Association between short-term exposure to ambient air pollutants and biomarkers indicative of inflammation and oxidative stress: a cross-sectional study using KoGES-HEXA data.

BACKGROUND: Air pollution-induced systemic inflammation and oxidative stress are hypothesized to be the major biological mechanisms underlying pathological outcomes. We examined the association between short-term exposure to ambient air pollutants and biomarkers of inflammation and oxidative stress in 2199 general middle-aged Korean population residing in metropolitan areas. METHODS: Serum levels of inflammatory cytokines (interleukin [IL]-1ß, IL-6, IL-8, IL-10, and tumor necrosis factor [TNF]-α) and urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured. Daily concentrations of a series of air pollutants (particulate matter [PM]10, PM2.5, SO2, NO2, CO, and O3) were predicted using the Community Multiscale Air Quality modeling system, and participant-level pollutant exposure was determined using geocoded residential addresses. Short-term exposure was defined as the 1- to 7-day moving averages. RESULTS: The multivariable-adjusted linear models controlling for the sociodemographic, lifestyle, temporal, and meteorological factors identified positive associations of PM with IL-1ß, IL-8, IL-10, TNF-α, and 8-OHdG levels; SO2 with IL-10 levels, CO with IL-1ß, IL-10, and TNF-α levels; and O3 with IL-1ß, IL-8, and 8-OHdG levels. O3 levels were inversely associated with IL-10 levels. For each pollutant, the strongest associations were observed for the 7-day average PM and CO with IL-1ß (per 10-µg/m3 increase in PM10: 2.7%, 95% confidence interval [CI] = 0.6-4.8; per 10-µg/m3 increase in PM2.5: 6.4%, 95% CI = 2.4-10.5; per 0.1-ppm increase in CO: 3.3%, 95% CI = 0.3-6.5); the 2-day average SO2 with IL-10 levels (per 1-ppb increase in SO2: 1.1%, 95% CI = 0.1-2.1); and the 7-day average O3 with IL-8 levels (per 1-ppb increase in O3: 1.3%, 95% CI = 0.7-1.9). CONCLUSIONS: Short-term exposure to ambient air pollutants may induce oxidative damage and pro-inflammatory roles, together with counter-regulatory anti-inflammatory response.

Effect of Short- to Long-Term Exposure to Ambient Particulate Matter on Cognitive Function in a Cohort of Middle-Aged and Older Adults: KoGES.

Exposure to ambient air pollution and its threat to human health is a global concern, especially in the elderly population. Therefore, more in-depth studies are required to understand the extent of the harmful effects of particulate matter (PM) based on duration and levels of exposure. An investigation was conducted to determine the association between short- (1-14 days), medium- (1, 3, and 6 months), and long-term (1, 2, and 3 years) exposure to air pollutants (PM2.5 and PM10) and cognitive function among Koreans (4175 participants, mean age 67.8 years, 55.2% women) aged over 50 years. Higher levels of PM2.5 exposure for short to long term and PM10 exposure for medium to long term were found to be associated with decreased cognitive function, as indicated by lower scores of the Mini-Mental State Examination adopted in Korean (K-MMSE). There were significant effect modifications by sex, age group, alcohol consumption, physical activity, and smoking status in the association between long-term PM2.5 and PM10 exposure and cognitive function. These findings, which underscore the importance of the efforts to reduce the exposure levels and durations of air pollutants, especially in the vulnerable elderly population, provide evidence for establishing more stringent policies for air pollution regulations.

Effect of Unmeasured Time Hours on Occupational Noise Exposure Assessment in the Shipbuilding Process in Korea.

