Depression is associated with discoordination between heart rate variability and physical acceleration in older women

Background and Aims

It is well known that depression is closely associated with the autonomic nervous system and physical acceleration (PA), which may cause functional time-deviance between these two parameters. Exploring this relationship is important in sustaining the mental and physical health of older adults in daily life. However, few studies have assessed the relationship between depression and the coordination of parasympathetic nervous activity (PSNA) and PA. The present study was designed to investigate whether the coordination between PSNA and PA is associated with the mental state of healthy volunteers in normal daily lives and the underlying mechanism.

Methods

In total, 95 adult women were divided into non-older and older groups comprising 50 (aged 20-59 years) and 45 (aged 60-85 years) women, respectively. PSNA and PA data were simultaneously obtained every minute for 24 h during the free-moving day using the ActiveTracer accelerometer. Lag time was determined as the time difference between PSNA and PA, and it was introduced as a parameter of %lag0, which is the percent ratio of the lag = 0 min between PSNA and PA in 1 h. The General Health Questionnaire 28 (GHQ28) was used to evaluate the effects of psychological distress, including depression.

Results

In the hour before sleep, %lag0 was significantly lower in older women (38.7 ± 6.4) who had higher GHQ28 values (subscale D = 0, n = 12) compared with that in older women (19.4 ± 10.5) with lower values (subscale D ≧ 1, n = 33) (p < 0.05).

Conclusion

Impairments in coordination between PSNA and PA are significantly associated with depression in older women, particularly in the hour before sleep on free-moving days.

Fructooligosaccharide feeding during gestation to pregnant mice provided excessive folic acid decreases maternal and female fetal oxidative stress by increasing intestinal microbe-derived hydrogen gas

Fructooligosaccharide (FOS) is fermented by intestinal microbes to generate intestinal microbe-derived hydrogen gas (IMDH). Oxidative stress increases during gestation, whereas hydrogen gas has antioxidant effects with therapeutic benefits. We have previously reported that the offspring from a pregnant, excessive folic acid mouse model (PEFAM) had abnormal glucose metabolism after growth. We hypothesized that IMDH by FOS feeding during gestation in PEFAM would suppress maternal and fetal oxidative stress. C57BL/6J mice on day 1 of gestation were divided into 3 groups and dissected at gestational day 18. The control (CONT) diet was AIN-93G containing folic acid 2 mg/kg diet; PEFAM was fed with an excessive folic acid (EFA) diet containing folic acid 40 mg/kg diet, and the EFA-FOS diet was replaced half of the sucrose in the EFA diet. Hydrogen gas concentrations in maternal livers and whole fetuses in EFA-FOS were significantly higher than those in CONT and EFA, respectively (P < .05). Maternal and fetal 8-hydroxy-2'-deoxyguanosine in EFA-FOS were not significantly different from those in the CONT group, whereas those in the EFA group were significantly increased compared with CONT and EFA-FOS (P < .05). In EFA-FOS, expression of protein and mRNA of superoxide dismutase and heme oxygenase 1 in mothers and superoxide dismutase in fetuses were not significantly different from those in CONT, whereas those in EFA were significantly increased (P < .05). The protein expression of Nrf2 in mothers and fetuses were not significantly different between EFA-FOS and CONT. Therefore, FOS feeding to PEFAM during gestation decreases maternal and fetal oxidative stress through IMDH.

Relationship between nonperfusion area from widefield optical coherence tomography angiography and macular vascular parameters in diabetic retinopathy

PURPOSE

To evaluate the relationship between the nonperfusion area (NPA) from widefield optical coherence tomography angiography (OCTA) and macular vascular parameters in diabetic retinopathy (DR).

METHODS

In total, 51 eyes from 51 patients with proliferative DR (PDR) or moderate/severe non-PDR were included. Widefield OCTA using the Zeiss Plex Elite 9000 was performed. A semi-automatic algorithm calculated the percentages of the NPA within the total image. Macular OCTA (3 × 3 mm and 6 × 6 mm area) was scanned using the RTVue-XR Avanti. Vessel density (VD) was automatically separated into the superficial (SCP) and deep capillary plexus (DCP), and foveal avascular zone (FAZ) measurements were computed according to the parafoveal (1-3 mm) and perifoveal (3-6 mm) regions.

RESULTS

A negative correlation was found between the average VD of the SCP and DCP obtained 3 × 3 mm and 6 × 6 mm area and the NPA. Multiple regression analysis revealed that the temporal-perifoveal region most negatively correlated with the NPA (r =  - 0.55, p < 0.0001). No correlation was found between FAZ measurements and DR severity (area, p = 0.07; perimeter, p = 0.13).

CONCLUSION

Diabetic macular nonperfusion was significantly associated with the NPA from widefield OCTA. In particular, the temporal-perifoveal DCP disorder may be a sensitive indicator of wide NPA.

Coordination between heart rate variability and physical activity may be diminished by fatigability in non-older women in the hour before sleep

Fatigability is related to several diseases as well as the autonomic nervous system. We investigated whether fatigability is associated with coordination between physical acceleration (PA) and parasympathetic nervous activity (PSNA) in women. Overall, 95 women were divided into non-old (n = 50; age: 22-59 years) and old (n = 45; age: ≥60 years) groups. PSNA and PA data were simultaneously obtained every minute for 24 h. We defined %lag0 as the percent ratio of lag = 0 min between PSNA and PA in 1 h. Cornell Medical Index was used to determine the degrees of physical and psychological symptoms. In the non-older group in the hour before sleep, the participants with high fatigability scores had significantly lower %lag0 than those with low fatigability (p < 0.05). Additionally, those with higher fatigability combined with exhaustion in the morning had significantly lower %lag0 than those without exhaustion in the hour before sleep (p < 0.05) but not in the hour after waking up. These results suggest that fatigability in non-older women was associated with loss of coordination between PSNA and PA in the hour before sleep. Additionally, exhaustion in the morning may be related to loss coordination of PSNA and PA during the previous night.

Why airborne transmission hasn't been conclusive in case of COVID-19? An atmospheric science perspective

Airborne transmission is one of the routes for the spread of COVID-19 which is caused by inhalation of smaller droplets1 containing SARS-CoV-2 (i.e., either virus-laden particulate matter: PM and/or droplet nuclei) in an indoor environment. Notably, a significant fraction of the small droplets, along with respiratory droplets, is produced by both symptomatic and asymptomatic individuals during expiratory events such as breathing, sneezing, coughing and speaking. When these small droplets are exposed to the ambient environment, they may interact with PM and may remain suspended in the atmosphere even for several hours. Therefore, it is important to know the fate of these droplets and processes (e.g., physical and chemical) in the atmosphere to better understand airborne transmission. Therefore, we reviewed existing literature focussed on the transmission of SARS-CoV-2 in the spread of COVID-19 and present an environmental perspective on why airborne transmission hasn't been very conclusive so far. In addition, we discuss various environmental factors (e.g., temperature, humidity, etc.) and sampling difficulties, which affect the conclusions of the studies focussed on airborne transmission. One of the reasons for reduced emphasis on airborne transmission could be that the smaller droplets have less number of viruses as compared to larger droplets. Further, smaller droplets can evaporate faster, exposing SARS-CoV-2 within the small droplets to the environment, whose viability may further reduce. For example, these small droplets containing SARS-CoV-2 might also physically combine with or attach to pre-existing PM so that their behaviour and fate may be governed by PM composition. Thus, the measurement of their infectivity and viability is highly uncertain due to a lack of robust sampling system to separately collect virions in the atmosphere. We believe that the present review will help to minimize the gap in our understanding of the current pandemic and develop a robust epidemiological method for mortality assessment.

