Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations.

AIM: The study was aimed at investigating the effects of wearing N95 and surgical facemasks with and without nano-functional treatments on thermophysiological responses and the subjective perception of discomfort. METHOD: Five healthy male and five healthy female participants performed intermittent exercise on a treadmill while wearing the protective facemasks in a climate chamber controlled at an air temperature of 25 degrees C and a relative humidity of 70%. Four types of facemasks, including N95 (3M 8210) and surgical facemasks, which were treated with nano-functional materials, were used in the study. RESULTS: (1) The subjects had significantly lower average heart rates when wearing nano-treated and untreated surgical facemasks than when wearing nano-treated and untreated N95 facemasks. (2) The outer surface temperature of both surgical facemasks was significantly higher than that of both N95 facemasks. On the other hand, the microclimate and skin temperatures inside the facemask were significantly lower than those in both N95 facemasks. (3) Both surgical facemasks had significantly higher absolute humidity outside the surface than both N95 facemasks. The absolute humidity inside the surgical facemask was significantly lower than that inside both N95 facemasks. (4) Both surgical facemasks were rated significantly lower for perception of humidity, heat, breath resistance and overall discomfort than both N95 facemasks. The ratings for other sensations, including feeling unfit, tight, itchy, fatigued, odorous and salty, that were obtained while the subjects were wearing the surgical facemasks were significantly lower than when the subjects were wearing the N95 facemasks. (5) Subjective preference for the nano-treated surgical facemasks was the highest. There was significant differences in preference between the nano-treated and untreated surgical facemasks and between the surgical and N95 facemasks. DISCUSSION: We discuss how N95 and surgical facemasks induce significantly different temperature and humidity in the microclimates of the facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.

The effects of two kinds of mask (with or without exhaust valve) on clothing microclimates inside the mask in participants wearing protective clothing for spraying pesticides.

AIM: The study aimed at discovering the effects of wearing two types of protective mask on the clothing microclimate (temperature, humidity) inside the mask, physiological parameters and subjective sensations. METHOD: Five healthy female students performed intermittent step exercise while wearing the protective clothing in a climate chamber at 28 degrees C and 60% relative humidity (RH). One mask was made of non-woven fabric and had no exhaust valve (mask A), and the other had an exhaust valve (mask B). RESULTS: (1) Clothing microclimate temperature inside the mask was significantly lower in mask B than in mask A. The final values were 35.5 +/- 0.3 degrees C in mask A and 34.6 +/- 0.8 degrees C in mask B. (2) Clothing microclimate humidity inside the mask was significantly lower in mask B than in mask A. The final values were 37.9 +/- 0.9 g/m3 in mask A and 35.7 +/- 2.0 g/m3 in mask B. (3) Cheek skin temperature inside the mask was kept significantly lower in mask B than in mask A. (4) Clothing microclimate humidity at trunk level increased more slowly with mask B than with mask A for four participants. (5) Rectal temperature increased more slowly with mask B than with mask A for three participants. (6) Tympanic temperature increased more slowly with mask B than with mask A for two out of four participants. DISCUSSION: We discussed these findings from the viewpoint that the dry and wet heat loss was accelerated through the nose under the influence of a reduced level of clothing microclimate inside mask B, having probably helped selective brain cooling by cooling more effectively the vein circulating blood through the nose.

[Clinical experience of intra-arterial chemotherapy for liver metastases of breast cancer patients].