Occupational noise is known to be one of the most hazardous risk factors, frequently exceeding the exposure limit thus causing hearing loss and other health outcomes among many field workers in various industries and workplaces. This study aims to characterize the levels of occupational noise exposure during the daily working hours and break periods (sampling preparation and lunch break), identify work-related characteristics affecting the noise exposure levels when including or excluding the break periods and finally determine the most effective approach for occupational noise exposure assessment by using the Korean and U.S. OSHA's guidelines. A total of 1575 workers employed by a large shipbuilding company participated in this study, and the historical exposure datasets of noise dosimeters, collected from 2016 to 2018, were classified by characteristics. A threshold level (TL) for the noise dosimeter was set as a value of 80 dBA during the break periods, including the preparation time for sampling instruments and one hour for the lunch break. The shipbuilding workers were exposed to high levels of occupational noise during the break periods, especially for those working in heating, grinding, and power processes in the painting-related departments. Out of 1575 samples, most cases were related to the preparation time (N = 1432, 90.9%) and lunch break (N = 1359, 86.9%). During the break time, the levels of noise exposure were measured depending on task-specific characteristics. When including the break time, the noise levels increased by approximately 1 dBA during the break, combining 0.8 dBA in the lunch hours and 0.2 dBA for the preparation of the sampling instrument. When excluding the break time, the levels of noise exposure collected using a Korean Occupational Safety and Health Administration (KOSHA) guide tended to be underestimated compared to those using the U.S. OSHA method. When including the break times, the proportion of noise exposure levels exceeding the compliance exposure limit declined from 37.9% to 34.5%, indicating that the break times might affect the decrease in the noise exposure levels. Taken together, shipbuilding workers could possibly be exposed to much greater amounts of noise exposure during break times in the shipbuilding processes, and the noise exposure levels in the department of painting were high. Therefore, it is recommended that industrial hygienists collect exposure monitoring data of occupational noise one hour after their job tasks begin and then consecutively monitor the noise exposure levels for at least 6 h including the break periods for each day.

Evaluation of Stoffenmanager and a New Exposure Model for Estimating Occupational Exposure to Styrene in the Fiberglass Reinforced Plastics Lamination Process.

This study aims to evaluate occupational exposure models by comparing model estimations of Stoffenmanager, version 8.2, and exposure scores calculated using a new exposure model with personal exposure measurements for styrene used in the fiberglass-reinforced plastic (FRP) lamination processes in Korea. Using the collected exposure measurements (n = 160) with detailed contextual information about the type of process, working conditions, local exhaust ventilation, respiratory protections, and task descriptions, we developed a new model algorithm to estimate the score for occupational exposures on situation level. We assumed that the source of exposure originates from the near field only (within the breathing zone of workers). The new model is designed as a simple formula of multiplying scores for job classification, exposure potential, engineering controls, chemical hazard, and exposure probability and then dividing the score for workplace size. The final score is log-transformed, ranging from 1 to 14, and the exposure category is divided into four ratings: no exposure (1), low (2), medium (3), and high (4) exposures. Using the contextual information, all the parameters and modifying factors are similarly entered into the two models through direct translation and coding processes with expert judgement, and the exposure estimations and scores using the two models are calculated for each situation. Overall bias and precision for Stoffenmanager are -1.00 ± 2.07 (50th) and -0.32 ± 2.32 (90th) for all situations (n = 36), indicating that Stoffenmanager slightly underestimated styrene exposures. Pearson's correlation coefficients are significantly high for Stoffenmanager (r = 0.87) and the new model (r = 0.88), and the correlation between the two models is significantly high (r = 0.93) (p < 0.01). Therefore, the model estimations using Stoffenmanager and the new model are significantly correlated with the styrene exposures in the FRP lamination process. Further studies are needed to validate and calibrate the models using a larger number of exposure measurements for various substances in the future.

Vitamin D status and risk of non-Hodgkin lymphoma: An updated meta-analysis.

