Serum Heavy Metals Research Articles

Associations of multiple serum metals with the risk of metabolic syndrome among the older population in China based on a community study: A mediation role of peripheral blood cells

Metal exposure has been reported to be associated with metabolic syndrome (MetS), however, the evidence remains inconclusive, particularly in elderly individuals. From May to July 2016, serum levels of 16 metals were measured using inductively coupled plasma mass spectrometry (ICP-MS) in 852 elderly individuals (≥65 years) residing in Wuhan, China. Biological detection and disease recognition were based on individual surveys conducted during health check-ups. Spearman’s rank correlation analysis was performed to identify the correlation among serum metals. The data were Ln-transformed to fit a normal distribution for further analyses. Linear and logistic regression were applied to explore the associations between metals and diseases. Restricted cubic spline (RCS) analysis was utilized to examine dose-response relationships. The Weighted Quantile Sum (WQS) score was applied to determine the empirical weights of each heavy metal in the context of their combined effect on metabolic diseases. The prevalence of MetS, hypertension, diabetes, and hyperlipidemia were 46.36 %, 68.90 %, 24.65 %, and 21.60 %, respectively. Serum metal mixture was positively associated with the prevalence of MetS (OR = 1.92, 95 % CI: 1.30–2.82), hypertension (OR = 1.50, 95 % CI: 1.01–2.23), and diabetes (OR = 2.18, 95 % CI: 1.48–3.22). In single metal models, we found that serum zinc levels were associated with an increased risk of MetS, while rubidium had a protective effect against MetS. Interestingly, different metals had distinct effects on specific diseases in this study: lithium and barium were more likely to influence blood pressure, while selenium had a more significant effect on blood glucose. Lipids were more susceptible to the effects of zinc, selenium, and strontium. Platelet count (PLT) and lymphocyte count (LYM) mediated the association between selenium exposure and hyperlipidemia, while neutrophil count (NEU) mediated the relationship between serum rubidium exposure and MetS. Our findings offer valuable etiological insights into the relationship between serum heavy metals and the prevalence of MetS, suggesting that peripheral blood cells may play a mediating role in this association.

Correlation between serum heavy metals and the risk of oral squamous cell carcinoma and oral potentially malignant disorders

Oral squamous cell carcinoma (OSCC) is a serious public health problem in various Asian countries, including Sri Lanka, and a combination of cultural practices, lifestyle factors, and genetic predispositions influences the incidence of these cancers. The examination of the connection between exposure to heavy metals and the probability of developing oral potentially malignant disorders (OPMD) and OSCC has been limited in its scope, and the overall consequences of such exposure remain largely unknown. This study aims to clarify the link between serum levels of heavy metals and the risk of OSCC and OPMD. The concentrations of seven heavy metals—namely, arsenic (As), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), and zinc (Zn)—were analyzed in serum samples from 60 cases and 15 controls in the Sri Lankan cohort. The Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES) was used for the analysis. Subsequently, the data underwent statistical evaluation via the Kruskal–Wallis H test, using the Statistical Package for Social Sciences (SPSS) version 28 software, with a confidence interval set at 95%. A p-value less than 0.05 was considered statistically significant. The cohort consisted of 48 men and 27 women, with 15 patients each diagnosed with OSCC, OSF, OLK, and OLP, and 15 healthy controls. The study used the Kruskal–Wallis Test to compare metal concentrations across groups, finding significant differences for all metals except As and Pb. Significant associations were observed between age, past medical history, drug history, gender, smoking, alcohol consumption, and betel chewing. The Spearman Correlation test showed significant correlations between the concentrations of Cr, Co, Cu, As, and Zn and the presence of cancer/precancer conditions. The study’s findings suggest that heavy metal contamination may be linked to the development of OSCC and precancerous conditions. When comparing OSCC and OPMD cases with controls, the serum concentrations of As and Pb did not differ significantly. However, Cd, Cr, Co, Cu, and Zn exhibited significantly higher concentrations among cases compared to controls (p < 0.05). This study observed significant variations in the levels of these five heavy metals among cancerous (OSCC), premalignant (OPMD), and healthy tissues, suggesting a potential role in the progression of malignancies. These findings underscore the importance of environmental pollution in this specific context.