The aim of this study was to evaluate retrospectively the effect of intra-arterial chemotherapy for liver metastases of breast cancer patients. Eleven patients treated between August 1991 and July 1997 at Keio University Hospital, Tokyo, Japan, were the subjects for this study. The duration of disease-free periods after the operation ranged from 9 to 78 months (median 27 months). The site of the recurrence was the liver alone in 6 cases, and the liver and lung in 1 case, bone in 1 case, lymph nodes in 2 cases, and a local region, in 1 case. The main drugs were adriamycin (ADM) and 5-fluorouracil (5-FU), administered in a single injection or continuously via an indwelling catheter in the hepatic artery. This method had a 36% response rate, including PR in 4 cases, NC in 3 cases and PD in 4 cases. The survival duration was 1 to 19 months (median 14 months) following this treatment, and 3 to 49 months (median 17 months) after the recognition of the recurrence. The only side effects of Grade 3 or 4 were leucocytopenia or granulocytopenia and nausea. These results suggest that intra-arterial chemotherapy for liver metastases of breast cancer patients may be an effective method for the control of liver metastases with minor side effects. However, further study may be necessary to establish methods to manage the indwelling catheter and to control patients with multiple metastases of the other organs, to improve the prognosis for recurrent breast cancer patients.

[Current status of adjuvant endocrine therapy for hormone responsive breast cancer].

Three important meetings on adjuvant hormone therapy for breast cancer were held recently: the 5th EBCTCG Meeting, NIH Consensus Meeting, 7th International Conference on Adjuvant Therapy of Primary Breast Cancer. The conclusions of these meetings are: 1. adjuvant hormone therapy should be indicated only for patients with estrogen/progesterone receptor positive cancer, 2. five years of tamoxifen is the standard care at present, 3. ovarian ablation by any means has been proved effective in premenopausal patients and LH-RH agonist should be given at least two years, and 4. aromatase inhibitors should not be used in clinical practice, because several prospective randomized trials are ongoing at present. The patients treated with LH-RH agonist combined with tamoxifen showed better relapse-free survival compared with LH-RH agonist alone in the INT-0101 trial. This was an important trial because combined hormone therapy had not been proven more effective than individual hormone therapy previously. Combined hormone therapy including LH-RH agonist may be considered in premenopausal patients. There is a growing consensus that chemotherapy is effective through the ovarian suppression. In this sense, hormonal therapy should be considered first for hormone responsive patients. On the contrary, standard chemotherapy has shifted from CMF combination to an anthracycline containing regimen. Chemoendocrine therapy may be considered in high risk patients.

Effect of skin pressure by clothing on small bowel transit time.

We examined the effect of increased skin pressure from tight clothing on small bowel transit time by means of the breath hydrogen test, using milk that contained lactulose as an additional indigestible disaccharide, which is used as a test meal after overnight fasting. In this experiment, we measured the small bowel transit time from 9 healthy and non-constipated female subjects with two different skin pressures that were applied by loose-fitting experimental garment or an additional tight-fitting girdle on two consecutive days. The skin pressure of the latter condition was 8-9 mmHg higher than that of the former one on the participants' waist, abdomen and hip region. The experimental order of the two skin pressure conditions was counterbalanced. As a result, the small bowel transit time obtained with and without girdle did not differ significantly (165.0 +/- 26.0 minutes for less skin pressure condition and 173.3 +/- 26.8 minutes for more skin pressure condition, n = 9, p = 0.43). This result indicated that the skin pressure from clothing has no effect on the passage rate of food through the small intestine.

Acute phase proteins, body temperature and urinary melatonin under the influence of bright and dim light intensities during the daytime.

Concentrations of five acute phase proteins: C-reactive protein (CRP), alpha 1-antichymotrypsin (ACT), transferin (Tf), alpha 2-macroglobulin (alpha 2-M) and haptoglobin (Hp) as well as glycosylation profiles of alpha 1-antichymotrypsin (ACT) were studied in sera samples with 7 healthy volunteers under the influence of two different light intensities during the daytime dim (100 lx) and bright (3000 lx) light. Concentration of transferin (negative proteins) under the influence of bright light during the daytime decreased significantly. Other proteins have the tendency to increase (positive proteins) under the influence of daytime bright light. The microheterogeneity of ACT did not change under the influence of different light intensities. Melatonin and rectal temperature were also measured simultaneously. Rectal temperature decreased to be lower during the first half of the night and urinary melatonin secretion rate increased to be higher during the night when the subjects spent time under the bright light during the day. Thus, it is concluded that the diurnal bright light exposure may activate some parameters of acute phase proteins, increase nocturnal melatonin secretion and accelerate a fall of rectal temperature during first half period of night sleep.

