Survival of a hemodynamically unstable pediatric liver trauma patient with aortic balloon occlusion catheter during air transport: A case report.

Background: The utility of resuscitative endovascular balloon occlusion of the aorta (REBOA) in children remains unclear. Case Presentation: An 11-year-old patient with liver trauma with massive extravasation was transported to a local hospital, where an emergency trauma surgery was unavailable. Following the placement of REBOA as a bridge to hemostasis, she was transferred to our hospital by a firefighting helicopter with balloon occlusion. Immediately, she underwent damage control laparotomy and transcatheter arterial embolization. She was subsequently discharged from the hospital 6 months after the accident without complications. Conclusion: REBOA as a bridge to hemostasis may be useful for pediatric patients.

Evaluation of the potentials of rice varieties and water management practices for reducing human health risks associated with polluted river water irrigated rice in Bangladesh.

The consumption of arsenic and trace-metal-contaminated rice is a human health concern worldwide, particularly in Bangladesh. In this study, the effects of rice varieties and water management practices on the concentrations of arsenic and trace metals in rice grains were investigated to reduce human health risks related to rice consumption. In addition, the performance of risk reduction using the optimum combination of rice variety and water management practices was quantitatively assessed using Monte Carlo simulation, in which non-carcinogenic and carcinogenic risk distributions under the status quo and the optimum combination were compared. The experimental results revealed that Dular and BRRI dhan45 (rice varieties) cultivated under alternate wetting and drying (AWD) and continuous flooding (CF) conditions showed the lowest hazard quotient (HQ) values for copper, cadmium, and arsenic and the lowest target cancer risk (TR) for arsenic. In Dular and BRRI dhan45 (AWD and CF) varieties, the proportion of the population for which HQs exceeded 1.0 (the reference value) tended to decrease (except for arsenic), compared with populations for which the rice varieties and water management practices were not specified. These results suggest that the use of optimum combinations of rice varieties and water management practices could reduce non-carcinogenic and carcinogenic risks associated with arsenic and trace metals uptake via rice grain consumption by the Bangladeshi people.

Determination of potential dermal exposure rates of phosphorus flame retardants via the direct contact with a car seat using artificial skin.

Dermal exposure to phosphorus flame retardants (PFRs) has received much attention as a major alternative exposure route in recent years. However, the information regarding dermal exposure via direct contact with a product is limited. In addition, in the commonly used dermal permeability test, the target substance is dissolved in a solvent, which is unrealistic. In this study, a dermal permeability test of PFRs in three car seats was performed using artificial skin. The PFR concentrations in the car seats are 0.12 wt% tris(2-chloroethyl) phosphate (TCEP), 0.030-0.25 wt% tris(2-chloroisopropyl) phosphate (TCPP), 0.15 wt% triphenyl phosphate (TPhP), 0.89 wt% cresyl diphenyl phosphate (CsDPhP), 0.074 wt% tricresyl phosphate (TCsP), and 0.46-4.7 wt% diethylene glycol bis [di (2-chloroisopropyl) phosphate (DEG-BDCIPP). The mean skin permeation rates for a contact time of 24 h are 14 (TCEP), 5.4-160 (TCPP), 0.67 (CsDPhP), 0.38 (TPhP), and 3.3-58 ng cm-2 h-1 (DEG-BDCIPP). The concentrations of TCsP in receptor liquid were lower than the limit of quantification at the contact time of 24 h. The skin permeation rates were significantly affected by the type of car seat (e.g., fabric or non-fabric). The potential dermal TCPP exposure rate for an adult via direct contact with the car seat during the average daily contact time (1.3 h), which was the highest value assessed in this study, was estimated to be 16,000 ng kg-1 day-1, which is higher than that related to inhalation and dust ingestion reported as significant exposure route of PFRs in previous studies. These facts reveal that dermal exposure associated with direct contact with the product might be an important exposure pathway for PFRs.

Development of a safety analysis method for volatile organic compounds using 2-phenoxyethanol as solvent.