A study on the mediating role of serum hormones in the effects of heavy metals on preeclampsia

Exposure to environmental heavy metals may pose a risk factor for developing preeclampsia (PE) modified through intervention. This case-control study aimed to investigate the association between serum heavy metal concentrations and PE in pregnant women and whether hormones served as mediating factors in the impact of heavy metals on PE. From October 2020 to 2022, 160 patients with PE and 160 pregnant women with normal deliveries were recruited at Dongguan Songshan Lake Central Hospital. Serum concentrations of manganese (Mn), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), cadmium (Cd), lead (Pb), β-human chorionic gonadotropin (β-hCG), progesterone (P), estradiol (E2), testosterone (T), cortisol (Cort), and cortisone (Cor) were measured. Logistic, restricted cubic splines, weighted quantile sum and multivariate linear regression models were employed to account for different aspects and explore the relationships among heavy metals, hormones, and PE. Mediation model analysis was performed to assess the role of hormones in mediation. The median concentrations of Mn, E2, and Cort were lower in the PE group than in the control group. The median concentrations of Cu, Zn, β-hCG, and T were higher in the PE than in the control. Mn, E2, and Cort showed negative associations with PE, while Cu, Zn, β-hCG, and T demonstrated positive associations, as determined through logistic regression. Mn, Cu, and Zn displayed linear dose-response relationships with PE. Zn and Cu had high weights in the positive association model of mixed heavy metal exposure with PE. The mediation analysis revealed that serum E2, P, T, Cort, and Cort/Cor might be potential mediators of the association between heavy metals (Mn, Cu, and Zn) and PE.

Impact of heavy metals exposure on herpes simplex virus type I infection: A population‐based cross‐sectional study

AbstractThis study aims to investigate the significant relationship between serum heavy metals (lead [Pb], cadmium [Cd], mercury [Hg]) and the risk of herpes simplex virus type 1 (HSV‐1) infection. Data were derived from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States from 2007 to 2016. This nationally representative survey, conducted by the National Center for Health Statistics, assessed the health status of participants through interviews, physical examinations, and laboratory tests. After excluding participants lacking serum Pb, Cd, and Hg data, as well as those missing HSV‐1 testing data and pregnant women, the analysis included 13 772 participants, among whom 3363 were adolescents. A survey‐weighted multivariate logistic regression model was used to evaluate the association between heavy metal exposure and the risk of HSV‐1 infection, and to explore the dose–response relationship between them. In adults and adolescents, serum concentrations of Pb and Cd were higher in those infected with HSV‐1 than in those not infected. However, an increase in serum Hg concentration was observed only in infected adolescents. After adjusting for potential confounders, elevated serum Pb and Cd concentrations in adults were associated with an increased risk of HSV‐1 infection. Higher serum Pb and Cd concentrations were associated with an increased risk of HSV‐2 infection, irrespective of HSV‐1 infection status. In adults, serum concentrations of Pb and Hg showed an approximately linear relationship with HSV‐1 infection risk (p for nonlinearity &gt; 0.05), whereas the dose–response relationship between serum Cd concentration and HSV‐1 infection was nonlinear (p for nonlinearity = 0.004). In adolescents, serum concentrations of heavy metals (Pb, Cd, Hg) showed an approximately linear relationship with HSV‐1 infection (p for nonlinearity &gt; 0.05). Furthermore, the study examined the relationship between serum heavy metal levels and the risk of HSV‐1 infection across different genders, races, income levels, weight statuses, and immune statuses. In conclusion, there is a significant association between serum heavy metal concentrations and HSV‐1 infection, which warrants further investigation into the causal relationship between them.

Heavy metals in cigarette smoke strongly inhibit pancreatic ductal function and promote development of chronic pancreatitis.

