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.

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.

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.

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 (

Comparison of rates of direct and indirect migration of phosphorus flame retardants from flame-retardant-treated polyester curtains to indoor dust.

In this study, the pathways for migration of phosphorus flame retardants (PFRs), tris(1,3-dichloroisopropyl) phosphate (TDCPP) and tricresyl phosphate (TCsP) which were detected from curtains often, from flame-retardant-treated polyester curtains to indoor dust were investigated. Two possible migration pathways were compared quantitatively: (1) an indirect pathway in which the PFRs in the curtains first evaporate from the curtains and are then adsorbed onto indoor dust and (2) a direct pathway in which the PFRs are directly transferred to dust placed on the curtains. The contribution of the indirect pathway was evaluated by means of emission cell tests, which showed that the area-specific emission rates from curtains treated with PFRs were 0.044 (TDCPP, Curtain 5), 0.17 (TDCPP, Curtain 8), and 0.060 (TCsP, Curtain 12) µg m-2 h-1 at 20 °C (averaged during 24 h). The contribution of the direct pathway was evaluated by measurement of the time dependence of PFR concentrations on the indoor dust placed on the curtains. These measurements indicated that PFR concentrations on the dust increased with time and that the direct migration rates of PFRs from curtains treated with PFRs were 4.4 (TDCPP, Curtain 5), 12 (TDCPP, Curtain 8), and 7.0 (TCsP, Curtain 12) µg m-2 h-1 at 20 °C (averaged during 24 h), or 71-120 times the indirect migration rate. This result suggests that the direct pathway can be expected to predominate.

Methods for the analysis of organophosphorus flame retardants-Comparison of GC-EI-MS, GC-NCI-MS, LC-ESI-MS/MS, and LC-APCI-MS/MS.

Organophosphorus flame retardants (PFRs) are extensively used as alternatives to banned polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCD). In this study, we analyzed 14 PFRs by means of four mass-spectrometry-based methods: gas chromatography combined with electron-impact mass spectrometry (GC-EI-MS) or negative-chemical-ionization mass spectrometry (GC-NCI-MS) and liquid chromatography combined with tandem mass spectrometry using electrospray ionization (LC-ESI-MS/MS) or atmospheric pressure chemical ionization (LC-APCI-MS/MS). The limits of quantification (LOQs) for LC-ESI-MS/MS and LC-APCI-MS/MS (0.81-970 pg) were 1-2 orders of magnitude lower than the LOQs for GC-EI-MS and GC-NCI-MS (2.3-3900 pg). LC-APCI-MS/MS showed the lowest LOQs (mean = 41 pg; median = 3.4 pg) for all but two of the PFRs targeted in this study. For LC-APCI-MS/MS, the lowest LOQ was observed for tributyl phosphate (TBP) (0.81 pg), and the highest was observed for tris(butoxyethyl) phosphate (TBOEP) (36 pg). The results of this study indicate that LC-APCI-MS/MS is the optimum analytical method for the target PFRs, at least in terms of LOQ.

Role of the Low-Density Lipoprotein-Cholesterol/High-Density Lipoprotein-Cholesterol Ratio in Predicting Serial Changes in the Lipid Component of Coronary Plaque.

BACKGROUND: The lipid component of coronary plaques is associated with their vulnerability. The aim of this study was to investigate which coronary risk factors were relevant in predicting serial changes in the lipid component of coronary plaques as evaluated by integrated backscatter intravascular ultrasound (IB-IVUS).Methods and Results:We enrolled 104 patients who underwent IB-IVUS-guided percutaneous coronary intervention (PCI) and were followed up with repeat IB-IVUS 6 months later. We investigated the serial changes in the plasma lipoprotein levels and the percentage of the lipid component of coronary plaques on IB-IVUS. In the multivariate linear regression analysis, the low-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol (L/H) ratio independently had a significant fixed effect with the percentage of the lipid component of coronary plaques at the time of PCI. In addition, the change in the L/H ratio at the 6-month follow-up was significantly associated with that in the lipid component of coronary plaques (regression coefficient, 9.645; 95% CI: 5.814-13.475; P<0.0001); furthermore, this change was also observed in patients with an LDL-C <100 mg/dL. CONCLUSIONS: The L/H ratio was the most relevant parameter in predicting the lipid component of coronary plaques. Furthermore, strict management of the L/H ratio may reduce this lipid component, even in patients with an LDL-C <100 mg/dL.

