Clinical analysis of acute peripheral facial palsy in older adults.

OBJECTIVE: Acute facial palsy is a consequence of various diseases, with the number of patients increasing with advancing age. This study aimed to analyse the clinical characteristics of acute peripheral facial palsy in older adults. METHODS: A total of 30 patients with a mean age of 68.4 ± 9.1 years were included in the study. All patients received a standardised investigation and follow up. The hospital charts of the patients with acute facial palsy were reviewed retrospectively. RESULTS: The predominant causes of acute facial palsy in older adults were: Bell's palsy, Ramsay Hunt syndrome, trauma, otitis media and malignancy. At baseline, complete and incomplete facial palsies were seen in 26.7 per cent and 73.3 per cent of patients, respectively. The overall rates of good recovery, partial recovery and no recovery were 66.7 per cent, 10 per cent and 23.3 per cent, respectively. Increased age led to a significantly lower level of recovery in older adults. CONCLUSION: Bell's palsy and Ramsay Hunt syndrome were the most common aetiologies of acute facial palsy in older adults, and such patients are likely to have incomplete recovery. Active early treatment is necessary for achieving good outcomes in older adults.

Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology.

BACKGROUND: Hidradenitis suppurativa (HS) is a devastating chronic inflammatory skin disease with frequent recurrences. Various systemic treatments and procedures have been used but the efficacy of fractional microneedling radiofrequency (FMR) has not been reported. AIM: To evaluate the clinical and histological efficacy of FMR in the treatment of HS lesions. METHODS: An 8-week, prospective, split-body, unblinded study was conducted, which enrolled 10 adult patients with mild to moderate HS to receive 3 sessions of FMR treatment biweekly. HS severity was assessed using the number and type of lesions, HS Physician Global Assessment (HS-PGA) and the modified Sartorius score (mSS). Skin biopsies were performed on participants to assess change in inflammation before and after FMR. RESULTS: Severity of HS was significantly reduced on the FMR-treated side of the body, but not on the control side. Inflammatory HS lesions were significantly reduced after 4 weeks, while HS-PGA and mSS were significantly decreased after 6 weeks. Immunohistochemistry staining showed decreased expression of inflammatory markers including neutrophil elastases, interleukin (IL)-8 and IL-17, tumour necrosis factor-α, transforming growth factor-ß1 and matrix metalloproteinases. CONCLUSION: FMR may be a viable treatment option for mild to moderate HS.

Dermatologist-level classification of malignant lip diseases using a deep convolutional neural network.

BACKGROUND: Deep convolutional neural networks (DCNNs) can classify skin diseases at a level equivalent to a dermatologist, but their performance in specific areas requires further research. OBJECTIVE: To evaluate the performance of a trained DCNN-based algorithm in classifying benign and malignant lip diseases. METHODS: A training set of 1629 images (743 malignant, 886 benign) was used with Inception-Resnet-V2. Performance was evaluated using another set of 344 images and 281 images from other hospitals. Classifications by 44 participants (six board-certified dermatologists, 12 dermatology residents, nine medical doctors not specialized in dermatology and 17 medical students) were used for comparison. RESULTS: The outcomes based on the area under curve, sensitivity and specificity were 0·827 [95% confidence interval (CI) 0·782-0·873], 0·755 (95% CI 0·673-0·827) and 0·803 (95% CI 0·752-0·855), respectively, for the set of 344 images; and 0·774 (95% CI 0·699-0·849), 0·702 (95% CI 0·579-0·808) and 0·759 (95% CI 0·701-0·813), respectively, for the set of 281 images. The DCNN was equivalent to the dermatologists and superior to the nondermatologists in classifying malignancy. After referencing the DCNN result, the mean ± SD Youden index increased significantly for nondermatologists, from 0·201 ± 0·156 to 0·322 ± 0·141 (P < 0·001). CONCLUSIONS: DCNNs can classify lip diseases at a level similar to dermatologists. This will help unskilled physicians discriminate between benign and malignant lip diseases. What's already known about this topic? Deep convolutional neural networks (DCNNs) can classify malignant and benign skin diseases at a level equivalent to dermatologists. The lips are a unique feature in terms of histology and morphology. Previous studies of DCNNs have not investigated tumours on specific locations. What does this study add? This study shows that DCNNs can distinguish rare malignant and benign lip disorders at the same rate as dermatologists. DCNNs can help nondermatologists to distinguish malignant lip diseases. What are the clinical implications of this work? DCNNs can distinguish malignant and benign skin diseases even at specific locations such as the lips, as well as board-certified dermatologists. Malignant lip diseases are rare and difficult for less trained doctors to differentiate them from benign lesions. This study shows that in dermatology, DCNN can help improve decision-making processes for rare skin diseases in specific areas of the body.