Smoking is recognised as an independent risk factor in the development of chronic pancreatitis (CP). Cystic fibrosis transmembrane conductance regulator (CFTR) function and ductal fluid and bicarbonate secretion are also known to be impaired in CP, so it is crucial to understand the relationships between smoking, pancreatic ductal function and the development of CP. We measured sweat chloride (Cl-) concentrations in patients with and without CP, both smokers and non-smokers, to assess CFTR activity. Serum heavy metal levels and tissue cadmium concentrations were determined by mass spectrometry in smoking and non-smoking patients. Guinea pigs were exposed to cigarette smoke, and cigarette smoke extract (CSE) was prepared to characterise its effects on pancreatic HCO3 - and fluid secretion and CFTR function. We administered cerulein to both the smoking and non-smoking groups of mice to induce pancreatitis. Sweat samples from smokers, both with and without CP, exhibited elevated Cl- concentrations compared to those from non-smokers, indicating a decrease in CFTR activity due to smoking. Pancreatic tissues from smokers, regardless of CP status, displayed lower CFTR expression than those from non-smokers. Serum levels of cadmium and mercury, as well as pancreatic tissue cadmium, were increased in smokers. Smoking, CSE, cadmium, mercury and nicotine all hindered fluid and HCO3 - secretion and CFTR activity in pancreatic ductal cells. These effects were mediated by sustained increases in intracellular calcium ([Ca2+]i), depletion of intracellular ATP (ATPi) and mitochondrial membrane depolarisation. Smoking impairs pancreatic ductal function and contributes to the development of CP. Heavy metals, notably cadmium, play a significant role in the harmful effects of smoking. Smoking and cigarette smoke extract diminish pancreatic ductal fluid and HCO3 - secretion as well as the expression and function of CFTR Cd and Hg concentrations are significantly higher in the serum samples of smokers Cd accumulates in the pancreatic tissue of smokers.

Pivotal relationship between heavy metal, PM2.5 exposures and tuberculosis in Bangladeshi children: protocol paper of a case–control study

IntroductionAir pollution is a global issue that poses a significant threat to public health. Children, due to their developing physiology, are particularly susceptible to the inhalation of environmental pollutants. Exposure...

Association between serum heavy metal levels and diabetic retinopathy in NHANES 2011–2020

The present study utilized the National Health and Nutrition Examination Survey (NHANES) database to examine the relationship between serum levels of heavy metals and Diabetic retinopathy (DR) in individuals aged over 30 years with type 2 diabetes mellitus (T2DM) in the United States. A cross-sectional analysis was conducted on 1583 individuals with T2DM from the NHANES 2011–2020, including 331 individuals in the DR group and 1252 individuals in the non-DR group. We collected data on serum levels of heavy metals, DR, and serum albumin for descriptive statistics, linear regression, and logistical regression analysis. After adjusting for age, gender, race and other factors, there was no statistically significant association between blood cadmium, selenium, mercury, or lead and DR. However, serum manganese (Mn) and DR had a significant negative association (β = − 0.2045, 95% CI = − 0.3484, − 0.0606). Serum albumin partially modulated the indirect influence of serum Mn on the incidence of DR, accounting for 12.80% of the association between serum Mn and DR. There was a negative association between serum Mn levels and the prevalence of DR in people with T2DM. Mn intake at least in this study has a little influence on the onset and development of DR.

Differences in Genomic Alterations and Accumulations of Heavy Metals Between Advanced Non-small Cell Lung Cancer Patients with and without Bone Metastasis.

