[Investigation of serum surface active protein D and clara cell protein levels in workers exposed to silica dust in ferrous metal foundry].

Objective: To investigate the levels of serum surface active protein D (SP-D) and clara cell protein (CCl6) in workers exposed to black silica dust, and analyze its influencing factors. Methods: From July to September 2021, 174 workers in 37 positions exposed to silica dust in 5 ferrous metal foundry were investigated by cross-sectional research method. The exposure concentration of silica dust workers was obtained through occupational health field investigation and detection, and the general situation of the study subjects was obtained through questionnaire survey and peripheral blood was collected. Double antigen sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of SP-D and CC16 in serum of workers. The mean values were compared by one-way ANOVA, and the influencing factors of SP-D and CC16 concentrations in serum were analyzed by ordered multiple logistic regression. Results: The time-weighted average concentration (C-TWA) of 174 workers exposed to silica dust (respirable dust) ranged from 0.09 mg/m(3)~3.58 mg/m(3), and the C-TWA overstandard rate of dust exposed workers was 32.18% (56/174) , with differences among workers in different positions (χ(2)=28.85, P<0.001) . The highest concentration of silica dust was (0.82±0.11) mg/m(3). Using C-TWA<50% OEL occupational exposure limit (OEL) as reference, serum SP-D concentration in workers with ≥50% OEL was increased (OR=4.95, 95%CI: 1.86~13.17, P=0.001) , while CC16 concentration was decreased (OR=0.15, 95%CI: 0.05~0.40, P<0.001) ; Serum CC16 concentration decreased in workers exposed to silica dust C-TWA≥OEL (OR=0.46, 95%CI: 0.28~0.98, P=0.043) . Compared with those with low occupational health literacy, the serum SP-D concentration of workers with high occupational health literacy decreased (OR=0.48, 95%CI: 0.25~0.92, P=0.027) and CC16 concentration increased (OR=2.09, 95%CI: 1.10-3.97, P=0.024) . Conclusion: When no abnormality was found in the physical examination of workers, the serum SP-D and CC16 concentration levels changed, and the change was related to the concentration of workers exposed to silica dust.

Real-space observation of ultraconfined in-plane anisotropic acoustic terahertz plasmon polaritons.

Thin layers of in-plane anisotropic materials can support ultraconfined polaritons, whose wavelengths depend on the propagation direction. Such polaritons hold potential for the exploration of fundamental material properties and the development of novel nanophotonic devices. However, the real-space observation of ultraconfined in-plane anisotropic plasmon polaritons (PPs)-which exist in much broader spectral ranges than phonon polaritons-has been elusive. Here we apply terahertz nanoscopy to image in-plane anisotropic low-energy PPs in monoclinic Ag2Te platelets. The hybridization of the PPs with their mirror image-by placing the platelets above a Au layer-increases the direction-dependent relative polariton propagation length and the directional polariton confinement. This allows for verifying a linear dispersion and elliptical isofrequency contour in momentum space, revealing in-plane anisotropic acoustic terahertz PPs. Our work shows high-symmetry (elliptical) polaritons on low-symmetry (monoclinic) crystals and demonstrates the use of terahertz PPs for local measurements of anisotropic charge carrier masses and damping.

[Analysis of dust hazard characteristics in 59 ferrous metal foundry enterprises in Ningbo City].