Safety of transorally-inserted anvil for esophagojejunostomy in laparoscopic total gastrectomy.

BACKGROUND: To assess the safety of transorally-inserted anvil (TOA) for use during esophagojejunostomy (EJ) reconstruction during laparoscopic total gastrectomy (LTG). METHODS: Between March 2009 and December 2011, 39 consecutive open total gastrectomies (OTGs) and 36 LTGs using TOA for gastric cancer were comparatively evaluated. We investigated postoperative complications, using the Clavien-Dindo classification. To evaluate the effect of a learning period in using TOA for LTG, we also investigated shifts in the patterns of complications and changes in total operation time over the course of the study. RESULTS: The patient characteristics at baseline were not different between both groups, except for the extent of lymphadenectomy (P < 0.001) and depth of tumor invasion (P = 0.003). Multivariate analysis revealed that TOA usage elevated the occurrence of infectious complications significantly (OR = 3.32, P = 0.042), but was not associated with EJ-related complications. TOA usage did not need a learning period for the length of time required to complete the operation, or the likelihood of developing an EJ-related or infectious complication. CONCLUSIONS: TOA use for EJ during LTG is relatively simple and easy enough not to require a learning period for surgeons. This procedure did not elevated the occurrence of EJ-related complications compared to circular stapling in open surgery, but it does require special prevention efforts to avoid infectious complications.

Expression of CCL1 and CCL18 in atopic dermatitis and psoriasis.

BACKGROUND: Recent studies have shown that chemoattractive proteins play an important role in the organization of the innate and adaptive immune responses. There are some reports that chemokine (C-C motif) ligand (CCL)1 and CCL18, members of a family of chemoattractive proteins, have increased expression in atopic dermatitis (AD). AIM: To evaluate the quantity and pattern of CCL1 and CCL18 expression in lesions and blood of patients with AD, and compare them with those of patients with psoriasis. METHODS: Biopsy specimens were taken from atopic skin and normal-appearing skin of patients with AD and from the psoriatic skin only of patients with psoriasis. Quantitative real-time PCR analysis and immunohistochemistry of CCL1 and CCL18 expression were performed, and the quantities of expressed CCL1 and CCL18 in acute AD were compared with those of normal-appearing atopic skin and psoriatic skin. The serum level of CCL1 and CCL18 was assessed by ELISA. RESULTS: Expression of CCL1 mRNA and protein was significantly higher in the acute lesional skin of patients with AD than in their nonlesional skin or in the lesional skin of patients with psoriasis. Both CCL18 mRNA and protein were abundant in acute AD lesions and in psoriatic lesions, but were lower in the nonlesional skin of patients with AD. The serum levels of CCL1 and CCL18 were not different in patients with AD and patients with psoriasis. CONCLUSIONS: CCL1 is a chemokine that is associated with AD. Both CCL1 and CCL18 may play important roles in the initiation and progression of atopic skin inflammation.

Age-associated changes in nicotine dependence.