Indoor volatile organic compounds (VOCs) are usually sampled using active carbon samplers and subsequently analyzed using gas chromatography-mass spectrometry (GC-MS) to assess the exposure risk to workers. Therefore, selection of a suitable solvent for VOC extraction is crucial. However, reports on the use of 2-phenoxyethanol-known for its low vapor pressure and low toxicity-as a solvent for extracting VOCs from activated carbon are lacking. Here, we show that 2-phenoxyethanol is a suitable alternative solvent with low toxicity and can extract a wide variety of VOCs without overlapping with target VOCs on the gas chromatogram. The recoveries of 2-phenoxyethanol were 57% (styrene) to 83% (methyl n-butyl ketone), which were higher than those of CS2, acetone, and n-hexane at room temperature. The recoveries improved to 67% (styrene) to 102% (isopentyl acetate) under 50 °C. Optimization of the GC conditions showed that a viscosity delay time of 3 s was required to avoid producing bubbles in the injection syringes. We selected DB-HeavyWAX as a column because it could be heated above the boiling point of 2-phenoxyethanol (247 °C), allowing the removal of 2-phenoxyethanol from the column. This study contributes to the development of analysis methods for VOCs under safe operating conditions.

Development of an analytical method for indoor polycyclic aromatic hydrocarbons and their halogenated derivatives by using thermal separation probe coupled to gas chromatography-tandem mass spectrometry.

Polycyclic aromatic hydrocarbons (PAHs) and their halogenated derivatives (XPAHs) have been a concern because of their high toxicity. Monitoring indoor PAHs and XPAHs concentrations is important for risk assessment because humans typically spend >90 % of their time indoors. However, the background levels of indoor PAHs and XPAHs concentrations are unknown because of the low sensitivity of conventional analytical methods. In this study, we developed a highly sensitive analytical method using a thermal separation probe (TSP) coupled to a gas chromatograph with a triple quadrupole mass spectrometer method for 26 PAHs and 40 XPAHs. The method quantification limit (MQL) values of the TSP method were 1.1 (3,8-dichlorofluoranthene)-906 (dibenzo[a,e]pyrene) times lower than those of the conventional method. The regression line comparing the TSP and conventional methods was y = (0.944 ± 0.0401)x, which was in good agreement. These results demonstrate that the TSP method can be applied to indoor air analysis. The total concentrations of PAHs and XPAHs were 944 and 73.5 pg m-3 for the house and 735 and 0.924 pg m-3 in the office, respectively. Among the detected compounds, 13 PAHs and XPAHs could not be detected using conventional methods because of their high MQL values. The composition of total toxicity equivalency values in the house was dominated by dibenzo[a,i]pyrene (DBaiP: 43.2 %) and dibenzo[a,h]pyrene (DBahP: 27.1 %), which could not be detected using the conventional method. Therefore, the TSP method can improve the risk assessment of indoor PAHs and XPAHs.

Permissive untreated pseudoaneurysm concept in damage control interventional radiology for traumatic pancreaticoduodenal artery injury.

Background: Angioembolization for traumatic pancreaticoduodenal artery injury with unstable circulation, which characteristically requires a prolonged procedure time, does not yet have a standardized strategy for damage control interventional radiology. Case Presentation: We encountered two cases of rare traumatic pancreaticoduodenal artery injury wherein the patients were saved by a multidisciplinary team with a shared goal of clinical success, rather than the procedural success of angioembolization. Both patients treated with angioembolization had residual pseudoaneurysm or faint extravasation in the pancreaticoduodenal artery arcade. We prioritized critical care with preemptive plasma transfusion and aggressive blood pressure control, and planned repeat angiography. The patients showed no clinical signs of rebleeding or pseudoaneurysm based on computed tomography during follow-up. Conclusion: Our findings suggest that the permissive untreated pseudoaneurysm concept can be useful in developing damage control interventional radiology strategies for trauma cases with challenging time limitations, such as traumatic pancreaticoduodenal artery injury with circulatory collapse.

Myocarditis as an immune-related adverse event following treatment with ipilimumab and nivolumab combination therapy for metastatic renal cell carcinoma: a case report.

