Association between circulating alpha-1 antitrypsin polymers and lung and liver disease.

BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) is considered one of the most common genetic diseases and is characterised by the misfolding and polymerisation of the alpha-1 antitrypsin (AAT) protein within hepatocytes. The relevance of circulating polymers (CP) of AAT in the pathogenesis of lung and liver disease is not completely understood. Therefore, the main objective of our study was to determine whether there is an association between the levels of CP of AAT and the severity of lung and liver disease. METHOD: This was a cross-sectional study in patients with different phenotypes of AATD and controls. To quantify CP, a sandwich ELISA was performed using the 2C1 monoclonal antibody against AAT polymers. Sociodemographic data, clinical characteristics, and liver and lung parameters were collected. RESULTS: A cohort of 70 patients was recruited: 32 Pi*ZZ (11 on augmentation therapy); 29 Z-heterozygous; 9 with other genotypes. CP were compared with a control group of 47 individuals (35 Pi*MM and 12 Pi*MS). ZZ patients had the highest concentrations of CP (p < 0.001) followed by Z heterozygous. The control group and patients with Pi*SS and Pi*SI had the lowest CP concentrations. Pi*ZZ also had higher levels of liver stiffness measurements (LSM) than the remaining AATD patients. Among patients with one or two Z alleles, two patients with lung and liver impairment showed the highest concentrations of CP (47.5 µg/mL), followed by those with only liver abnormality (n = 6, CP = 34 µg/mL), only lung (n = 18, CP = 26.5 µg/mL) and no abnormalities (n = 23, CP = 14.3 µg/mL). Differences were highly significant (p = 0.004). CONCLUSIONS: Non-augmented Pi*ZZ and Z-patients with impaired lung function and increased liver stiffness presented higher levels of CP than other clinical phenotypes. Therefore, CP may help to identify patients more at risk of developing lung and liver disease and may provide some insight into the mechanisms of disease.

Sex differences in the association between salivary telomere length and multimorbidity within the US Health & Retirement Study.

BACKGROUND: Telomere length is associated with several physical and mental health conditions, but whether it is a marker of multimorbidity is unclear. We investigated associations between telomere length and multimorbidity by sex. METHODS: Data from adults (N = 5,495) aged ≥50 years were taken from the US Health and Retirement Study (2008-14). Telomere length was measured in 2008 from salivary samples. The cross-sectional associations between telomere length and eight chronic health conditions were explored using logistic regression, adjusting for confounders and stratified by sex. Logistic, ordinal and multinomial regression models were calculated to explore relationships between telomere length and multimorbidity (using a binary variable and a sum of the number of health conditions) and the type of multimorbidity (no multimorbidity, physical multimorbidity, or multimorbidity including psychiatric problems). Using multilevel logistic regression, prospective relationships between telomere length and incident multimorbidity were also explored. RESULTS: In cross-sectional analyses, longer telomeres were associated with reduced likelihood of lung disease and psychiatric problems among men, but not women. Longer telomeres were associated with lower risk of multimorbidity that included psychiatric problems among men (OR=0.521, 95% CI: 0.284 to 0.957), but not women (OR=1.188, 95% CI: 0.771 to 1.831). Prospective analyses suggested little association between telomere length and the onset of multimorbidity in men (OR=1.378, 95% CI: 0.931 to 2.038) nor women (OR=1.224, 95% CI: 0.825 to 1.815). CONCLUSIONS: Although telomere length does not appear to be a biomarker of overall multimorbidity, further exploration of the relationships is merited particularly for multimorbidity including psychiatric conditions among men.

Prevalence of Periodontitis and its Association with Reduced Pulmonary Function: Results from the Korean National Health and Nutrition Examination Survey.

