Fluorescence kinetics study of twice laser irradiation based HpD-PDT for nonmelanoma skin cancer.

BACKGROUND: Hematoporphyrine injection (HpD)-based photodynamic therapy (HpD-PDT) has emerged as a promising cancer therapy. However, its tumor-targeting ability and metabolokinetics in nonmelanoma skin cancer (NMSC) have not been well explored. Importantly, photodynamic diagnosis is widely used for cancer lesion assessment and positioning to ensure effective therapy, while the photosensitizer metabolic kinetics study is utilized for biosafety assessment and light-protection instruction. These are particularly important for the optimization of therapeutic parameters. OBJECTIVES: In the present study, NMSC patients were subjected to twice laser irradiation-based HpD-PDT strategy. Broadly, the study aimed to assess long-term variations in fluorescence (FL) intensity in vivo in NMSC patients after intravenous (i.v.) administration of HpD, and thus obtain information regarding metabolism, biosafety, and light-protection instruction for HpD during the therapy. METHODS: In vitro experiments were used for the evaluation of absorption and fluorescent characterization of HpD in aqueous solution and cutaneous squamous cell carcinoma (SCC) cells. For in vivo assessment, 20 patients with NMSC, including SCC, basal cell carcinoma (BCC), Bowen disease (BD), extramammary Paget's disease (EMPD), and malignant proliferating tricholemmoma (APT), were recruited, and treated with HpD-PDT. To evaluate the selectivity and pharmacokinetics of HpD in vivo, relative changes in FL intensity for lesional, perilesional, and nonlesional skin of nonmelanoma skin cancer patients, before and after HpD injection, were semiquantitatively analyzed for 1 month, using the FL detection system and Wood's lamp. RESULTS: The absorption and FL spectra were detected and semiquantitatively analyzed in HpD diluted solution and SCC cells after coincubation with HpD. After i.v. administration of HpD in EMPD patients, FL was detected in the skin lesions at 24 hours, and it was characterized by clear edges. Importantly, FL intensity in the skin lesions increased significantly at 48 and 72 hours postinjection, which was suitable for HpD-PDT. After 72 h, it decreased gradually and reached close to the baseline value at 4 weeks postinjection. No severe side effects were observed during HpD injection and the therapy. Urinary tract infection was recorded in one patient (with a previous history of recurrent urinary tract infections) after HpD-PDT, and the patient was cured afterward. Transient light was observed in two patients after HpD-PDT and they soon recovered after therapy. CONCLUSIONS: The present study reported a significant increase in FL intensities at 48 and 72 hours after i.v. administration of HpD in patients with nonmelanoma skin cancers, which indicated accumulation of HpD at the cancer site. Importantly, HpD was found to be safe for NMSC patients. After therapy, FL intensities decreased, which indicated expending and metabolization of HpD. Thus, the results of the present study highlighted the suitability of a twice red-light laser irradiation strategy for the application of HpD-PDT in nonmelanoma skin cancer treatment.

Local production of prolactin in lesions may play a pathogenic role in psoriatic patients and imiquimod-induced psoriasis-like mouse model.

Human prolactin (PRL) is a well-known hormone for pituitary of lactation and reproduction, but it also has immunostimulatory effect in some inflammatory or autoimmune diseases including psoriasis, which has not been well elucidated. This study aimed to determine the relationship between PRL and psoriasis through clinical case-control studies, and explore the function of PRL in the pathogenesis of imiquimod (IMQ)-induced psoriasis-like mouse model. Serum from patients with psoriasis vulgaris (PsV), patients with erythrodermic psoriasis, and healthy controls (HCs) were collected for PRL test. Skin biopsies were collected for PRL, PRL receptors (PRLRs), cytokines mRNA level determination, PRL immunohistochemistry and PRL Western blotting. Mice were divided into four groups (each n = 6): control group (CON), IMQ group, anti-PRL group and solvent group. Anti-PRL group and solvent group mice were treated with PRL antagonist (cabergoline) and the solvent (0.25% methylcellulose) separately. The serum PRL level of PsV patients was significantly higher than that of HCs (P < 0.001). Compared with HCs, the mRNA levels of PRL and Th1/Th17 cytokines in skin lesions increased significantly (P < 0.05), and the PRL protein level was also significantly elevated in the epidermis and dermis of PsV patients. In IMQ-induced psoriasis-like mouse model, the mRNA and protein levels of PRL in skin lesions were significantly higher than CON group (P < 0.01). Comparing to solvent group, serum PRL level and PRL, cytokines mRNA levels in skin lesions all decreased significantly and the skin inflammatory condition was also alleviated obviously in anti-PRL group. This study suggests that local production of PRL is the main resource of PRL in skin lesions and may play an important role in skin inflammatory of psoriasis.

