Preoperative evaluation and indications for pulmonary metastasectomy

Pulmonary metastasectomy (PM) is an established treatment that can provide improved long-term survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.     

VitD在降低PM2.5对肺泡上皮细胞毒性中的影响分析

目的分析维生素D(vitamin D, VitD)在降低PM_2.5对肺泡上皮细胞毒性中的影响。 方法采用透射电子显微镜和激光诱导荧光分析对比VitD处理前后,PM_2.5的毒性能力。MMT观察VitD处理前后细胞生存率,分析PM_2.5对A549的毒性影响。 结果VitD作用后的PM_2.5平均粒径减小5.5 nm,颗粒聚结和团聚更为明显,颗粒平均条纹长度增加、弯曲度减小,差异有统计学意义。PM_2.5条纹间距无统计学差异,有明显减小,接近0.06 nm。VitD溶液从PM_2.5解吸3环和4环多环芳香烃(polycyclic aromatic hydrocarbons, PAHs),减少PM_2.5表面附着的致病性PAHs。PM_2.5可引起肺上皮细胞A549生存率明显下降,给予VitD干预后,PM_2.5对A549细胞生存率的抑制改善了54.7%,PM_2.5的生物毒性降低。 结论VitD可减少PM_2.5上吸附的致病性PAHs,抑制其致病活性,减小PM_2.5对肺上皮细胞的毒性。     

Indoor particle counts during Asian dust events under everyday conditions at an apartment in Japan

Objective

Asian dust storms originating from arid regions of Mongolia and China are a well-known springtime phenomenon throughout East Asia. Evidence is increasing for the adverse health effects caused by airborne desert dust inhalation. Given that people spend approximately 90 % of their time indoors, indoor air quality is a significant concern. The present study aimed to examine the influence of outdoor particulate matter (PM) levels on indoor PM levels during Asian dust events under everyday conditions.

Methods

We simultaneously monitored counts of particles larger than 0.3, 0.5, 1, 2, and 5 μm using two direct-reading instruments (KC-01D1 airborne particle counter; Rion), one placed in an apartment room and another on the veranda, under everyday conditions before and during an Asian dust event. We also examined how indoor particle counts were affected by opening a window, crawling, and air purifier use.

Results

An Asian dust event on 24 April 2012 caused 50- and 20-fold increases in PM counts in outdoor and indoor air, respectively. A window open for 10 min resulted in a rapid increase of indoor PM counts up to 70 % of outside levels that did not return to baseline levels after 3 h. An air purifier rapidly reduced PM counts for all particle sizes measured.

Conclusions

It is important to account for occupant behavior, such as window-opening and air purifier use, when estimating residential exposure to particulate matter.     

济宁市市区居民PM2.5相关知识知晓情况调查

目的分析济宁市居民对PM2.5相关知识知晓情况,为政府以及相关部门制定科学合理的政策及措施提供科学依据。方法 2013年4月对400名调查对象进行问卷调查。调查居民对PM2.5的主要来源、化学成分、健康危害等的认知情况,对空气质量的关注程度,济宁雾霾天气的好发季节,在雾霾天气时所采取的防护措施以及对如何有效减少雾霾天气的建议和意见。根据数据类型采用统计描述、t检验、单因素方差分析等统计学方法,P0.05为差异有统计学意义。结果发放问卷400份,实际收回369份,有效问卷369份,回收率为92.3%。被调查的369名居民中,关于PM2.5主要来源完全了解的70名,占19.0%;非常了解的107名,占29.0%;一般了解的163名,占44.2%;完全不了解的29名,占7.8%。关于化学成分完全了解的12名,占3.3%;非常了解的42名,占11.4%;一般了解的256名,占69.4%;完全不了解的59名,占15.9%。对PM2.5的健康危害认知平均得分(3.01±1.87)分。不同性别的居民对PM2.5健康危害认知得分差异无统计学意义(P0.05),不同年龄、文化程度、职业的居民对PM2.5健康危害认知的得分差异均有统计学意义(F=2.332、3.906、3.409,均P0.05)。被调查的369名居民中在雾霾天气时绝大多数人都采取了相应的防护措施,未采取任何防护措施仅42名,占11.4%。结论政府和相关部门有必要加强雾霾天气危害的宣传力度和采取相关措施,引起社会各方重视,提高居民在雾霾天气时的防护意识。     