Parasympathetic Nervous Activity Associated with Discoordination Between Physical Acceleration and Heart Rate Variability in Patients with Sleep Apnea

Sleep apnea syndrome (SAS) often accompanies alterations in heart rate variability (HRV). The severity of SAS is sometimes evaluated using the oxygen desaturation index (ODI). We hypothesized that effects of the autonomic nervous system could be involved in the coordination between HRV and physical acceleration during free movement in patients with SAS. Among 33 women aged 60 years or older, 19 had a high ODI (>5). Their HRV and physical acceleration were simultaneously obtained every minute for 24 hours. The low frequency/high frequency (LF/HF) ratio and the high frequency in normalized units (HFnu) were used as HRV indices. Low levels of %Lag0, defined as the percentage of the lag = 0 min in 1 h, indicated coordination between physical acceleration and HRV. Nineteen participants were divided into group A (high %Lag0 before sleep [n = 9]) or group B (low %Lag0 [n = 10]). In group B participants with a high ODI and low %Lag0 in the hour after waking, HFnu was significantly increased compared to that in group A participants with high ODI and high %Lag0 in the hour after waking (p < 0.05). These results suggest that close associations between high ODI and discoordination between HRV and physical acceleration may be due to higher parasympathetic nervous system activity after waking.

Association Between Alterations of the Choriocapillaris Microcirculation and Visual Function and Cone Photoreceptors in Patients With Diabetes

Purpose

The purpose of this study was to investigate the association between the choriocapillaris microcirculation and the visual function and cone photoreceptor structure in patients with diabetes.

Methods

Thirteen control subjects and 26 patients with type 2 diabetes were recruited. The patients with diabetes were divided into three groups based on the grade of diabetic retinopathy (DR). The retinal sensitivity (RS) was evaluated using microperimetry. Cone photoreceptor mosaics were imaged using an adaptive optics retinal camera, and the cone heterogeneity packing index (HPi) was calculated. Optical coherence tomography angiography (OCTA) images of the choriocapillaris were obtained using spectral-domain OCTA, and the area of flow deficit (FD) was evaluated. All parameters were evaluated in the foveal and parafoveal areas.

Results

The study included four patients with diabetes without retinopathy, 12 patients with nonproliferative diabetic retinopathy (NPDR), and 10 patients with proliferative diabetic retinopathy (PDR). The foveal and parafoveal FDs were correlated significantly (fovea, r = −0.58; P = 0.046 and r = −0.82; P = 0.003; parafovea, r = −0.59; P = 0.044 and r = −0.72; and P = 0.019, respectively) with the RS in patients with NPDR and PDR, but not in control and no diabetic retinopathy (NDR) groups. There were no differences in the foveal HPi among the groups.

Conclusions

Impaired choriocapillaris microcirculation is associated with impaired visual function but not cone photoreceptor integrity in eyes with DR.

Effects of Cooking Processes on Breath Hydrogen and Colonic Fermentation of Soybean

Background:

Soybean is rich in dietary fibers; consequently, soybean ingestion considerably increases the breath level of hydrogen molecules via anaerobic colonic fermentation. However, the influence of cooking methods on this effect, which can affect the overall health benefits of soybean, remains unknown.

Objectives:

The aim is to examine whether different methods of cooking soybean affect the colonic fermentation process.

Methods:

Nine healthy adult volunteers participated in the study; they ingested either roasted soybean flour (kinako) or well-boiled soybean (BS). Differences in their breath components were compared. Both test meals were cooked using 80 g of soybeans per individual. After a 12 h fast, the participants ate the test meals, and their breath hydrogen level was analyzed every 1 h for 9 h by using a gas chromatograph with a semiconductor detector. In addition, particle size distribution and soluble/ insoluble fibers in the feces were examined.

Results:

The oro-cecal transit time did not significantly differ between individuals who ingested kinako and BS. However, the area under the curve between 7 and 9 h after the ingestion of BS was significantly increased compared with that after the ingestion of kinako. The nutritional analysis indicated that the content of both soluble and insoluble fibers in BS was higher than that in kinako. In addition, the levels of unfermented fragments and soluble/insoluble fibers in the feces were increased after the ingestion of kinako compared with those after the ingestion of kinako.

Conclusion:

Cooking methods alter the composition of non-digestible fibers in soybean, and this can result in the lack of fermentative particles in the feces, thereby causing alterations in the breath level of hydrogen via colonic fermentation.

A Proposed Classification of Intraretinal Microvascular Abnormalities in Diabetic Retinopathy Following Panretinal Photocoagulation

Purpose

To investigate the characteristics of intraretinal microvascular abnormalities (IRMAs) before and after panretinal photocoagulation (PRP) for diabetic retinopathy (DR) by using optical coherence tomography angiography (OCTA).

Methods

Forty-six eyes of 29 patients with DR were included (26 eyes with severe nonproliferative diabetic retinopathy [SNPDR] and 20 eyes with proliferative diabetic retinopathy [PDR]). En face OCTA images of IRMAs in a 6 × 6-mm area were acquired by using Cirrus 5000 with AngioPlex. The morphological changes in IRMAs were evaluated before and after PRP. The changes in the IRMAs were divided into five subtypes: unchanged; tuft regression; reperfusion; mixed (combined tuft regression/reperfusion); and worsening (new appearance of tuft).

Results

Unchanged IRMAs were identified in 15 SNPDR eyes and 2 PDR eyes; all neovascularization (NV) had regressed after PRP. Tufts were more frequently observed in the PDR eyes (15/20, 75%) than in the SNPDR eyes (8/26, 31%) (P = 0.003), and two tufts tended to exceed the inner limiting membrane, which showed progression to NV before PRP. The reperfusion phenomenon was observed in 7/26 SNPDR eyes and 4/20 PDR eyes, including the mixed type, and showed two vascular patterns: abnormal (dilated, tortuous, and twisted) and normal vessels. The worsening type was observed in 1/26 SNPDR eye and 2/20 PDR eyes.

Conclusions

OCTA enabled classification of IRMA into more detailed types. The unchanged and reperfusion types suggested that IRMAs had aspects of remodeling. However, IRMAs with tufts were observed in 75% of the PDR eyes, and the tufts had aspects of NV.

Decrease in exhaled hydrogen as marker of congestive heart failure

Objective

Hydrogen excretion is thought to be related to systemic antioxidation activity. H₂ selectively reduces the hydroxyl radical of free hydrogen (·OH), a highly cytotoxic form of reactive oxygen species, in cultured cells.

Methods

We investigated whether exhaled H₂ decreased during night sleep, reflected ·OH production and was associated with heart failure severity. We enrolled 108 patients with chronic heart failure (CHF) and 15 control participants without CHF. H₂ concentration was measured by gas chromatography in exhaled breath collected before sleep and in the morning after overnight fasting. Overnight change in H₂ concentration (ΔH₂) was calculated. Mitochondrial morphology evaluated by transmission electron microscopy in endomyocardial biopsies collected from 18 patients with dilated cardiomyopathy.