OBJECTIVES: Nicotine is the primary factor responsible for tobacco dependence among individuals who smoke. Nicotinic receptors and nicotine-associated metabolism, two significant aspects of nicotine dependence, are influenced by age. To date, however, the relationship between age and nicotine dependence has not been investigated. STUDY DESIGN: Cross-sectional. METHODS: Data were obtained from the national smoking cessation programme for South Korea. Data obtained from current smokers in 2008 (n = 338,566) were used as baseline measures. Nicotine dependence was determined by the Fagerström Test for Nicotine Dependence (FTND). Cigarettes per day (CPD) and FTND were the dependent variables. As CPD is a major component of FTND, scores on the FTND minus scores related to CPD were also used as a dependent variable. The relationships between age and the dependent variables (FTND, CPD, partial FTND) were investigated. Quadratic regression models were used to test the non-linear relationship between age and nicotine dependence after adjusting for other covariates. RESULTS: Analyses relying on nicotine dependence (FTND and partial FTND scores) and CPD produced similar results in relation to age. Specifically, the values of all three dependent variables increased with age until approximately 50 years of age, at which point they decreased. Additionally, nicotine dependence and CPD were associated with age of smoking initiation, smoking duration, alcohol-related problems, body mass index and residential area. After adjusting for other nicotine-dependence-related factors, the linear and quadratic terms of age were statistically significant in the multiple regression models. CONCLUSIONS: In the present study, both nicotine dependence and CPD displayed an inverse U-shaped relationship with age, with a significant peak at 50 years of age. The results suggest that tobacco control policies should target issues related to nicotine dependence according to age group.

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men.

OBJECTIVES: Although the existence of metabolically healthy obese (MHO) individuals has been recognized, little is known regarding metabolic health status in these subjects over time. Thus, we evaluated longitudinal changes in metabolic parameters among MHO subjects compared with metabolically healthy, normal-weight (MHNW) subjects. METHODS: A cohort study was performed on 2599 Korean men, 30-59 years of age, with no evidence of fatty liver disease on ultrasound and no traits of metabolic syndrome at baseline. BMI was categorized based on criteria for Asian population. Study participants were followed annually or biennially between 2002 and 2009. At each visit, the fatty liver on ultrasound was assessed and metabolic abnormalities were measured. Parametric Cox models and a pooled logistic regression models were used to evaluate the relationships of BMI with incident metabolic abnormalities. RESULTS: During 9647.1 person-years of follow-up, 1673 participants developed metabolic abnormalities. After adjusting for age, smoking, alcohol intake and exercise, higher baseline BMI categories predicted increased incidences of metabolic abnormalities in a dose-response manner. The hazard ratios (95% confidence intervals) for hypertriglyceridemia, prediabetes, pre-hypertension, low high-density lipoprotein-cholesterol, fatty liver, elevated high sensitivity-C reactive protein, elevated homeostasis model assessment of insulin resistance, any metabolic abnormality and metabolic syndrome among the MHO subjects compared with the MHNW subjects were 1.51 (1.23-1.85), 1.43 (1.19-1.72), 1.79 (1.45-2.22), 1.80 (1.30-2.49), 2.69 (2.19-3.31), 1.39 (1.16-1.67), 2.90 (2.31-3.62), 1.68 (1.45-1.93) and 1.84(1.02-3.30), respectively. CONCLUSION: In this study, MHO individuals showed higher incidences of metabolic abnormalities compared with MHNW individuals. This suggests that initially MHO individuals undergo adverse metabolic changes associated with obesity over time.

The p53-inducible gene 3 (PIG3) contributes to early cellular response to DNA damage.

The p53-inducible gene 3 (PIG3) is originally isolated as a p53 downstream target gene, but its function remains unknown. Here, we report a role of PIG3 in the activation of DNA damage checkpoints, after UV irradiation or radiomimetic drug neocarzinostatin (NCS). We show that depletion of endogenous PIG3 sensitizes cells to DNA damage agents, and impaired DNA repair. PIG3 depletion also allows for UV- and NCS-resistant DNA synthesis and permits cells to progress into mitosis, indicating that PIG3 knockdown can suppress intra-S phase and G2/M checkpoints. PIG3-depleted cells show reduced Chk1 and Chk2 phosphorylation after DNA damage, which may directly contribute to checkpoint bypass. PIG3 exhibited diffuse nuclear staining in the majority of untreated cells and forms discrete nuclear foci in response to DNA damage. PIG3 colocalizes with gamma-H2AX and 53BP1 to sites of DNA damage after DNA damage, and binds to a gamma-H2AX. Notably, PIG3 depletion decreases the efficient induction and maintenance of H2AX phosphorylation after DNA damage. Moreover, PIG3 contributes to the recruitment of 53BP1, Mre11, Rad50 and Nbs1 to the sites of DNA break lesions in response to DNA damage. Our combined results suggest that PIG3 is a critical component of the DNA damage response pathway and has a direct role in the transmission of the DNA damage signal from damaged DNA to the intra-S and G2/M checkpoint machinery in human cells.

