Air quality influence on chronic obstructive pulmonary disease (COPD) patients' quality of life.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death. The relationship between urban air pollution and its short-term health effects on patients suffering from COPD is confirmed. However, information about the impact of air pollutants upon the quality of life (QOL) in patients with COPD is lacking. Through a cross-sectional survey, this study investigates such impact in terms of the scores of the (Chinese) chronic respiratory questionnaire (CCRQ) and the measurements of indoor air quality (IAQ), lung function and Moser's activities of daily living (ADL). Using Yule's Q statistic with a cutoff |Q|>0.7 to identify the strong relationships between environmental parameters and CRQ sub-scores, this study reveals that patient emotion is strongly associated with indoor environmental quality although the evidence of a causal relationship between them needs further research. PRACTICAL IMPLICATIONS: As QOL in patients with COPD and indoor environmental parameters are strongly associated, indoor air pollutants must be monitored for related studies in the future.

Mathematical models for accurate prediction of atmospheric visibility with particular reference to the seasonal and environmental patterns in Hong Kong.

Atmospheric visibility impairment has gained increasing concern as it is associated with the existence of a number of aerosols as well as common air pollutants and produces unfavorable conditions for observation, dispersion, and transportation. This study analyzed the atmospheric visibility data measured in urban and suburban Hong Kong (two selected stations) with respect to time-matched mass concentrations of common air pollutants including nitrogen dioxide (NO(2)), nitrogen monoxide (NO), respirable suspended particulates (PM(10)), sulfur dioxide (SO(2)), carbon monoxide (CO), and meteorological parameters including air temperature, relative humidity, and wind speed. No significant difference in atmospheric visibility was reported between the two measurement locations (p > or = 0.6, t test); and good atmospheric visibility was observed more frequently in summer and autumn than in winter and spring (p < 0.01, t test). It was also found that atmospheric visibility increased with temperature but decreased with the concentrations of SO(2), CO, PM(10), NO, and NO(2). The results showed that atmospheric visibility was season dependent and would have significant correlations with temperature, the mass concentrations of PM(10) and NO(2), and the air pollution index API (correlation coefficients mid R: R mid R: > or = 0.7, p < or = 0.0001, t test). Mathematical expressions catering to the seasonal variations of atmospheric visibility were thus proposed. By comparison, the proposed visibility prediction models were more accurate than some existing regional models. In addition to improving visibility prediction accuracy, this study would be useful for understanding the context of low atmospheric visibility, exploring possible remedial measures, and evaluating the impact of air pollution and atmospheric visibility impairment in this region.

An approach to assessing the probability of unsatisfactory radon in air-conditioned offices of Hong Kong.

In order to maintain an acceptable Indoor Air Quality (IAQ), policies, strategies and guidelines have been developed worldwide and exposure concentrations of the indoor radon have been specified. Mapping indoor radon levels for a region could be done with intensive measurements on a large number of samples. To obtain the most accurate estimate of the levels with the uncertainties specified, a statistical model has been developed in this study to predict the fractions of samples in a region having an average radon level above the action levels of 150Bqm(-3) and 200Bqm(-3). The model was based on a transformation of the variation from a small sample set of data to a population geometric distribution via an estimator, known as the 'sample correction factor'. Using a dataset from a cross-sectional measurement of indoor radon levels in 216 Hong Kong offices, where the mean was 37.2Bqm(-3) and the 68% range was from 17.3Bqm(-3) to 80.3Bqm(-3), the 'sample correction factor' was evaluated and tested by the Monte-Carlo simulations. The model estimates of the fractions above the indoor radon action levels 150Bqm(-3) and 200Bqm(-3) (1.2-7.7% and 0.4-4.1% for a sample size of 20, 2.8-5.1% and 0.8-2.4% for a sample size of 60) were demonstrated to be consistent with those determined from the dataset (3.5% and 1.4%). With the 'sample correction factor' thus quantified, it will be possible to provide the required data for the policymakers making appropriate decisions on resources and manpower management.