PURPOSE: This meta-analysis aimed to extensively investigate the association between various measures of vitamin D status and non-Hodgkin lymphoma (NHL) and its subtypes. METHODS: We searched MEDLINE (PubMed), Embase, and the Cochrane Library in February 2018. Two authors independently reviewed and selected articles based on predetermined criteria. RESULTS: A total of 30 studies with 56,458 NHL cases were finally selected, with 24, 9, and 3 studies on sunlight/ultraviolet radiation (UVR) exposure, dietary intake, and serum/plasma 25-hydroxyvitamin D levels, respectively. Significant protective effects of overall sunlight/UVR exposure on NHL and subtypes were observed, with summary relative risks (RRs) ranging from 0.67-0.80 (RR for NHL = 0.80; 95% confidence interval [CI]: 0.71-0.90) among subjects with high exposure compared to those with low exposure. The results were consistent with various classifications of sunlight/UVR exposure. In contrast, when exposure measures of dietary vitamin D intake (RR for NHL = 1.03; 95% CI: 0.90-1.19) and serum/plasma 25-hydroxyvitamin D levels (RR for NHL = 0.97; 95% CI: 0.82-1.15) were used, risk estimates were inconsistent or non-significant for NHL and the subtypes. CONCLUSION: While risk estimates varied by different measures of vitamin D status, a protective effect of sunlight/UVR exposure on NHL incidence was verified, across most of the tested subtypes as well as exposure categories.

Comparison of Quantitative Exposure Models for Occupational Exposure to Organic Solvents in Korea.

This study aims to evaluate the accuracy, precision and conservatism of three models (ECETOC TRA 3.1, Stoffenmanager 7.0 and ART 1.5) by comparing model predictions and repeated exposure measurements in Korea. We collected the exposure measurements (n = 390) and detailed contextual information extracted from 10 survey reports published by Ministry of Employment and Labour in the mid-2000s. Using these three models, seven occupational health professionals predicted inhalation exposure to 10 solvents used for cleaning tasks in 51 situations at 33 companies in 15 industries. We applied four comparison approaches previously used by several European studies and calculated the lack of agreement (bias, relative bias, precision), Pearson correlation coefficients (r), level of conservatism, and residuals between the log-transformed predicted estimates and measured exposures on both individual and situation levels. The overall bias and precision were -0.53 ± 2.11 with ART, -1.32 ± 5.88 with Stoffenmanager, and -1.03 ± 8.88 with ECETOC TRA. Pearson correlation coefficients were significantly high in ART (r = 0.95) and Stoffenmanager (r = 0.82), but moderate in ECETOC TRA (r = 0.58). We found ART to be the most accurate model, and Stoffenmanager was the most balanced model in terms of good accuracy, high correlation, and medium conservatism in the model predictions. However, ECETOC TRA showed less accurate outcomes and lower level of conservatism but still had moderate correlations. We observed a systematic tendency to overestimate low exposures and underestimate higher exposures in all models, similar to previous studies. Therefore, our findings suggest that these European models can be used to predict occupational exposure to solvents in Korea.

Single Copy Transgene Integration in a Transcriptionally Active Site for Recombinant Protein Synthesis.

For the biomanufacturing of protein biologics, establishing stable cell lines with high transgene transcription is critical for high productivity. Modern genome engineering tools can direct transgene insertion to a specified genomic locus and can potentially become a valuable tool for cell line generation. In this study, the authors survey transgene integration sites and their transcriptional activity to identify characteristics of desirable regions. A lentivirus containing destabilized Green Fluorescent Protein (dGFP) is used to infect Chinese hamster ovary cells at a low multiplicity of infection, and cells with high or low GFP fluorescence are isolated. RNA sequencing and Assay for Transposase Accessible Chromatin using sequencing data shows integration sites with high GFP expression are in larger regions of high transcriptional activity and accessibility, but not necessarily within highly transcribed genes. This method is used to obtain high Immunoglobulin G (IgG) expressing cell lines with a single copy of the transgene integrated into transcriptionally active and accessible genomic regions. Dual recombinase-mediated cassette exchange is then employed to swap the IgG transgene for erythropoietin or tumor necrosis factor receptor-Fc. This work thus highlights a strategy to identify desirable sites for transgene integration and to streamline the development of new product producing cell lines.

Indoor levels of volatile organic compounds and formaldehyde from emission sources at elderly care centers in Korea.