Purpose: Bone metastasis (BoM) has been closely associated with increased morbidity and poor survival outcomes in patients with non-small cell lung cancer (NSCLC). Given its significant implications, this study aimed to systematically compare the biological characteristics between advanced NSCLC patients with and without BoM. Methods: In this study, the genomic alterations from the tumor tissue DNA of 42 advanced NSCLC patients without BoM and 67 patients with BoM and were analyzed by a next-generation sequencing (NGS) panel. The serum concentrations of 18 heavy metals were detected by inductively coupled plasma emission spectrometry (ICP-MS). Results: A total of 157 somatic mutations across 18 mutated genes and 105 somatic mutations spanning 16 mutant genes were identified in 61 out of 67 (91.05%) patients with BoM and 37 of 42 (88.10%) patients without BoM, respectively. Among these mutated genes, NTRK1, FGFR1, ERBB4, NTRK3, and FGFR2 stood out exclusively in patients with BoM, whereas BRAF, GNAS, and AKT1 manifested solely in those without BoM. Moreover, both co-occurring sets of genes and mutually exclusive sets of genes in patients with BoM were different from those in patients without BoM. In addition, the serum concentrations of Cu and Sr in patients with BoM were significantly higher than in patients without BoM. One of our aims was to explore how these heavy metals associated with BoM interacted with other heavy metals, and significant positive correlations were observed between Cu and Co, between Cu and Cr, between Sr and Ba, and between Sr and Ni in patients with BoM. Given the significant impacts of molecular characteristics on patients' prognosis, we also observed a noteworthy negative correlation between EGFR mutations and Co, alongside a significant positive correlation between TP53 mutations and Cd. Conclusions: The genomic alterations, somatic interactions, key signaling pathways, functional biological information, and accumulations of serum heavy metals were markedly different between advanced NSCLC patients with and without BoM, and certain heavy metals (e.g., Cu, Sr) might have potentials to identify high-risk patients with BoM.

Assessing Cross-Sectional Association of Uremic Pruritus with Serum Heavy Metal Levels: A Single-Center Study

(1) Background: Uremic pruritus (UP) is a common and taxing symptom in patients on maintenance hemodialysis (MHD). We have previously shown that blood lead levels (BLLs) and blood aluminum levels (BALs) were separately positively associated with UP in MHD patients. We also found that blood cadmium levels (BCLs) were positively associated with all-cause mortality and cardiovascular-related mortality in MHD patients. We wondered whether there is any correlation between BCLs and UP after adjusting for BLLs and BALs. (2) Methods: Patients enrolled in this study were all from three hemodialysis (HD) centers at Chang Gung Memorial Hospital, Lin-Kou Medical Center, including both the Taipei and Taoyuan branches. Correlations between UP and BLLs, BALs, BCLs, and other clinical data were analyzed. (3) Results: Eight hundred and fifty-three patients were recruited. Univariate logistic regressions showed that diabetes mellitus, hepatitis B virus infection, hepatitis C virus infection, HD duration, hemodiafiltration, dialysis clearance of urea, normalized protein catabolic rate, non-anuria, serum albumin levels, log (intact-parathyroid hormone levels), total serum cholesterol levels, serum low-density lipoprotein levels, log (blood aluminum levels), and log (blood lead levels) were associated with UP. Although log BCLs were not significantly associated with UP (p = 0.136) in univariate analysis, we still included log BCLs in multivariate logistic regression to verify their effect on UP given that our aim in this study was to verify associations between serum heavy metals and UP. Multivariate logistic regressions showed that log BLLs (OR: 27.556, 95% CI: 10.912–69.587, p &lt; 0.001) and log BALs (OR: 5.485, 95% CI: 2.985–10.079, p &lt; 0.001) were positively associated with UP. The other logistic regression, which stratified BLLs and BALs into high and low BLLs and BALs, respectively, showed that high BLLs or high BALs (low BLLs and low BALs as reference) (OR: 3.760, 95% CI: 2.554–5.535, p &lt; 0.001) and high BLLs and high BALs combined (low BLLs and low BALs as reference) (OR: 10.838, 95% CI: 5.381–21.828, p &lt; 0.001) were positively correlated with UP. (4) Conclusions: BLLs and BALs were positively correlated with UP. BCLs were not correlated with UP. Clinicians should pay more attention to the environmental sources of lead and aluminum to prevent UP.

Cardiovascular risk factors and kidney function among automobile mechanic and their association with serum heavy metals in Southwest Nigeria: A cross-sectional study.