Influence of in-tunnel environment to in-bus air quality and thermal condition in Hong Kong.

In this study, the potential exposure of bus commuters to significant air parameters (CO(2), CO and RSP) and thermal environment (air temperature and relative humidity) when buses traveled through tunnels in Hong Kong was investigated. It was found that air-conditioned buses provided a better commuting environment than non-air-conditioned buses. The blate increasing trend was found on air-conditioned buses as the in-bus air parameters concentration levels rose slowly throughout the traveling process. In contrast, the in-bus environment varied rapidly on non-air-conditioned buses as it depended on the out-bus environment. The measured in-bus CO concentration was 2.9 ppm on air-conditioned buses, while it was 4.6 ppm (even reaching the highest level at 12.0 ppm) on non-air-conditioned buses. Considering the in-bus thermal environment, air-conditioned buses provided thermally comfortable cabins (about 24 degrees C and 59% of relative humidity). However, on non-air-conditioned buses, the thermal environment varied with the out-bus environment. The mean in-bus air temperature was about 34 degrees C and 66% of relative humidity, and the in-bus air temperature varied between 29 and 38 degrees C. Also, the lower-deck to upper-deck air parameters concentration ratios indicated that the vertical dispersion of air pollutants in tunnels influenced non-air-conditioned buses as higher air parameters concentration levels were obtained on the lower-deck cabins.

Distribution of Fos- and Jun-related proteins and activator protein-1 composite factors in mouse brain induced by neuroleptics.

The mechanisms by which the direct actions of neuroleptics are translated into therapeutic effects are unknown. We immunocytochemically investigated the expression of Fos- and Jun-related proteins and examined activator protein-1 DNA-binding activity in ddY mouse brain 120 min after the administration of haloperidol (1 mg/kg), (-)-sulpiride (20 mg/kg) and a selective dopamine D1 receptor antagonist, SCH23390 (1 mg/kg). The densities of Fos-, FosB-, Fra-1-, Jun- and JunD-immunoreactive nuclei induced by haloperidol and sulpiride in the hippocampus, piriform cortex and accumbens nucleus were higher than those in the control groups. The same regions showed higher densities of FosB-, Fra-1- and JunD-immunoreactive nuclei induced by SCH23390 compared with the control groups. We investigated further the activator protein-1 composite factors using super gel shift assays. These results suggested that induced Fos, FosB, Fra-1, Jun and JunD proteins constitute the activator protein-1 complex after the administration of haloperidol and sulpiride. In contrast, FosB, Fra-1 and JunD appear to constitute the activator protein-1 complex after the administration of SCH23390. Therefore, the diversity of activator protein-1 composite factors suggests that various kinds of gene are induced to act by some neuroleptics.

Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep Processor.

Recent clinical trials indicated that the ThinPrep method of sample preparation has greater diagnostic sensitivity than the conventional direct Papanicolaou smear. The authors hypothesized that nonhomogeneous cell sampling during transfer from the sampling device to the microscope slide was a contributing factor to the reduced accuracy of the conventional direct Pap smears in these trials. To test this hypothesis, four direct smear methods were compared with the newly developed, fluid-based, filter-transfer method. Counts of epithelial cells on conventional smears showed that only a fraction of the available epithelial cells on the sampling devices (medians, 6.5% to 62.5%) was actually deposited on the slides. In all 27 cases studied with the ThinPrep method, equivalent diagnostic material was obtained on each of the replicate slides prepared per specimen. This identifies a new source of error, preparation error, in conventional smears.

Comparison of the effects of dopamine D1 and D2 receptor antagonists on nerve growth factor mRNA expression.