Background and Objectives: The current study was performed to evaluate the prevalence of periodontitis and to examine the association between reduced pulmonary function and periodontitis using Sixth Korea National Health and Nutrition Examination Survey (KNHANES) in 2014. Materials and Methods: A cross-sectional evaluation was conducted to estimate the prevalence of periodontitis and to examine the association between periodontitis and reduced pulmonary function while adjusting for sociodemographic characteristics and current smoking status in survey participants between 40 and 79 years old. The presence of periodontitis was evaluated by community periodontal index defined by the World Health Organization, and the assessments of reduced pulmonary function data were made as "normal," "restrictive impairment," or "obstructive impairment." Results: A total of 4004 survey participants representing 25.4 million Koreans were included in the study. Overall, 41.1% of the study population were determined to have periodontitis, and 22.1% had reduced pulmonary function; 7.9% and 14.2% had restrictive- and obstructive- pulmonary impairments, respectively. Age, male gender, and current smoking status were positive predictors for periodontitis. Insurance coverage by workplace and higher education were protective factors against periodontitis. The association between periodontitis and restrictive impairment (adjusted odds ratio (OR) = 1.059, 95% CI 0.729-1.540) or obstructive impairment (adjusted OR = 1.140, 95% CI 0.849-1.530) was not significant. Conclusions: For Koreans, 40-79 years old, age, smoking status, gender, education, and insurance coverage were significant predictors of periodontitis. The prevalence of periodontitis was not significantly associated with reduced pulmonary function. To better understand the relationship between periodontitis and reduced pulmonary function, well-designed and larger scale epidemiologic studies are needed.

The toxicology of air pollution predicts its epidemiology.

The epidemiologic investigation has successively delineated associations of air pollution exposure with non-malignant and malignant lung disease, cardiovascular disease, cerebrovascular disease, pregnancy outcomes, perinatal effects and other extra-pulmonary disease including diabetes. Defining these relationships between air pollution exposure and human health closely parallels results of an earlier epidemiologic investigation into cigarette smoking and environmental tobacco smoke (ETS), two other particle-related exposures. Humic-like substances (HULIS) have been identified as a chemical component common to cigarette smoke and air pollution particles. Toxicology studies provide evidence that a disruption of iron homeostasis with sequestration of host metal by HULIS is a fundamental mechanistic pathway through which biological effects are initiated by cigarette smoke and air pollution particles. As a result of a common chemical component and a shared mechanistic pathway, it should be possible to extrapolate from the epidemiology of cigarette smoking and ETS to predict associations of air pollution exposure with human disease, which are currently unrecognized. Accordingly, it is anticipated that the forthcoming epidemiologic investigation will demonstrate relationships of air pollution with COPD causation, peripheral vascular disease, hypertension, renal disease, digestive disease, loss of bone mass/risk of fractures, dental disease, eye disease, fertility problems, and extrapulmonary malignancies.

Left double-lumen tube with or without a carinal hook: A randomised controlled trial.

BACKGROUND: Left double-lumen tracheal tubes (DLTs), with or without a hook to engage the carina, remain the standard device for lung isolation during anaesthesia. OBJECTIVE: The purpose of the study was to compare these DLTs with and without a hook. DESIGN: A randomised, controlled, single-blinded study. SETTING: University hospital. PARTICIPANTS: One hundred and eighty-four patients undergoing lung resection. MAIN OUTCOME MEASURE: Time required to position the tube from the introduction of the tube into the mouth to confirmation of correct placement in the supine position. RESULTS: Baseline characteristics were well balanced between the groups. Time to place DLTs was similar in both groups: median (interquartile range, IQR) 81.0 (50.0 to 146.2) s for DLTs without a hook and 67.5 s (45.0 to 138.7) for DLTs with a hook (P = 0.43). The incidence of adequate position at the first attempt was 68.5% in the No hook group and 69.6% in the Hook group (P = 0.95). Patients in both groups suffered similar incidences of sore throat at day 0 and day 1 (P = 0.80 and P = 0.20, respectively). No major lesion of the vocal cords or tracheobronchial tree was discovered and the incidence of minor lesions was similar in both groups. CONCLUSION: When a DLT is used, the presence of a carinal hook gives neither advantage nor added complications. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00969683.

[Pulmonary manifestations of polyvinyl chloride exposure]. / Polivinil klorür maruziyetinin pulmoner sisteme etkileri.