Mechanism of Formation of Chlorinated Pyrene during Combustion of Polyvinyl Chloride.

Chlorinated polycyclic aromatic hydrocarbons (ClPAHs) are an emerging class of environmental contaminants, but the sources of these chemicals in the environment are not well-known. In this study, we developed a kinetic model describing the chlorination of PAHs to elucidate the mechanism of formation of ClPAHs during the combustion of organic waste containing chlorinated compounds and/or chlorine in an incinerator. Pyrene (Pyr) and polyvinyl chloride (PVC) were selected as a model PAH and a model organic substrate, respectively. All combustion experiments were carried out using a model furnace operated under similar experimental conditions. Combustion of PVC in the model furnace produced 1-ClPyr, 1,3-Cl2Pyr, 1,6-Cl2Pyr, 1,8-Cl2Pyr, 1,3,6-Cl3Pyr, and 1,3,6,8-Cl4Pyr. The developed model supported the experimental data on the sequential chlorination of pyrene. The rate constants for the formation of mono- to trichlorinated pyrenes were over 30 times of those for the formation of tetra- and penta-chlorinated pyrenes. A qualitative analysis of the formation of highly chlorinated pyrenes based on the comparison of theoretical and empirical isotopic patterns of the mass spectrum revealed that penta- and hexa-chlorinated pyrenes, whose analytical standards were not available, were also produced by the combustion of PVC.

Rate of hexabromocyclododecane decomposition and production of brominated polycyclic aromatic hydrocarbons during combustion in a pilot-scale incinerator.

Here, we examined the incineration of extruded polystyrene containing hexabromocyclododecane (HBCD) in a pilot-scale incinerator under various combustion temperatures (800-950°C) and flue gas residence times (2-8sec). Rates of HBCD decomposition ranged from 99.996% (800°C, 2sec) to 99.9999% (950°C, 8sec); the decomposition of HBCD, except during the initial stage of combustion (flue gas residence time<2sec), followed a pseudo-first-order kinetics model. An Arrhenius plot revealed that the activation energy and frequency factor of the decomposition of HBCD by combustion were 14.2kJ/mol and 1.69sec-1, respectively. During combustion, 11 brominated polycyclic aromatic hydrocarbons (BrPAHs) were detected as unintentional by-products. Of the 11 BrPAHs detected, 2-bromoanthracene and 1-bromopyrene were detected at the highest concentrations. The mutagenic and carcinogenic BrPAHs 1,5-dibromoanthracene and 1-bromopyrene were most frequently detected in the flue gases analyzed. The total concentration of BrPAHs exponentially increased (range, 87.8-2,040,000ng/m3) with increasing flue gas residence time. Results from a qualitative analysis using gas chromatography/high-resolution mass spectrometry suggest that bromofluorene and bromopyrene (or fluoranthene) congeners were also produced during the combustion.

Development of a Dehumidification System for a Passive Sampler for Determining 1,3-Butadiene.

The passive sampler is a simple device for collecting gaseous compounds. It is affected by environmental conditions such as relative humidity, but a dehumidification system (DHS) has not been developed for it. We have developed a dehumidification device for the passive sampler for determining 1,3-butadiene. It consists of a passive sampler surrounded by a DHS consisting of a basket filled with granular magnesium perchlorate as the dehumidification agent. The passive sampler consists of a porous polytetrafluoroethylene tube packed with Carboxen 1000 adsorbent. We compared the amounts of water adsorbed on the Carboxen 1000 adsorbent in the presence and in the absence of the DHS; the results showed that the DHS prevented water from entering the sampler. Volatile organic compounds that entered the sampler were collected by the Carboxen 1000 adsorbent. In the case of 1,3-butadiene, much higher amounts were collected by the passive sampler with the DHS than without it. This may be due to interference of adsorption or acceleration of 1,3-butadiene degradation by the water-soluble oxidant on the surface of the Carboxen 1000 adsorbent.

Comparison study on observed and estimated concentrations of perfluorooctane sulfonate using a fate model in Tokyo Bay of Japan.