Metabolic syndrome and cancer-related mortality among Korean men and women.

BACKGROUND: We examined the association between the metabolic syndrome and cancer mortality in Koreans. MATERIALS AND METHODS: This study included 42 336 men and 32 168 women aged > or =20 years who took health examination and were followed up for 5.6 years. Mortality data were analyzed according to the metabolic syndrome. RESULTS: The relative risk (RR) and 95% confidence interval (CI) of cancer mortality in subjects with metabolic syndrome compared with subjects without metabolic syndrome was 1.41 (1.08-1.84) after adjustment for possible confounding factors. The association is significant only among men [RR 1.52 (1.10-2.10)], but not among women. The RRs and 95% CIs for cancer deaths in subjects with elevated body mass index, blood pressure, fasting glucose, and triglycerides were 1.36 (1.07-1.71), 1.34 (1.07-1.69), 1.45 (1.14-1.86), and 1.60 (1.26-2.02) after mutual adjustment, respectively. Upon increasing the number of metabolic risk factors to 1, 2-3, and 4-5, the RRs and 95% CIs of death from cancer were 1.32 (0.83-1.48), 1.47 (1.10-1.96), and 2.42 (1.25-4.68), respectively, with a graded fashion (P for trend < 0.005). CONCLUSION: Our results indicate that metabolic syndrome is a risk factor for cancer-related death in Korean adults. Prevention and management of the metabolic syndrome would be needed to reduce cancer mortality.

Secular trends in adult male smoking from 1992 to 2006 in South Korea: age-specific changes with evolving tobacco-control policies.

OBJECTIVES: For years, South Korea has had one of the highest levels of tobacco use among males in the world, but a steady decline has been observed recently. This study examined how the smoking behaviour of male adults changed with age after the implementation of national tobacco control policies in 1995. STUDY DESIGN: Repeated cross-sectional study using a national survey. METHODS: Data were obtained from the 1992, 1995, 1999, 2003 and 2006 results of a repeated cross-sectional survey, the Social Statistics Survey. The smoking status of adult men was compared before (1992 and 1995 surveys) and after (1999, 2003 and 2006 surveys) the implementation of government-directed tobacco control policies using graphical methods and logistic regression analysis. RESULTS: After the implementation of tobacco control policies, the percentage of current male smokers decreased while the percentage of former smokers increased markedly. Smoking prevalence among older men (aged 50 years or more) reduced initially, and this decline was more pronounced after the tobacco control policies were implemented. Smoking prevalence in younger men (aged 30-49 years) declined in 2003 when more comprehensive tobacco control policies were implemented. CONCLUSIONS: This study suggests that comprehensive tobacco control policies in South Korea reduced smoking prevalence among males, initially among older men and later among both older men and younger men.

Socio-economic status and the risk of liver cancer mortality: a prospective study in Korean men.

OBJECTIVE: To examine the association between socio-economic status (SES) and liver cancer mortality among Korean men. STUDY DESIGN: Prospective cohort study METHODS: Data were acquired from a large, prospective cohort study that included 548,530 civil service workers aged 30-59 years who had undergone health examination in 1998 provided by the Korean National Health Insurance System. Information on lifestyle and demographic characteristics was acquired through self-administered questionnaires. The main outcome event was mortality from liver cancer. Cox proportional hazards model was used to estimate relative risks (RRs) and 95% confidence intervals (95% CIs) after adjusting for age, body mass index, fasting serum glucose, alcohol consumption, smoking and hepatitis B surface antigen (HBsAg) status. RESULTS: Liver cancer mortality differentials relating to SES were statistically significant and consistent in the fully adjusted model. Compared with the highest SES category, excess risk associated with liver cancer mortality was observed with decreasing SES levels: the RRs in the upper middle, lower middle and low SES categories were 1.35 (95% CI 1.13-1.61), 1.54 (95% CI 1.28-1.86) and 1.72 (95% CI 1.45-2.04), respectively. There was no effect modification by HBsAg status on the association between SES and liver cancer mortality. CONCLUSIONS: This study demonstrated an inverse association between SES and liver cancer mortality, suggesting that SES is an independent predictor of liver cancer mortality. The policies and interventions regarding prevention of liver cancer need to focus on disadvantaged groups in order to reduce health disparities related to liver cancer.