Curcumin-mediated photodynamic therapy for mild to moderate Acne: A self-controlled split-face randomized study.

OBJECTIVE: To evaluate the effectiveness and safety of Curcumin-mediated Photodynamic Therapy (Curcumin-PDT) in the treatment of mild to moderate acne. METHODS: In this randomized split-face controlled study, 11 patients with mild to moderate acne were randomly divided into two groups. One side received a single 445 nm LED light exposure of 36 J/cm2, while the other side received Curcumin-PDT. The process of Curcumin-PDT involves the application of a mask containing 1 % curcumin for 20 min, followed by exposure to 445 nm LED light at 36 J/cm². The treatment consists of sessions spaced every 3 days, with a total of 2 treatments per week, administered continuously for 2 weeks. Efficacy assessment and comparison were conducted on both groups of patients before treatment and 2 weeks after the last treatment, and adverse reactions were observed and recorded. RESULTS: At the 2-week follow-up after the last treatment, the total lesion clearance rates for Curcumin-PDT and monotherapy light were 54.7 ± 21.5 % and 28.1 ± 19.9 %, respectively (P = 0.001). The clearance rates for non-inflammatory lesions were 32.3 ± 25.7 % and 21.9 ± 14.0 % for Curcumin-PDT and monotherapy light sides (P = 0.252), while for inflammatory lesions, the clearance rates were 59.3 ± 28.2 % and 36.5 ± 21.6 % (P = 0.013). Both groups experienced mild erythema after treatment, which subsided within 1-2 h. Two patients developed mild localized pigmentation, which self-resolved after 1 month of follow-up. Both groups did not exhibit edema, crust formation, scaling, pigment reduction, or scarring. CONCLUSION: Curcumin-PDT can be considered a safe and effective method for the treatment of mild to moderate acne.

A prospective, split-face, randomized controlled trial of intense pulsed light-photodynamic therapy for seborrhea.

BACKGROUND: Seborrhea poses a common cosmetic concern in adolescents and young adults, often accompanied by enlarged pores, and contributing to various skin conditions, including acne vulgaris and seborrheic dermatitis. At present, there is a lack of effective treatment for this problem, and the potential of photodynamic therapy (PDT) in reducing sebum remains inconclusive. OBJECTIVE: This exploratory, prospective, single-center, double-blinded, randomized split-face controlled trial aimed to compare the efficacy and safety of intense pulsed light-photodynamic therapy (IPL-PDT) versus IPL therapy for seborrhea. METHODS: Participants with seborrhea underwent 3 times of IPL treatment (590 nm, 15-17 J/cm2 based on patient's tolerance) for one hemifacial part and IPL-PDT treatment for the other. Follow-up assessment was conducted up to 8 weeks after the final treatment. RESULTS: Compared with single IPL treatment, IPL-PDT can significantly inhibit sebum secretion and decrease pore size. PDT group exhibited no additional damage to the skin barrier, with even lower transepidermal water loss (TEWL). Additionally, the PDT group showed superior improvement in scores of porphyrins, red areas, and ultraviolet (UV) spots. Both groups experienced only mild topical adverse effects, well tolerated by the participants. CONCLUSION: IPL-PDT is a more effective method than IPL in the treatment of seborrhea, as well as on the improvement of the skin barrier function.

Vigilance estimation using truncated l1 distance kernel-based sparse representation regression with physiological signals.