2012年北京市丰台区公共场所集中空调通风系统卫生状况调查

目的调查分析2012年北京市丰台区公共场所集中空调通风系统卫生状况,探讨其影响因素并为卫生管理提供技术支持。方法依据《公共场所集中空调通风系统卫生规范》,检测集中空调送风中细菌总数、真菌、β-溶血性链球菌及PM10,风管内表面细菌总数、真菌总数、积尘量,冷却（凝）水中嗜肺军团菌。结果丰台区集中空调通风系统送风中细菌总数、真菌总数、β-溶血性链球菌、PM10合格率分别为61.42%、88.89%、100.00%、90.91%,风管内表面积尘量、细菌总数、真菌总数合格率分别为100.00%、100.00%、99.20%,冷却（凝）水中嗜肺军团菌合格率为98.20%,血清分型以LP1型为主。集中空调送风中细菌总数存在着明显的季节性差异（χ^2=12.338,P〈0.01）,而送风中真菌、PM10未见明显的季节性差异（χ^2=3.155,P〉0.05;χ^2=6.976,P〉0.05）。不同类型集中空调送风中细菌总数、真菌未见明显差异（χ^2=5.782,P〉0.05;χ^2=2.653,P〉0.05）。结论细菌总数、真菌总数、PM10是丰台区集中空调送风卫生质量的主要影响因素,应加强集中空调管理,定期清洗消毒,并主动开展卫生委托监测。     

煤矿区大气污染与儿童呼吸道疾病住院人数的时间序列分析

目的评价神木县大气污染与儿童呼吸道感染住院人数的关系。方法收集2009年11月至2012年10月间神木县的气象因素（气温、相对湿度）和环境因素：二氧化硫（SO,）、二氧化氮（NO：）和可吸入颗粒物（PM10）,以及16岁及以下儿童的住院资料。利用SAS9．3对气象、环境因素和住院人数资料进行描述性分析,并判断主要污染物。利用R3．0．1统计软件的建立Poisson回归的广义相加模型,引入大气污染物浓度及气象因素拟合线性模型,并考虑其滞后效应,评价主要大气污染物对儿童呼吸道感染住院的相对危险度。结果神木县的首要污染物为PM10,PM10与空气污染指数（API）的相关系数为0．917,P〈0．01。在控制了长期趋势、“星期几效应”、气象因素及其它污染物的影响后发现,首要大气污染物PM10浓度每上升10μg／m3时,每日呼吸道感染住院患儿的上呼吸道相对危险度（RR）及其95％可信区间（95％cx）为1．002（0．996～1．007）,t=0．589,P=0．556;下呼吸道为1．000（0．995～1．005）,t=-0．007,P=0．995。当日或滞后1～10日内PM10浓度变化均不能显著改变儿童上、下呼吸道感染的住院率。结论神木县首要污染物PM10浓度变化对儿童上、下呼吸道感染的住院情况无明显影响。     

Investigation of inflammation inducing substances in PM2.5 particles by an elimination method using thermal decomposition