Objective: To analyze the post distribution of dust concentration in ferrous metal foundry enterprises and evaluate the occupational health risks, and provide basis for policies of the formulation of pneumoconiosis prevention and control. Methods: From August to September in 2020, the basic information, dust hazard information and occupational health management information of 59 ferrous metal casting enterprises were investigated, the dust concentration distribution was analyzed, and the risk assessment was carried out by using the quantitative assignment model. The dust concentration is tested by LSD method after logarithmic treatment. The 3 times time weighted average allowable exposure concentration of dust is taken as the peak concentration limit of dust; The time weighted average allowable exposure concentration of dust converted by exposure time is taken as the time weighted average exposure concentration limit of dust, and whether the time weighted average exposure concentration and peak concentration of dust at the same post exceed the limit is taken as the basis for exceeding the limit of dust post concentration to calculate the post exceeding the limit rate. Results: The dust hazards were mainly distributed in the posts of sand treatment, molding, sand falling, sand cleaning and cutting and grinding. Dust exposure time weighted average concentration was 0.44 (0.03, 5.11) mg/m(3), peak exposure concentration was 1.30 (0.18, 10.94) mg/m(3), and the over standard rate of Posts was 38.92% (79/203) . Weighted average exposure concentration of other dust (total dust) in the cutting and grinding post is 1.50 (0.15, 7.40) mg/m(3), peak exposure concentration is 0.90 (0.07, 12.48) mg/m(3), and the post exceedance rate is 4.88% (2/41) . Weighted average exposure concentration of silica dust (exhaling dust) in dust operation posts of investment casting enterprises is 0.43 (0.05, 6.35) mg/m(3), peak exposure concentration is 0.90 (0.12, 8.28) mg/m(3), and the post over standard rate is 35.77% (49/137) ; Weighted average exposure concentration of other dust (total dust) at the cutting and grinding post is 2.00 (11.00, 21.00) mg/m(3), and the post exceedance rate is 2.50% (2/80) . There was no significant difference in the concentration of respirable dust between sand casting and investment casting (P>0.05) . The concentration of respirable dust in sand casting was higher than that in sand treatment, molding and sand cleaning posts (P<0.05) . The concentration of silica dust in investment casting was higher than that in sand treatment and molding posts, and that in sand cleaning posts was higher than that in sand treatment posts (P<0.05) . 98.48% (454/461) of the dust operation posts have an occupational health risk value greater than or equal to 400, and 1.52% (7/461) of the dust operation posts have an occupational health risk value of 200~399. Conclusion: there is a high rate of exceeding the standard in the dust work posts in the ferrous metal foundry enterprises in Ningbo, and the workers have a high occupational health risk of pneumoconiosis or metal and its compound pneumoconiosis. Targeted measures should be taken to reduce the occupational health risk.

[Analysis of incidence characteristics and trend of pneumoconiosis in Ningbo City from 1967 to 2019].

Objective: To understand the incidence of pneumoconiosis in Ningbo city from 1967 to 2019, and to analyze the distribution characteristics and change trend of pneumoconiosis. Methods: In February 2021, the data of pneumoconiosis patients in Ningbo city from 1967 to 2019 were sorted out. The data from 1967 to 1987 were from historical case files of Zhejiang Center for Disease Control and Prevention, the data from 1988 to 2005 were from the historical case files of Ningbo Center for Disease Control and Prevention, and the data from 2006 to 2019 were from the pneumoconiosis report card in China Disease Prevention and Control Information System; Followed up and supplement relevant information, including basic information, basic information of employers and information related to pneumoconiosis diagnosis, and comprehensively analyze the composition and development trend, population characteristics and industry characteristics of pneumoconiosis. Results: From 1967 to 2019, a total of 1715 cases of pneumoconiosis were reported in Ningbo City, including 1254 cases of stageⅠpneumoconiosis, 258 cases of stageⅡpneumoconiosis, 172 cases of stage Ⅲpneumoconiosis. 1202 cases of silicosis (70.09%) , 296 cases of asbestosis (17.26%) , 40 cases of welder's pneumoconiosis (2.33%) , 32 cases of graphite pneumoconiosis (1.87%) were reported. There were 1296 male cases (75.57%) and 419 female cases (24.43%) were reported. Silicosis (91.15%, 1102/1209) and welder's pneumoconiosis (100.00%, 40/40) were the most common pneumoconiosis in males, while asbestosis (90.24%, 268/297) and graphite pneumoconiosis (87.50%, 28/32) were the most common pneumoconiosis in females. The average age was (49.71±10.90) years old and the average length of service was (10.98±6.96) years. The top three reported pneumoconiosis cases were construction industry (336 cases, 19.59%) , ferrous metal smelting and rolling industry (317 cases, 18.48%) and non-metallic mineral products industry (315 cases, 18.37%) . The top three reported pneumoconiosis cases were 414 cases (24.14%) in Ninghai County, 294 cases (17.14%) in Yuyao City and 272 cases (15.86%) in Yinzhou District. Conclusion: With the development of industries in Ningbo City, government departments should strengthen supervision and management of enterprises involving silica dust and welding fume to curb the high incidence of pneumoconiosis.