BACKGROUND: With a large number of accidents caused by the decline in the vigilance of operators, finding effective automatic vigilance monitoring methods is a work of great significance in recent years. Based on physiological signals and machine learning algorithms, researchers have opened up a path for objective vigilance estimation. METHODS: Sparse representation (SR)-based recognition algorithms with excellent performance and simple models are very promising approaches in this field. This paper aims to study the adaptability and performance improvement of truncated l1 distance (TL1) kernel on SR-based algorithm in the context of physiological signal vigilance estimation. Compared with the traditional radial basis function (RBF), the TL1 kernel has good adaptiveness to nonlinearity and is suitable for the discrimination of complex physiological signals. A recognition framework based on TL1 and SR theory is proposed. Firstly, the inseparable physiological features are mapped to the reproducing kernel Krein space through the infinite-dimensional projection of the TL1 kernel. Then the obtained kernel matrix is converted into the symmetric positive definite matrix according to the eigenspectrum approaches. Finally, the final prediction result is obtained through the sparse representation regression process. RESULTS: We verified the performance of the proposed framework on the popular SEED-VIG dataset containing physiological signals (electroencephalogram and electrooculogram) associated with vigilance. In the experimental results, the TL1 kernel is superior to the RBF kernel in both performance and kernel parameter stability. CONCLUSIONS: This demonstrates the effectiveness of the TL1 kernel in distinguishing physiological signals and the excellent vigilance estimation capability of the proposed framework. Moreover, the contribution of our research motivates the development of physiological signal recognition based on kernel methods.

Analysis of Altered Brain Dynamics During Episodic Recall and Detection of Generalized Anxiety Disorder.

Numerous blood oxygenation level-dependent (BOLD) imaging studies have shown that generalized anxiety disorder (GAD) can lead to abnormal activation of specific brain regions in patients. However, these methods lack sufficient temporal resolution to explain the underlying brain dynamics of GAD. The electroencephalogram (EEG) microstate allows us to explore brain dynamics at the subsecond level. We performed microstate analysis and source localization on the EEG data of 15 GADs and 14 healthy controls (HCs). We found two kinds of noncanonical microstate topologies (MS-4 and MS-5) in the episodic recall tasks. Compared with HCs, the duration and coverage of MS-5 were significantly reduced in GADs and positively correlated with the GAD-7 scores. The results of source localization showed obvious activation in the prefrontal lobe, parietal lobe, temporal lobe, and fusiform gyri. Moreover, we propose an improved capsule network to capture EEG spatial features and combine them with temporal parameters of microstates for more reliable GAD detection. The sensor-level EEG data and the source-level EEG data obtained by source reconstruction are used as input to the model. The optimal configuration combined the spatial features of source-level data with microstate features and achieved the highest classification accuracy. Collectively, the statistical results indicated remarkable differences in dynamic brain parameters between the two groups, and patients with GAD may have abnormalities in their higher sensory cortex that affect the processing of anxiety signals. Furthermore, our proposed fusion framework provides a reliable method for GAD automatic detection.

[Development of animal model for lung injury in rats caused by unknown polymer via intratracheal instillation].

OBJECTIVE: To establish an animal model of lung injury in SD rats using intratracheal instillation of unknown polymer and to provide the base for exploring the molecular mechanism of lung tissue injury induced by occupational exposure. METHODS: One hundred forty SD rats were randomly divided into seven groups, including the control group 1 which was exposed to normal solution, the control group 2 which was not exposed to any one and five treatment groups which were exposed to 1 ml unknown polymer (0.5 ml for each lung) at the doses of 40, 30, 20, 10 and 5 mg/ml, respectively by intratracheal instillation. The rats were sacrificed on the 1st, 3rd, 7th, 10th, 14th, 21th and 28th day after exposure, then the lung tissues were examined pathologically and the blood bio-chemical analysis was conducted. RESULTS: The results of blood biochemical analysis indicated that ALT and AST levels in rats exposed to 30 and 40 mg/ml unknown polymer were significantly higher than those in control groups. Intratracheal instillation of unknown polymer can causes PLF in experimental animals on the 14th days after exposure. The results of pathological examination exhibited that the lung tissue injury in rats exposed to unknown polymer for 14 days or more was found and the dose-effect relationship was observed. CONCLUSION: An animal model of lung injury in SD rats induced by unknown polymer with intratracheal instillation was established successfully. The results of pathological examination showed that the types of rat lung injury were similar to the clinical lung injury after exposure to unknown polymer, which provided a base for studying the mechanism of lung injury caused by occupational exposure to unknown polymer.

Remodeling Lymphatic Vessels in Intrinsically Aged Skin on SKH-1 Mouse Using Low Dose 5-aminolevulinic Acid Photodynamic Therapy via VEGF-C/VEGFR3 Pathway.