The burden of cardiovascular disease (CVD) is huge due to its associated morbidity, mortality and adverse socio-economic impact. Environmental pollution as a risk factor contributes significantly to the burden of CVD, especially in the low and middle income countries. One of the effective strategies to reduce CVD burden is to prevent or detect cardiovascular risk factors early in at-risk population. This study determined some cardiovascular risk factors, kidney function, and their association with heavy metals among automobile mechanics. This was a cross-sectional study involving 162 automobile mechanics and 81 age and sex matched controls. Serum levels of lead, cadmium and some cardiovascular risks were assessed and compared in the two groups. Associations between serum lead, cadmium and some cardiovascular risks were determined using correlation analysis. P value of <0.05 was taken as significant. The mean ages of the automobile mechanics and controls were 47.27±9.99 years and 48.94±10.34 years, respectively. The prevalence of elevated serum cadmium was significantly higher in the automobile mechanics (25.9% vs 7.9%; p = <0.001). The significant cardiovascular risk factors in the automobile mechanics vs controls were elevated total cholesterol (32.1% vs 18.5%; p = 0.017), hyperuricemia (20.4% vs 1.2%; p = <0.001), elevated blood glucose (16.0% vs 4.9% p = 0.013); and alcohol use (55.1% vs 30.0%; p = 0.001). Among the automobile mechanics, there were significant positive correlations between serum cadmium, atherogenic index of plasma (AIP) (p = 0.024; r = 0.382) and triglyceride (p = 0.020; r = 0.391). Significant positive correlation was found between serum lead and neutrophil gelatinase associated lipocalin (NGAL) (p = <0.001; r = 0.329). There were significant positive correlation between serum cadmium level, AIP (p = 0.016; r = 0.373) and TG (p = 0.004; r = 0.439); between serum lead and NGAL in all the study participants (p = 0.005; r = 0.206). Automobile mechanics have notable exposure to heavy metals and a higher prevalence of some cardiovascular risk factors. Health education and sensitisation as well as policies that would regulate exposure of persons to heavy metals should be implemented in Nigeria.

Effects of crude acetylene fumes on serum heavy metals, haematological indices and histology of the lung tissues of adult Wistar rats

Background: Crude acetylene fumes generated from Calcium carbide (CaC2) is one of the most widely used source of acetylene gas for occupational gas welding and as an artificial fruit ripener despite numerous health warnings from the government and health groups in Nigeria.&#x0D; Aim: The study was aimed at evaluating the effects of crude acetylene on heavy metals present in serum, haematological indices and histology of the lung tissues.&#x0D; Materials and Methods: Twenty (20) adult male wistar rats were used. The rats were divided into two groups; Group 1 (control) and Group 2 (Test group) (n=10). The animals from the Test group (n = 10) were subsequently exposed to crude acetylene fumes released from the dissolution of 20g of calcium carbide in water for 30 minutes daily for a period of 4 weeks. At the end of the 4th week, the rats were anaesthetized and blood samples were collected for serum heavy metals and haematological analysis and tissues were harvested for histological studies.&#x0D; Results: a significant increase is seen in serum heavy metals (Cr, Fe and Cd) but no significant difference in Pb in the Test group compared with the control group. Also, there was a decrease in percentage granulocytes and histological results show destruction of respiratory epithelium. Also, there were significant damages to the lung tissues which include mild interstitial haemorrhage, bronchiolar ulceration with luminal debris, interstitial oedema, bronchiolar haemorrhage vascular distortion and congestion.&#x0D; Conclusion: Exposure to crude acetylene fumes increases serum heavy metals and can cause disruption of the respiratory epithelium

Determination of Some Heavy Metal Levels in Young and Adult Cattle in the Şiran District of Gümüşhane by ICP-MS

The purpose of this study was to evaluate certain heavy metal levels in young and adult cattle in the Şiran district of Gümüşhane. For this, a total of 100 blood samples were taken from 50 young (aged 1 to 3 years old) and 50 adult (aged 4 to 6 years old) cattle slaughtered at an abattoir in the Şiran. Serum was then separated from the blood samples by centrifugation, and analysed for certain heavy metals by using the ICP-MS method. The levels of serum heavy metals in the serum of young and adult cattle breed in the Şiran were determined. When comparing young and adult cattle, the adult cattle had significantly higher concentrations of Al, V, Ni, and Sn. As a result, in this study, serum heavy metal concentrations and age-related bioaccumulation in cattle farmed in the Şiran district were determined for the first time. The periodic monitoring of the levels of these heavy metals may be helpful in improving animal health and production.

