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As a cotton defoliator, tribufos (S,S,S-tributyl phosphorotrithioate) is widespread in the environment. It can cause neurotoxicity in chickens, reproductive toxicity in rats, and can also cause headaches and nausea in humans. However, little is known about its impact on the reproduction of birds. Here, by analyzing the differences in reproductive indexs and histopathological characteristics, we investigated the chronic effects of 32 mg a.i./kg, 160 mg a.i./kg and 800 mg a.i./kg tribufos treatment on the reproductive ability of Japanese quail (Coturnix japonica). The results indicated that 32 mg a.i./kg and 160 mg a.i./kg tribufos treatment significantly reduced the food intake of quails, significantly increased the broken egg rate, and had adverse effects on gonads and liver tissue. The 160 mg a.i./kg tribufos treatment also significantly reduced the average egg production. Moreover, 800 mg a.i./kg treatment had significant negative effects on feed intake (FI), body weight (BW), eggshell thickness, egg production (EP), fertilization rate, hatchability and progeny 14-d survival rate, and it also significantly increased the broken egg rate. In addition, tribufos exposure caused lesions in quail gonads and liver tissue. Overall, our results revealed that tribufos had adverse effects on the reproductive ability of Japanese quail, especially at high concentrations.

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Fusarium wilt, caused by Fusarium oxysporum f. sp. cucumerinum (FOC), poses a serious threat to cucumber productivity. Compared to traditional chemical pesticides, biological control strategies have attracted more attention recently owing to their effectiveness against pathogens and their environmental safety. This study investigated the effect of white rot fungi Pleurotus ostreatus P5 on the production of cyclic lipopeptides (CLPs) of Bacillus amyloliquefaciens B2 and the potential co-culture filtrate of strains B2 and P5 to control cucumber Fusarium wilt. A PCR amplification of CLP genes revealed that B. amyloliquefaciens B2 had two antibiotic biosynthesis genes, namely, ituA and srf, which are involved in iturin A and surfactin synthesis. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) revealed that CLPs derived from strain B2 contained two families, iturin A (C14, C15) and surfactin (C12-C17). The co-culture exhibited an enhanced accumulation of iturin A and surfactin compared to the monoculture of strain B2. Furthermore, the gene expressions of ituA and srf were both significantly upregulated when co-cultured with the fungus compared to monocultures. In an in vitro experiment, the co-culture filtrate and monoculture filtrate of B. amyloliquefaciens B2 inhibited mycelial growth by 48.2% and 33.2%, respectively. In a greenhouse experiment, the co-culture filtrate was superior to the monoculture filtrate in controlling cucumber Fusarium wilt disease and in the promotion of plant growth. Co-culture filtrate treatment significantly enhanced the microbial metabolic activity and decreased the abundance of FOC in the rhizosphere soil. These results show that the co-culture of P. ostreatus P5 and B. amyloliquefaciens B2 has great potential in cucumber Fusarium wilt disease prevention by enhancing the production of bacterial CLPs.

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Background and Aims: Fatigue is an unpleasant experience accompanied by functional deterioration involving both mental and physical factors. Caregivers of patients with severe illnesses who require long-term treatment often experience marked physical and mental fatigue. This study investigated the factors affecting fatigue among caregivers of patients with severe chronic diseases. Methods: The study enrolled 100 caregivers of patients providing home care nursing at a university hospital in Gyeonggi-do of Korea, including 47 caregivers caring for cancer patients and 53 caregivers caring for chronic disease patients (e.g., dementia, amyotrophic lateral sclerosis, and Parkinson's disease). The degree of fatigue was measured using the Korean version of the multidimensional fatigue inventory (MFI-K). Caregiver depression and anxiety were examined using the Hospital Anxiety and Depression Scale. Results: The average MFI-K score of all caregivers was 60.43 ± 13.77 and did not differ significantly between those caring for cancer patients and those caring for patients with severe chronic diseases (62.15 ± 13.27 vs. 58.49 ± 14.20, respectively, p=0.186). The longer the disease duration, the greater the general and physical fatigue of the caregiver (r = 0.284, p=0.004). However, caregiver mental fatigue did not differ according to disease duration (r = 0.169, p=0.094). The main factors affecting caregiver general and physical fatigue were caregiver anxiety and depression and patient's disease duration. Conclusions: The caregivers of patients with cancer or chronic severe illnesses experience high levels of fatigue: the longer the disease duration, the greater the degrees of depression, anxiety, and physical fatigue experienced by the caregivers. Such caregivers need strategies to manage their fatigue and depression.