The objective of this study is to characterize indoor and outdoor levels of volatile organic compounds (VOCs) and formaldehyde (HCHO) and identify indoor emission sources in thirty elderly care centers (ECCs) located in the Seoul metropolitan city and Gyeonggi province in Korea. Air monitoring samples from indoor and outdoor environments were collected from January to December in 2007. Statistical analyses of indoor and outdoor VOCs and HCHO levels in three rooms (a bedroom, living, and dining rooms) of each ECC were performed, and these were compared to identify environmental factors associated with an increase of indoor pollution levels. Total volatile organic compounds (TVOC) levels were significantly (p<0.05) different between indoor (230.7±1.7 µg/m3) and outdoor (137.8±1.9 µg/m3) environments, with an I/O ratio of 1.67. The indoor HCHO level (20.1±1.6 µg/m3) was significantly (p<0.05) higher than the outdoor level (8.1±1.9 µg/m3), with an I/O ratio of 2.48. Indoor VOCs and HCHO levels in the bedrooms were significantly (p<0.05) higher than those in the living and dining rooms. Furthermore, indoor levels of VOCs and HCHO at ECCs were significantly (p<0.05) different depending on environmental factors such as the use of carpet, paint, and wooden furniture. In multiple regression analysis, indoor VOCs and HCHO levels at ECCs were significantly (p<0.05) correlated with two micro-environmental factors: the use of carpet and paint. This study confirmed that indoor VOCs and HCHO levels were significantly higher than those in outdoor environments. These air pollutants were mainly emitted from indoor sources, such as carpet, paint, and construction materials at the ECCs in Korea.

Effects of Environmental Air Pollution on Pulmonary Function Level of Residents in Korean Industrial Complexes.

This study aims to identify environmental air pollution adversely affecting pulmonary function among a community-based general population living in Korean industrial complexes. A total of 1963 residents participated in a pulmonary function test (PFT). The sample population consisted of an exposed group (n = 1487) living within a radius of 5 km of industrial complexes and a control group (n = 476) living over a radius of 10 km from the industrial complexes in Gwangyang and Yeosu cities. PFT results were calculated for each resident of the study population. On-site questionnaire surveys with face-to-face interviews were also conducted to collect more detailed information on personal lifestyles, medical history, exposure to air pollution, and respiratory disease and related symptoms. A total of 486 measured samples were collected by eight automated air-monitoring stations installed in four counties of Gwangyang and four counties of Yeosu in South Korea from January 2006 to February 2007. Mean levels of SO2 (0.012 ppm), CO (0.648 ppm), NO2 (0.02 ppm), O3 (0.034 ppm), and PM10 (43.07 μg/m³), collected within a radius of 5 km, were significantly higher than those collected over a radius of 10 km from Gwangyang and Yeosu industrial complexes. Prevalence odds ratio (OR) of abnormal pulmonary function in the exposed group of residents (<5 km) was elevated at 1.24 (95% CI 0.71⁻1.96), but not statistically significant (p > 0.05). In multiple linear regression analysis, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) levels significantly declined as SO2, CO, and O3 levels increased when adjusting for age, sex, body mass index (BMI), alcohol, smoking, secondhand smoke, and respiratory disease and related symptoms (n = 1963) (p < 0.05). These results suggest that exposure to air pollution affects pulmonary function levels of residents living in Korean industrial complexes.

A longitudinal study of atrazine and 2,4-D exposure and oxidative stress markers among iowa corn farmers.