Results

ΔH₂ was significantly lower in patients with CHF compared with controls (−4.3±1.0 vs 2.0±2.1 ppm, p=0.030) and was positively correlated with cardiac index (CI; r = −0.285, p=0.003). Patients with a ΔH₂<0 ppm had a significantly lower CI compared with those who had a ΔH₂>0 ppm (2.85±0.61 vs 3.24±0.65 L/min/m², p=0.005). ΔH₂ was negatively correlated with both the percentage of vacuole-containing mitochondria and indices of cristae remodelling (r = −0.61, p=0.007).

Conclusions

Decrease in exhaled H₂ during night sleep was associated with CHF severity. ΔH₂ warrants investigation as marker of CHF severity.

Change of Exhaled Acetone Concentration Levels in Patients with Acute Decompensated Heart Failure

Exhaled acetone concentration is one of the expected compounds to be a breath biomarker in heart failure. However, it has not been clarified how exhaled acetone concentration changes in clinical course of heart failure.To investigate whether exhaled acetone concentration changes after treatment in acute decompensated heart failure (ADHF).This study included 19 patients with ADHF (ADHF group) and eight patients with stable heart failure (control group). Exhaled acetone was collected from these patients, and the concentration was measured with gas chromatography.The ADHF group had higher heart rates (P = 0.046), higher New York Heart Association class (P < 0.001), higher levels of brain natriuretic peptide (P = 0.026), blood total ketone bodies (P = 0.015), and exhaled acetone concentration (P < 0.001), compared with the control group. In ADHF group, exhaled acetone concentration significantly decreased after treatment (median: 2.40 versus 0.92 ppm, P < 0.001). However, in the control group, exhaled acetone concentration did not significantly change (median: 0.73 versus 0.49 ppm, P = 0.141).In these preliminary findings, exhaled acetone concentration in patients with ADHF drastically decreased by treatment. Serial exhaled acetone measurement might be useful to evaluate the course of ADHF.

Enhancing tuberculosis patient detection and care through community volunteers in the urban poor, The Philippines

Setting: The Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association Philippines is a local non-governmental organisation (NGO) established in 2008 to improve access to tuberculosis (TB) services. Community health volunteers (CHVs) from NGO referring facilities were engaged to assist in local TB control activities. Objective: To describe the activities of the CHVs and the barriers experienced by patients with presumptive TB in seeking health care to treatment as documented on a master list, and to identify the CHVs' challenges in community TB care implementation. Design: This was a retrospective evaluation with a non-experimental design reviewing the presumptive TB master list and TB reports and conducting a free discussion session (FDS) in 2012. Results: Of the 78% (281/362) of referred presumptive TB patients who accessed a DOTS facility, 69% (194/281) underwent a diagnostic examination and 42% (81/194) were diagnosed with active TB. Of the 93% (75/81) initiated on treatment, 92% (69/75) were successfully treated. The CHVs contributed approximately 3% (75/2534) to the total TB cases diagnosed at the DOTS facilities. In the FDS, barriers evoked in seeking health care for treatment were transfer of residence and lack of interest in seeking a consultation. In 2012, the CHV attrition rate was 55% (80/145). Conclusion: The CHVs assisted in enhancing access to TB care and case detection. Sustainability of the CHVs' efforts should be explored to retain them in the programme.

Elevated exhaled acetone concentration in stage C heart failure patients with diabetes mellitus

BACKGROUND

Breath acetone is a noninvasive biomarker of heart failure; however, its significance in heart failure patients with diabetes mellitus has yet to be clarified. The objective of this study is to investigate whether exhaled acetone concentration is a noninvasive biomarker in heart failure patients with diabetes mellitus.

METHODS

This study prospectively included 35 diabetic patients with stage C heart failure and 20 diabetic patients with or at risk of heart failure (stage A or B). Exhaled breath was collected after an overnight fast.

RESULTS

The stage C group had significantly higher brain natriuretic peptide levels, larger left ventricular diameter, lower left ventricular ejection fraction, and more frequent use of β-blocker, compared with the stage A or B group. The stage C group had higher exhaled acetone concentrations than the stage A or B group (p = 0.013). Exhaled acetone concentration was correlated with total ketone bodies (r = 0.588, p < 0.001) and brain natriuretic peptide (r = 0.415, p = 0.002).

CONCLUSION

Stage C heart failure patients with diabetes mellitus have elevated exhaled acetone concentrations. Exhaled acetone concentration could be a noninvasive biomarker in heart failure patients with diabetes mellitus.

Exhaled Acetone Concentration Is Related to Hemodynamic Severity in Patients With Non-Ischemic Chronic Heart Failure

BACKGROUND

We hypothesized that exhaled acetone concentration (EAC), reflecting altered blood ketone body metabolism and increased acetone exhaust because of pulmonary congestion in heart failure (HF), would correlate with hemodynamic parameters in patients with non-ischemic chronic HF.

METHODS AND RESULTS

We prospectively enrolled 102 non-ischemic HF patients with New York Heart Association (NYHA) class I-III. Exhaled breath was collected after an overnight fast. Echocardiography and cardiac catheterization were performed in all patients. We also enrolled 17 control patients without HF. EAC in the HF patients was significantly higher than that in the control patients (median EAC; 0.53 vs. 0.38 ppm, P=0.012). EAC positively correlated with blood total ketone bodies (r=0.454, P<0.001), NYHA class (r=0.489, P<0.001), and plasma B-type natriuretic peptide (r=0.316, P=0.001). Right heart catheterization revealed that EAC significantly correlated with pulmonary capillary wedge pressure (PCWP, r=0.377, P<0.001). Receiver-operating characteristic analysis revealed that EAC >1.05 ppm was associated with PCWP ≥18 mmHg (area under the curve [AUC] 0.726, sensitivity 50%, specificity 89%). EAC was shown to be a comparable diagnostic biomarker for HF to BNP (AUC 0.760, sensitivity 80%, specificity 70%).

CONCLUSIONS

EAC may be a novel noninvasive biomarker that correlates hemodynamic severity in non-ischemic chronic HF. (Circ J 2016; 80: 1178-1186).

Neuroprotective effect of water-dispersible hesperetin in retinal ischemia reperfusion injury

PURPOSE

To determine whether water-dispersible hesperetin (WD-Hpt) can prevent degeneration of ganglion cell neurons in the ischemic retina.

METHODS

Ischemia reperfusion (I/R) injury was induced by increasing the intraocular pressure of mice to 110 mmHg for 40 min. Mice received daily intraperitoneal injections with either normal saline (NS, 0.3 ml/day) or WD-Hpt (0.3 ml, 200 mg/kg/day). Reactive oxygen species (ROS) was assessed by dihydroethidium and nitrotyrosine formation. Inflammation was estimated by microglial morphology in the retina. Lipopolysaccharide (LPS)-stimulated BV-2 cells were used to explore the anti-inflammatory effect of WD-Hpt on activated microglia by quantifying the expression of IL-1β using real-time quantitative reverse transcription-polymerase chain reaction. Ganglion cell loss was assessed by immunohistochemistry of NeuN. Glial activation was quantified with glial fibrillary acidic protein (GFAP) immunoreactivity. Apoptosis was evaluated with a terminal deoxynucleotidyl transferase (TUNEL) assay and immunohistochemistry of cleaved caspase-3. Phosphorylation of extracellular signal-regulated kinase (p-ERK) was surveyed by western blotting.