Influence of bright light during daytime on sleep parameters in hospitalized elderly patients.

Nurses frequently care for sleepless elderly patients on bed rest in a hospital environment. Our previous study with young adults showed that bright light exposure during the daytime affected the induction of nocturnal deep sleep. The purpose of this study is aimed at finding whether similar research could be observed with hospitalized elderly patients. Seven patients (mean age 67; range 57-77 yrs, males 3: females 4) served as participants and their informed written consent was obtained. A fluorescent lamp fixed in the bed frame near the head of the patient was turned on at 10:00 h and off at 15:00 h each day for 1 week (BL). Moreover, each patient was required to stay near this light during this period. The patients lived in a room facing north, where the ambient light intensities ranged from 50 to 300 lx during the daytime. Their activities were continuously measured using an Actiwatch (model-AWL, Mini-Mitter, USA). Salivary samples were collected at midnight for the measurement of melatonin. The findings were compared between 2 days before BL exposure (baseline) and the last 2 days during BL exposure, respectively. The bright light exposure during the daytime prolonged "Time in Bed" (p < 0.05), increased "Immobile Minutes" (p < 0.05), and delayed "Get up Time" (p < 0.01). The average melatonin secretion at midnight in four patients increased from 7.5 +/- 2.6 pg/ml to 13.3 +/- 9.2 pg/ml. These findings suggest that diurnal bright light exposure for hospitalized elderly patients lying in bed under dark condition during the daytime may favor clinically the induction of nocturnal deep sleep. Attention should be given to the illumination conditions for elderly patients in hospitals to improve their impaired sleep.

The effects of skin pressure by clothing on circadian rhythms of core temperature and salivary melatonin.

The present experiment investigated the effects of skin pressure by foundation garments (girdle and brassiere) on the circadian rhythms of core temperature and salivary melatonin. Ten healthy females (18-23 years) maintained regular sleep-wake cycles for a week prior to participation in the experiment. The experiments were performed from June to August 1999 using a bioclimatic chamber controlled at 26.5 degrees C +/- 0.2 degrees C and 62% +/- 3% RH. Ambient light intensity was controlled at 500 lux from 07:30 to 17:30, 100 lux from 17:30 to 19:30, 20 lux from 19:30 to 23:30; there was total darkness from 23:30 to 07:30. The experiment lasted for 58h over three nights. The participants arose at 07:30 on the first full day and retired at 23:30, adhering to a set schedule for 24h, but without wearing foundation garments. For the final 24h of the second full day, the subjects wore foundation garments. Rectal and leg skin temperatures were measured continuously throughout the experiment. Saliva and urine were collected every 4h for the analysis of melatonin and catecholamines, respectively. Skin pressure applied by the foundation garments was in the range 11-17 gf/cm2 at the regions of the abdomen, hip, chest, and back. The main results were as follows: (1) Rectal temperatures were significantly higher throughout the day and night when wearing foundation garments. (2) The nocturnal level of salivary melatonin measured at 03:30 was 115.2 +/- 40.4 pg/mL (mean +/- SEM, N = 10) without and 51.3 +/- 18.4 pg/mL (mean +/- SEM, N = 10) with foundation garments. (3) Mean urinary noradrenaline excretion was significantly lower throughout the day and night when wearing foundation garments (p < .05), but mean urinary adrenaline excretion was not different. The results suggest that skin pressure by clothing could markedly suppress the nocturnal elevation of salivary melatonin, resulting in an increase of rectal temperature.

Sentinel lymph node biopsy using tin colloid RI and blue dye method.