There is currently no national data on the effects of polyvinyl chloride (PVC) exposure on pulmonary function. In this study we recruited workers and administrative staff from two PVC plants between July 2008 and July 2009. A questionnaire, pulmonary function tests, carbon monoxide diffusion capacity, and peak flows were recorded. Particulate matter analyses were performed by the Adana Central Laboratory of the Directorate of Occupational Health and Safety. Data were analyzed with SPSS 13.0 software. Nine of the 147 subjects were female. The incidence of a cough was more common in the administrative group. Of the study population, 59.1% were smokers. Tobacco addiction significantly increased cough and dyspnea [OR= 1.10 (1.00-1.20, 95% CI) p= 0.007 and OR= 1.08 (1.02-1.14, 95% CI), p= 0.008, respectively]. Dust exposure was correlated with the incidence of a cough [OR= 0.20 (0.04-0.80, 95% CI) p= 0.008]. The period of work correlated with sputum production [OR= 1.00 (1.00-1.02, 95% CI) p= 0.044]. The FVC% was significantly higher in the administrative group, and FEV1/FVC and DLCO were higher in the exposed group. Tobacco addiction increased the risk of airflow limitation, as evaluated by FEV1/FVC < 70% and FEF25-75 < 50% [OR= 1.15 (1.06-1.25, 95% CI) p= 0.001 and OR= 1.09 (1.02-1.17, 95% CI) p= 0.010, respectively]. Tobacco addiction and increasing duration of work had a negative influence on DLCO in the exposed group (r= -0.270, p= 0.025 and r= -0.210, p= 0.037). In the exposed group PEF variability was significantly greater on workdays, compared with rest days. This study shows that tobacco consumption has a greater affect on the airways than PVC dust exposure. A median of 36 months exposure to PVC dust had no significant impact on pulmonary function parameters, except for DLCO and PEF variability.

The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: review and recommendations.

Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and, combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report new findings regarding associated risks for aspiration pneumonia, as well as research on oral care and health outcomes. The PubMed MeSH database was utilized to direct a specific search by entering terms "aspiration pneumonia" and "oral hygiene" from 1970 to 2009, which yielded 34 articles. The Ovid and Google Scholar databases were utilized as well and provided no additional references for the two terms. A manual search of references from other articles, including three systematic reviews published over the past decade, provided additional information regarding oral microorganisms and respiratory pathogens, as well as investigations of oral care. Finally, a brief but comprehensive introductory review was organized regarding oral microorganisms, biofilm, periodontal disease, and pneumonia to establish a framework for discussion. Overall, studies suggest (1) an association between poor oral hygiene and respiratory pathogens, (2) a decrease in the incidence of respiratory complications when patients are provided chemical or mechanical interventions for improved oral care, (3) the complex nature of periodontal disease and aspiration pneumonia make direct connections between the two challenging, and (4) additional studies are warranted to determine adequate oral hygiene protocols for nursing home patients to further reduce the incidence of aspiration pneumonia.

Health Implications of Occupational Exposure of Butchers to Emissions from Burning Tyres.

BACKGROUND: Flames from burning scrap tyres are used in de-furring animals for human consumption in most parts of Nigeria. Emissions from tyres are known to contain a myriad of toxic mixtures especially particulate matter (PM), volatile organic compounds, hazardous air pollutants, and inspirable metals, some of which are known human carcinogens. This cross-sectional study investigated the deleterious health effects of these emissions in occupationally-exposed workers at the Dei-Dei Abattoir, Abuja, Nigeria. METHODS: A total of 156 respondents were divided into two groups. Group 1 (124 butchers) and group 2 [32 administrative staff (AS)]. Data from digital spirometry were used to determine the association between chronic exposure to tyre emissions and lung function. Urinary 1-Hydroxypyrene concentration, phenolic compounds levels and heavy metal concentrations were determined. Also ambient PM and polycyclic aromatic hydrocarbons (PAHs) concentrations at 3 delineated points in the abattoir were measured. FINDINGS: Spirometry results showed significant deterioration of lung function in the butchers. The concentration of 1-Hydroxypyrene (µg/molCret) in the post-shift urine samples of the butchers was significantly higher (P < 0.05) in butchers relative to the AS (0.52 ± 0.13 Vs 0.20 ± 0.07, respectively). Similarly the concentrations of zinc and nickel (mg/l) were significantly higher in the butchers compared to the AS (zinc: 0.91 ± 0.19 Vs 0.31 ± 0.28, respectively; nickel: 0.11 ± 0.06 Vs 0.06 ± 0.02, respectively). Anthracene, fluoranthene, pyrene, benzo-a- pyrene, and PM concentrations were significantly higher at the de-furring point when compared to the wash bay and the administrative building, especially between 8.00 and 8.30 am. CONCLUSION: Occupational exposure to scrap tyre emissions resulted in significant adverse health effects. The existing laws banning the use of burning tyres in meat processing should be enforced while the use of personal protective equipment should be encouraged in abattoirs.