RESULTS

WD-Hpt decreased I/R-induced ROS formation. WD-Hpt alleviated microglial activation induced by I/R and reduced mRNA levels of IL-1β in LPS-stimulated BV-2. I/R resulted in a 37% reduction in the number of ganglion cells in the NS-treated mice, whereas the reduction was only 5% in the WD-Hpt-treated mice. In addition, WD-Hpt mitigated the immunoreactivity of GFAP, increased expression of cleaved caspase-3, increased number of TUNEL positive cells and p-ERK after I/R.

CONCLUSIONS

WD-Hpt protected ganglion cells from I/R injury by inhibiting oxidative stress and modulating cell death signaling. Moreover, WD-Hpt had an anti-inflammatory effect through the suppression of activated microglia.

Serum prorenin levels are not associated with ocular diseases in non-diabetic subjects

INTRODUCTION

To determine if the serum prorenin level is useful for detecting ocular disease in a non-diabetic population.

MATERIALS AND METHODS

We enrolled non-diabetic men (n = 402) and women (n = 349) in our study. We used the antibody-activating direct enzyme kinetic assay of human prorenin to determine serum prorenin levels. We performed multiple regression analysis to determine the factors that affect serum prorenin levels, such as: age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, fasting blood sugar, and HbA1c or estimated glomerular filtration rate. Our study subjects were divided into groups by their ophthalmologic diagnosis. One-way analysis of variance (ANOVA) was performed to detect a significant difference in the serum prorenin levels among the groups.

RESULTS

There were no significant differences in serum prorenin levels among the ocular diseases and disorders. The DBP was negatively correlated with serum prorenin levels in men (r = - 0.1992; p = 0.021) and in women (r = - 0.2067; p = 0.031).

CONCLUSION

Considering the current results and those of previous studies together, we found that the prorenin value is useful solely for predicting development of diabetic retinopathy in adults.

Molecular hydrogen consumption in the human body during the inhalation of hydrogen gas

Inhaling or ingesting hydrogen (H2) gas improves oxidative stress-induced damage in animal models and humans. We previously reported that H2 was consumed throughout the human body after the ingestion of H2-rich water and that the H2 consumption rate ([Formula: see text]) was 1.0 μmol/min/m(2) body surface area. To confirm this result, we evaluated [Formula: see text]during the inhalation of low levels of H2 gas. After measuring the baseline levels of exhaled H2 during room air breathing via a one-way valve and a mouthpiece, the subject breathed low levels (160 ppm) of H2 gas mixed with purified artificial air. The H2 levels of their inspired and expired breath were measured by gas chromatography using a semiconductor sensor. [Formula: see text] was calculated using a ventilation equation derived from the inspired and expired concentrations of O2/CO2/H2, and the expired minute ventilation volume, which was measured with a respiromonitor. As a result, [Formula: see text] was found to be approximately 0.7 μmol/min/m(2)BSA, which was compatible with the findings we obtained using H2-rich water. [Formula: see text] varied markedly when pretreatment fasting to reduce colonic fermentation was not employed, i.e., when the subject's baseline breath hydrogen level was 10 ppm or greater. Our H2 inhalation method might be useful for the noninvasive monitoring of hydroxyl radical production in the human body.

Insufflation of hydrogen gas restrains the inflammatory response of cardiopulmonary bypass in a rat model

Systemic inflammatory responses in patients receiving cardiac surgery with the use of the cardiopulmonary bypass (CPB) significantly contribute to CPB-associated morbidity and mortality. We hypothesized that insufflated hydrogen gas (H₂) would provide systemic anti-inflammatory and anti-apoptotic effects during CPB, therefore reducing proinflammatory cytokine levels. In this study, we examined the protective effect of H₂ on a rat CPB model. Rats were divided into three groups: the sham operation (SHAM) group, received sternotomy only; the CPB group, which was initiated and maintained for 60 min; and the CPB + H₂ group in which H₂ was given via an oxygenator during CPB for 60 min. We collected blood samples before, 20 min, and 60 min after the initiation of CPB. We measured the serum cytokine levels of (tumor necrosis factor-α, interleukin-6, and interleukin-10) and biochemical markers (lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase). We also measured the wet-to-dry weight (W/D) ratio of the left lung 60 min after the initiation of CPB. In the CPB group, the cytokine and biochemical marker levels significantly increased 20 min after the CPB initiation and further increased 60 min after the CPB initiation as compared with the SHAM group. In the CPB + H₂ group, however, such increases were significantly suppressed at 60 min after the CPB initiation. Although the W/D ratio in the CPB group significantly increased as compared with that in the SHAM group, such an increase was also suppressed significantly in the CPB + H₂ group. We suggest that H₂ insufflation is a possible new potential therapy for counteracting CPB-induced systemic inflammation.

Tuberculosis Diagnostic Committees' contribution to the National TB Program in Manila and Quezon Cities

SETTING

The Philippines Tuberculosis Diagnostic Committees (TBDCs) were created to improve the quality of diagnosis of sputum smear-negative chest radiography suggestive of pulmonary tuberculosis (sn-PTB).

OBJECTIVE

To determine current TBDC activities, obstacles and possible solutions for improvements in the quality of diagnosis of sn-PTB in Manila City and Quezon City.

DESIGN

A descriptive review of TBDC Masterlist records and interviews with TBDC members using a semi-structured questionnaire.

RESULTS

A record review of nine of 10 TBDCs was conducted, with interviews of 33 of the 49 current members. During the second and third quarters of 2009, respectively 1142 and 1563 sn-PTB cases were evaluated by the TBDCs in both cities. Of these, 53% in Manila City and 65% in Quezon City were classified as active TB patients. There were significant variations in the percentage of patients recommended for anti-tuberculosis treatment by the TBDC. The participation of its members is based on their expressed commitment to program sustainability.

CONCLUSION

TBDC activities contribute to TB control in the Philippines by ensuring the judicious use of resources. Further research to assess the contributions of TBDCs in reducing diagnostic and treatment delays, and factors affecting the sustainability of the TBDCs, is recommended.