BACKGROUND: Decline of lymphatic vessel (LV) density and function in intrinsically aged skin can lead to harmful substance accumulation and fluid imbalance. Whether it will be improved by low dose ALA-PDT needs to be investigated. AIMS: To investigate the effect of low dose ALA-PDT on remodeling LVs in intrinsically aged skin. METHODS: Low dose ALA-PDT with 3 sessions were applied on the dorsal skin of intrinsically aged SKH-1 mice (15 months old). Skin biopsies were obtained from young mice (4 months old, Young-control), intrinsically aged mice before PDT (Old-pre-PDT), and after PDT at different time points (Old-PDT-24h, Old-PDT-1w, Old-PDT-4w), and skin phenotypes were evaluated by dermoscopy. The structure of LVs and extracellular matrix were evaluated via immunofluorescence staining and HE. The drainage function of LVs was evaluated by Evans Blue assay in vivo. The expression of Calcium-binding EGF domain-containing protein 1 (CCBE1), VE-cadherin, and the activation of VEGF-C/VEGFR3 signaling pathway were evaluated by ELISA and Western Blot. RESULTS: The density of LVs decreased and the lymphatic clearance was significantly delayed in aged skin. Low dose ALA-PDT increased the density of LVs and blood vessels. The clearance of Evans Blue assay showed the drainage function of LVs was improved after PDT treatments in vivo. The VE-cadherin and VEGF-C/VEGFR3 pathway up-regulated in intrinsically aged skin after ALA-PDT treatments. CONCLUSIONS: LVs in intrinsically aged skin were remodeled and their function were restored by low dose ALA-PDT via up-regulating the VEGF-C/VEGFR3 pathway and stimulating the expression of VE-cadherin.

Photodynamic therapy of intravenous injection combined with intratumoral administration of photosensitizer in squamous cell carcinoma.

Cutaneous squamous cell carcinomas (cSCC) is one of the most common types of non-melanoma skin cancer (NMSC), and surgical excision is the primary regimen in most cases. However, in some circumstances of special lesion locations like lips, eyelids or vulva, old age or patient choice non-surgical therapy may be alternative. This is a case of one 93-year-old female cSCC patient who declined surgery. Treatment of hematoporphyrin derivatives photodynamic therapy (HpD-PDT) consisting of both intravenous and topical photosensitizers plus red light irradiation was prescribed. Clinical remission was achieved without evidence of recurrence and most cosmetic function was preserved.

Efficacy and safety of HpD-PDT for Extramammary Paget's Disease refractory to conventional therapy: A prospective, open-label and single arm pilot study.

BACKGROUND: Extramammary Paget's Disease (EMPD) is an intraepithelial cancer that is prone to recurrence and sometimes refractory to therapy. A few EMPD cases have been treated with Photodynamic therapy (PDT), which reported high complete remission (CR) rates and low recurrence with hematoporphyrin derivatives (HpD) The aim of this study was to further explore the efficacy and safety of HpD-PDT for EMPD patients. METHODS: Open-label, single arm, pilot study was designed to investigate the role of HpD-PDT in EMPD. The HpD sensitizer was given intravenously at a dose of 3 or 5 mg/kg 48 h before light irradiation with a laser 630 nm red light at a dose level of 150-200 J/cm2. Clinical parameters involving gender, age, disease course, previous treatment, tumor thickness, long diameter of lesion, TNM staging, EMPD staging, HpD dosage, Visual Analogue Scale (VAS) score, 1st month visit result, subsequent treatment, follow up period and endpoint outcomes were collected to evaluate efficacy and safety of the intervention. RESULTS: Eleven patients with pathologic confirmed EMPD were treated with HpD-PDT. The thickness of skin lesions which were located in vulva, penis, scrotum, and perianal area is 0.8∼6.7 mm (mean thickness 2.9 mm). All patients were followed up for an average of 17.4 months (12∼27 months). Complete remission (CR) rate and partial remission (PR) rate at the 1st month were 90.1% (10/11) and 9.1% (1/11) respectively. At the end of follow-up, 72.7% of the subjects (8/11) showed CR. Pain, infection, photosensitivity and uroschesis are recorded as adverse events (AEs) in this population, and no event of hepatic impairment was reported. After treatment, all the eleven patients showed different degrees of scar in the treatment site, but none of them had any structural or functional abnormalities. CONCLUSIONS: According to our study, HpD-PDT in EMPD is able to offer acceptable disease outcomes including relatively high CR rate, with good cosmetic and functional outcomes, and could be considered a potential recommended therapy for patients with EMPD. TRIAL REGISTRATION: Chinese Clinical Trial Register (ChiCTR-1900024965).