Regulation of the expression of the nerve growth factor (NGF) gene has been reported previously to be mediated by the interaction of c-fos with an activator protein-1 (AP-1) binding site present in the first intron on the NGF gene. Using an RNase protection assay and in situ hybridization, we examined the effects of dopamine D1 and D2 receptor antagonists on NGF mRNA. Haloperidol (0.1-8 mg/kg) and (-)-sulpiride (10-100 mg/kg), induced NGF mRNA in a dose-dependent fashion in the hippocampus, piriform cortex, striatum and nucleus accumbens. The haloperidol (1 mg/kg)- and (-)-sulpiride (20 mg/kg)-induced NGF mRNA expression attained a maximum level 120 min after injection and returned to control levels 24 h later. Prior administration of the protein synthesis inhibitor cycloheximide blocked the haloperidol- and (-)-sulpiride-mediated induction of NGF mRNA. In contrast, R-(-)-8-chloro-2,3,4,5-tetrahydro-3,1-methyl-5-phenyl-11-3-benzyoepin e-7-ol (SCH23390) did not induce NGF mRNA expression in either a dose-dependent or time-dependent manner. Our previous studies have shown that haloperidol and (-)-sulpiride induce the expression of c-fos and c-jun mRNAs and increase their AP-1 DNA binding activities. Thus, the data suggest that neuroleptics induce NGF gene expression by increasing AP-1 DNA binding activity.

Sequence complexity of polyadenylated RNA from seizure-susceptible El mouse brain polysomes.

The hybridization kinetics in the complementary DNAs (cDNA) to polyadenylated messenger RNA (mRNA) in the brain of seizure-susceptible El mice were examined to elucidate the correlation between seizure susceptibility and genetic expression. Homologous and heterologous saturation hybridizations indicated that cDNA of seizure-nonsusceptible ddY mice hybridized with less mRNA in seizure-experienced El(+) or seizure-nonexperienced El(o) mice than that in ddY mice, cDNA of El(+) mice hybridized to a lesser extent with mRNA of El(o) mice than that of ddY or El(+) mice, and no difference was observed with cDNA hybridization results of El(o) mice to individual mRNAs of ddY, El(+) or El(o) mice. The results suggest that some sequences found in mRNA of ddY are lacking in both El strains and are responsible for the inbred predisposition, while those present in El(+) mRNA but missing in El(o) may associate with seizure susceptibility, since common sequences are present in the mRNA of those groups of animal. The sequence diversity among the 3 groups of mice was mainly observed with the rare class of mRNA. Molecular cloning of the cDNA corresponding to this class of mRNA found in the El(+) mice would clarify the gene expression in the brains of epileptics.

The clinical effect of bifemelane hydrochloride on dementia in aged patients.

The effect of bifemelane hydrochloride on dementia in the elderly was studied in thirty-one patients having cerebrovascular disorders. Alzheimer's disease, Parkinsonism and related diseases. The drug (150 mg) was administered orally three times daily for 10 weeks. The final global improvement rating was 77.4% for all patients. The rates of improvement for Alzheimer's disease were higher than those for cerebrovascular disorders, suggesting that this drug affects Alzheimer's disease through a cholinergic potentiating action. Psychotic, neurological and subjective symptoms, and the activity of daily life, were rated before, during and after treatment. All mean rates of improvement were based on observations made in the 4th week after the start of treatment. Improvement rates for global symptoms were more than 80% for emotional incontinence and prejudice or querulous attitudes toward the nurses, and in headache, tinnitus and dizziness among the subjective symptoms. The improvement in intellectual function was evaluated by the dementia rating scale for the elderly (DRSE), and a significant increase was found in DRSE after treatment with this drug. Side effects attributable to the drug were noted in one patient developing urticaria. It is thus suggested that bifemelane hydrochloride is useful in the treatment of different symptoms of dementia.

The effects of bifemelane hydrochloride on depressive illness of the elderly.