Role of Rho-kinase signaling and endothelial dysfunction in modulating blood flow distribution in pulmonary hypertension

Rho-kinase-mediated vasoconstriction and endothelial dysfunction are considered two primary instigators of pulmonary arterial hypertension (PAH). However, their contribution to the adverse changes in pulmonary blood flow distribution associated with PAH has not been addressed. This study utilizes synchrotron radiation microangiography to assess the specific role, and contribution of, Rho-kinase-mediated vasoconstriction and endothelial dysfunction in PAH. Male adult Sprague-Dawley rats were injected with saline (Cont-rats) or monocrotaline (MCT-rats) 3 wk before microangiography was performed on the left lung. We assessed dynamic changes in vessel internal diameter (ID) in response to 1) the Rho-kinase inhibitor fasudil (10 mg/kg iv); or 2) ACh (3 μg · kg−1 · min−1), sodium nitroprusside (SNP, 5 μg · kg−1 · min−1), and Nω-nitro-l-arginine methyl ester (l-NAME, 50 mg/kg iv). We observed that MCT-rats had fewer vessels of the microcirculation compared with Cont-rats. The fundamental result of this study is that fasudil improved pulmonary blood flow distribution and reduced pulmonary pressure in PAH rats, not only by dilating already-perfused vessels (ID > 100 μm), but also by restoring blood flow to vessels that had previously been constricted closed (ID < 100 μm). Endothelium-dependent vasodilation was impaired in MCT-rats primarily in vessels with an ID < 200 μm. Moreover the vasoconstrictor response to l-NAME was accentuated in MCT-rats, but only in the 200- to 300-μm vessels. These results highlight the importance of Rho-kinase-mediated control and endothelial control of pulmonary vascular tone in PAH. Indeed, an effective therapeutic strategy for treating PAH should target both the smooth muscle Rho-kinase and endothelial pathways.

Apical Cl-/HCO3- exchanger stoichiometry in the modeling of HCO3- transport by pancreatic duct epithelium

Pancreatic duct cells secrete a HCO(3)(-)-rich (approximately 140 mM) fluid. Using a computer model of the pancreatic duct, Sohma, et al. have demonstrated that the activity of a Cl(-)/HCO(3)(-) exchanger with a 1: 1 stoichiometry at the apical membrane would have to be suppressed in order to achieve such a HCO(3)(-)-rich secretion. Recently the apical exchanger in pancreatic ducts has been identified as SLC26A6 and this probably mediates most of Cl(-)-dependent HCO(3)(-) secretion across the apical membrane. SLC26A6 is reported to mediate electrogenic Cl(-)/2HCO(3)(-) exchange when expressed in Xenopus oocytes. To assess the implications of this 1: 2 stoichiometry for HCO(3)(-) secretion, we have reconstructed the Sohma model using MATLAB/Simulink. To do this we have formulated an expression for the turnover rate of Cl(-)/2HCO(3)(-) exchange using network thermodynamics and we have estimated the constants from published experimental data. Preliminary data suggest that the 1: 2 stoichiometry of SLC26A6 would favor HCO(3)(-) secretion at higher concentrations.

A tracer analysis study on the redistribution and oxidization of endogenous carbon monoxide in the human body

Past studies have suggested that some carbon monoxide (CO) moves from blood haemoglobin to tissue cells and that mitochondrial cytochrome c oxidase oxidizes CO to carbon dioxide (CO₂). However, no study has demonstrated this redistribution and oxidization of CO under physiological conditions. The objective of this study was to trace the redistribution and oxidization of CO in the human body by detecting ¹³CO₂ production after the inhalation of ¹³CO. In Experiment 1, we asked a healthy subject to inhale 50 ppm ¹³CO gas. In Experiment 2, we circulated heparinized human blood in a cardio-pulmonary bypass circuit and supplied 50 ppm ¹³CO gas to the oxygenator. We sequentially sampled exhaled and output gases and measured the ¹³CO₂/¹²CO₂ ratios. In Experiment 1, the exhaled ¹³CO₂/¹²CO₂ ratio increased significantly between 4 to 31 h of ¹³CO inhalation. In Experiment 2, the output ¹³CO₂/¹²CO₂ ratio showed no significant increase within 36 h of ¹³CO input. Experiment 1 demonstrated the oxidization of CO in the human body under physiological conditions. Experiment 2 confirmed that oxidization does not occur in the circulating blood and indicated the redistribution of CO from blood carboxyhaemoglobin to tissue cells.

Effect of dietary turmeric on breath hydrogen

Turmeric is widely used in Indian cuisine. The main constituents of turmeric are curcumin and its analogues, which are well-known antioxidant compounds. In the present study, we hypothesized that turmeric in curry might increase bowel motility and activate hydrogen-producing bacterial flora in the colon, thereby increasing the concentration of breath hydrogen. Eight healthy subjects fasted for 12 h and ingested curry and rice with or without turmeric (turmeric knockout curry). Breath-hydrogen concentrations were analyzed every 15 min for 6 h by gas chromatography with a semiconductor detector. Curry with turmeric significantly increased the area under the curve of breath hydrogen and shortened small-bowel transit time, compared with curry not containing turmeric. These results suggested that dietary turmeric activated bowel motility and carbohydrate colonic fermentation.

Breath hydrogen produced by ingestion of commercial hydrogen water and milk

OBJECTIVE

To compare how and to what extent ingestion of hydrogen water and milk increase breath hydrogen in adults.

METHODS

Five subjects without specific diseases, ingested distilled or hydrogen water and milk as a reference material that could increase breath hydrogen. Their end-alveolar breath hydrogen was measured.

RESULTS

Ingestion of hydrogen water rapidly increased breath hydrogen to the maximal level of approximately 40 ppm 10-15 min after ingestion and thereafter rapidly decreased to the baseline level, whereas ingestion of the same amount of distilled water did not change breath hydrogen (p < 0.001). Ingestion of hydrogen water increased both hydrogen peaks and the area under the curve (AUC) of breath hydrogen in a dose-dependent manner. Ingestion of milk showed a delayed and sustained increase of breath hydrogen in subjects with milk intolerance for up to 540 min. Ingestion of hydrogen water produced breath hydrogen at AUC levels of 2 to 9 ppm hour, whereas milk increased breath hydrogen to AUC levels of 164 ppm hour for 540 min after drinking.

CONCLUSION

Hydrogen water caused a rapid increase in breath hydrogen in a dose-dependent manner; however, the rise in breath hydrogen was not sustained compared with milk.

Case study on changes in exhalation of carbon monoxide and nitrogen oxide in breath and skin gas during 2-day smoking cessation and restart

It is generally accepted that the breath of current smokers contains higher carbon monoxide (CO) and lower nitric oxide (NO) and that smoking cessation increases NO and decreases CO in breath. However, it remains unknown whether cigarette cessation reversibly changes breath NO/CO levels and how smoking cessation and restart could modify CO/NO-producing abilities in breath and skin gas. In the present case study, a so-called healthy smoker repeatedly performed 2-day smoking cessation and restart. To compare breath and skin exhalation, minute exhalation volumes per body surface of CO (VCO), NO (VNO) and nitrogen oxide (NO(x), VNO(x)) in breath and skin gas were calculated using gas chromatography with a semiconductor sensor, chemiluminescence method and respiro-monitor. We found a rapid decrease of breath VCO during smoking cessation and an increase of breath VCO after restart, insignificant changes in skin VCO, insignificant changes in breath and skin VNO, and significant biphasic and reversible changes in breath and skin VNO(x)/VNO(2) (= VNO(x) - VNO). Dominant NO(x) was NO in breath and NO(2) in skin gas. These results suggested that CO and NO(x) in breath and skin gas could be reversibly and acutely altered during 2-day smoking cessation and restart even in the case of a long-term cigarette smoker.