[Occupational Health Risk Assessment of Low Concentrations Benzene Toluene and Xylenes].

Objective: To Assess occupational health risks of exposuring to low concentrations (lower than occupational exposure limit, OEL) benzene, toluene and Xylenes. Methods: Qualitative evaluation, semi-quantitative evaluation and quantitative evaluation from guidelines for occupational health risk assessment of chemicals in the workplace were conducted to assess occupational health risks exposure to benzene compounds in different workplaces of 5 manufacturing enterprises, respectively. Results: Concentrations of benzene, toluene and Xylenes in all workplaces were lower than OEL. Qualitative evaluation showed that occupational health risk level was 4 exposure to benzene and Xylenes in all workpalces, while 2 exposure to toluene. Semi-quantitative evaluation showed low level (2 of 5) risks in all workplaces exposured to benzene compounds excepted 4 workpalces exposured to benzene, the latter was moderate (3 of 5) . Quantitative evaluation gave unacceptable carcinogenic risk (higher than 10(-4)) of benzene in the wood toy manufactory, and the highest risk was (1.48~5.26) ×10(-4). The occupational health risks of benzene and Xylenes were all unacceptable (HQ>1) in 9 workplaces. Conclusion: There still need more attention to occupational health risks exposure to benzene, toluene and Xylenes lower than OEL.

[Analysis on occupational health surveillance to workers exposed to toxic environment in Ningbo].

Objective: To analyze the occupational health surveillance data of toxic and harmful workers in Ningbo, and provide scientific basis for making protective measures. Methods: To export the occupational health surveillance data of toxic and harmful workers reported by occupational health examination institutions in Ningbo during the January 1, 2011 to December 31, 2017 from the China Information System for Disease Control and Prevention, and analyze the trend of the suspected occupational disease and occupational contraindication detection rate, and compare the the health status of workers in different industry nature, economic type, enterprise scale and occupational hazards. Results: From 2011 to 2017, the number of occupational health surveillance of toxic and harmful workers in Ningbo was increasing year by year. The detection rates of suspected occupational diseases and occupational contraindications generally showed a downward trend (P<0.05) . In 2017, the distribution of occupational health care for toxic and harmful workers in Ningbo was mainly based on manufacturing (187 681/220 895, 84.96%) , private economic enterprises (103 960/220 895, 47.06%) and small enterprises (100 357/220 895, 45.43%) , Workers exposed to chemical poisons had the largest number of physical examinations (101 813/220 895, 46.09%) . The highest detection rates of suspected occupational diseases were mining industry (2/1225, 0.16%) , collective economic enterprises (4/2622, 0.15%) and small enterprises (88/100 357, 0.09%) . The highest detection rates of occupational contraindications were rental and business services (16/1 320, 1.21%) , private economic enterprises (1 190/103 960, 1.14%) and small enterprises (995/100 357, 0.99%) . In addition, workers exposed to dust had the highest detection rate of suspected occupational diseases (57/46 740, 0.12%) and workers exposed to physical factors had the highest detection rate of occupational contraindications (1207/69 567, 1.74%) . There were significant differences between the detection rate of suspected occupational disease and occupational contraindication in different industries, economic types, enterprise scale and occupational hazards (P<0.05) . Conclusion: The occupational health surveillance of toxic and harmful workers in Ningbo has been strengthened year by year, attention should be paid to small, private enterprises, and strengthen the supervision of occupational health and further standardize the work of occupational health examination so as to effectively protect the health of the occupational population.

Retrospective Study of Reported Adverse Events Due to Complementary Health Products in Singapore From 2010 to 2016.