The prevalence of and risk factors for erosive oesophagitis and non-erosive reflux disease: a nationwide multicentre prospective study in Korea.

BACKGROUND: Prospective nationwide multicentre studies that have evaluated endoscopic findings and reflux symptoms using a well-designed questionnaire are very rare. AIM: To compare the prevalence rates of and risk factors for erosive oesophagitis and non-erosive reflux disease (NERD) in the Korean population. METHODS: A gastroscopic examination was performed on 25 536 subjects who visited 40 Healthcare Centers for a health check-up. A gastro-oesophageal reflux questionnaire and multivariate analysis were used to determine the risk factors for erosive oesophagitis and NERD. RESULTS: 2019 (8%) and 996 subjects (4%) had erosive oesophagitis and non-erosive reflux disease, respectively; only 58% of subjects with erosive oesophagitis had reflux symptoms. Multivariate analysis showed that the risk factors for erosive oesophagitis and NERD differed, i.e. those of erosive oesophagitis were male, a Helicobacter pylori eradication history, alcohol, body mass index > or =25 and hiatal hernia. In contrast, the risk factors for NERD were female, age <40 and > or =60 vs. 40-59 years, body mass index <23 and a monthly income <$1000, glucose > or =126 mg/dL, smoking, a stooping posture at work and antibiotic usage. CONCLUSIONS: The prevalence rates of erosive oesophagitis and NERD were 8% and 4%, respectively, in Korean health check-up subjects. The risk factors for erosive oesophagitis and NERD were found to differ, which indicates that their underlying pathogeneses are distinct.

Genetic polymorphisms of OPG, RANK, and ESR1 and bone mineral density in Korean postmenopausal women.

To evaluate the effects of genetic polymorphisms of OPG, RANK, and ESR1, which regulate osteoclastogenesis, on bone mineral density (BMD), a cross-sectional study was conducted in 650 Korean postmenopausal women. BMDs of the distal radius and the calcaneus were measured by dual energy X-ray absorptiometry (DXA). Genetic polymorphisms of OPG 163 A > G, 1181 G > C; RANK 421 C > T, 575 T > C; and ESR1 1335 C > T, 2142 G > A were determined by matrix-assisted laser desorption/ionization-time of flight (MALDI-ToF) mass spectrometry. The differences between the BMDs of the genotypes of OPG, RANK, and ESR1 were analyzed by multiple linear regression model adjusted for age and body mass index. Women with the OPG 1181 CC genotype had higher BMDs at the distal radius (7%) and calcaneus (10%) than those with the GG genotype; and these differences were statistically significant (P = 0.001 and P = 0.007, respectively). A significant association was also observed between RANK 575 T > C and calcaneus BMD (P for trend = 0.017). No significant association was observed between BMDs and the polymorphisms of ESR1. The association between OPG 1181 G > C and BMD was profound in subjects with the RANK 575 TT or ESR1 2142 GG genotypes; women with OPG 1181 CC had higher BMDs at the distal radius (11%) and calcaneus (11%) than those with OPG 1181 GG only in women with RANK 575 TT genotype (P = 0.002 and P = 0.021, respectively). These results suggest that OPG genetic polymorphisms, especially with the RANK 575 TT or ESR1 2142 GG genotypes, are related to low BMD in postmenopausal Korean women.

Association of DDT with spontaneous abortion: a case-control study.