Reactive oxygen species, potentially formed through environmental exposures, can overwhelm an organism's antioxidant capabilities resulting in oxidative stress. Long-term oxidative stress is linked with chronic diseases. Pesticide exposures have been shown to cause oxidative stress in vivo. We utilized a longitudinal study of corn farmers and non-farming controls in Iowa to examine the impact of exposure to the widely used herbicides atrazine and 2,4-dichlorophenoxyacetic acid (2,4-D) on markers of oxidative stress. 225 urine samples were collected during five agricultural time periods (pre-planting, planting, growing, harvest, off-season) for 30 farmers who applied pesticides occupationally and 10 controls who did not; all were non-smoking men ages 40-60. Atrazine mercapturate (atrazine metabolite), 2,4-D, and oxidative stress markers (malondialdehyde [MDA], 8-hydroxy-2'-deoxyguanosine [8-OHdG], and 8-isoprostaglandin-F2α [8-isoPGF]) were measured in urine. We calculated ß estimates and 95% confidence intervals (95%CI) for each pesticide-oxidative stress marker combination using multivariate linear mixed-effect models for repeated measures. Farmers had higher urinary atrazine mercapturate and 2,4-D levels compared with controls. In regression models, after natural log transformation, 2,4-D was associated with elevated levels of 8-OHdG (ß = 0.066, 95%CI = 0.008-0.124) and 8-isoPGF (ß = 0.088, 95%CI = 0.004-0.172). 2,4-D may be associated with oxidative stress because of modest increases in 8-OHdG, a marker of oxidative DNA damage, and 8-isoPGF, a product of lipoprotein peroxidation, with recent 2,4-D exposure. Future studies should investigate the role of 2,4-D-induced oxidative stress in the pathogenesis of human diseases. Environ. Mol. Mutagen. 58:30-38, 2017. © 2016 Wiley Periodicals, Inc.

Dynamic Changes in Helicobacter pylori Status Following Gastric Cancer Surgery.

BACKGROUND/AIMS: Helicobacter pylori eradication is recommended in patients with early gastric cancer. However, the possibility of spontaneous regression raises a question for clinicians about the need for "retesting" postoperative H. pylori status. METHODS: Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive H. pylori status without eradication therapy at the time of gastric cancer diagnosis were prospectively enrolled in this study. H. pylori status and atrophic gastritis (AG) and intestinal metaplasia (IM) histologic status were assessed pre- and postoperatively. RESULTS: One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for H. pylori, and 60 (42.9%) showed spontaneous negative conversion at least once during follow-up. Of these 60 patients, eight (13.3%) showed more complex postoperative dynamic changes between negative and positive results. The spontaneous negative conversion group showed a trend of having more postoperative IM compared to the persistent H. pylori group. CONCLUSIONS: A high percentage of spontaneous regression and complex dynamic changes in H. pylori status were observed after partial gastrectomy, especially in individuals with postoperative histological IM. It is better to consider postoperative eradication therapy after retesting for H. pylori.

Relationship between body mass index and the risk of early gastric cancer and dysplasia regardless of Helicobacter pylori infection.

BACKGROUND: Obesity is known to be associated with an increased risk of gastric cardia cancer but not with noncardia cancer. In terms of gastric dysplasia, few studies have evaluated its relationship with obesity. In addition, no study on the relationship between obesity and the risk of gastric cancer has analyzed the status of Helicobacter pylori infection. METHODS: A case-control study was designed to investigate the relationship between obesity and the risk of gastric cancer and dysplasia adjusted for the status of H. pylori infection in Koreans. Nine hundred ninety-eight gastric cancer patients, 313 gastric dysplasia patients, and 1,288 subjects with normal endoscopic findings were included. RESULTS: As gender differences could be the largest confounding factor, the risk of gastric cancer and dysplasia with an increasing body mass index (BMI) was analyzed in men and women, separately, and was adjusted for age, smoking, drinking, family history of gastric cancer, H. pylori infection, atrophic gastritis, intestinal metaplasia, and serum pepsinogen I/pepsinogen II ratio. Obesity (BMI 25 kg/m(2) or greater but less than 30 kg/m(2)) was associated with increased risk of early gastric cancer [adjusted odds ratio (aOR) 1.657; 95 % confidence interval (CI) 1.086-2.528; P = 0.019] and well or moderately differentiated adenocarcinoma (aOR 1.566; 95 % CI 1.011-2.424; P = 0.044) compared with normal BMI status (BMI < 23 kg/m(2)) in men. Obesity was related to gastric dysplasia (aOR 2.086; 95 % CI 1.011-4.302; P = 0.047) in women. CONCLUSIONS: The effect of obesity on gastric cancer showed a gender difference. That is, in men it was related to increased risk of early gastric cancer and well or moderately differentiated adenocarcinoma, but it was associated with gastric dysplasia in women regardless of H. pylori infection in Korea. Further research into this difference is necessary.