The objective of this study is to collate and analyse adverse event reports associated with the use of complementary health products (CHP) submitted to the Health Sciences Authority (HSA) of Singapore for the period 2010-2016 to identify various trends and signals for pharmacovigilance purposes. A total of 147,215 adverse event reports suspected to be associated with pharmaceutical products and CHP were received by HSA between 2010 and 2016. Of these, 143,191 (97.3%) were associated with chemical drugs, 1,807 (1.2%) with vaccines, 1,324 (0.9%) with biological drugs (biologics), and 893 (0.6%) with CHP. The number of adverse event reports associated with Chinese Proprietary Medicine, other complementary medicine and health supplements are presented. Eight hundred and ninety three adverse event reports associated with CHP in the 7-year period have been successfully collated and analyzed. In agreement with other studies, adverse events related to the "skin and appendages disorders" were the most commonly reported. Most of the cases involved dermal allergies (e.g., rashes) associated with the use of glucosamine products and most of the adulterated products were associated with the illegal addition of undeclared drugs for pain relief. Dexamethasone, chlorpheniramine, and piroxicam were the most common adulterants detected. Reporting suspected adverse events is strongly encouraged even if the causality is not confirmed because any signs of clustering will allow rapid regulatory actions to be taken. The findings from this study help to create greater awareness on the health risks, albeit low, when consuming CHP and dispelling the common misconception that "natural" means "safe." In particular, healthcare professionals and the general public should be aware of potential adulteration of CHP. The analysis of spontaneously reported adverse events is an important surveillance system in monitoring the safety of CHP and helps in the understanding of the risk associated with the use of such products. Greater collaboration and communication between healthcare professionals, regulators, patients, manufacturers, researchers, and the general public are important to ensure the quality and safety of CHP.

[Analysis of acute pesticide poisoning in Ningbo city from 2011 to 2016].

Objective: To analyze the characteristics of acute pesticide poisoning in Ningbo, and to provide scientific basis for the prevention and control strategy. Methods: In February 2017, the pesticide poisoning report card of Ningbo from 2011 to 2016 was drawn from the China Disease Control and prevention information system. The data of the report card was organized by Excel and analyzed by SPSS19.0 software. Results: 2593 cases of acute pesticide poisoning were reported in Ningbo from 2011 to 2016, 125 deaths, and the case fatality rate was 4.82%. The productive pesticide poisoning and unproductive pesticide poisoning were 299 and 2294, respectively, the ratio was 1: 7.67. The case fatality rate were 0.33% and 5.41%, respectively. The difference was statistically significant (χ(2)=14.83, P<0.01). The productive Pesticide poisoning mainly occurred from July to September (55.85%) , the unproductive pesticides mainly occurred from April to June (30.64%) and July to September (30.34%). The seasonal distribution of the pesticide poisoning in the two groups was statistically significant (χ2=82.21, P<0.01). The productive pesticide poisoning in male (80.27%) was significantly higher than the proportion of unproductive pesticide poisoning (52.09%) , the differences in gender composition between the two types of pesticide poisoning was significant (χ2=84.97, P<0.01). The productive pesticide poisoning from 55 to 65 years old group was in the largest number (35.45%) , and the distribution of unproductive pesticide poisoning was uniform in each age group including 25 years old and above, the difference in age composition between two types of pesticide poisoning was statistically significant (χ2=177.84, P<0.01). All of the 10 counties of Ningbo had reports of pesticide poisoning. The counties with more reports were Ninghai county (18.28%) , Fenghua district (14.69%) and Yuyao (12.42%). The acute pesticide poisoning was mainly caused by pesticides and herbicides, mainly in organophosphorus (45.74%) and paraquat (16.81%) . Conclusions: At present, the pesticide poisoning in Ningbo is given priority to unproductive pesticide poisoning currently, seasonal distribution characteristics was obvious, and occurred both in different sex and age groups, suggesting that the relevant departments should carry out targeted health education, and strengthen the management of high toxic and highly toxic pesticides.

[Incidence and trend of occupational diseases in Ningbo, China, from 2006 to 2015].

