OH-PAHs) were analyzed . The results show that concentrations of Σ15PAHs ranged from 6.24 to 692 ng/g dry weight (dw) and Σ12OH-PAHs from undetected to 187 ng/g dw in hair external (hair-Ex), and ranged from 31.7 to 738 ng/g dw and 21.6 to 1887 ng/g dw in hair internal (hair-In). There was no significant difference in exposure levels between EW dismantling workers and residents of the surrounding area. For the parent PAHs, the concentrations of Σ15PAHs of hair-In were comparable with those of hair-Ex for all populations except for the child residents. On the contrary, for the OH-PAHs, the concentrations of Σ12OH-PAHs of hair-In were 9-37 times higher than those of hair-Ex for populations. Moreover, the congener profiles of OH-PAHs of hair-In were different from those of hair-Ex, but similar to that of urine. Particularly, 3-OH-Bap, which is a carcinogenic metabolite, was only detected in the hair-In. These results indicate that OH-PAHs in hair-In, just like in urine, are mainly derived from endogenous metabolism and could be considered as reliable biomarkers for PAHs exposure. However, there was almost no significant correlations between hair-In and urine for OH-PAHs. This indicates that more attention should be paid to OH-PAHs when conducting PAHs exposure risk assessment using hair, which will help to obtain more reliable and comprehensive information on health risk assessments.

C-Reactive Protein Can Be an Early Predictor of Poststroke Apathy in Acute Ischemic Stroke Patients.

BACKGROUND: Apathy is a multidimensional syndrome referring to a primary lack of motivation that occurs frequently in survivors of stroke. Higher C-reactive protein (CRP) level was associated with higher apathy scores among Alzheimer disease cases. However, data on the relationship between CRP levels and apathy in patients with stroke are lacking. So, we hypothesized an association between CRP and poststroke apathy (PSA). METHODS: Two hundred ninety-two consecutive patients with stroke were recruited within 7 days after stroke. Apathy symptoms were assessed at baseline and at 1, 3, and 6 months after stoke using the Apathy Evaluation Scale-Clinical (AES-C). Demographic and clinical information were obtained using the National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI) scores, Mini-Mental State Examination (MMSE) scores, Hamilton Depression Scale (HAMD) scores, and Hamilton Anxiety Scale (HAMA) scores. CRP was measured at baseline. The presence and the location of infarcts were evaluated using magnetic resonance imaging. RESULTS: Apathy at baseline was significantly associated with body mass index (BMI), NIHSS, BI, MMSE, HAMD, and CRP (P < .05) upon admission. PSA at 6 months was significantly associated with elevated CRP concentrations, high AES-C score, and low BI score (P < .05) upon admission. The AES-C scores peaked 3 months after stroke, but then abated over 6 months. CONCLUSIONS: CRP, BMI, MMSE, depression, and disability are closely related to apathy during the acute stage of ischemic stroke. Lower BI scores, higher CRP concentrations, and apathy in acute stroke phase increased the risk of PSA at 6 months.

Combined ultrasound with Fenton treatment for the degradation of carcinogenic polycyclic aromatic hydrocarbons in textile dying sludge.

To develop an effective method to remove the toxic and carcinogenic polycyclic aromatic hydrocarbons (CPAHs) from textile dyeing sludge, five CPAHs were selected to investigate the degradation efficiencies using ultrasound combined with Fenton process (US/Fenton). The results showed that the synergistic effect of the US/Fenton process on the degradation of CPAHs in textile dyeing sludge was significant with the synergy degree of 30.4. During the US/Fenton process, low ultrasonic density showed significant advantage in degrading the CPAHs in textile dyeing sludge. Key reaction parameters on CPAHs degradation were optimized by the central composite design as followed: H2O2 concentration of 152 mmol/L, ultrasonic density of 408 W/L, pH value of 3.7, the molar ratio of H2O2 to Fe2+ of 1.3 and reaction time of 43 min. Under the optimal conditions of the US/Fenton process, the degradation efficiencies of five CPAHs were obtained as 81.23% (benzo[a]pyrene) to 84.98% (benz[a]anthracene), and the benzo[a]pyrene equivalent (BaPeq) concentrations of five CPAHs declined by 81.22-85.19%, which indicated the high potency of US/Fenton process for removing toxic CPAHs from textile dyeing sludge.

Levels, composition profiles and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in sludge from ten textile dyeing plants.

As components of synthetic dyes, polycyclic aromatic hydrocarbons (PAHs) are present as contaminants in textile dyeing sludge due to the recalcitrance in wastewater treatment process, which may pose a threat to environment in the process of sludge disposal. In order to evaluate PAHs in textile dyeing sludge, comprehensive investigation comprising 10 textile dyeing plants was undertaken. Levels, composition profiles and risk assessment of 16 EPA-priority PAHs were analyzed in this study. The total concentrations of 16 PAHs (∑16 PAHs) varied from 1463 ± 177 ng g(-1) to 16,714 ± 1,507 ng g(-1) with a mean value of 6386 ng g(-1). The composition profiles of PAHs were characterized by 3- and 4-ring PAHs, among which phenanthrene, anthracene and fluoranthene were the most dominant components. The mean benzo[a]pyrene equivalent (BaPeq) concentration of ∑16 PAHs in textile dyeing sludge was 423 ng g(-1), which was 2-3 times higher than concentrations reported for urban soil. According to ecological risk assessment, the levels of PAHs in the textile dyeing sludge may cause a significant risk to soil ecosystem after landfill or dumping on soil.

Characterization and environmental risk assessment of heavy metals found in fly ashes from waste filter bags obtained from a Chinese steel plant.

The environmental risk of exposure to six heavy metals (Cu, Pb, Zn, Cr, Ni, and Cd) found in fly ashes from waste filter bags obtained from a steel plant was estimated based on the mineralogical compositions, total concentrations and speciation of the metals in the fly ashes. The results indicated that the fly ashes mainly consisted of hematite, magnetite, cyanite, spinel, coesite and amorphous materials. The concentrations of Zn and Pb were much higher than that of other materials. After Zn and Pb, Ni was present in the highest concentration, followed by Cu, Cr and Cd. Each heavy metal was distributed differently in fly ashes. The levels of Zn, Cd and Pb in the active fraction were very high, and ranged from 64.83 to 81.96%, 34.48 to 82.4% and 6.92 to 79.65% respectively, while Cu, Cr and Ni were mainly present in the residual fraction. The risk assessment code (RAC) values of fly ashes showed that the Zn and Cd present in the H3 sample presented a very high risk, with RAC values greater than 50%. The Cu present in the H3 sample, Cd in the H2 sample and Zn in the H4 and H5 samples presented a high risk. The Pb present in the H2 sample, Cd in the H4 sample, Ni in the H1 and H5 samples, and Zn in the H1 sample presented a medium risk. A low risk was presented by the Cu present in the H1, H2, H4 and H5 samples, the Pb in the H1, H3 and H5 samples, the Cd in the H1 and H5 samples, and the Ni in the H2 sample. No risk was presented by Cr in any sample.