The therapeutic efficacy, utility and safety of bifemelane hydrochloride were studied in 52 elderly depressive patients. The drug was administered as a tablet containing 50 mg orally three times daily for 8 consecutive weeks. The final global improvement rating and global utility rating were respectively 80.8 and 73.1 percent for all patients. The improvement rates on the Hamilton depression rating scale (HAM-D) were more than 60% for depressed mood, guilt, suicide, middle insomnia, delayed insomnia, psychotic anxiety, gastro-intestinal symptom, hypochondriasis, depersonalization and derealization. The rates regarding global symptoms evaluated by the Psychoneurotic rating scale for doctor's use were more than 60% for tension, agitation, irritability and excitement, phobia, depression, hypochondria and nocturnal delirium in psychotic symptoms, and insomnia in addition to palpitation in somatic symptoms. A significant decrease was also observed in the symptoms covered by the Self-rating depression scale of Zung after treatment with this drug. There were no instances of side-effects, nor any abnormalities in laboratory tests, encountered throughout the trial. Therefore, bifemelane hydrochloride is of value for the treatment of geriatric depression.

Immunocytochemical localization of human papilloma virus and cytomorphologic correlation in smears and biopsies of cervical flat condylomata.

The cytomorphologic features in cervical biopsies and smears associated with human papilloma virus antigen (Ag) expression as demonstrated by immunoperoxidase staining techniques are presented. There was good concordance between cytology and biopsy results with respect to immunoperoxidase staining for human papilloma virus Ag. Cytomorphologic scoring of low-grade lesions (cervical intraepithelial neoplasias, grades O and I) showed atypical mitoses, macronucleated koilocytes, superficial cell keratohyaline granules, and multinucleation to be more frequent in Ag+ biopsy specimens. Chronic inflammation was more evident in Ag- biopsy specimens (P less than 0.05). Parakeratosis was more frequent in Ag+ cytologic specimens. Koilocytosis was not a reliable indicator of Ag expression in either preparation. Human papilloma virus (HPV) Ag testing by immunoperoxidase techniques appears to be a useful adjunct for screening low-grade atypias of the cervix.

Cytodiagnosis of lesions of the pancreas and related areas.

Our experience of six and one-half years with cyto-diagnosis of pancreatic and related lesions is presented. We studied 22 cases of direct (perioperative and endoscopic) aspiration (group A) and 14 cases of percutaneous aspiration using ultrasound guidance (group B). Cytohistologic correlation in the direct aspiration cases and cytoclinical correlation in the percutaneous aspiration cases showed a specificity of 90% in group A and 100% in group B. Sensitivity was 100% in group A and 72.7% in group B. Predictive value of positive results was 92% in group A and 100% in group B. Eight of ten positive cancer cases in group A were confirmed by initial endoscopic tissue biopsies. One periampullary duodenal aspiration and one bile aspirate were cytologically positive, with negative endoscopic biopsy; final clinical evaluation with laparotomy confirmed these two cases as cancer. Thus, cytodiagnosis was more sensitive than tissue biopsy.