Objective: To investigate the incidence, distribution features, and incidence trend of occupational diseases in Ningbo, China, from 2006 to 2015. Methods: In February 2016, the data on occupational disease report cards in the occupational disease and occupational health information system from 2006 to 2015 were collected to perform a comprehensive analysis of the types, incidence trend, population characteristics, and enterprise characteristics of occupational diseases. Results: There were 845 new cases of occupational diseases in Ningbo from 2006 to 2015, among which 596 (70.53%) were pneumoconiosis; there were 445 (74.66%) cases of stage I pneumoconiosis, 73 (12.25%) cases of stage II pneumoconiosis, and 78 (13.09%) cases of stage III pneumoconiosis; silicosis (59.76%) was the most common type of pneumoconiosis. Of all patients with occupational diseases, 84.97% were male, 64.50%were aged 35-55 years, and 63.67% had 5-20 working years. Most of the patients with occupational diseases worked in small and medium-sized private (or foreign) enterprises; the most common industries were black metal smelting and rolling (38.76%) , construction (17.11%) , and non-metallic ore mining (13.09%) . A total of 51.28%, 10.26%, and 7.69% of the patients with occupational poisoning worked in the electric apparatus manufacturing industry, furniture manufacturing industry, and chemical raw material and chemical product manufacturing industry, respectively. The cases of occupational diseases are mainly distributed in Yuyao City (24.62%) , Yinzhou District (23.91%) , and Ninghai County (15.62%) . Conclusion: Pneumoconiosis is the most common type of occupational disease in Ningbo and most of these patients work in small and medium-sized private (or foreign) enterprises. The supervision of small and medium-sized private enterprises should be enhanced to protect workers' health.

[The application of two occupation health risk assessment models in a wooden furniture manufacturing industry].

Objective: To explore the applicability of 2 different models of occupational health risk assessment in wooden furniture manufacturing industry. Methods: American EPA inhalation risk model and ICMM model of occupational health risk assessment were conducted to assess occupational health risk in a small wooden furniture enterprises, respectively. Results: There was poor protective measure and equipment of occupational disease in the plant. The concentration of wood dust in the air of two workshops was over occupational exposure limit (OEL) , and the CTWA was 8.9 mg/m3 and 3.6 mg/m3, respectively. According to EPA model, the workers who exposed to benzene in this plant had high risk (9.7×10-6 ~34.3×10-6) of leukemia, and who exposed to formaldehyde had high risk (11.4 × 10-6) of squamous cell carcinoma. There were inconsistent evaluation results using the ICMM tools of standard-based matrix and calculated risk rating. There were very high risks to be attacked by rhinocarcinoma of the workers who exposed to wood dust for the tool of calculated risk rating, while high risk for the tool of standard-based matrix. For the workers who exposed to noise, risk of noise-induced deafness was unacceptable and medium risk using two tools, respectively. Conclusion: Both EPA model and ICMM model can appropriately predict and assessthe occupational health risk in wooden furniture manufactory, ICMM due to the relatively simple operation, easy evaluation parameters, assessment of occupational- disease-inductive factors comprehensively, and more suitable for wooden furniture production enterprise.

Outbreak of Serratia marcescens postoperative infection traced to barbers and razors.

BACKGROUND: Fourteen postoperative infections caused by Serratia marcescens were detected in patients on the neurosurgical wards and spinal surgery ward of a 2640-bed hospital between 26th December 2012 and 5th June 2013. AIM: To investigate the source of the outbreak, identify risk factors and implement infection control measures. METHODS: Cultures were collected from healthcare workers and potential environmental sources. S. marcescens isolates were characterized by antibiotic susceptibility testing and pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was performed to identify the risk factors. FINDINGS: The outbreak involved 14 patients, five of whom required more than one surgical procedure. S. marcescens was isolated from cerebrospinal fluid, brain tissue, sputum and other secretions. S. marcescens was also cultured from samples taken from the hands of two barbers and their razors. Exposure to the two barbers [odds ratio (OR) 78.0, P < 0.0001] and wound drainage (OR 4.889, P = 0.028) were risk factors. Pre-operative shaving by the barbers was the only independent risk factor (OR 78.0, P < 0.0001). Isolates of S. marcescens from patients, barbers and razors were indistinguishable by PFGE and antibiotic susceptibility pattern. The outbreak ended after removal of the implicated barbers, extensive re-inforcement of infection control procedures and re-education. CONCLUSION: These results underscore the risk of postoperative infection associated with pre-operative wet shaving.