Pulmonary function in multiple sclerosis without any respiratory complaints.

OBJECTIVES: Pulmonary complications in severe multiple sclerosis (MS) are often seen secondary to respiratory muscle dysfunction. The development of respiratory muscle dysfunction and its association with disability during the course of MS is unknown. In our study, we investigated the predictive value of respiratory muscle functions and the change in forced vital capacity (Delta forced vital capacity [FVC]; FVC upright-FVC supine) to detect deterioration of respiratory muscle functions in the early phase of MS. PATIENTS AND METHODS: Twenty-one MS patients with a median age of 34.5+/-9.45 years were enrolled. Fourteen cases were relapsing-remitting, six were secondary progressive, one was primary progressive type. The mean duration of disease was 10.76+/-6.6 years. Seventeen healthy subjects with a median age of 40.7+/-7.6 years were chosen as a control group. Smoking habit was similar in both groups. Pulmonary function tests (PFT), lung volumes, diffusion, respiratory muscle function ( P(Imax) , P(Emax)), mouth occlusion pressure, and indirect sign of respiratory center function (P(0.1)) tests were performed. PFT were repeated in supine and upright positions. RESULTS: Our results in the MS group and the control group, respectively, were: diffusion (DL(CO): 18.8+/-4.2 vs. 26.4+/-7.3 mL/mmHg/min), P(I(max) (82.1+/-26.3 vs. 109.1+/-23.3 cm H(2)O), P(E(max) (119.2+/-42 vs. 171.8+/-50.2 cm H(2)O), P(0.1) (2.6+/-0.7 vs. 4.2+/-0.7). All parameters were lower in the MS group compared with the control group (p<0.05). In the MS group, FVC values in the upright position were higher than FVC values in the supine position. The difference in FVC values in MS patients between the upright and supine positions (Delta FVC) was also found to be significantly higher than in the control group (Delta FVC 262.3+/-247.6 (MS), 98.8+/-179.1 mL (CONTROL)) (p<0.01). CONCLUSION: Our results indicate the presence of pulmonary dysfunction in MS even in the absence of any respiratory symptoms.

[Pulmonary disease in dental laboratory technicians]. / Manifestations pulmonaires des prothésistes dentaires.

INTRODUCTION: The manufacture of dental prostheses exposes the technician to inhalation of various potentially dangerous dusts (silica, hard metals, dental alloys and acrylic resins). BACKGROUND AND VIEWPOINT: Inhalation of dusts produced by the technician in the work place may lead to several respiratory disorders (pneumoconiosis, hypersensitivity pneumonitis, asthma, lung cancer). The continuous development of new materials leads to further manifestations of these disorders and justifies their notification, even in the absence of an accepted occupational disease. This step is taken inconsistently as many dental technicians are not salaried or insured. CONCLUSION: The seriousness of some of these disorders and the absence of effective treatment makes it important to develop effective methods of prevention for the protection of individuals and groups, and for early detection.

Recent developments in human biomonitoring: non-invasive assessment of target tissue dose and effects of pneumotoxic metals.

Tobacco smoke and polluted environments substantially increase the lung burden of pneumotoxic chemicals, particularly pneumotoxic metallic elements. To achieve a better understanding of the early events between exposure to inhaled toxicants and the onset of adverse effects on the lung, the characterization of dose at the target organ would be extremely useful. Exhaled breath condensate (EBC), obtained by cooling exhaled air under conditions of spontaneous breathing, is a novel technique that could provide a non-invasive assessment of pulmonary pathobiology. Considering that EBC is water practically free of interfering solutes, it represents an ideal biological matrix for elemental characterization. Published data show that several toxic metals and trace elements are detectable in EBC, raising the possibility of using this medium to quantify the lung tissue dose of pneumotoxic substances. This novel approach may represent a significant advance over the analysis of alternative media (blood, serum, urine, hair), which are not as reliable (owing to interfering substances in the complex matrix) and reflect systemic rather than lung (target tissue) levels of both toxic metals and essential trace elements. Data obtained among workers occupationally exposed to either hard metals or chromium (VI) and in smokers with or without chronic obstructive pulmonary disease (COPD) are reviewed to show that--together with biomarkers of exposure--EBC also allows the simultaneous quantification of biomarkers of effect directly sampled from the epithelial lining fluid, thus providing novel insights on both kinetic and dynamic aspects of metal toxicology.