PURPOSE: Spontaneous abortion (SAB), the most common adverse pregnancy outcome, affects approximately 15% of clinically recognized pregnancies. Except for advanced maternal age and smoking, there are not well-established risk factors for SAB. Animal models associate increased fetal resorption or abortion with exposure to the pesticide dichlorodiphenyl trichloroethane (DDT), but epidemiologic investigations of DDT and SAB are inconsistent. We undertook a pilot investigation of the hypothesized association of DDT with SAB. METHODS: Participants in this case-control study were selected from a longitudinal study of reproductive effects of rotating shifts among female Chinese textile workers who were married, ages 22-34, nulliparous without history of SAB or infertility, and planning pregnancy. From 412 pregnancies, 42 of which ended in SAB, 15 SAB cases and 15 full-term controls were randomly selected and phlebotomized. Serum was analyzed for p,p'-DDT, o,p'-DDT, their metabolites (DDE and DDD), and other organochlorines including polychlorinated biphenyls. RESULTS: Cases and controls were nonsmokers and did not differ in age (mean 25 years), body mass index (BMI), passive smoke exposure, or workplace exposures. Cases had significantly (p < 0.05) higher serum levels of p,p'-DDE (22 vs.12 ng/g) and o,p'-DDE (0.09 vs. 0.05 ng/g) than controls. After adjustment for age and BMI, each ng/g serum increase in p,p'-DDE was associated with a 1.13 (CI, 1.02-1.26) increased odds of SAB. With adjustment of serum DDE levels for excretion via breastfeeding, DDE-associated increased odds of SAB remained significant with up to 7% declines in maternal serum DDE levels for each month of breastfeeding. CONCLUSIONS: A potential increased risk of SAB is associated with maternal serum DDE levels.

Comparative studies of various run buffers for chiral capillary electrophoresis using chiral crown ether as a chiral selector.

In the capillary electrophoretic separation of primary amine enantiomers using (+)-(18-crown-6)-tetracarboxylic acid (18C6H4) as a chiral selector, the presence of run buffer constituents such as tris(hydroxymethyl)aminomethane (Tris) or Na+ competing with analytes for 18C6H4, diminishes the effectiveness of 18C6H4. In order to determine appropriate buffer systems for 18C6H4, various run buffer cationic components including Tris, 1,3-bis[tris(hydroxymethyl)methylamino]propane, bis(2-hydroxyethyl)iminotris(hydroxymethyl)methane, triethanolamine, tetramethylammonium, and Na+ were compared. Quantitative studies of the effects of the competitive constituents were carried out by measuring the electrophoretic mobilities of histidine as a function of the 18C6H4 concentration. We also derived a simple equation to estimate the optimal chiral selector concentration for a maximum mobility difference in the presence of a competitive inhibitor.

Prospective study of exposure to environmental tobacco smoke and dysmenorrhea.

Dysmenorrhea is a common gynecologic disorder in women of reproductive age. Previous studies have found an association between current cigarette smoking and prevalence of dysmenorrhea. This study investigated the association between exposure to environmental tobacco smoke (ETS) and the occurrence of dysmenorrhea among women without a history of this disorder. The study population consisted of 165 newly wed, nonsmoking Chinese women (in Shenyang, China), who intended to get pregnant and who had no past history of dysmenorrhea at the time of enrollment. These women completed a baseline questionnaire interview upon enrollment and were prospectively followed by daily diary. Dysmenorrhea was defined as a diary recording of abdominal pain or low back pain for at least 2 days during a menstrual period. A subject's ETS exposure was defined as the mean number of cigarettes smoked per day at home by household members over an entire menstrual cycle before the menstrual period. A logistic regression model was used to assess the effect of ETS on the risk of dysmenorrhea, with adjustment for age, body mass index, education, season, area of residence, occupation, shift work, perceived stress, passive smoking at work, and occupational exposure to chemical hazards, dust, and noise. Generalized estimating equations were used to account for autocorrelations as a result of multiple cycles per subject. This report is based on 625 prospectively followed menstrual cycles with complete baseline and diary data. ETS exposure was reported in 77% of cycles, within which average daily exposures throughout the cycle ranged from 0.02 to 10. 3 cigarettes. The incidence of dysmenorrhea was 9.7% and 13.3% among nonexposed and exposed cycles, respectively. Among ETS-exposed cycles, there was a positive dose-response relationship between the numbers of cigarettes smoked and the relative risk of dysmenorrhea. The adjusted odds ratios of dysmenorrhea associated with "low," "middle," and "high" tertiles of ETS exposure versus no exposure were 1.1 [95% confidence interval (CI), 0.5-2.6], 2.5 (CI, 0.9-6.7), and 3.1 (CI, 1.2-8.3), respectively. The findings were consistent with those of analyses limited to the first follow-up menstrual cycle from each woman. These data suggest a significant dose-response relationship between exposure to ETS and an increased incidence of dysmenorrhea in this cohort of young women.