First Report of Anthracnose Caused by Colletotrichum gloeosporioides on Pistachio (Pistacia vera) in China.

In the 1990s, pistachio (Pistacia vera L. 'Kerman' and 'Peters') was introduced in China. They are found in many orchards in Beijing and Gansu and Hebei provinces, northern China. In 2009, a new disease was observed on leaves, stems, and fruits in pistachio orchards in Gansu Province. Disease incidence in 8- to 12-year-old orchards was 30%. Yield losses reached 25%. Symptoms began as discrete, sunken, black spots, approximately 10 mm in diameter, followed by circular lesions that eventually coalesced with tissue death recorded and orange fructifications developed on lesions. Pieces of diseased leaves, stems, and fruits were surfaced sterilized and placed on 2% potato dextrose agar (PDA) at 25°C. A fungus was consistently isolated. After 10 days, cultures on PDA showed aerial, white mycelium that turned gray to grayish black with a salmon-to-orange conidial mass at 25°C and a 12-h photoperiod. Brown, 80 to 120 µm long setae were observed in the acervulus. Conidia were hyaline, fusiform to nearly straight, and averaged 12 to 18 × 3 to 5 µm. On the basis of morphological characteristics, the fungus was identified as Colletotrichum gloeosporioides (Penz.) Sacc. (2). On PDA, 0.5 µg/ml of benomyl was applied for the sensitivity test (3). Benomyl completely inhibited the growth of the fungus. Mycelial DNA was extracted, PCR amplified using ITS1 and ITS4 primers for the ribosomal DNA internal transcribed spacers 1 and 2, and sequenced. The DNA sequence was recorded in GenBank as No. HQ631378. The DNA sequence was blasted showing 99% identity with Accession Nos. GQ144454 and GU004376, for C. gloeosporioides. Pathogenicity tests were conducted under greenhouse conditions at 25°C. Three replicates of 2-year-old 'Kerman' plants were inoculated with mycelial PDA plugs placed on 0.5-cm2 stem wounds and then wrapped with Parafilm. Controls were inoculated with PDA plugs without the fungus. After 3 weeks, stem cankers were observed on inoculated plants. Control plants remained healthy. Pathogenicity was also tested on injured leaves and fruits. A 10-µl drop of a spore suspension of 104 conidia/ml was applied on 'Kerman' and 'Peters' leaves and 'Kerman' fruits and placed on plates with a wet filter paper at 25°C. Small, black lesions were observed at 2 days after inoculation. At 7 days, necrotic lesions covered the entire surface. C. gloeosporioides was reisolated from necrotic lesions. Controls did not develop symptoms. C. acutatum has been reported on pistachio in Australia (1), but to our knowledge, this is the first report of anthracnose caused by C. gloeosporioides on pistachio. References: (1) G. J. Ash and V. M. Lanoiselet. Australas. Plant Pathol. 30:365, 2001. (2) J. Y. Lu. Plant Pathogenic Mycology. China Agricultural Press, Beijing, 2001. (3) N. A. R. Peres et al. Plant Dis. 86:620, 2002.

Plagiochin E, a botanic-derived phenolic compound, reverses fungal resistance to fluconazole relating to the efflux pump.