Increasing risk of diabetes mellitus according to liver function alterations in electronic workers.

AIMS/INTRODUCTION: We sought to determine the association between change in fasting plasma glucose (FPG) and levels of liver enzymes, such as aspartate transaminase, alanine transaminase and gamma-glutamyltransferase, from health examinations. MATERIALS AND METHODS: A total of 9,393 health screen examinees with no evidence of viral hepatitis, liver diseases, abnormal liver function and diabetes in their past disease history were enrolled in the present study. All the participants underwent three health examinations. Group 1 and 4 were stationary groups of those with normal liver enzyme levels in the first and second health examinations (G1), and abnormal liver enzyme levels in the first and second health check-up (G4). Groups 2 and 3 were altered groups of those with abnormal liver enzyme levels in the first health examination, which became normal in the second health examination (G2), and from a normal liver enzymes level to an abnormal liver enzymes level (G3). RESULTS: FPG levels were elevated in male participants (P < 0.01), and were related to old age (P < 0.01), drinking (P < 0.01), smoking (P < 0.01) and so on. There was a strong relationship between FPG levels in the last health examination and altered liver function enzyme levels from the first health examination to the second check-up. In other words, group 4 had the highest level of FPG compared with the other groups (G1 < G2 < G3). CONCLUSIONS: An association was observed between FPG levels and abnormal liver function in manufacturing workers. Abnormal liver function can be closely associated with the development of diabetes.

Korea National Survey for Environmental Pollutants in the human body 2008: 1-hydroxypyrene, 2-naphthol, and cotinine in urine of the Korean population.

The Korea National Survey for Environmental Pollutants in the human body conducts representative Korean population studies, which were first initiated in 2005 in Korea. This study was conducted from 2008 to 2009 to determine the exposure levels of polycyclic aromatic hydrocarbons and nicotine in the Korean general population. The study population consisted of 4702 adult subjects from 196 sampling locations including coastal, rural, and urban areas. The urinary levels of 1-hydroxypyrene, 2-naphthol, and cotinine were measured for exposure of polycyclic aromatic hydrocarbons and nicotine. The geometric means of the urinary 1-hydroxypyrene, 2-naphthol and cotinine concentrations in the Korean general population were 0.15 µg/L (95% confidence interval (CI): 0.13-0.17), 3.84 µg/L (95% CI: 3.57-4.11) and 47.42 µg/L (95% CI: 40.52-54.32) respectively. When these values were compared with reference ranges for the United States and Germany, the levels of 1-hydroxypyrene, 2-naphthol, and cotinine were very similar for Korea and Germany, however, these levels were slightly lower in the United States. This study is the first nationwide survey of exposure to polycyclic aromatic hydrocarbons and nicotine in Korea and provides a background reference range for exposure to polycyclic aromatic hydrocarbons and nicotine in the Korean general population.

Polycyclic aromatic hydrocarbon (1-OHPG and 2-naphthol) and oxidative stress (malondialdehyde) biomarkers in urine among Korean adults and children.