High-throughput assay of nitric oxide metabolites in human plasma without deproteinization by lab-on-a-chip electrophoresis using a zwitterionic additive

In order to develop a high-throughput assay for nitric oxide metabolites, nitrite (NO2-) and nitrate (NO3-), in biological fluids, we have investigated the simultaneous determination of them using an electrophoretic lab-on-a-chip (microchip capillary electrophoresis, MCE) technique. In this study, in order to establish an MCE assay process without deproteinization, the addition of a zwitterionic additive into the running buffer to reduce the adsorption of protein onto the surface of channel was investigated. Initially, some zwitterionic additives were investigated by making a comparison of relative standard deviations (RSDs) of the migration times for NO2(-) and NO3(-) on capillary electrophoresis. From the results of our comparison of the RSD values, 2% (w/w) N-cyclohexyl-2-aminoethanesulfonic acid (CHES) was selected. As a result of the application of the running buffer with CHES to the MCE process, the complete separation of NO2(-) and NO3(-) in human plasma without deproteinization was achieved within 1 min. Since the RSD values of the positions of the peaks were less than 2.3%, beneficial reduction effects on MCE were suggested. When we used an internal standard method in order to correct the injection volume, the RSDs of the peak heights and areas were less than 10%, and the correlation coefficients of spiked calibration curves ranging from 0 to 350 microM were 0.999 and 0.997 for NO2(-) and NO3(-), respectively. The limits of detection (S/N=3) were 53 microM for NO2(-) and 41 microM for NO3(-). Moreover, the correlation coefficients in excess of 0.99 between the MCE method and a conventional Griess method were achieved for both NO2(-) and NO3(-). Consequently, the possibility of establishing a high-throughput assay process was obtained by utilizing 2% (w/w) CHES to reduce protein adsorption.

α2-Adrenoreceptor mediated sympathoinhibition of heart rate during acute hypoxia is diminished in conscious prostacyclin synthase deficient mice

Acute hypoxia increases ventilatory drive in conscious animals, resulting in tachycardia. Sustained hypoxia changes the initial chemoreflex ventilatory increase to secondary ventilatory depression, which then evokes a gradual secondary heart rate (HR) reduction. Prostacyclin (PGI(2)) release is known to potentiate alpha(2)-adrenoreceptor (alpha(2)-AR) mediated inhibition of sympathoactivation during ischaemia and hypoxia. We examined whether alpha(2)-AR mediated sympathoinhibition was responsible for limiting hypoxic heart rate increases during initial sympathoactivation, and subsequent secondary HR depression, and if PGI(2) is required for sympathoinhibition of HR. The responses of unrestrained PGI(2) synthase deficient (PGID) and wild type (WT) mice to acute hypoxia (10% O(2) for 30 min) were investigated by simultaneous telemetry, whole body plethysmography and open-flow respirometry. PGID mice exhibited potentiated .V(E) (p < 0.007) after intraperitoneal vehicle injection (n = 8), but not so HR responses compared to WT mice during sustained hypoxia. Idazoxan (alpha(2)-AR antagonist, i.p. bolus 3 mg/kg) pretreatment did not change hypoxic ventilatory response in either group, but significantly elevated hypoxic HR in WT mice only (p < 0.013). Sodium meclofenamate (cyclooxygenase inhibition, i.p. bolus 25 mg/kg) pretreatment eliminated the potentiated .V(E) of PGID and caused significant basal hypotension that led to a transient hypertensive response to hypoxia. From these results, we suggest that alpha(2)-AR activation is required for coupling HR to central inspiratory drive during acute hypoxia, and that PGI(2) is required to enhance the inhibition of sympathoactivation.

Changes in functional and histological distributions of nitric oxide synthase caused by chronic hypoxia in rat small pulmonary arteries

1. Chronic hypoxia (CH) increases lung tissue expression of all types of nitric oxide synthase (NOS) in the rat. However, it remains unknown whether CH-induced changes in functional and histological NOS distributions are correlated in rat small pulmonary arteries. 2. We measured the effects of NOS inhibitors on the internal diameters (ID) of muscular (MPA) and elastic (EPA) pulmonary arteries (100-700 micro m ID) using an X-ray television system on anaesthetized rats. We also conducted NOS immunohistochemical localization on the same vessels. 3. Nonselective NOS inhibitors induced ID reductions in almost all MPA of CH rats (mean reduction, 36+/-3%), as compared to approximately 60% of control rat MPA (mean, 10+/-2%). The inhibitors reduced the ID of almost all EPA with similar mean values (approximately 26%) in both CH and control rats. On the other hand, inducible NOS (iNOS)-selective inhibitors caused ID reductions in approximately 60% of CH rat MPA (mean, 15+/-3%), but did so in only approximately 20% of control rat MPA (mean, 2+/-2%). This inhibition caused only a small reduction (mean, approximately 4%) in both CH and control rat EPA. A neuronal NOS-selective inhibitor had no effect. 4. The percentage of endothelial NOS (eNOS)-positive vessels was approximately 96% in both MPA and EPA from CH rats, whereas it was 51 and 91% in control MPA and EPA, respectively. The percentage for iNOS was approximately 60% in both MPA and EPA from CH rats, but was only approximately 8% in both arteries from control rats. 5. The data indicate that in CH rats, both functional and histological upregulation of eNOS extensively occurs within MPA. iNOS protein increases sporadically among parallel-arranged branches in both MPA and EPA, but its vasodilatory effect is predominantly observed in MPA. Such NOS upregulation may serve to attenuate hypoxic vasoconstriction, which occurs primarily in MPA and inhibit the progress of pulmonary hypertension.

K(ATP) channels predominantly regulate conduit vessel tone in normoxic cat pulmonary arteries in vivo

Through our investigations of the intact pulmonary circulation, we aimed to find out whether K(ATP) channels contribute to regulating basal vascular tone and to clarify which vascular segments dilate during K(ATP) channel activation under basal tone conditions. Using an X-ray television system on anesthetized cat lungs, we measured internal diameter (ID) responses to two K(ATP) channel inhibitors (glibenclamide and 4-morpholinecarboximidine-N-1-adamantyl-N'-cyclohexyl-hydrochloride (U-37883A)) and to an activator (levcromakalim) in normoxic pulmonary arteries. In conduit arteries (800-3000 microm ID), the inhibitors and activator induced larger ID constrictions (14-17%) and dilatations (29-32%), respectively. However, in resistance arteries (<500 microm), the constriction response was negligible and the dilatation response relatively small (5-10%). The data suggest that K(ATP) channels are active and capable of regulating basal vascular tone primarily within conduit pulmonary arteries even though these channels are present in all pulmonary arteries.

Two-week, but not 1-week, hypoxic exposure enhances nitric oxide-mediated basal tone regulation in rat resistance pulmonary arteries

We measured internal diameter (ID) changes in resistance and conduit pulmonary arteries of 1- and 2-week hypoxic rats and normoxic control rats in response to nitric oxide synthase (NOS) inhibitors in vivo. At 2 weeks of hypoxic exposure, the ID reduction as a result of NOS inhibition was enhanced within the resistance arteries, but not at 1 week of hypoxia.