Axillary dissection has been considered essential for breast cancer staging because nodal metastasis is the most powerful predictive factor for recurrence. On the other hand, morbidity, such as lymphedema and shoulder dysfunction, may occur. Sentinel node biopsy is a good way to avoid unnecessary axillary dissection. We used tin colloid as a carrier of Tc99m tracer together with the blue dye method. The detection rate of the sentinel node was 27 cases out of 29 (90%) for the blue dye method, 10 cases out of 19 (53%) for the RI method, and 27 out of 33 (82%) for the combined method. The detection rate of the RI method was improved after adding the subcutaneous injection over the tumor from 45% before adding the subcutaneous injection to 82% after adding it. The false negative rate was 11% for the blue dye method, 0% for the RI method, and 10% for the combined method. This yields a sensitivity of 89% for the blue dye method, 100% for the RI method, and 90% for the combined method. Specificity was 100% for all three methods. Accuracy was 96% for the blue dye method, 100% for the RI method, and 96% for the combined method. There were two false negative cases. The average number of sentinel lymph nodes was 2.12 for the dye method, 1.66 for the RI method, and 1.95 for the combined method. There were three of 49 cases with identified parasternal lymph nodes by RI imaging. Lymphatic mapping using tin colloid may be useful for detecting sentinel nodes.

Field studies on inhibitory influence of skin pressure exerted by a body compensatory brassiere on the amount of feces.

The present experiment investigated the effects of skin pressure produced by a body compensatory brassiere on defecation activity. Seven healthy females (11-41 yrs) volunteered as participants, being free of medication and constipation. The experiment lasted 3 weeks. The participants did not wear the body compensatory brassiere for the first week, wore it during waking hours for the second week, and again did not wear it for the third week. Whenever they desired to defecate, they did so and then weighted the amount of feces immediately by themselves. Eating times, daily amounts of foods and drinks, their menu, work intensity and its duration, retiring and rising time were controlled to be as similar as possible from day to day. The main finding was that the amount of feces was significantly smaller during the second week (wearing the body compensatory brassiere) than the first and third weeks (not wearing the body compensatory brassiere). These observations are discussed in terms of the suppression of the parasympathetic nervous system and intestine motility, and the delayed transit time in the large intestine.

Influence of light intensities on dressing behavior in elderly people.

With civilized environments in modern society, since the people tend to depend more on artificial illumination than on natural illumination which makes less discrepancy between day and night life, clarifying the relationship between human life and illumination is necessary. In our previous studies, we found that the subjects dressed faster with thicker clothing in the morning than in the evening when the room temperature decreased from 30 degrees C to 15 degrees C over 1 hour. We considered these results in terms of load error between the actual and set-point values in the core temperature. The present study was designed to examine the effect of bright light (3,000 lx)/dim light (50 lx) exposure (09:30 h-14:30 h) on dressing behavior and thermoregulatory responses in the elderly people during the afternoon cold exposure. Five female subjects were instructed to dress to feel comfortable when the room temperature was decreased from 30 degrees C to 15 degrees C (15:00 h-17:00 h). The subjects felt cooler and dressed more quickly with thicker clothing after dim light exposure, it is conceivable that the set-point value of core temperature is reduced under the bright light condition. We discussed these results in terms of the establishment of set-point values in the core temperature at bright light condition. If the set-point of the core temperature is lower in the bright than in the dim light condition in present experiment, the dressing behavior with thinner clothing in the bright light condition is advantageous, since it enables the core temperature to reach its set-point value more easily.

[Chemo/endocrine therapy for breast cancer patients].

Standard adjuvant chemo/endocrine therapy for breast cancer patient is based upon St. Gallen's consensus 1998. Recent development in the field of adjuvant chemo/endocrine therapy is an usage of LH-RH analogue with tamoxifen for premenopausal hormone receptor positive women, and also an emerging role of taxans. Orally given 5-FU derivatives may work in adjuvant settings. The third generation aromatase inhibitors have established their role in second line hormone therapy for the advanced or recurrent breast cancer patients. High dose chemotherapy should not be used in outside clinical trials.

The effects of skin pressure by clothing on whole gut transit time and amount of feces.