[Effect of oxygen therapy on the morphology of cardiac muscle, lung and liver in rats with acute hydrogen sulfide intoxication].

OBJECTIVE: To evaluate the effects of different oxygen therapy technique (different concentrations of normobaric oxygen and the hyperbaric oxygen) on the ultrastructure of cardiac muscle, lung and liver in rats with acute hydrogen sulfide intoxication. METHODS: One hundred healthy male Wistar rats were randomly divided into five groups: normal control group (A), poisoned group (B), oxygen therapy group (C), oxygen therapy group (D) and oxygen therapy group (E). After the exposure to 300 ppm H2S for 60 min in a static exposure tank (1 m3), the rats were treated with oxygen therapy, C, D and E groups were given 33% oxygen, 50% oxygen of atmospheric oxygen and hyperbaric oxygen therapy for 100 min, respectively. The rats in normal control group inhaled air under the same environment. After exposure and therapy, the tissues of lung, heart and liver were observed under light microscope and electron microscope. RESULTS: The results of light microscope examination showed that the broken and not well aligned cardiac myofilaments, cytoplasmic edema and pyknosis could be seen in group B. The well aligned and clear cardiac myofilaments appeared in group C, D and E. The alveolar hemorrhage, edema and inflammatory cells exudation could not be seen in group A. Alveolar epithelial cell edema, unsmooth alveolar edge and alveolar inflammatory cells exudation could be found in group B. The unsmooth alveolar septal borders and pulmonary edema could be seen occasionally in group C and D, the alveolar inflammatory cells exudation could not be seen in group E. The regular hepatic boards and the uniform hepatic cellular nuclei were found in group A. The disordered hepatic boards, widened cellular gaps and cytoplasmic edema could be seen occasionally in group B. The irregular hepatic boards and ballooning degeneration could be seen in group C and D. The regular hepatic boards and uniform cytoplasm could be found in group E. The results of electron microscope examination indicated that the mitochondrial swelling, autolyzing, fuzzy and breakage of myocardial cells were observed in group B; the clear mitochondrial structure appeared in group E. The apoptosis and organelle vacuole of alveolar epithelial cells could be observed in group B. The relatively normal nuclei of alveolar epithelial cells could be seen in group E. The lax cytoplast structure of hepatocytes, unclear nuclear membrane, lumped chromatin, slightly swelled mitochondria and phagosomes were observed in group B. However, no improved change was observed in group C, D and E. CONCLUSION: Hydrogen sulfide could induce the extensive and severe damage of myocardial mitochondria, alveolar epithelial cells and hepatocytes, the oxygen therapy in good time could reduce significantly the myocardial injury, and improve the lung injury to some extent. High-pressure oxygen therapy is better than the normobaric oxygen therapy.

Bimodal photodynamic therapy for treatment of a 91-year-old patient with locally advanced cutaneous basal cell carcinoma and postoperative scar management.

Locally advanced basal cell carcinoma (laBCC) is an uncommon cutaneous malignant tumor characterized by direct spread and extensive tissue destruction. The optimal therapy for laBCC remains a challenge, especially for elderly patients. Photodynamic therapy (PDT) has its advantage of better tumor selectivity, providing focal treatment for various non-melanoma carcinomas. We report that a new combination treatment of HiPorfin-photodynamic therapy (HiPorfin-PDT) and modified topical 5-aminolevulinic acid-photodynamic therapy (ALA-PDT), named bimodal PDT was successful to treat a 91-year-old patient with laBCC. As for side effects, hypertrophic scar and pain were observed. The symptoms were relieved after intralesional corticosteroid, 980 nm laser and 595 nm pulsed dye laser treatment in 3 months.

Hematoporphyrin monomethyl ether-mediated photodynamic therapy temporarily relieves severe pruritis from phakomatosis pigmentovascularis: A case report.

Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome characterized by (a) capillary malformations, such as port-wine stain (PWS), and (b) pigmented lesions, such as pigmented trichoepidermal nevus, café-au-lait spots, and dermal melanocytosis with or without systemic damage. Severe pruritus has not previously been reported among PPV patients. Here, we report a pediatric case of PPV with severe pruritus, which was refractory to various long-term oral antiallergic agents and topical tacrolimus but was temporarily responsive to hematoporphyrin monomethyl ether-mediated photodynamic therapy (HMME-PDT). HMME-PDT is the latest technology used in treating PWS following the basic principle of targeted photodynamic destruction of the vascular wall of the lesion. Furthermore, many studies have confirmed the safety and efficacy of HMME-PDT for PWS in both adults and children. Specific pathophysiologic mechanisms and treatment methods must be further explored to advance our understanding of the disease and improve the quality of life in PPV patients.

fNIRS Evidence for Distinguishing Patients With Major Depression and Healthy Controls.