Using the urinary biomarkers 1-hydroxypyrene-glucuronide (1-OHPG), 2-naphthol, and malondialdehyde (MDA), we evaluated seasonal and regional variations in polycyclic aromatic hydrocarbon (PAH) exposure and oxidative stress among Korean adults and children. In total, 322 children (175 male and 147 female) and 332 adults (47 male and 285 female) were recruited in two regions of Korea, one representing a metropolitan area (Seoul/Incheon) and the other an industrial (Pohang) area, from winter 2002 to spring 2003. The subjects voluntarily gathered their first morning urine void, which was immediately transported to our laboratory and stored at -20 °C. Urinary 1-OHPG was measured by synchronous fluorescence spectroscopy, 2-naphthol by HPLC, and urinary MDA by HPLC with a UV detector. The median urinary 1-OHPG concentration tended to be higher in the industrial region than in the metropolitan region (0.92 vs. 0.77 ng/mL; p=0.03), and higher in winter than in spring (0.95 vs. 0.73 ng/mL; p<0.001). The median 2-naphthol concentration was also higher in the industrial region than in the metropolitan region (21.0 vs. 12.3 ng/mL; p<0.0001), but was higher in spring than in winter (19.7 vs. 10.3 ng/mL; p<0.0001). The median MDA concentration was significantly higher in winter than in spring (2.19 vs. 1.03 µmol/L; p<0.0001), whereas regional variation in MDA was observed only in female adults (p=0.02). In winter, the level of 1-OHPG was higher in children exposed to environmental tobacco smoke than in unexposed children (0.94 vs. 0.86 ng/mL; p=0.02). Our results indicate that both region and season can significantly influence the levels of PAH exposure and oxidative stress biomarkers.

Two Cases of Chronic Idiopathic Intestinal Pseudo-obstruction with Different Clinical Features.

Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder characterized by a severe impairment of gastrointestinal propulsion in the absence of mechanical obstruction. We experienced a case of chronic pseudo-obstruction in the initial phase mimicking acute pseudo-obstruction, which was treated medically. This ongoing case was compared to another recurrent and intractable case successfully treated with surgery and diagnosed as hypoganglionosis. These two cases showed different clinical features and therapeutic approaches for CIPO; one with the first episode of CIPO mimicking Ogilvie's syndrome; the other with recurrent episodes of CIPO with typical features. In conclusion, CIPO is a difficult disorder with various clinical manifestations and different treatment modalities, therefore individualized diagnostic and therapeutic approaches are needed.

Heart rate variability and urinary catecholamines from job stress in korean male manufacturing workers according to work seniority.

The aim of this study was to evaluate the relationships between job stress and indicators of autonomic nervous system activity in employees of the manufacturing industry. A total of 140 employees from a company that manufactures consumer goods (i.e., diapers and paper towels) were recruited for participation in this study. Job stress was assessed using Karasek's Job Content Questionnaire. Heart rate variability (HRV) was measured using a heart rate monitor, and urinary catecholamines were measured by an HPLC-ECD. Information on demographic characteristics, previous job history, smoking status and alcohol consumption was also collected. Job stress did not have a significant effect on HRV or catecholamines. However, low-frequency HRV was significantly higher in the high-strain group of subjects with a short duration of employment. Low- and high-frequency HRV were higher in the high-strain group than in the low-strain group, but these differences were not statistically significant. The results of the present study indicate that low-frequency HRV was significantly higher in the high-strain group of subjects with a short duration of employment. In addition, the results of this study show that HRV can be used as a potential physiologic indicator of job stress in employees with a short duration of employment.

Breast cancer and urinary biomarkers of polycyclic aromatic hydrocarbon and oxidative stress in the Shanghai Women's Health Study.

Polycyclic aromatic hydrocarbon (PAH) exposure and oxidative stress from such and other exposures have been associated with breast cancer in some studies. To further evaluate the role of PAH metabolites and oxidative stress on the development of breast cancer, we conducted a nested case-control study in the Shanghai Women's Health Study. We measured urinary 1-hydroxypyrene and 2-naphthol as PAH metabolites and urinary levels of 8-hydroxy-2'-deoxyguanosine and malondialdehyde as oxidative stress biomarkers in 327 breast cancer cases and 654 controls in the Shanghai Women's Health Study. Information on demographic characteristics, past medical history, lifestyles, history of menstruation, pregnancy history, eating and drinking habit, history of residence, employment history, family history, husband's information, and physical activity were collected by a self-administered questionnaire. The mean age was 52.3 in breast cancer cases (n = 354) and 52.5 in controls (n = 708). Age at menarche (P = 0.04), months of breast-feeding the first baby (P = 0.05), and grade of education (P(trend) < 0.01) were significantly different between cases and controls. No association was observed for PAH metabolites and the oxidative stress biomarkers of urinary malondialdehyde and 8-hydroxy-2'-deoxyguanosine and risk of breast cancer. This nested case-control study provides no evidence of association between PAH exposure and oxidative stress and risk of breast cancer in Shanghai women.

