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Contact with air pollution for a longer time period lowers surfactant resistances (168) and raises oxidative phospholipid-altered substances in surfactant fluids, such as 1-palmitoyl-2-phosphorylcholine (PAPC)-3-arachidonic-sn-glycero and other metabolic byproducts, which may play a role in endothelial barrier dysfunction and the selection of inflammatory cells (Figure 2), facilitating effective signal transfer to the systemic circulation of these and other signals (153)

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