In recent years, major depressive disorder (MDD) has been shown to negatively impact physical recovery in a variety of patients. Functional near-infrared spectroscopy (fNIRS) is a tool that can potentially supplement clinical interviews and mental state examinations to establish a psychiatric diagnosis and monitor treatment progress. Thirty-two subjects, including 16 patients clinically diagnosed with MDD and 16 healthy controls (HCs), participated in the study. Brain oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) responses were recorded using a 22-channel continuous-wave fNIRS device while the subjects performed the emotional sound test. This study evaluated the difference between MDD patients and HCs using a variety of methods. In a comparison of the Pearson correlation coefficients between the HbO/HbR responses of each fNIRS channel and four scores, MDD patients and HCs had significantly different Athens Insomnia Scale (AIS) scores. By quantitative evaluation of the functional association, we found that MDD patients had aberrant functional connectivity compared with HCs. Furthermore, we concluded that compared with HCs, there were marked abnormalities in blood oxygen in the bilateral ventrolateral prefrontal cortex (VLPFC) and bilateral dorsolateral prefrontal cortex (DLPFC). Four statistical-based features extracted from HbO signals and four vector-based features from both HbO and HbR served as inputs to four simple neural networks (multilayer neural network (MNN), feedforward neural network (FNN), cascade forward neural network (CFNN) and recurrent neural network (RNN)). Through an analysis of combinations of different features, the combination of 4 common features (mean, STD, area under the receiver operating characteristic curve (AUC) and slope) yielded the highest classification accuracy of 89.74% for fear emotion. The combination of four novel feature (CBV, COE, |L | and K) resulted in a classification accuracy of 99.94% for fear emotion. The top 10 common and novel features were selected by the ReliefF feature selection algorithm, resulting in classification accuracies of 83.52% and 91.99%, respectively. This study identified the AUC and angle K as specific neuromarkers for predicting MDD across specific depression-related regions of the prefrontal cortex (PFC). These findings suggest that the fNIRS measurement of the PFC may serve as a supplementary test in routine clinical practice to further support a diagnosis of MDD.

Alteration of saliva and serum concentrations of manganese, copper, zinc, cadmium and lead among career welders.

Human saliva offers a unique noninvasive approach for populational study. Purposes of this study were to investigate the feasibility of using saliva manganese (Mn) concentration as a biomarker of Mn exposure among career welders and to study the variations of Mn, copper (Cu), zinc (Zn), cadmium (Cd), and lead (Pb) in saliva as affected by the welding profession. Forty-nine male welders, of whom 28 were in the low exposed group and 21 in the high exposed group, were recruited. Control subjects were 33 military soldiers without metal exposure. Ambient Mn levels in breathing zones were 0.01, 0.24 and 2.21mg/m(3) for control, low, and high exposed groups, respectively. Saliva samples were collected to quantify metals by inductive coupled plasma mass spectrometer (ICP-MS). Saliva concentrations of Mn and Cu were significantly higher in welders than in controls (p<0.01); the variation in saliva levels appeared likely to be associated with airborne Mn levels among study populations. Saliva levels of Zn were significantly lower in welders than in controls (p<0.05), while Cd and Pb levels in saliva were unchanged. Significant associations were observed between saliva and serum for Mn (r=0.575, p<0.05) and Cu (r=0.50, p<0.05). Moreover, saliva Mn concentrations were higher among welders with 5-10years of employment than those with less than 5years of employment. Linear regression analysis revealed a significant correlation between saliva Mn and Cu and between saliva Mn and Zn. Taken together, these data suggest that Mn concentrations in saliva appear reflective of welders' exposure to airborne Mn and their years of welding experience, respectively. Elevated Mn levels among welders may alter the homeostasis of Cu and Zn.

[Clinical study on pneumoconiosis with pulmonary thromboembolism].