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Water is an important pathway for human exposure to heavy metals. Accurate assessment of the health risks that are related to exposure to heavy metals in drinking and household water are required for the preparation of targeted health risk prevention measures. This study explores and identifies the health risks related to exposure to heavy metals via drinking and household water pathways in Xigu District, Lanzhou, northwestern China, using household water samples and survey data obtained during July-September 2015 (wet season) and December 2015-January 2016 (dry season). During each period, drinking water and household water that were available for use by children aged 0-5 and 6-17 years were sampled and a questionnaire on water-related behavior patterns was completed for each household. Cd, Cr, Pb, and As concentrations were analyzed in all water samples, and were used along with water-related exposure factors from the questionnaires to estimate exposure doses and associated health risks using models recommended by the United States Environmental Protection Agency (US EPA). The results showed that the concentrations of Cd, Cr, Pb, and As in both drinking and household water samples did not exceed the relative thresholds defined in China's national water quality standards. The concentrations of heavy metals in household water were more affected by seasonal factors than of those of drinking water. The non-cancer and cancer risks were in the ranges of 2.82×10-8-2.43×10-2 and 7.55×10-9-3.62×10-5, respectively, which are within acceptable levels, although the non-cancer and cancer risks from drinking water were both higher than of those determined for household water. Furthermore, the non-cancer and cancer risks from household water for children aged 0-5 years were lower than of those for children aged 6-17 years in each period. However, the cancer risk from drinking water for children aged 0-5 years was lower than of that for children aged 6-17 years, whereas the reverse was found for non-cancer risks. This study indicates that Cd, Cr, Pb, and As in drinking and household water did not pose significant detrimental effects to human health, and that the refined exposure assessment used could reduce uncertainties in health risk assessments.

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Atmospheric particulate matter was collected during the heating period and the non-heating period of a typical steel industrial process in Northeast China to study the following:① the size-depended distribution and enrichment characteristics of polycyclic aromatic hydrocarbons (PAHs); ② the deposition concentrations of PAHs of different particle sizes in various organs of the human respiratory system; and 3 the risk from human respiratory exposure. The 14 priority PAHs in the samples were determined by high-performance liquid chromatography (HPLC), and respiratory exposure assessment was conducted by combining the atmospheric particle size fractionation sampling technique with an internal deposition model. The results showed that the PAH concentrations during the heating periods (743.9 ng·m-3) were higher than those during the non-heating periods (169.0 ng·m-3). Most PAH contributions (86.3%-89.9%) were related to fine particles with a diameter ≤ 2.06 µm; medium and low molecular weight PAHs showed two concentration peaks in 1.07-2.06 µm and 7.04-9.99 µm range, respectively. In contrast, high molecular weight PAHs showed a unimodal peak in 1.07-2.06 µm range. Four-ring PAHs accounted for 40% of the total PAHs concentrations. With respect to human exposure, 53.3% and 55.3% of the granular PAHs were deposited in the lungs during the heating and non-heating periods, respectively. The incremental lifetime cancer risk (R) of particulate PAHs in the population was calculated using the concentration in the human respiratory system and the total concentration associated with the particulate matter. The R values for adults ranged between 1.3×10-5 and 2.9×10-5 during the heating period, and between 3.1×10-6 and 6.0×10-6 during the non-heating period. The R values for children during the heating period ranged between 1.0×10-5 and 2.3×10-5, and between 2.4×10-6 and 4.8×10-6 during the non-heating period. The results indicated that particle size greatly affected the concentrations of particles deposited in the respiratory system and the level of carcinogenic risk. The combination of the grading sampling technique and the respiratory system settlement model can effectively avoid the over-evaluation of human respiratory exposure.

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PURPOSE: In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives. MATERIALS AND METHODS: Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated. RESULTS: Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients' poor condition after late referral was the main barrier to missing EOL discussions; however, family members' concerns about patient's distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively. CONCLUSION: Our results suggested that the use of advance directive promote patient participation in EOL discussion.

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BACKGROUND: Cough is a distressing symptom in advanced cancer. Opioids are used to relieve respiratory symptoms including dyspnea and cough. In addition to a central mechanism, opioids are thought to work peripherally via opioid receptors of the lung. Therefore, direct inhalation of morphine has been investigated in chronic lung disease or cancer. We report our experience of a nebulized form of morphine to control intractable cough in patients with advanced cancer. METHODS AND RESULTS: Case 1 is a 63-year-old female with terminal lung cancer complaining of a severe dry cough with dyspnea and sleeplessness. Case 2 is a 53-year-old female with thymic carcinoma with multiple lung metastases suffering from severe cough accompanying chest pain and dyspnea. With usual treatment, cough did not improve in these patients. We then administered a nebulized form of morphine: hydrochloro-morphine 5 mg mixed with 3 mL normal saline inhaled by mouth using a nebulizer. When the morphine dose was increased to 10 mg and 15 mg, the patients' cough was relieved to a symptom level of moderate and mild, respectively. Without experiencing any severe systemic side effects of opioids, the patients continued nebulized morphine until death or discharge. CONCLUSION: Nebulized morphine was effective in controlling intractable cough due to cancer and it was convenient and safe.

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To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

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