Computerized training and proficiency testing. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Computerized technologies probably will revolutionize the field of gynecologic cytology in the next century. Such technologies will be useful in both training and evaluating proficiency. However, manual screening/review of gynecologic cytology preparations is the current "gold standard" for both training and assessment of proficiency. CONSENSUS POSITION: Training programs for cytotechnologists and pathologists should provide instruction and experience in new technologies, but their introduction may depend on the availability of equipment and staff. Advantages of digital images for training include standardization of teaching sets and interactive capabilities, allowing educational feedback. Computerized support/assistance devices aid in complete screening of the slide during training and provide feedback to cytologists on screening techniques. Liquid-based cytopreparatory instruments facilitate multiple glass slides for teaching or testing. Proficiency testing (PT) in cytology has similar quality assurance goals as in other areas of the laboratory, but the subjective nature of cytologic analysis poses many challenges for implementation. There is consensus that all cytology practitioners would like to know the proficiency of the laboratory. However, the majority question the value and validity of any large-scale formal testing programs. Locator and diagnostic skills are both critical in cytology, but assessment of each skill may occur in different ways using computerized technologies. Any type of assessment should provide educational feedback to participants. Psychometric issues in PT include the consideration of different types of validity, including face, content, construct and criterion related. The reliability or consistency of the testing event is also critical. A valid and reliable correlation between work performance and performance on a PT needs to be established. The goal is to ensure that PT will identify submarginal practitioners and that persons successful on PT are in fact competent. Any cytology PT program should also be considered in the context of other laboratory quality assurance tools and the entire cervical cancer screening program. Regulatory agencies should evaluate entire laboratory performance, while each laboratory director should assume primary responsibility for evaluating and documenting the competency and daily performance of each practicing cytologist. Professional scientific organizations should take the lead in recommending methods and standards of performance assessment. ONGOING ISSUES: A reliable method of correlating daily competency with results on PT is not yet established. Methods may evolve ever time using new technologies. The use of computerized techniques and images for assessment will require careful deliberation by experts as well as validation by practicing cytologists. Variables include diagnostic categories for testing, numbers of challenges per testing event, types of slide preparations and characteristics of the digital images. Availability of equipment and staff will affect the introduction of new technologies in different regions.

Thyrotoxic hyperemesis: a case report.

A male patient with hyperemesis as a result of hyperthyroidism was presented. Investigations for causes were negative except for hyperthyroxinaemia. Treatment with antithyroid drug relieved the symptom. Hyperemesis associated with hyperthyroidism occurs predominantly in females. A likely emetic factor oestrogen. Hyperthyroidism could have potentiated this effect. Levels of oestrogens are raised in thyrotoxicosis. The hyperthyroidism, the raised oestrogens and a low emetic threshold conspired to hyperemesis in this patient, a situation not unlike hyperemesis gravidarum. Thyrotoxic vomiting once recognised is readily by antithyroid treatment.

Relationship of risk factors to subsequent development of stroke and ischemic heart disease in a rural community.

A baseline examination of all residents aged 40 years and over, in the A-I district, Shibata City, Niigata Prefecture, Japan, was conducted in July 1977. The response rate for this examination was 84.5% for males and 92.6% for females. Nine hundred sixty males and 1,339 females, who were initially free from stroke, constituted the stroke cohort. Similarly 984 males and 1,342 females, who were free from myocardial infarction and angina pectoris on effort, made up the ischemic heart disease cohort. Both cohorts were followed for 10 years through June 1987. It is concluded that, in the agricultural community, the strongest risk factor for not only stroke but ischemic heart disease was hypertension, and that the attribution of hypercholesterolemia and obesity was small. The population that was studied experienced a period of relative economic deprivation before 1950, and there seems to be residual effects from this period to this day. The definition of cerebral infarction used in this study includes several pathologically different types (cerebral infarction of the cortical branches, cerebral infarction of the perforating branches, cerebral embolism and so on), and this may affect the results. On the other hand, the strongest risk factor for ischemic heart disease found in the A-I district is hypertension. This differs from the European/American type of ischemic heart disease, to which hypercholesterolemia and obesity are basic. These results also suggest the possibility that there is a difference not only etiologically but pathologically between the two types.

[The prevalence survey on chronic tuberculosis patients with bacilli discharge in Osaka prefecture].