Air pollution epidemiologic studies in South Africa--need for freshening up.

The results of epidemiologic studies obtained in developed countries cannot be extrapolated with complete confidence to developing countries. The objectives of this review were to examine the evidence from local studies for associations between air pollution and adverse health along with a critical review for methodologic limitations. The literature search strategy and selection criteria involved a MEDLINE search up to June 2005. Of 267 journal articles found, 14 focused on air pollution epidemiology (excluding active smoking and internal dose as a proxy for health outcomes). Two studies were also located by word of mouth or through the references from the selected studies. The local studies provide some evidence of an association with a range of serious and common health problems. No study established an exposure-response curve for the criteria pollutants carbon monoxide, sulfur dioxide, nitrogen oxides, lead, and ozone. Therefore, using the results of such studies in risk-assessment is impossible. The studies were fraught with systematic and random errors, which limit their validity and precision. We recommend conducting a quantitative intervention study with an analytical study design in all major cities in the countries where residents are still using dirty fuels for cooking, lighting, and space heating. Future studies must involve national and international multidisciplinary stakeholders and must be planned well in advance.

Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study.

Hydrophilic polymers are commonly applied as surface coatings on vascular devices and have been shown to dissociate during endovascular use, causing hydrophilic polymer embolism (HPE). Adverse effects related to this phenomenon have been recognized and reported. The prevalence of this complication is unknown. We conducted a retrospective study to determine the prevalence of HPE among hospital autopsies over a 29-month period. Postmortem tissue was histologically evaluated for the presence, location(s) and extent of HPE. HPE findings were correlated with documented clinical and laboratory data and patient outcome. Of 136 hospital autopsies examined, 18 (13%) showed evidence of HPE involving the lungs (n = 18), heart (n = 1) or central nervous system (n = 1). Localized pulmonary HPE was seen in 12 patients (9%). Multifocal pulmonary HPE was found in 6 patients (4%) and was associated with clinical vasculitis (33%; P < .0001), suspected pulmonary ischemia (50%; P = .008), coagulopathy (67%; P = .002), and constitutional disease (83%; P = .01). Within affected lung, associated histopathologic changes included occlusive intravascular or perivascular inflammation (89%), intravascular fibrous response (56%), microthrombus formation (44%), vasculitis (28%), and/or pulmonary microinfarction (28%). Statistically significant differences in hospital days (P = .008) and number of vascular interventions (P = .01) were noted between affected and unaffected patients. We conclude that HPE is an underdiagnosed phenomenon with primary involvement of the lungs, where secondary vascular changes are common. Additional studies may be needed to clarify risks and to identify preventative strategies for this iatrogenic complication of catheterizations and "minimally invasive" endovascular techniques.

[Respiratory and gastrointestinal symptoms in 7-10 year old children in Reykjavík, Iceland]. / Öndunar- og meltingarfæaeinkenni hjá 7-10 ára börnum í Reykjavík.

INTRODUCTION: Asthma and rhinitis are common diseases in children often but not always caused by allergy. Gastroesophageal reflux is also prevalent in children and relationship with respiratory symptoms has been suggested. The aim of this study was to investigate this relationship in schoolchildren. MATERIAL AND METHODS: As a part of multi-centre cross-sectional food allergy study (Europrevall), a short questionnaire was sent out to 2895 schoolchildren in Reykjavik 7-10 year old. Of the 2346 (81%) children we received answers from we selected those that answered positively to questions regarding common foods and a random sample of those who denied any symptoms related to food. The selected children were invited to further study where they answered an extensive questionnaire that included questions regarding respiratory and gastrointestinal symptoms. RESULTS: A significant correlation was found between a history of wheezing over the previous year and vomiting, (p<0.001) and feeling nauseous (p<0.001) in the past 6 months. There was also a correlation between asthma in the previous year and feeling nauseous (p<0.05), having a a burning or painful feeling in the middle of the chest (p<0.001) as well as nasal symptoms and vomiting (p<0.01), feeling nauseous (p<0.01), having a burning or painful feeling in the middle of the chest (p<0.01) and having a sour taste, like a taste of vomit in the mouth (p<0.001). CONCLUSION: This study shows a significant correlation between symptoms of gastroesophageal reflux and respiratory and nasal symptoms. Clinicians should be aware of this association though the nature and direction of this association is still unclear.