The experiment investigated the effects of skin pressure by clothing on whole gut transit time and amount of feces. Comparisons of transit time and amount of feces were taken between 6 young female adults with and without a girdle. The skin pressure applied by a girdle (mean +/- SD) on participant's waist, abdomen and hip region was 16.6 +/- 7.80 mmHg, 17.1 +/- 4.5 mmHg and 12.6 +/- 5.0 mmHg, respectively. The difference of skin pressure with and without a girdle was about 10 mmHg. During each experimental period of 4 days with and without a girdle, the whole gut transit time and amount of feces were measured. The whole gut transit time of each day was determined as the time between the oral intake of each day's markers and their first appearance in the stool. The whole gut transit times of the markers taken on the first day were significantly prolonged (p < 0.05) and those of the markers taken on the second day tended to be prolonged for participant using a girdle (p < 0.1). The whole gut transit time of the markers taken on the third day could not be compared because they were not excreted into the stool. The cumulative increases of feces on the third day and the fourth day were significantly reduced with a girdle (p < 0.05). These results indicate that the skin pressure by clothing has an effect on whole gut transit time and the amount of feces.

Effects of skin pressure by clothing on digestion and orocecal transit time of food.

In order to reveal the influence of clothing skin pressure on digestion of food through the gastrointestinal tract, we examined the absorption of dietary carbohydrate and orocecal transit time of a test meal by means of a breath hydrogen test on 7 healthy young women. In this experiment, we collected breath samples from the participants wearing loose-fitting experimental garment on the second day of the experiment and from the same participants but wearing an additional tight-fitting girdle on the following day for 16 hours and 9 hours, respectively. Skin pressure applied by a girdle on participant's waist, abdomen and hip region was 15.5 +/- 0.4 mmHg (mean +/- SE), 11.0 +/- 0.2 mmHg, and 13.6 +/- 0.6 mmHg, respectively, and the values were 2-3 times larger than those of the experimental garment. The hydrogen concentration vs. time curve showed that breath hydrogen levels at its peaks (15:00, 15:30, 16:00, 16:30, and 17:00 hr) on the third day of the experiment were significantly higher than those of the corresponding time on the second day (p < 0.05 at 17:00 and 15:00, p < 0.01 at 15:00, 16:00 and 16:30). Consequently, significantly pronounced breath hydrogen excretion was observed under the "pressure" clothing condition (p < 0.01). On the other hand, the transit time of the test meal for the subjects wearing a girdle did not differ significantly from that for the subjects wearing the garment of less pressure (270 +/- 18 minutes and 263 +/- 21 minutes, respectively). These results indicate that the clothing skin pressure has an inhibitory effect on the absorption of dietary carbohydrate in the small intestine, but no effect on the orocecal transit time of a meal.

Cutaneous monomorphous CD4- and CD56-positive large-cell lymphoma.

BACKGROUND: Recently, CD56 (NCAM)-positive lymphomas, such as nasal and nasal-type angiocentric NK/T cell lymphoma, aggressive NK cell leukemia/lymphoma and blastic NK cell lymphoma, were described by several authors as a unique group of lymphoma. OBJECTIVE: In this study, we intend to clarify the clinicopathological features of cutaneous CD4+ and CD56+ lymphoma. METHODS: Four patients with cutaneous CD4+ and CD56+ lymphoma were studied. RESULTS: Age at the first examination ranged from 71 to 89 years (mean = 81.2 years). One patient was female and 3 were males. The organ mainly involved at presentation was the skin. Lymphadenopathy, splenomegaly, leukemic spread and central nervous system involvement were observed as the disease progressed. The mean survival time was 12.2 months. Epstein-Barr virus was not detected within the tumor cells. CONCLUSION: This peculiar lymphoma is different from nasal and nasal-type angiocentric NK/T cell lymphoma and aggressive NK cell leukemia/lymphoma. Similar cases have been reported as blastic NK cell lymphoma/leukemia.

Effects of skin pressure applied by cuffs on resting salivary secretion.