This survey was made at the end of 1996 in Osaka prefecture including three ordinance designated cities of Osaka, Sakai and Higashiosaka. As of December 31 1996, 109 or 3.3% of active tuberculosis cases were found to be chronic tubercle bacilli excreters in Osaka city, and 128 or 3.6% in Osaka prefecture other than Osaka city, respectively. In the area called Airin at Nishinari-ward, Osaka, which has been an area with high prevalence of the disease, 33 or 5.8% were chronic tubercle bacilli excreters, and the rate was slightly higher than the other areas. Compared to the survey conducted 10 years ago, while the number of the chronic tubercle bacilli excreters decreased by half to 109 from 200 in Osaka city, to 128 from 211 in Osaka prefecture excluding Osaka city, the rate of chronic excreters to total active tuberculosis showed almost no change. Various factors such as difficult living conditions often attributed to defaulting of active tuberculosis patients from their treatment, thus resulting to development of chronic excretion. It is highly recommended to apply DOTS strategy for the completion of their treatment. Public health centers that have personal clinical records of each patient should be familiar with the results of their bacillus examinations. They should also be required to cooperate with medical institutions to cope with those who need retreatment.

[Left high R wave amplitude and blood pressure levels before and after 5 minutes' rest in a mass screening program].

In order to evaluate the implication of blood pressures measured without 5 minutes' rest in mass screening programs, blood pressures were measured before and after 5 minutes' rest on 820 subjects in a rural community, aged 35 to 65 years and not receiving hypertensive treatment. Although the systolic blood pressure showed a significant drop of an average of 3 mmHg among males and 4 mmHg among females after rest, 23.3% of 820 subjects had higher systolic blood pressure reading after rest than before. The relationship between left high R (LHR) in electrocardiograms and blood pressure (BP) before and after rest was studied. The presence of LHR was significantly related to BP both before and after rest among males, but more strongly associated to BP before rest. The relationship of the difference between BP before and after rest to the prevalence of LHR was analyzed by multiple logistic method. A significantly higher prevalence of LHR with greater difference between systolic BP before and after rest was observed among males, even with age and systolic BP level after rest taken into account. These findings suggest the potential significance of blood pressure readings before 5 minutes' rest which may be a response to mental stress of having the initial blood pressure reading taken by the observer. It would seem worthy to obtain blood pressure before rest as well as after rest in detecting blood pressure abnormalities.

[Relation of the difference between blood pressure before and after 5 minutes' rest to blood pressure status one year later in an epidemiological setting].

The relationship of the difference between blood pressures before and after 5 minutes' rest (before minus after) to resting blood pressures one year later was studied on 439 subjects, aged 35 to 44 years, not being treated for hypertension, in an epidemiological setting. Multiple regression analysis was applied to systolic (SBP) and diastolic blood pressure (DBP) separately. Both the resting SBP level and the SBP difference were significant predictors of the resting SBP one year later in both sexes. For resting DBP one year later, the resting DBP level and DBP difference were found to be significant in females. Multiple logistic analysis was used to identify the factors which predict development from normotension to above borderline hypertension one year later. The SBP difference as well as the resting DBP level were significant predictors in males. These findings suggest that BP difference between before and after 5 minutes' rest may be an important indicator of subsequent BP status, and therefore there would be value in measuring blood pressure before as well as after rest with particular attention to BP difference.

[Evaluation of urinary incontinence among the nursing home elderly].

We assessed the prevalence of urinary incontinence and contributory factors such as senile dementia, impaired mobility, medication, associated disorders and urinary tract infection in 98 elderly residents of a nursing home. The residents' mean age was 79 years, and 78% were women. Urinary incontinence was found in 47 (48%), of whom 21 had severe urinary incontinence for which they needed to wear diapers. Senile dementia and impaired mobility were observed in 53 (54%) and 45 (46%), respectively. We also found that those with both dementia and impaired mobility had significantly (p less than 0.01) precipitated urinary incontinence. However, no significant effects on urinary incontinence were observed for associated disorders, medication or urinary tract infection. A cystometrogram performed in 73 of the 98 residents revealed detrusor overactivity in 47%. In addition, there were significant correlations between the incidence of detrusor overactivity, and the prevalence of dementia or urinary incontinence. These results suggest that senile dementia and immobility are independent risk factors for urinary incontinence in the elderly, and that detrusor overactivity, which was found to be associated with senile dementia, is a possible cause of urinary incontinence.