Tuberculosis problems in the Asia-Pacific region

Tuberculosis (TB) is the top killer of the productive age group in developing countries. More than half of cases in the world occur in Asia-Pacific region. The number of cases will increase in the next decades due to increase in urban poor population and HIV incidence, and poor access to health services and poor TB programme. The mainstay of effective strategy is to promote DOTS. DOTS population coverage is high, 58% in the Western Pacific Region but low; 29% in the southeast Asia region. Even among intermediate TB-burden countries in Asia, reduction of incidence has stagnated in recent years because of aging population, health problems in the urban poor population and influx of populations from high endemic areas. Indicators of successful TB programmes are high cure rate and low drug resistance rate. There is a strong correlation between the overall quality of TB control in the past and the current primary drug-resistant rate. To solve these problems, priority should be given to nationwide implementation of DOTS in high TB-burden countries with emphasis on ensuring availability of free anti-TB drugs and strengthening primary health care. General hospitals and private sector should be involved in control programmes to prevent drug resistant cases.

Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal

SETTING

Directly observed treatment for tuberculosis using a short-course regimen (DOTS) was introduced in a rural area of Nepal. All new patients assigned to DOTS from mid-December 1997 to mid-June 1999 were eligible for the study.

OBJECTIVE

To examine delays in tuberculosis (TB) diagnosis and compare health care seeking behaviour between men and women.

DESIGN

A cross-sectional analysis of patient interviews.

RESULTS

Women were found to have a significantly longer total delay before diagnosis of tuberculosis (median 2.3 months for men, 3.3 months for women). When they visited traditional healers first, women had a significantly longer delay than men from the first visit to health care providers to diagnosis (median 1.5 months for men, 3.0 months for women). More women (35%) visited traditional healers before diagnosis than men (18%), and were more likely to receive more complicated charms from traditional healers. Men tended to visit the government medical establishment first if they knew that free TB treatment was available, but women did not.

CONCLUSION

Women were more likely to visit and to believe in traditional healers; this might lead to the longer delays experienced before TB diagnosis.

Improvement in exercise capacity with nitric oxide inhalation in patients with precapillary pulmonary hypertension

BACKGROUND

Patients with precapillary pulmonary hypertension (PH) exhibit a poor exercise capacity due to an impaired vasodilatory response of their pulmonary arteries. By causing the pulmonary artery to dilate, inhaled nitric oxide (NO) may allow an increase in exercise capacity in patients with PH.

METHODS AND RESULTS

On 2 separate days, 3 days apart, 14 patients with precapillary PH (10 primary PH, 4 residual PH after correction of an intracardiac shunt; age, 40+/-12 years; mean pulmonary artery pressure, 60+/-23 mm Hg) performed exercise, with and without inhalation of 20 ppm NO, on a cycle ergometer. The work rate was increased 15 W/min until their symptom-limited maximum, with breath-by-breath gas analysis. Patients were randomly and blindly selected to inhale NO on either their first or second test. Peak exercise load and anaerobic threshold tended to increase, but not significantly. Peak oxygen consumption (f1.gif" BORDER="0">O(2)) and Deltaf1.gif" BORDER="0">O(2)/DeltaW ratio increased significantly, by 18% and 22%, respectively (peak f1.gif" BORDER="0">O(2), 13.6+/-3.6 to 16.0+/-4. 1 mL. kg(-1). min(-1); Deltaf1.gif" BORDER="0">O(2)/DeltaW ratio, 5. 8+/-2.4 to 7.1+/-2.3 mL. kg(-1). min(-1). W(-1); both P<0.01). Peak f1.gif" BORDER="0">O(2) increased >10% in 12 of the 14 patients. However, respiratory quotient at peak exercise decreased from 1. 22+/-0.15 to 1.09+/-0.15 (P<0.01).

CONCLUSIONS

Inhaled NO substantially increases oxygen consumption at the same workload during exercise. This finding supports the possibility of ambulatory NO inhalation therapy in patients with precapillary PH.

Segmental differences in vasodilatation due to basal NO release in in vivo cat pulmonary vessels

This study was conducted to examine segmental differences in vasodilatation caused by the basal release of nitric oxide (NO) in the serially connected pulmonary vessels and to estimate the relative contributions of endothelial and neuronal NO synthase (NOS), and inducible NOS to the vasodilatation. Using an X-ray TV system on in vivo cat lungs, we measured internal diameter (ID) changes in resistance (100-400 microm ID), small conduit (600-1000 microm) and large conduit (1200-1700 microm) arteries, and veins of the same size. Non-selective NOS inhibitors, L-NAME (30-50 mg/kg i.v.) and L-NMMA (40-60 mg/kg i.v.), decreased the ID of all vessels studied, although their D-isomers had no effect. The decrease was larger in conduit arteries than in resistance arteries, with maximum response of small conduit arteries (25 +/- 2%), while venous segments displayed relatively uniform response (10-12%). L-Arginine completely abolished the ID decrease but hexamethonium bromide and phentolamine had no effect. Selective inhibitors of inducible NOS, L-canavanine (100 mg/kg i.v.) and S-methylisothiourea (10 mg/kg i.v.) did not affect any of the vessels. The data suggest that basal release of NO chiefly derived from endothelial NOS serves to dilate cat pulmonary arteries and veins, particularly small conduit arteries.

Pulmonary microvascular responses to inhaled prostacyclin, nitric oxide, and their combination in anesthetized cats

Using an X-ray television system on anesthetized cats, we directly measured internal diameter (ID) changes in identical small pulmonary vessels (100-1,100 microm ID) in response to inhalations of 25, 250, and 2,500 ng/kg/min aerosolized prostacyclin (PGI2), 4 and 34 ppm nitric oxide (NO), and the combination of aerosolized PGI2 and NO. We also compared ID changes during 250 ng/kg/min PGI2 inhalation both with and without an Nomega-nitro-L-arginine methyl ester (L-NAME, 30 mg/kg I.V.) pretreatment. In the arteries, inhaled PGI2 increased 100-900 microm vessel ID in a dose-dependent manner but caused no significant, or only slight, ID increases in the vessels larger than this. The greatest ID increase ( approximately 22%) was in the 100-500 microm arteries in response to 2,500 ng/kg/min PGI2 inhalation. PGI2 also increased the ID of the veins (6-12%), but the results were not dose related. NO inhalation also resulted in non-uniform ID response patterns similar to PGI2 with no significant, or only minimal, ID increases of the arteries >900 microm. The simultaneous inhalation of 2,500 ng/kg/min PGI2 and 34 ppm NO increased the arterial ID (maximum approximately 34%) more than either drug alone and to almost the same extent as brought about by injected papaverine (2 mg/kg), a smooth muscle relaxant. Inhaled PGI2 (250 ng/kg/min) decreased pulmonary arterial pressure and increased arterial ID to nearly the same extent with or without L-NAME pretreatment. These results indicate that inhaled PGI2 and inhaled NO locally dilate 100-900 microm pulmonary arteries in a dose-dependent manner and with a similar ID response pattern, and that the combination of these drugs produces a more enhanced vasodilator effect compared to their separate effects and induces the maximum dilated states. The data also suggest that inhaled PGI2 dilates these arteries directly, rather than via secondary release of endogenous NO.