The substances associated with PM2.5‐induced inflammatory response were investigated using an elimination method. PM2.5 were heated at temperatures of 120, 250, and 360°C. The results demonstrated microbial substances such as LPS and b‐glucan, and chemicals including BaP, 1,2‐NQ, and 9,10‐PQ were reduced drastically in PM2.5 heated at 120°C. On the other hand, DBA, 7,12‐BAQ, and BaP‐1,6‐Q were not noticeably reduced. Most of these substances had disappeared in PM2.5 heated at 250°C and 360°C. Metals (eg, Fe, Cu, Cr, Ni) in PM2.5 exhibited a slight thermo‐dependent increase. RAW264.7 macrophages with or without NAC were exposed to unheated PM2.5, oxidative stress‐related and unrelated inflammatory responses were induced. PM2.5‐induced lung inflammation in mice is caused mainly by thermo‐sensitive substances (LPS, b‐glucan, BaP, 1,2‐NQ, 9,10‐PQ, etc.). Also, a slight involvement of thermo‐resistant substances (DBA, 7,12‐BAQ, BaP‐1,6‐Q, etc.) and transition metals was observed. The thermal decomposition method could assist to evaluate the PM2.5‐induded lung inflammation.     

PM2．5急性暴露对大鼠凝血功能的影响及其机制

目的探讨PM2．5暴露对大鼠凝血功能的影响及机制。方法24只雌性SD大鼠随机分为4组：对照组、PM2.53．75mg／kg组、PM257．5mg／kg组、PM2s15mg／kg组。将大鼠暴露于不同剂量PM2．5,24h后处死大鼠,取大鼠血浆检测凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤维蛋白原（FIB）,取BALF显微镜下细胞计数及分类,大鼠肺脏石蜡切片HE染色观察病理改变,酶联免疫吸附试验法检测BALF中IL-6、肿瘤坏死因子α（TNFd）含量、肺组织丙二醛（MDA）含量及血清血管性血友病因子（vWF）含量,蛋白免疫电泳法（Westernblot）检测血管紧张素Ⅱ的1型受体（ATl）蛋白表达。结果PM2.57．5mg／kg组、PM2.5 15mg／kg组PT、APTT值较对照组及PM2.53．75mg／kg组缩短（P〈0．05）,各组血浆FIB值均无统计学差异（P〉0．05）。PM2.5各剂量组BALF中细胞总数及中性粒细胞比例均明显高于对照组（P〈0．05）,且随着PM2.5剂量增加而呈剂量依赖性升高。PM2.57．5mg／kg组和PMzs15mg／kg组BALF中II-6、TNF-α含量、肺组织MDA含量、血清vwF含量及肺组织ATl受体蛋白表达明显高于对照组及PM2.53．75mg／kg组（P〈0．05）。结论PM2.5暴露可导致PT、APTT缩短,诱发血液高凝,其机制可能与炎症反应及血管内皮损伤相关。     

Regression calibration for models with two predictor variables measured with error and their interaction,using instrumental variables and longitudinal data

Regression calibration provides a way to obtain unbiased estimators of fixed effects in regression models when one or more predictors are measured with error. Recent development of measurement error methods has focused on models that include interaction terms between measured‐with‐error predictors, and separately, methods for estimation in models that account for correlated data. In this work, we derive explicit and novel forms of regression calibration estimators and associated asymptotic variances for longitudinal models that include interaction terms, when data from instrumental and unbiased surrogate variables are available but not the actual predictors of interest. The longitudinal data are fit using linear mixed models that contain random intercepts and account for serial correlation and unequally spaced observations. The motivating application involves a longitudinal study of exposure to two pollutants (predictors) – outdoor fine particulate matter and cigarette smoke – and their association in interactive form with levels of a biomarker of inflammation, leukotriene E4 (LTE ₄, outcome) in asthmatic children. Because the exposure concentrations could not be directly observed, we used measurements from a fixed outdoor monitor and urinary cotinine concentrations as instrumental variables, and we used concentrations of fine ambient particulate matter and cigarette smoke measured with error by personal monitors as unbiased surrogate variables. We applied the derived regression calibration methods to estimate coefficients of the unobserved predictors and their interaction, allowing for direct comparison of toxicity of the different pollutants. We used simulations to verify accuracy of inferential methods based on asymptotic theory. Copyright © 2013 John Wiley & Sons, Ltd.