BACKGROUND: Immune checkpoint inhibitors are new immunotherapy drugs globally used for many malignancies, including renal cell carcinoma. Myocarditis as an immune-related adverse event is rare but highly fatal, suggesting that its frequency may be higher than reported. This paper describes a case of myocarditis that developed asymptomatically following ipilimumab and nivolumab combination therapy for renal cell carcinoma. CASE PRESENTATION: A 71-year-old Asian man who presented to hospital with fever, fatigue, and weight loss of approximately 10 kg within 2 months was diagnosed with Xp.11.2 translocation renal cell carcinoma. Computed tomography revealed multiple lung masses, mediastinal lymph node enlargement, and a level II tumor thrombus reaching the inferior vena cava (cT3bN0M1; International Metastatic Renal Cell Carcinoma Database Consortium, poor risk). Ipilimumab/nivolumab combination therapy was started as induction therapy. The patient experienced acute interstitial nephritis as an immune-related adverse event after treatment initiation; however, a good response to steroid therapy was observed. The antitumor effect of the immunotherapy was notable. Although he experienced pulmonary embolism, it seemed asymptomatic and harmless; thus, a second infusion was introduced. From the eighth day, he demonstrated rapidly worsening cardiogenic shock with asymptomatic electrocardiographic changes and drastic drop in cardiac biomarkers, and a diagnosis of myocarditis as an immune-related adverse event was made. Although immediate methylprednisolone mini-pulse therapy followed by tapered prednisolone prevented mortality, extensive myocardial fibrosis with marked ejection fraction decline persisted as a sequela. Consequently, follow-up without treatment was instituted; however, much of the tumor response initially observed was maintained over several months. CONCLUSION: Physicians treating patients with immune checkpoint inhibitors should be aware of their potentially life-threatening cardiotoxic effects. This study emphasized the importance of a high index of suspicion, prompt diagnosis, and early intervention in patients who present with cardiac abnormalities and possible myocarditis after receiving immunotherapy.

Occurrence, potential source, and cancer risk of PM2.5-bound polycyclic aromatic hydrocarbons and their halogenated derivatives in Shizuoka, Japan, and Dhaka, Bangladesh.

Because of their unintentional formation and low vapor pressure, polycyclic aromatic hydrocarbons (PAHs) and their halogenated derivatives (XPAHs) in the atmosphere are distributed primarily to aerosolized particles with an aerodynamic diameter less than 2.5 µm (PM2.5). However, no information is available regarding the occurrence of PM2.5-bound PAHs and XPAHs in Bangladesh, one of the most highly PM2.5-polluted regions worldwide. In this study, we investigated the occurrence of PM2.5-bound PAHs and XPAHs in the atmospheres of Dhaka in Bangladesh and Shizuoka in Japan (as a reference) and estimated their incremental lifetime cancer risks (ILCRs). In addition, we statistically estimated the potential sources of PM2.5-bound PAHs and XPAHs by using principal component analysis and positive matrix factorization. The median concentration of total PM2.5-bound PAHs and XPAHs in Bangladesh was 24.2 times that in Japan. The estimated potential sources of PAHs clearly differed between Japan and Bangladesh, whereas those of XPAHs were largely (>80%) unknown in both countries. The median ILCR in Bangladesh was 2.81 × 10-3, which greatly exceeded the upper limit of acceptable risk (10-4). These results indicate that comprehensive monitoring and control of atmospheric PM2.5-bound PAHs and XPAHs are needed urgently, especially in highly polluted countries.

Accurate and ultrasensitive determination of 72 parent and halogenated polycyclic aromatic hydrocarbons in a variety of environmental samples via gas chromatography-triple quadrupole mass spectrometry.

Polycyclic aromatic hydrocarbons (PAHs) and their halogenated derivatives (XPAHs) are ubiquitous in various environmental media. Analytical problems, however, make it difficult to accurately determine their concentrations. To develop a satisfactory analytical method suitable for a diversity of PAHs and XPAHs in multiple environmental samples, we evaluated three commercial analytical columns (DB-5MS, Select PAH, and Rxi-PAH) for better chromatographic separation and optimized the analytical conditions for gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). Comparison of the abilities of the columns to separate peaks revealed that the Rxi-PAH was the best column for both PAH and XPAH analyses. Optimization of analytical conditions for GC-MS/MS resulted in sensitivities for PAHs and XPAHs that were 4.2-fold-2600-fold higher than the sensitivities of GC-high-resolution MS (GC-HRMS) (an example of a traditional analytical method). Although there were no statistically significant differences between the instrumental detection limits (IDLs) of PAHs and XPAHs measured by GC-HRMS, the IDLs of XPAHs were significantly lower than those of PAHs when measured by GC-MS/MS. This difference could be attributed to the unique ionization patterns of XPAHs in the GC-MS/MS analysis, which suppressed background noise and increased the analytical sensitivity. Analyses of PAHs and XPAHs in grilled chicken, vehicle exhaust, sea sediment, ambient air, and indoor dust via the analytical method optimized in this study revealed that the proposed method was sufficiently sensitive, comprehensive, and versatile for risk assessment purposes, and could eliminate interferences associated with the co-elution of target PAHs and XPAHs.