AIM: In this study, we investigated the effect of plagiochin E (PLE), a botanic-derived phenolic natural product, on reversal of fungal resistance to fluconazole (FLC) in vitro and the related mechanism. METHODS AND RESULTS: A synergistic action of PLE and FLC was observed in the FLC-resistant Candida albicans strains and was evaluated using the fractional inhibited concentration index. The effect of PLE on FLC intracellular uptake was investigated in FLC-resistant C. albicans cells by liquid chromatography-tandem mass spectrometry, and the effect on efflux drug pump was assessed by measuring the efflux of Rhodamine 123 (Rh123). PLE significantly inhibited the efflux, but not the absorption, of Rh123 in FLC-resistant strains in phosphate-buffered saline with 5% glucose. Overexpression of the multidrug-resistance gene CDR1 in FLC-resistant C. albicans isolates was detected, and the introduction of PLE to the cells showed a significant reduction of the CDR1 expression in those FLC-resistant isolates. CONCLUSIONS: These findings indicate that PLE could reverse the fungal resistant to FLC by inhibiting the efflux of FLC from C. albicans, and this effect may be related to the efflux pump. SIGNIFICANCE AND IMPACT OF THE STUDY: These results indicate that the combination of PLE and FLC may provide an approach for the clinical therapy of fungus infection induced by FLC-resistant strains.

The clinical predictors of hypertension and sleepiness in an Asian population with sleep-disordered breathing.

INTRODUCTION: The objective of this study was to identify the clinical predictors for hypertension and sleepiness in an Asian population with sleep-disordered breathing (SDB). MATERIALS AND METHODS: This is a retrospective, consecutive case series of 228 patients with symptoms of SDB referred to a tertiary level sleep disorders unit. A full sleep history, body mass index (BMI), Epworth Sleepiness Score (ESS), apnoea-hypopnoea index (AHI) and lowest oxygen saturation were recorded. All patients had an in-hospital polysomnogram. AHI > or =5 defined SDB. ESS >8 defined sleepiness. RESULTS: A BMI of 25 had a positive and negative predictive value of 75% and 56%, respectively, for predicting AHI > or =5, area ROC (receiver operating curve) = 0.668. Patients with AHI >5 had 3 times the risk of developing hypertension compared to the population with AHI <5. Using stepwise multivariate analyses with constant, age, BMI and lowest oxygen desaturation were predictors for hypertension. Patients with AHI > or =5 were 1.88 times more likely to have ESS >8. After stepwise multivariate analyses, the subjective complaint of sleepiness and lowest oxygen saturation during sleep were predictors of ESS >8. CONCLUSION: The lowest oxygen saturation attained during sleep was the common factor for hypertension and sleepiness in our Asian SDB population. Mild obesity predisposes to AHI > or =5 in our population, the threshold at which the risk of hypertension is 3-fold compared with AHI <5. The subjective complaint of sleepiness predicted an ESS of >8.

Early predictors of mortality in pneumococcal bacteraemia.

INTRODUCTION: Streptococcus pneumoniae bacteraemia is associated with significant mortality rates worldwide. The purpose of this study is to identify risk factors for predicting mortality in patients with S. pneumoniae bacteraemia. MATERIALS AND METHODS: A retrospective cohort study was carried out in a university-affiliated acute tertiary care hospital in Singapore. Thirty-eight patients with blood cultures positive for Streptococcus pneumoniae over a 2-year period from January 2000 to December 2001 were recruited for the study. RESULTS: The records of patients admitted to hospital with blood cultures positive for S. pneumoniae between January 2000 and December 2001 were reviewed. Thirty-eight patients were found positive for S. pneumonia; this included 31 men (81.6%) and 7 women (18.4%) between the ages of 14 years and 90 years. Of this, 7 patients (18.4%) required admission to the intensive care unit, 5 of whom required mechanical ventilation. The factors that predicted mortality were the presence of septic shock (P <0.005), leukopenia or leukocytosis (P <0.005), the presence of an underlying malignancy (P = 0.008), anaemia (P = 0.025) and the presence of a high anion gap (P = 0.047) on admission. CONCLUSION: Of all the risk factors observed, those that predicted mortality in patients on initial presentation of S. pneumoniae bacteraemia were the presence of septic shock, leukopenia or leukocytosis, anaemia, a raised anion gap and the presence of an underlying malignancy.

Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised, double blind, placebo controlled study.