OBJECTIVE: To probe into the clinical features and the rescue of pneumoconiosis with pulmonary thromboembolism (PTE). METHODS: 26 patients with pneumoconiosis and PTE, male 16, female 10, were collected from June 2002 to June 2006 and 42 patients only with pneumoconiosis served as control. Tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), thrombomodulin (TM), plasma protein S, C (Ps, Pc), homocysteine (Hcy) were measured by the methods of ILISA, and antithrombin (AT-III) by chromo substrate method before and after the treatment of heparin. RESULTS: The average age of patients with pneumoconiosis and PTE was 66.0 +/- 11.9 years old. The number of patients with pneumoconiosis of degree 1, 2, 3 was 3, 16 and 7 respectively. After anticoagulant therapy of heparin, 23 were well improved, and 3 died of acute respiratory failure. Dyspnea, chest pain, hemoptysis, syncope were the conspicuous symptoms. The levels of D-Dimer (0.63 +/- 0.14 mg/L), TM (5.02 +/- 1.24 microg/L) were significantly higher than those of the control (P < 0.05), and significantly lower again after the treatment (P < 0.05). The level of AT-III (96.68 +/- 7.23%) was significantly lower than that of the control, and higher again after the treatment (P < 0.05). CONCLUSION: PTE is often developed in the elder patients with high degree of pneumoconiosis (> or = 2 degree). Clinical features are complicated and non-specific, with the high negative ratio of D-Dimer (7/26), high mortality and high complications of anticoagulant therapy.

Severe acute arsine poisoning treated by plasma exchange.

INTRODUCTION: Exposure to arsine gas can cause fatal hemolysis and multiorgan damage. Whole blood exchange transfusion and hemodialysis have been recommended to treat severe acute arsine poisoning, but are associated with significant complications and sub-optimal outcomes. Plasma exchange is another method of blood purification technique but there are no data on its use in acute arsine poisoning. This retrospective study evaluated the clinical and effects and arsenic clearance from the use of plasma exchange treatment of patients with acute arsine poisoning. METHODS: Data from patients with severe acute arsine poisoning, treated with plasma exchange from December 2000 to December 2005 were collected and analyzed. Measured laboratory factors, performed before and after plasma exchange treatment included routine biochemistry and hematology tests as well as arsenic concentrations in blood, urine, and discarded plasma. RESULTS: During the study period, 12 patients with severe acute arsine poisoning were treated with plasma exchange. Plasma exchange was performed one or two times on each patient, during which the replacement fluid was fresh frozen plasma (total volume ranged from 1,400 to 4,000 mL). The range of concentrations of arsenic in discarded plasma was 27.7 to 88.7 mg/L and the range of total arsenic removed by plasma exchange was 55.4 to 177.4 mg. Plasma exchange appears to rapidly terminate arsine-induced hemolysis and favorably modify damage to the kidneys and other organs. Laboratory factors that showed significant association with treatment response were creatine kinase, lactate dehydrogenase, blood urea nitrogen, total bilirubin, and heart-related enzymes. All patients recovered from the poisoning and were in good condition at a 2 to 3 months follow-up. CONCLUSIONS: Plasma exchange appears to be an effective treatment intervention for patients with severe acute arsine poisoning. It is suggested that it be used as early as possible.

[The etiology and rescue modalities of 1692 cases of acute chemical poisoning].

OBJECTIVE: To investigate the etiology and characteristics of rescue of acute chemical poisoning. METHODS: A total of 1692 cases of acute chemical poisoning were analyzed retrospectively. The kinds of chemicals, the modes of exposure, the characteristics of poisoning and the methods of treatment were analyzed. RESULTS: Poisoning was due to occupational exposure to chemicals in 44.91%, daily life exposure to chemicals in 38.82% and environment chemical pollution in 16.25% of the cases. The total number of chemicals harming the patients was 173. The most common three of the chemicals were pesticides, harmful gases and organic solvents. Recently, the accidents of mass poisoning were increasing in number. CONCLUSIONS: To know the numerous chemicals responsible for acute chemical poisoning is essential for enhancing the pre-hospital care, emergency treatment and follow-up treatment. Further more, extensive clinical knowledge and numerous biologic laboratory tests are need to improve the diagnosis and rescue of acute chemical poisoning. In cases of chemical emergency that involves mass exposure, the majority of the affected persons are likely to be exposed to the poisoning chemicals, though some are exposed minimally. Moreover, resources to provide psychological support must be available both for the family member of casualties and the affected personnel.