Time Course Changes in Urinary Angiotensinogen and Circulating N-Terminal Pro-B-Type Natriuretic Peptide in Patients Hospitalized with Acute Heart Failure.

Objective Home care is important in patients with heart failure (HF) in order to maintain their quality of life. A biomarker that can be measured noninvasively is needed to optimize the home care of patients with HF. Urinary angiotensinogen (uAGT) is an indicator of the intrarenal renin-angiotensin system activity, which may be augmented in HF. We hypothesized that uAGT might be a urinary biomarker in HF. Methods We measured uAGT by an enzyme-linked immunosorbent assay and uAGT normalized by urinary creatinine (uCr)-designated uAGT/uCr-at admission and discharge in 45 patients hospitalized for HF. Results We found that both uAGT/uCr [median (interquartile range): 65.5 (17.1-127.7) µg/g Cr at admission; 12.1 (6.0-37.0) µg/g Cr at discharge; p<0.01] and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels [5,422 (2,280-9,907) pg/mL at admission; 903 (510-1,729) pg/mL at discharge; p<0.01] significantly decreased between admission and discharge along with an improvement in patient's clinical status [New York Heart Association scores: 3 (3-4) at admission; 1 (1-1) at discharge; p<0.01]. The generalized least squares model revealed that the time course changes in uAGT/uCr also correlated with those in NT-proBNP levels between admission and readmission in five patients readmitted for HF. Conclusion The results indicated that the time course changes in uAGT/uCr correlated with those in the NT-proBNP levels in patients with HF who showed a clinical improvement. Further investigation and development of a kit for the rapid measurement of uAGT are needed to evaluate the clinical utility of uAGT as a biomarker in HF.

Quantification of Brominated Polycyclic Aromatic Hydrocarbons in Environmental Samples by Liquid Chromatography Tandem Mass Spectrometry with Atmospheric Pressure Photoionization and Post-column Infusion of Dopant.

A sensitive method for the quantification of brominated polycyclic aromatic hydrocarbons (BrPAHs) in environmental samples is yet to be developed. Here, we optimized the analytical conditions for liquid chromatography tandem mass spectrometry with atmospheric pressure photoionization and post-column infusion of dopant (LC-DA-APPI-MS/MS). We then compared the sensitivity of our developed method with that of conventional gas chromatography high-resolution MS (GC-HRMS) by comparing the limits of quantification (LOQs) for a range of BrPAHs. Finally, to evaluate our developed method, 12 BrPAHs in sediments and fish collected from Tokyo Bay, Japan, were analyzed; 9 common PAHs were also targeted. The LOQs of the developed analytical method were 14 - 160 times lower than those of GC-HRMS for the targeted BrPAHs. The developed analytical method is a sensitive approach for determining the concentrations of BrPAHs in sediment and fish samples.

Risk assessment of polycyclic aromatic hydrocarbons and their chlorinated derivatives produced during cooking and released in exhaust gas.