Serum zinc deficiency could be associated with dementia conversion in Parkinson's disease.

Association between heavy metals and Parkinson's disease (PD) is well noted, but studies regarding heavy metal levels and non-motor symptoms of PD, such as PD's dementia (PD-D), are lacking. In this retrospective cohort study, we compared five serum heavy metal levels (Zn, Cu, Pb, Hg, and Mn) of newly diagnosed PD patients (n = 124). Among 124 patients, 40 patients were later converted to Parkinson's disease dementia (PD-D), and 84 patients remained without dementia during the follow-up time. We collected clinical parameters of PD and conducted correlation analysis with heavy metal levels. PD-D conversion time was defined as the initiation time of cholinesterase inhibitors. Cox proportional hazard models were used to identify factors associated with dementia conversion in PD subjects. Zn deficiency was significant in the PD-D group than in the PD without dementia group (87.53 ± 13.20 vs. 74.91 ± 14.43, p < 0.01). Lower serum Zn level was significantly correlated with K-MMSE and LEDD at 3 months (r = -0.28, p < 0.01; r = 0.38, p < 0.01). Zn deficiency also contributed to a shorter time to dementia conversion (HR 0.953, 95% CI 0.919 to 0.988, p < 0.01). This clinical study suggests that a low serum Zn level can be a risk factor for developing PD-D and could be used as a biological marker for PD-D conversion.

Association Between Serum Trace Heavy Metals and Liver Function Among Adolescents.

Exposure to metals has been associated with liver-related disease. Few studies have explored the effect of sex stratification on adolescent liver function. From the National Health and Nutrition Examination Survey (2011-2016), 1143 subjects aged 12-19 years were selected for analysis. The outcome variables were the levels of alanine aminotransferase (ALT), aspartate aminotransferase, and gamma-glutamyl transpeptidase. The results showed a positive association between serum zinc and ALT in boys (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.11-5.06). Serum mercury was associated with an increase in ALT level in girls (OR, 2.73; 95% CI, 1.14-6.57). Mechanistically, the efficacy mediated by total cholesterol accounted for 24.38% and 6.19% of the association between serum zinc and ALT. The results imply that serum heavy metals were associated with the risk of liver injury, possibly mediated by serum cholesterol, in adolescents.

Serum heavy metals and breast cancer risk: A case-control study nested in the Florence cohort of the EPIC (European Prospective Investigation into Cancer and nutrition) study

BackgroundChronic exposure to heavy metals is of concern for its potential carcinogenic effect. An association with increased breast cancer (BC) risk was hypothesized, but literature data are conflicting and the question remains unresolved. We aimed to investigate the association between heavy metals and BC risk in a case-control study nested within the Florence section of the EPIC (European Prospective Investigation into Cancer and nutrition) cohort. MethodsWe included 150 BC cases and an equal number of controls individually matched to cases by age and year of enrolment. In order to avoid confounding by smoking, the study was restricted to never smokers. Serum levels of six heavy metals (Cd, Co, Cr, Mn, Pb, and Tl) were quantified in pre-diagnostic samples using inductively coupled plasma mass spectrometry. Odds ratios (ORs) and corresponding 95 % confidence intervals (CI) were calculated via multivariable conditional logistic regression models. ResultsSerum levels of cobalt were inversely associated with BC risk (OR for the comparison of 3rd vs. 1st tertiles: 0.33, 95 % CI 0.12–0.91, p-value 0.033). None of the other heavy metals under study was significantly associated with BC risk in multivariable models. For Cd, Cr, and Tl, over half of the study participants had serum levels below the limit of quantitation. ConclusionsOur results do not support the hypothesis that exposure to heavy metals is associated with an increased BC risk among never smokers from the general population. The inverse association between cobalt serum levels and BC risk requires confirmation in future studies.