Laparoscopic approach for suspected early-stage gallbladder carcinoma.

OBJECTIVE: To determine the feasibility of the laparoscopic approach for treating suspected early-stage gallbladder carcinoma. DESIGN, SETTING, AND PATIENTS: Prospective study from a university hospital. From May 10, 2004, to October 9, 2007, the laparoscopic approach was considered for treating 36 patients with suspected gallbladder carcinoma at T2 or less without liver invasion based on the preoperative computed tomographic scan. To further exclude liver invasion, preoperative endoscopic ultrasonography (US) and laparoscopic US were additionally performed. Frozen biopsy was performed after completing the cholecystectomy. If carcinoma was found, laparoscopic lymphadenectomy was performed. MAIN OUTCOME MEASURES: Feasibility and operative outcome. RESULTS: Three patients who had liver invasion on endoscopic US underwent open surgery. An additional 3 patients who had liver invasion noted on laparoscopic US had their surgical procedure converted to laparotomy. Finally, 30 patients underwent a laparoscopic procedure. With combined computed tomography, endoscopic US, and laparoscopic US, the negative predictive value for excluding hepatic invasion reached 100%. For the 12 patients who had benign lesions noted on their frozen biopsies, their laparoscopic surgical procedure was completed. The remaining 18 patients who had gallbladder carcinoma underwent additional laparoscopic lymphadenectomy. During laparoscopic lymphadenectomy 1 conversion occurred owing to bleeding, the median operative time was 190 minutes, and the median blood loss was 50 mL. The complication rate was 16.7% and the median postoperative hospital stay was 4 days. After a median follow-up of 27 months, all 18 patients who underwent laparoscopic lymphadenectomy survived without any evidence of recurrence or metastasis. CONCLUSION: Laparoscopic treatment is feasible and safe in selected patients with early-stage gallbladder carcinoma.

Smoking increases rheumatoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody status.

OBJECTIVE: Smoking is associated with rheumatoid arthritis (RA) in individuals with the HLA-DRB1 shared epitope (SE). SE alleles have been shown to be predominantly associated with anti-cyclic citrullinated peptide (anti-CCP)-positive RA. These risk factors have not been identified for anti-CCP-negative RA. The aim of this study was to investigate whether SE-containing HLA-DRB1 alleles, smoking, or the combination of these factors contributes to the development of RA, depending on the presence or absence of serologic markers, in a Korean population. METHODS: All of the patients with RA (n =1,482) and all of the control subjects (n = 1,119) were Korean. Four-digit HLA-DRB1 typing was performed by a conventional polymerase chain reaction-sequence-based typing method. Information about smoking history was obtained through a questionnaire. The patients with RA were tested for anti-CCP antibodies and rheumatoid factor (RF). RESULTS: The SE alleles had significant effects on anti-CCP antibody and RF formation. The DRB1*0901 allele was associated with the presence of anti-CCP antibodies (odds ratio [OR] 2.49) and RF (OR 2.09). SE alleles and smoking were associated with both anti-CCP-positive and anti-CCP-negative RA. The combination of smoking and double copies of the SE allele increased the risk of anti-CCP-positive RA 36.11-fold and increased the risk of anti-CCP-negative RA 12.29-fold, compared with the risk among nonsmokers not carrying SE alleles. Interactions between SE alleles and smoking were observed for both anti-CCP-positive and RF-positive RA, although the associations of RF-positive RA could be consequences of the underlying anti-CCP antibody status. CONCLUSION: We demonstrated that the combination of SE alleles and smoking is associated with RA susceptibility regardless of anti-CCP antibody or RF status, but that the combination shows stronger effects in anti-CCP-positive/RF-positive patients with RA than in anti-CCP-negative/RF-negative patients with RA. The SE-smoking interactions were present in anti-CCP-positive and RF-positive RA.