Cooking exhaust gas includes polycyclic aromatic hydrocarbons (PAHs) that are unintentionally generated during cooking, which exposes the cook and others in the vicinity to these toxic compounds. However, information on the occurrence of PAHs, particularly their chlorinated derivatives (ClPAHs), in cooking exhaust gas is limited. Here, we determined the concentrations of 12 PAHs and 20 ClPAHs in cooking exhaust gas emitted during gas-grilling of a Pacific saury using a typical Japanese fish grill in an indoor kitchen. The total concentrations of PAHs and ClPAHs in the cooking exhaust gas were 3400 and 19 ng m-3, respectively. All 12 PAHs were detected in the cooking exhaust gas, with phenanthrene (2100 ng m-3), fluorene (630 ng m-3), and anthracene (200 ng m-3) detected at the highest concentrations. Four of the 20 ClPAHs were detected, with 9-monochlorinated phenanthrene detected at the highest concentration (12 ng m-3). The exposure rates for the cook to the PAHs and ClPAHs in the cooking exhaust gas, estimated using the National Institute of Advanced Industrial Science and Technology - Indoor Consumer Exposure Assessment Tool (AIST-ICET), were in the range of 7.2-72 ng-BaPeq kg-1 day-1 (toxic equivalent concentrations relative to the toxicity of benzo[a]pyrene), which was comparable with that for dietary ingestion of cooked foods (54 ng-BaPeq kg-1 day-1). A risk assessment of exposure to PAHs and ClPAHs in cooking exhaust gas in the indoor environment revealed that this gas may pose a health risk to the cook (incremental lifetime cancer risk: 2.1 × 10-6 to 2.1 × 10-5), indicating that further investigations are warranted.

Mitigation of the inhibitory effects of co-existing substances on the Fenton process by UV light irradiation.

Co-existing substances (substances not targeted for degradation) can negatively affect wastewater treatment process performance. Here, we quantitatively evaluated the effects of propanal, a common co-existing substance, on the degradation of the azo-dye Orange II, a common pollutant, by the Fenton process to provide data for the development of measures to reduce the effects of co-existing substances on this wastewater treatment process. Inhibition rate (IR; ratio of the reaction rate constants obtained in the absence and presence of propanal) was calculated to examine the effects of propanal on the degradation of Orange II. The IRs for the Fenton process in the first phase and the second phase were 1.6 and 4.2, respectively. However, addition of ultraviolet irradiation to the Fenton process (i.e., the photo-Fenton process) resulted in a comparable IR for the first phase but a markedly lower IR for the second phase. We attributed this to the improvement of the photo-reduction reaction rate due to complexation of propanal with ferric ions, which compensated for the scavenger effects (the trapping of OH radicals) of propanal. Thus, ultraviolet irradiation reduced the inhibitory effects of propanal on the degradation of Orange II by the Fenton process.

Twelve-lead electrocardiography identifies the therapeutic target of paroxysmal supraventricular tachycardia.

Twelve-lead electrocardiography provides us the clue about the differential diagnosis between atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia.

Probabilistic exposure assessment of aggregate rates of dermal exposure of Japanese women and children to parabens in personal care products.

Parabens (p-hydroxybenzoic acids) are commonly used as preservatives in personal care products. Although the rate of exposure to a single product may be small, it is possible for an individual to have marked exposure to parabens through the use of multiple personal care products (aggregate exposure). To assess the risks associated with aggregate exposure to parabens, we estimated the dermal exposure rate distributions of four major parabens (methylparaben, MP; ethylparaben, EP; propylparaben, PP; butylparaben, BP) in various products for women (>20 years old) and children (1-3 years old) by using the probabilistic exposure assessment tool ConsExpo. Integrated exposure rates were then calculated as the sum of exposure rates for individual products. Aggregate exposure rates for women were 1.2 (median) (0.13 [5%ile], 6.9 [95%ile]), 0.43 (0.029, 3.0), 0.35 (0.032, 1.9), and 0.25 (0.027, 1.2) mg kg-bw-1 day-1 for MP, EP, PP, and BP, respectively. Those for children were 0.47 (0.054, 2.2), 0.11 (0.012, 0.60), 0.13 (0.012, 0.78), and 0.13 (0.0065, 0.85) mg kg-bw-1 day-1 for MP, EP, PP, and BP, respectively. Integrated exposure rates for women were several times those for children. In both cases, personal care products that were applied to larger areas of skin and were used more frequently were more likely to be associated with higher exposure rates. According to the results of a risk assessment using a margin of exposure approach, aggregate rates of exposure to PP and BP, but not MP or EP, were high enough to warrant concern about disruption of the reproductive system.

Development of a Novel Algorithm to Detect Atrial Fibrillation Using an Automated Blood Pressure Monitor With an Irregular Heartbeat Detector.