Investigation of heavy metal exposure and trace element levels in acute exacerbatıon of COPD

ObjectivesThe study aims to evaluate the levels of trace and heavy metals among chronic obstructive pulmonary disease (COPD) patients with acute exacerbation and their impact on the severity and mortality of the disease. Methods100 healthy volunteers and 114 patients with acute exacerbation participated in this work. According to Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, COPD patients are divided into 4 groups. Analysis of heavy metals (lead, cadmium, arsenic, cobalt, nickel, mercury, aluminum, calcium, and manganese) and trace metals (copper, chromium, and zinc) was performed using a plasma mass spectrometer. ResultsBody mass index was lower in COPD exacerbation patients (p < 0.05) in comparison to the control. In comparison with the control group, the levels of heavy metals were greater in COPD cases (p < 0.001). Al, Ca, Co, Ni, Cu, As, Cd, and Hg levels of GOLD group 4 were found to be higher compared to GOLD Group 1 (p < 0.001). Likewise, the Mn level was found higher in GOLD Group 1 (p < 0.05). However, the level of Zn was lower in GOLD group 4 in comparison with GOLD 1 cases (p < 0.001). The factors for the prediction of the disease in the COPD patient group were determined using multivariate regression analysis. Al, Ca, Mn, Co, As, and Hg was determined to be independent risk factors in predicting COPD exacerbations (p < 0.05). Al, Co, Pb, Ni, Hg, and Cd levels were higher in COPD exacerbations that resulted in mortality (p < 0.05). Co, Cd, Hg, and Pb were determined to be independent risk factors for mortality in COPD exacerbation cases (p < 0.05). ConclusionsOur study showed that serum heavy metal levels are linked with the harshness and mortality of acute COPD attacks. These findings may indicate that changes in serum heavy metal levels can be used to determine the severity of a COPD exacerbation.

Spastic Paraplegia and Ataxia in a Welder.

A 51-year-old welder (nonsmoker) developed subacute lower paresthesias and progressive spastic paraplegia and ataxia. Symptoms appeared 10 days after the first zinc exposure in the yacht construction site (8-hour day/40 days in a confined space with face shield only). Examination revealed loss of vibratory sensation, spasticity, hyperreflexia, and sensory ataxia. Serum heavy metals (Cu 1 mg/L and Pb 4,22 μg/L), B-complex vitamins, and paraneoplastics on serum and CSF were unremarkable. The elevated zinc level (137 μg/dL) was found. Spinal MRI showed combined degeneration (Figure). Myelopathy in zinc smelter workers was reported in the 19th century1 and recently rediscovered in excessive zinc ingestion. Copper secondary deficiency is hypothesized even if the normal copper serum level is reported.2 Two months later, copper became low (0.8 mg/L), a time-dependent process might explain late copper deficiency in our case. Symptoms ameliorated 4 months later with normalization of serum zinc/copper levels.

RELATIONSHIP BETWEEN CADMIUM EXPOSURE, TRIGLYCERIDE-GLUCOSE INDEX AND CAROTID ARTERY ATHEROSCLEROSIS

Objective: Cadmium exposure is suggested to be associated with cardiovascular and metabolic diseases. We investigated the association between cadmium and carotid artery atherosclerosis and the mediating effect of serum triglyceride and glucose level represented by triglyceride-glucose index (TyG index). Design and method: Among Cardiovascular and Metabolic disease Etiology Research Center (CMERC) Cohort participants, participants who received serum heavy metal screening tests were selected (N = 200). Patients with more than 3 standard deviation level of serum cadmium were excluded (N = 1). TyG index was calculated as formula: ln [{fasting blood glucose (mg/dL) × triglyceride (mg/dL)}/2]. Carotid artery ultrasonography was conducted to test carotid artery atherosclerosis. Carotid artery plaque was considered present if the thickness is greater by 50% or more than the surrounding intima-media thickness or if its size was 1.5 mm or more. We used linear regression to test the association between serum cadmium level and TyG index, and Poisson regression to test the association between serum cadmium level, TyG index and number of plaques. Mediation analyses was conducted to detect the mediating effect of TyG index. Results: Serum cadmium level was associated with TyG index (=0.155, p-value = 0.042). Both serum cadmium level(=0.753, p-value = 0.039) and TyG index(=1.049, p = 0.010) were associated with number of carotid artery plaques. Mediation analyses showed that TyG index significantly mediated the association between serum cadmium level and carotid artery plaque (direct effect: =0.733, p-value = 0.042; indirect effect: =0.165, p-value = 0.048). Conclusions: Cadmium exposure increases the risk of carotid artery atherosclerosis. The assocaition is mediated by disturbance in serum triglyceride and glucose level.