Chronic diseases in the rubber industry.

An overview is presented of epidemiologic studies of chronic diseases in the rubber industry. Analyses of the mortality experience during the period 1964-1972 of workers age 40-64 and retirees age 65-84 of two large rubber and tire manufacturing companies consistently disclosed excesses of deaths attributed to leukemia and lymphosarcoma, and for cancers of the stomach, large intestine, and prostate. The relation of site-specific malignancies to work histories and grouped occupational titles as surrogate measures of work-related exposures to possible carcinogens is described. There was no evidence of company-wide, sizable, consistent excess for the other major chronic diseases causes of death. Although a total cohort deficit in the mortality rate for lung cancer was found, there was a history of increased frequency of exposure to certain work areas among lung cancer decedents. Morbidity studies, including analysis of disability retirements, and ad hoc questionnaire and health testing surveys, disclosed excesses of chronic pulmonary diseases. There was evidence of an interactive effect in the association of work and smoking histories with pulmonary disability retirement.

Successful bone marrow transplantation in patients with previous invasive fungal infections: report of four cases.

Patients with previous invasive fungal infections (IFI) are at high risk of reactivation of the infection during BMT, even after an apparently curative antifungal treatment. We report four patients who suffered an IFI after intensive chemotherapy for acute leukemia and were later submitted for BMT. One patient had developed a chronic systemic candidiasis during consolidation chemotherapy and received prophylactic oral or iv fluconazole (200 mg daily) throughout BMT. Two patients developed an invasive pulmonary aspergillosis after intensive chemotherapy, one of them after salvage therapy for post-allogeneic BMT relapse and the other after consolidation therapy. The former patient underwent partial lobectomy after treatment with amphotericin B before a second allogeneic BMT was performed. Both patients received prophylactic itraconazole (400 mg daily by mouth) throughout the BMT procedure. The fourth patient had pneumonia caused by Scedosporium apiospermum (the anamorph form of the fungus Pseudallescheria boydii) during consolidation chemotherapy which was successfully treated with itraconazole. During BMT he also received oral itraconazole (400 mg daily) as prophylaxis against reactivation of the infection. All four patients had successful BMT and none had clinical, radiological or microbiological evidence of reactivation of IFI during BMT.

Epidemiology of gastroesophageal reflux disease: a general population-based study in Xi'an of Northwest China.

AIM: Gastroesophageal reflux disease (GERD) is a common disorder in the Western population, but detailed population-based data in China are limited. The aim of this study was to understand the epidemiology of symptomatic gastroesophageal reflux (SGER) in adults of Xi'an, a northwestern city of China, and to explore the potential risk factors of GERD. METHODS: Symptoms suggestive of GERD, functional dyspepsia (FD), irritable bowel syndrome (IBS), upper respiratory diseases and some potential risk factors were investigated in a face-to-face manner in a region-stratified random samples of 2789 residents aged 18-70 years in Xi'an by using a standardized questionnaire. METHODS: With a response rate of 91.8%, the prevalence of SGER was 16.98% (95% CI, 14.2-18.92) in Xi'an adults, and no gender-related difference was observed (P<0.05). SGER was more common among subjects aged 30-70 years than in those aged 18-29 years (P<0.01). The prevalence of SGER in rural, urban and suburban subjects was 21.07%, 17.44% and 12.12%, respectively, and there was a significant difference between rural, urban and suburban regions (P<0.05). Compared with subjects without SGER, the prevalence of symptoms suggestive of FD and IBS, pneumonia, asthma, bronchitis, laryngitis, pharyngitis, chronic cough, wheeze, globus sensation, oral ulcer and snore was significantly increased in subjects with SGER (P<0.01). Heavy smoking (OR=5.76; CI, 3.70-6.67), heavy alcohol use (OR=2.85; CI, 1.67-4.49), peptic ulcer (OR=5.76; CI, 3.99-8.32), cerebral palsy (OR=3.97; CI, 1.97-8.00), abdominal operation (OR=2.69; CI, 1.75-4.13), obesity (OR=2.16; CI, 1.47-3.16), excessive food intake (OR=1.43; CI, 1.17-1.15), sweet food (OR=1.23; CI, 0.89-1.54), and consumption of coffee (OR=1.23; CI, 0.17-2.00) were independently associated with SGER. The episodes of GERD were commonly precipitated by dietary factors (66.05%), followed by body posture (26.54%), ill temper (23.72%), fatigue (22.32%) and stress (10.93%). CONCLUSION: GERD is common in Xi'an's adult population with a mild or moderate degree. The etiology and pathogenesis of GERD are probably associated with FD, IBS, and some respiratory, laryngopharyngeal and odontostological diseases or symptoms. Some lifestyles, diseases and dietary factors are the risk factors of GERD.