Exposure to benzene, occupational stress, and reduced birth weight.

OBJECTIVES: The association between birth weight and exposure to benzene, work stress, and other occupational and environmental hazards was investigated. METHODS: In a large petrochemical industry, 792 pregnant workers were enrolled and followed up through delivery between May 1996 and December 1998. Exposure to benzene and other solvents was assessed by an industrial hygienist based on each woman's job title and workplace information. Other occupational and environmental exposures and personal information, including perceived work stress, exposure to noise, physical exertion at work, and passive smoking, were obtained by an interview questionnaire. Univariate and multivariate regression models were used to examine the individual and combined associations of occupational and environmental exposures with birth weight, with adjustment for major confounders including gestational age. RESULTS: In the univariate model, birth weight was negatively associated with exposure to benzene (-58 g (95% confidence interval (95% CI), -115 to -2)) and with work stress (-84 g (95% CI, -158 to -10)). In the multivariate model, there was a significant interaction between exposure to benzene and work stress relative to reduced birth weight, after adjustment for other environmental and occupational exposures and personal variables. Adjusted mean birth weight was 3445 g (95% CI 3401 to 3489) among those with neither exposure, 3430 g for those with exposure to benzene only, 3426 g for those with work stress only, and 3262 g (95% CI 3156 to 3369) for those with both exposures. In other words, there was 183 g (95% CI 65 to 301) reduction in birth weight among those with both exposure to benzene and work stress compared with those with neither exposure. Other work or environmental factors could not explain these findings. CONCLUSIONS: Low level exposure to benzene and work stress interact to reduce birth weight in this population.

Competitive binding of a Tris run buffer with chiral crown ether in chiral capillary electrophoresis.

In capillary electrophoresis of primary amine racemates using (+)-(18-crown-6)-tetracarboxylic acid (18C6H4) as a chiral selector, chiral recognition emanates from the differences in the complex formation between 18C6H4 and the two protonated amine enantiomers. The presence of buffer constituents such as tris(hydroxymethyl)aminomethane (Tris) or Na+, capable of forming complexes with 18C6H4, is thus detrimental to the chiral separation of primary amines. Such a competitive binding of buffer constituents was studied by comparing the electrophoretic mobilities of racemic analytes obtained in Tris/citric acid and triethylamine/citric acid buffers. We developed a simple fitting method to determine the competitive binding constant and applied it to the Tris buffer system. The competitive binding constant of Tris with 18C6H4 obtained at pH 3.0 was 27 +/- 4.

Treatment of atrophic facial scars with combined use of high-energy pulsed CO2 laser and Er:YAG laser: a practical guide of the laser techniques for the Er:YAG laser.

BACKGROUND: Although CO2 laser resurfacing provides substantial clinical improvement for atrophic facial scars, the CO2 laser often results in excessive thermal damage to the skin. It increases complications postoperatively. The Er:YAG laser ablates thinner layers of tissue than the CO2 laser with minimal thermal damage to the surrounding skin. OBJECTIVE: To determine the efficacy of combined treatment of atrophic facial scars with high-energy pulsed CO2 laser and Er:YAG laser. METHODS: One hundred fifty-eight patients were treated with a combination of high-energy pulsed CO2 laser and Er:YAG laser for atrophic facial scars. All patients were evaluated after 3 months of treatment. RESULTS: The scars improved 80-89% in 65 patients, 70-79% in 56 patients, more than 90% in 32 patients, 60-69% in 2 patients, and less than 60% in 3 patients after laser treatment. CONCLUSION: Treatment of atrophic facial scars with combined use of high-energy pulsed CO2 laser and Er:YAG laser is a very effective and useful method.