BACKGROUND: Atrial fibrillation (AF), which contributes to an increased risk of stroke, frequently remains undetected, suggesting an unmet need for easier and more reliable AF screening. The reports on screening AF using an Omron blood pressure (BP) monitor with an irregular heartbeat (IHB) detector show inconsistent results, so the aim of this study was to develop a novel algorithm to accurately diagnose AF with 3 BP measurements using an Omron automated BP monitor with IHB detector.Methods and Results:In total, 303 general cardiac patients were included. Real-time single-lead ECG revealed AF in 44 patients. BP measurement was performed 3 times per patient using the Omron BP monitor HEM-907, and the number of IHBs detected was recorded. Based on these data, we developed the following algorithm: ≥1 IHB is detected during at least 2 of 3 BP measurements and the maximum number of IHBs detected is ≥2. Using this algorithm, we achieved a sensitivity of 95.5% and specificity of 96.5%, for diagnosing AF. CONCLUSIONS: The novel algorithm with 3 BP measurements using the Omron automated BP monitor with IHB detector showed high sensitivity and specificity for diagnosing AF in general cardiac patients.

Unexpected Aldehyde Generation in the Exhaust Gas at Waste Incineration Facilities.

Acid gases generated during the thermal treatment of waste are neutralized using devices, such as bag filters coated with slaked lime. However, residual trace organic substances can react with the highly reactive slaked lime. This study investigates the dynamics of organic substances generated in the bag filter when slaked lime is used in the exhaust gas treatment process. The mechanism of aldehyde generation was clarified using head space gas chromatography mass spectrometer (HS-GC/MS). Results indicated that methanol was converted to formaldehyde at a conversion ratio of 0.097% and ethanol was converted to acetaldehyde at a conversion ratio of 0.260%. In addition, when amines used as emulsifiers during slaked lime production persisted in the matrix, acetaldehyde formed at a maximum concentration of 121 mg/m3. The simulation method developed in this study can be used for the initial evaluation of aldehydes unexpectedly produced in an incineration treatment facility.

Simultaneous determination of polycyclic aromatic hydrocarbons and their chlorinated derivatives in grilled foods.

Polycyclic aromatic hydrocarbons (PAHs) are unintentionally generated in foods that are cooked, and dietary ingestion of these PAHs is regarded as the dominant route of exposure to PAHs. Some chlorinated PAHs (ClPAHs) are more toxic than their corresponding parent PAHs and can also be generated in food during cooking. Knowledge of the concentrations of ClPAHs in cooked foods has been limited by the lack of an adequate analytical method for measuring ClPAH concentrations in cooked foods. In this study, we developed an analytical method for simultaneous determination of PAHs and ClPAHs in lipid-rich foods. The combination of a potassium hydroxide silica gel column and an activated carbon cartridge enabled us to simultaneously measure PAH and ClPAH concentrations in raw and grilled fish and meats. Twelve kinds of PAHs (e.g., fluorene [Fle], phenanthrene [Phe], fluoranthene [Flu], and pyrene [Pyr]) were detected in grilled foods. The concentrations ranged from below the limit of quantitation (

Dermal exposure to plasticizers in nail polishes: An alternative major exposure pathway of phosphorus-based compounds.

Phosphorus-based compounds are used as plasticizers in the manufacture of many products found in the indoor environment. Here we quantitatively investigated dermal exposure to phosphorus-based compounds contained in 45 nail polishes purchased in Japan. The alternative plasticizer triphenyl phosphate (TPhP) was detected in some samples of the nail polishes made in the USA (concentration, 1.1-1.8 wt%). The potential dermal exposure rates for TPhP, estimated using ConsExpo (version 5.0; Dutch National Institute for Public Health and the Environment), were in the range 200 (5%ile)-1700 (50%ile)-5000 (95%ile) ng kg-bw-1 day-1, which is more than 1400 times the reported values for exposure via dust ingestion and inhalation. Thus, dermal exposure via nail polish may be a major route of exposure to TPhP. The margin of exposure range for TPhP was 3.6 × 105-4.1 × 104-1.4 × 104. For comparison, the potential dermal exposure rate range for the conventional plasticizer dibutyl phthalate and the alternative plasticizer acetyl tributyl citrate was 360-3500-14,000 and 430-4100-17,000 ng kg-bw-1 day-1, respectively, and the margin of exposure range was 4.1 × 103-4.2 × 102-1.1 × 102 and 2.3 × 105-2.4 × 104-5.9 × 103, respectively.