Actinomycosis: diagnostic and therapeutic considerations and a review of 32 cases.

Actinomycosis was at one time a common diagnosis in this country. It still is fairly common in some parts of the world. As the numbers of antibiotics and indications for their use have increased, the disease has almost become a medical rarity in the United States. This fact might be thought a paradox in view of the universal presence of the actinomyces organisms in every human mouth. However, it is perhaps not well recognized that the actinomyces are true bacteria, and that they are particularly sensitive to most of the common antibacterials in current usage. These facts have combined to decrease the clinical frequency of the disease as well as effectively reduce the opportunity for securing a satisfactory specimen for laboratory culture in suspected cases. Actinomycosis can present in a variety of forms and may mimic other infections or even neoplasms. The clinical pattern of remission and exacerbation of symptoms occurring in parallel sequence with initiation and cessation of antibiotic administration is a phenomenon which should increase suspicion for actinomycosis in any of its manifestations.

Acute respiratory effects of exposure to stainless steel and mild steel welding fumes.

Over the past few years, many studies, including one on our previous work, have examined the chronic effects of fumes from stainless steel (SS) welding on the health of welders. These chronic effects have been related to concentrations of chromium and nickel in SS welding fumes. The present study examined the acute respiratory effects of welding fumes in the workplace by measuring the across-shift changes in a population of 144 SS and mild steel (MS) welders and 223 controls. Manual Metal Arc, Metal Inert Gas, and Tungsten Inert Gas welding processes were studied. Pulmonary function tests were performed at the start (ante, or A) and at the end (post, or P) of the work shift. The study of sensitization to harmful respiratory effects of welding was based on the study of the (P-A)/A ratio (%) of the spirometric variations during the shift. The means of these ratios in the control subjects were used to account for the circadian effect. In SS welders we observed a significant decrease in forced vital capacity (FVC) during the shift. Significant across-shift decrements in forced expiratory volume in 1 second (FEV1) and FVC were related to the SS welding exposure compared with MS welding. Moreover, the across-shift decreases in FEV1, FVC, and peak expiratory flow (PEF) were significantly related to the Manual Metal Arc welding process, compared with Metal Inert Gas techniques (respectively, PEF = -2.7% of baseline values [SD, 11.9] vs 2.0% of baseline values [SD, 7.7] P = 0.04; FVC = -1.5% of baseline values [SD, 4.8] vs 0.2% of baseline values [SD, 4.5] P = 0.05). We also demonstrated the influence of duration of SS welding exposure on the course of lung function during the work shift. After 20 years of SS welding activity, SS welders had more significant across-shift decreases than MS welders with a similar MS exposure duration (respectively, FEV1 = -2.7% of baseline values [SD, 5.9] vs 0.7% of baseline values [SD, 4.2] P = 0.008; PEF = -3.8% of baseline values [SD, 9.6] vs 2.3% of baseline values [SD, 6.5] P = 0.04). We concluded that welding-related lung function responses are seen in SS compared with MS welders and in those with a longer lifetime welding history.