The effects of pressure applied by cuffs to the abdomen, thighs and legs on resting salivary flow rate and digestive function of saliva were investigated in 9 healthy female students, aged 18 to 33 yrs (Experiment I) in a climatic chamber (Ta: 28 degrees C, RH: 50%). Each participant changed from street clothing into loose-fitting experimental garments so as to avoid any skin pressure on the body, and sat calmly in a reclining chair throughout the experimental period (195 min). After 90 min (FREE period), the physiological effects of skin pressure applied by their own clothing disappeared, and skin pressure was applied for the next 60 min to the abdomen (40 mmHg) and thighs (40 mmHg) then to the legs (60 mmHg) by the use of air-inflated cuffs (PRESSURE period). During the next 45 min, the skin pressure was again removed by letting the air of the cuffs out (FREE' period). The resting salivary flow rate was significantly suppressed while the skin pressure was applied by the cuffs. The digestive time for starch investigated in terms of the iodine starch reaction was longer with the skin pressure than without. The concentration of amylase measured in 20 female participants aged 21 to 23 yrs, decreased with skin pressure applied by the usage of the rubber tape (Experiment II). These results suggest that the pressure applied to the body can influence the digestive response by decreasing the amount of saliva via the autonomic nervous system.

The different effects of black and white Vietnamese Aodai folk costumes on rectal temperature and heart rate in women walking intermittently in hot and sunny environment.

The present study was undertaken to investigate whether there is any difference in the rectal temperature and heart rate between women wearing black or white Aodai folk costume and walking intermittently in natural sunlight. The experiment was performed in the field outside buildings in Hanoi, Vietnam, between May and June, 1998. The only difference was in the colour (black or white) of clothing other physical characteristics, like materials, thickness, weight and so on, were nearly identical. Air temperature was around 39 degrees C, globe temperature around 52 degrees C and sun radiation reached 1010 W.m-2. Eight young female students (aged 20 years) participated in the experiment. They sat quietly on a chair inside the building for the first 30 min. Then they walked for 20 min at their ordinary walking speed in the sun, and rested for 10 min in the shade. This schedule was repeated three times. The main results are summarised as follows: (1) Rectal temperature was significantly lower in the black than in the white Aodai; (2) Clothing microclimate temperature at frontal chest level was also significantly lower in the black Aodai; (3) Heart rate was significantly lower in the black than in the white Aodai; (4) Clothing surface and inside temperatures measured at frontal chest level were significantly higher in the black than in the white Aodai. These results strongly suggest that the black Aodai could reduce heat strain more effectively than the white one. The physiological mechanism may result from more effective ventilation between skin and clothing in the black Aodai, due to higher temperature inside and outside this garment.

Improvement of thermophysiological stress in participants wearing protective clothing for spraying pesticide, and its application in the field.

Thermoregulatory responses were compared under two experimental conditions, in the laboratory (Experiment I), and in the field (Experiment II), between two kinds of protective clothing for spraying pesticides. One was currently being used (Type A), and was composed of ready made Gore-Tex clothing, mask, polyurethane gloves and rubber boots. The other one was newly designed (Type B), and was composed of pesticide-proof clothing (100% cotton with water repellent finish), mask, Gore-Tex gloves, and special boots consisting of rubber for the feet and ankle and Gore-Tex around the legs. In addition, the head and chest were cooled by frozen gel strips fixed in the cap and undershirt. In Experiment I, five female adults took part, in a climate-chamber controlled at an ambient temperature of 28 degrees C and a relative humidity of 60%. In Experiment II, five farmers (one male and four female) were tested in an apple orchard in July, August and September. The main results are summarized as follows: (1) change of rectal temperature was inhibited more effectively in Type B in Experiment I, (2) change of heart rate tended to be lower in Type B than in Type A in both experiments, (3) salivary lactic acid concentration at the end of the first exercise was significantly higher in Type A than in Type B in Experiment I, (4) the number of contractions in the handgrip exercise which was performed immediately after the third exercise, was significantly smaller in Type A than in Type B in Experiment I, (5) subjective comfort sensation was significantly improved in Type B in Experiments I and II. Thus, it was concluded that the newly designed protective clothing could reduce thermal stress during the spraying of pesticides in an apple orchard in summer.