Perfluorooctane sulfonate (PFOS) was quantified in seawater and sediment samples collected from Tokyo Bay, Japan, ranging from 2.0 to 7.3 ng/L for surface seawater, 2.2 to 5.7 ng/L for intermediate seawater, 1.5 to 5.7 ng/L for bottom seawater, and 0.3 to 0.9 ng/g dry wt. for sediment. In addition, a 3-D chemical fate prediction model (National Institute of Advanced Industrial Science and Technology - Risk Assessment Model: AIST-RAM) has been applied to determine the accuracy of estimating PFOS in Tokyo Bay. A decreasing trend of PFOS from the northwestern part (i.e., the closed-off section of Tokyo Bay) to the mouth of the bay was observed, and the trend obtained from the actual surveys in this study was accurately represented by simulation with appropriate input parameters for AIST-RAM. From the comparison of observed concentrations with estimated concentrations, AIST-RAM showed a high degree of accuracy in estimating the concentrations of PFOS in seawater, whereas the estimations of PFOS concentrations in sediment had a relatively larger margin of error than those in seawater. However, our results indicate that AIST-RAM allows estimation of PFOS concentrations in seawater and sediment in Tokyo Bay with satisfactory accuracy.

Impact of tightening environmental regulations against long-chain perfluoroalkyl acids on composition of durable water repellents containing side-chain fluorinated polymers.

Tightening of environmental regulations against long-chain perfluoroalkyl acids (PFAAs) since the 2000s may have led to significant increases in the occurrence of short-chain PFAAs in the environment. Understanding the impact of the regulations on composition of durable water repellents (DWRs) is imperative to guide implementation of pragmatic actions during their use and end-of-life treatment. Substantial decreases in the frequencies of detection and concentrations of long-chain PFAAs and long-chain PFAA-precursors, and substantial increases in those of short-chain PFAAs and short-chain PFAA-precursors, have been observed in the impurities and hydrolysis products of side-chain fluorinated polymers (SCFPs). Comparison of profiles among the DWRs containing fluorinated ingredients in 2011 indicated that DWRs containing C8F17- and C10F21-SCFPs were the dominant products and accounted for 90 % of the samples, whereas DWRs containing C4F9- and C6F13-SCFPs were the dominant products and accounted for 70 % of the samples collected in 2021. Tightening of the regulations have caused decreasing applications of long-chain SCFPs and increasing use of short-chain SCFPs in DWRs containing fluorinated ingredients. The ingredients of one DWR were changed from PFAS-free alternatives to short-chain SCFPs, whereas those of another DWR were changed from short-chain SCFPs to PFAS-free alternatives. The presence of unexplained extractable organic fluorine has been observed in DWRs containing fluorinated ingredients, which may be difficult to be hydrolyzed and form known compounds. A historical series of DWRs available from before and after the tightening of regulations and a multifaceted analytical technique consisting of combustion ion chromatographic and mass spectrometric approaches combined with two extraction techniques involving ultrasonic treatment and alkaline hydrolysis revealed the impact of tightening regulations on composition of DWRs.

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.

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.

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.

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.

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.

Impact of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio on long-term outcome in patients undergoing percutaneous coronary intervention.

BACKGROUND: Several studies have demonstrated that the low-density lipoprotein cholesterol/high-denisty lipoprotein-cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease. The aim of the present study was to determine whether the LDL-C/HDL-C ratio would affect outcome in patients after percutaneous coronary intervention (PCI). METHODS AND RESULTS: Six-hundred-eighty-seven participants who underwent successful PCI for acute coronary syndromes or stable angina were enrolled. They were divided into 3 groups on the basis of the LDL-C/HDL-C ratio recorded 6 months after PCI: those with LDL-C/HDL-C≤1.5 (n=125); 1.52 (n=357). In the 3 groups, the incidence of major adverse cardiac events (MACE) was measured during the 5 years after baseline evaluation. MACE was defined as cardiac death, non-fatal myocardial infarction, new lesions, and restenosis. The median follow-up duration was 33 months. Kaplan-Meier analysis demonstrated that patients with LDL-C/HDL-C≤1.5 had a significantly lower incidence of MACE after PCI than patients with 1.52.0 (P<0.001). In addition, Cox proportional hazards analysis indicated that the LDL-C/HDL-C ratio was correlated with the incidence of MACE (HR=1.39, 95% confidence interval: 1.20-1.61, P<0.001). CONCLUSIONS: The LDL-C/HDL-C ratio had an impact on long-term outcome in patients undergoing PCI.