BACKGROUND AND AIMS: Melatonin, a sleep promoting agent, is involved in the regulation of gastrointestinal motility and sensation. We aimed to determine if melatonin was effective in improving bowel symptoms and sleep disturbances in irritable bowel syndrome (IBS) patients with sleep disturbance. METHODS: Forty IBS patients (aged 20-64 years; 24 female) with sleep disturbances were randomly assigned to receive either melatonin 3 mg (n = 20) or matching placebo (n = 20) at bedtime for two weeks. Immediately before and after the treatment, subjects completed bowel, sleep, and psychological questionnaires, and underwent rectal manometry and overnight polysomnography. RESULTS: Compared with placebo, melatonin taken for two weeks significantly decreased mean abdominal pain score (2.35 v 0.70; p<0.001) and increased mean rectal pain threshold (8.9 v -1.2 mm Hg; p<0.01). Bloating, stool type, stool frequency, and anxiety and depression scores did not significantly differ after treatment in both groups. Data from sleep questionnaires and polysomnography showed that the two week course of melatonin did not influence sleep parameters, including total sleep time, sleep latency, sleep efficiency, sleep onset latency, arousals, duration of stages 1-4, rapid eye movement (REM) sleep, and REM onset latency. CONCLUSIONS: Administration of melatonin 3 mg at bedtime for two weeks significantly attenuated abdominal pain and reduced rectal pain sensitivity without improvements in sleep disturbance or psychological distress. The findings suggest that the beneficial effects of melatonin on abdominal pain in IBS patients with sleep disturbances are independent of its action on sleep disturbances or psychological profiles.

An unusual cause of pulmonary haemorrhage in a patient with rheumatoid arthritis.

INTRODUCTION: Pulmonary haemorrhage is a rare presentation of strongyloides hyperinfection. CLINICAL PICTURE: A 69-year-old female patient with rheumatoid arthritis on methotrexate and prednisolone presented with severe community acquired pneumonia. Intravenous trimethoprim/ sulfamethoxazole (bactrim) and high dose hydrocortisone for Pneumocystis carinii pneumonia were commenced. She developed pulmonary haemorrhage 2 weeks later and bronchoalveolar lavage cytology revealed helminthic larvae identified as strongyloides. TREATMENT AND OUTCOME: Despite treatment with ivermectin and albendazole with rapid tailing down of hydrocortisone, she succumbed to her illness. CONCLUSIONS: Strongyloides hyperinfection should be considered in an immunocompromised patient on high dose corticosteroid presenting with pulmonary haemorrhage. Prognosis remains dismal as supported by our case report and current literature.

NRG1 represses yeast-hypha morphogenesis and hypha-specific gene expression in Candida albicans.

We have characterized CaNrg1 from Candida albicans, the major fungal pathogen in humans. CaNrg1 contains a zinc finger domain that is conserved in transcriptional regulators from fungi to humans. It is most closely related to ScNrg1, which represses transcription in a Tup1-dependent fashion in Saccharomyces cerevisiae. Inactivation of CaNrg1 in C.albicans causes filamentous and invasive growth, derepresses hypha-specific genes, increases sensitivity to some stresses and attenuates virulence. A tup1 mutant displays similar phenotypes. However, unlike tup1 cells, nrg1 cells can form normal hyphae, generate chlamydospores at normal rates and grow at 42 degrees C. Transcript profiling of 2002 C.albicans genes reveals that CaNrg1 represses a subset of CaTup1-regulated genes, which includes known hypha-specific genes and other virulence factors. Most of these genes contain an Nrg1 response element (NRE) in their promoter. CaNrg1 interacts specifically with an NRE in vitro. Also, deletion of two NREs from the ALS8 promoter releases it from Nrg1-mediated repression. Hence, CaNrg1 is a transcriptional repressor that appears to target CaTup1 to a distinct set of virulence-related functions, including yeast-hypha morphogenesis.

Efg1, a morphogenetic regulator in Candida albicans, is a sequence-specific DNA binding protein.

Efg1 is essential for hyphal development in the human pathogen Candida albicans under most conditions. Efg1 is related to basic helix-loop-helix regulators, and therefore most workers presume that Efg1 is a transcription factor. Here we confirm that Efg1 is a DNA binding protein that can interact specifically with the E box.