Changes in serum heavy metals in polycystic ovary syndrome and their association with endocrine, lipid-metabolism, inflammatory characteristics and pregnancy outcomes

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Heavy metals, a nonnegligible pollutant, have significant effects on human health, and they are related to reproductive dysfunction. This study aimed to investigate whether serum heavy metal levels were related to PCOS and the association of increased heavy metals with endocrine, lipid-metabolism and inflammatory characteristics and pregnancy outcomes. 80 subjects (40 with PCOS and 40 for control) were selected to analyze their clinical characteristics and serum heavy metal concentrations. Serum chromium (Cr), mercury (Hg) and copper (Cu) were significantly higher in PCOS patients. Cr was positively correlated with luteinizing hormone (LH) (ρ = 0.240 and P = 0.033) and negatively correlated with prolactin (PRL) (ρ = −0.248 and P = 0.032), Hg was positively correlated with LH (ρ = 0.446 and P < 0.001), testosterone (T) (ρ = 0.300 and P = 0.008), androstenedione (A) (ρ = 0.316 and P = 0.006), interleukin-6 (IL-6) (ρ = 0.344 and P = 0.002), and tumour necrosis factor-α (TNF-α) (ρ = 0.248 and P = 0.026), and Cu was found to be positively correlated with low-density lipids (LDL) (ρ = 0.264 and P = 0.021), IL-6 (ρ = 0.295 and P = 0.008), TNF-α (ρ = 0.336 and P = 0.002) and white blood cells (WBC) count (ρ = 0.300 and P = 0.008). Cu levels were significantly higher in nonpregnant patients than in pregnant patients who received in vitro fertilization and embryo transfer treatments. In conclusion, the present study shows that PCOS patients exhibited increased serum Cr, Hg and Cu levels, which were related to some sex hormones and lipid-metabolism disturbances and inflammatory cytokines releases, and elevated Cu levels were related to pregnancy failure, suggesting that these heavy metals may provide valuable information to predict PCOS.

Effects of heavy metals on hypertension during menopause: a Korean community-based cross-sectional study.

To examine the associations between serum cadmium, lead, and mercury and hypertension in pre- and postmenopausal women. Serum heavy metal (cadmium, lead, and mercury) levels were analyzed in 7,226 randomly selected women who participated in Korean National Health and Nutrition Examination Surveys from 2009 to 2017. Odds ratios (ORs) for hypertension were calculated for log2-transformed serum heavy metal levels, median tertile levels of serum cadmium, mercury, and lead, and for interactions between heavy metal levels and tertiles, after covariate adjustment. A doubling of serum cadmium was associated with hypertension in premenopausal (OR 2.47; 95% CI, 1.01-6.10, P = 0.049) and postmenopausal women (OR 1.70; 95% CI, 1.02-2.84, P = 0.043), and significant trends were observed for cadmium tertiles (P < 0.01). In premenopausal women, a two-fold increase in serum mercury increased the OR of hypertension by 3.08 (95% CI, 1.12-8.43, P = 0.029), and significant trends were also observed for serum mercury tertiles (P < 0.01). Interactions between serum cadmium, lead, and mercury levels in pre- and postmenopausal women were found to impact the prevalence of hypertension. Given increasing exposure to heavy metals in Korea, further prospective study is needed to identify associations between heavy metal exposures, both separately and in combination, with the prevalence of cardiovascular disease risk factors in well-characterized cohorts of different populations and to determine means of preventing heavy metal exposure.