Vasodilator effects of adrenomedullin on small pulmonary arteries and veins in anaesthetized cats

1. This study was conducted to determine adrenomedullin (AM) action sites in the pulmonary vascular bed and the relation between its vasodilator effects and vascular tone. Moreover, an examination was made into whether calcitonin gene-related peptide (CGRP) receptors mediate pulmonary vasodilatations induced by AM. To this end, we directly measured internal diameter (i.d.) changes in small pulmonary arteries and veins (100-1100 microns i.d.) by use of an X-ray television system on the in vivo cat lung. 2. Under control (resting vascular tone) conditions, AM injections into the left main pulmonary artery caused dose-related i.d. increases in both small arteries and veins. The mean i.d. increase of the 100-1100 microns arteries (4 +/- 1, 11 +/- 2, and 17 +/- 2% with 0.01, 0.1, and 1 nmol kg-1 AM, respectively) was significantly larger than that for the veins (1 +/- 1, 5 +/- 2, and 7 +/- 2% with 0.01, 0.1 and 1 nmol kg-1 AM, respectively) whatever the injected dose of AM. 3. When unilobar hypoxia (5% O2) had decreased the i.d. of the 100-1100 microns arteries and veins by 16 +/- 3 and 6 +/- 3%, respectively, AM (0.1 nmol kg-1) was able to induce significantly larger i.d. increases in the arteries (28 +/- 3%) and veins (11 +/- 3%) than those under control conditions. 4. The AM-induced i.d. response pattern in the serially connected pulmonary arteries was quite different from that induced by CGRP; AM caused a greater increase in smaller vessels (100-500 microns) than in larger vessels (500-1100 microns). In the case of CGRP, a greater increase was observed in the larger vessels. 5. CGRP8-37 (100 nmol kg-1, i.v., followed by a continuous infusion of 0.2 nmol kg-1 min-1) had no significant effect on the i.d. increase induced by AM (0.1 nmol kg-1) in any serial segments of the arteries and veins. 6. The results indicate that, in the cat, AM induces greater vasodilatation in small pulmonary arteries and lesser vasodilatation in small veins, the maximum dilatation being in the more peripheral arterial segment (100-500 microns). The vasodilator effect of AM was enhanced when vascular tone was elevated. The data suggest that the AM-induced pulmonary vasodilatation is not mediated by CGRP receptors but by its own specific receptor.

[Cross sectional study of the relationship between bone density to diet and life style using ultrasound bone densitometry]

The relationship between bone density to diet and life style was investigated in pre- and postmenopausal women in Kyoto Prefecture in 1994 by a cross-sectional study. Bone densities of 453 women aged 30-86 years were measured by ultrasound bone densitometry. History of pregnancy and delivery, menstruation, medical history, bone and arthral symptoms, life style, food intake frequency, current and past intake of dairy products, and physical activity were examined by self-administered questionnaire. Analysis of covariance and multiple-regression analysis were performed to determine the relation between bone density and life style adjusted for age and obesity index among 151 premenopausal women (PRE), 244 postmenopausal but not sedentary (under 65 years of age) women (POST), and 58 sedentary (older than 65 years of age) women (SED). The results were as follows; 1) A marked age-related decline in bone density was observed at 45-55 years of age. The correlation coefficient between age and bone density was significant at -0.65 (p < 0.01). 2) Obesity index and bone density were positively correlated in each group. 3) Among the PRE group women, there was no relation between life style and bone density. Those who experienced bone fractures tended toward low bone density. Among the POST group, time since menopause, exercise, and current milk intake were significantly correlated with bone density. In the SED group, women with arthralgia showed significantly lower densities. 4) From multiple-regression analysis, age, obesity index, and milk intake during childhood were shown to be related to bone density in each group.

Effects of infant mortality, family planning and socioeconomic factors on fertility reduction in developing countries

The demographic transition theory that mortality reduction is followed by fertility reduction is challenged by reports that many developing countries are trapped in the stage of high fertility and lower mortality. We examined the extent to which reduced infant mortality lowers fertility both directly and indirectly relative to other determinants of fertility in developing countries. According to the available information, determinants of fertility were selected. Data from the United Nations on fertility and its determinants in 117 developing countries were analyzed. Remarkable fertility reduction started only when the infant mortality rate was reduced to a certain "threshold" level around 50-125 per 1000 live births. Fertility reduction is related to the level of infant mortality and other socioeconomic variables mainly indirectly through the increase in contraceptive prevalence. Thus, the demographic transition theory is still maintained. Even in the country group which was "trapped" in the stage of "low" mortality of around 125 and high fertility, fertility reduction seems to be possible by further reducing the infant mortality rate, e.g. to lower than 100, which helps increase family planning practices.

Inhaled nitric oxide: diameter response patterns in feline small pulmonary arteries and veins

Using an X-ray television system on the in vivo cat lung, we directly measured internal diameter (ID) changes in the small pulmonary arteries and veins (100-1,100 microns ID) in response to 5, 15, and 40 ppm nitric oxide (NO) inhalations. We also measured to what extent 40 ppm NO inhalation can attenuate large ID constrictions at the different serial segments of the small vessels due to unilobar anoxic (0% O2) exposure. Under normoxic conditions, 5-40 ppm NO inhalations significantly increased the ID of both arteries and veins less than approximately 900 microns dose dependently but caused no significant, or only slight, ID increases in the vessels larger than this, if any at all. The ID increase in the serially connected arteries was nonuniform (4-18, 8-28, and 7-35% with 5, 15, and 40 ppm NO inhalations, respectively), whereas that for the veins was relatively uniform (4-9, 6-17, and 7-18% with 5, 15, and 40 ppm NO, respectively). The maximum ID increase occurred in the 200- to 500- and 200- to 700-microns arteries in response to 5-15 and 40 ppm NO, respectively. Unilobar anoxic exposure significantly decreased the ID of the 100- to 700-microns arteries and veins, but not the ID of the other-sized vessels. The ID decrease in the serially connected arteries was nonuniform (13-29%) but relatively uniform in the veins (8-12%). The maximum ID decrease occurred in the 200- to 300-microns arteries. However, adding 40 ppm NO to the lobe completely eradicated the ID decreases at all segments of the arteries and veins and, instead, caused significant ID increase (11-21%) in the arteries and (10-12%) in the veins. The data indicate that, according to dosage, 5-40 ppm NO inhalations cause selective dilation of approximately 100- to 900-microns pulmonary arteries and veins, particularly the 200- to 700-microns arteries. During anoxic exposure, the vasodilator effect of NO is preserved and can completely reverse the marked pulmonary vasoconstriction.

[Incidence, risk factors relating to bacillary tuberculosis and secondary infections from registered patients in Hunai-Gun, Kyoto Prefecture]

To review how to strengthen tuberculosis program in Hunai-Gun, Kyoto Prefecture, the recent trend of incidence of tuberculosis and 148 index cases with pulmonary tuberculosis newly registered from 1987 to 1992 were analyzed regarding the mode of detection, conditions when consulting medical facilities, risk factors, bacteriological findings, and secondary infections among contacts. 1. The high crude incidence of tuberculosis in Hunai-Gun is explained by the high proportion (19.3%) of the elderly population of 65 years old and over in Hunai-Gun compared with the average (12.6%) in the Prefecture and the high tuberculosis incidence among age group of 70 years old and over in Hunai-Gun compared with the prefectural average. However, the reason of higher incidence of tuberculosis among the elderly in the district was not clear. 2. The proportion of bacillary as well as culture positive cases were higher among patients who were diagnosed by consulting medical facilities than those detected by regular health check. The proportion of bacillary cases without risk factors for tuberculosis among patients who were diagnosed at medical facilities was the highest among those newly attending medical facilities due to complaints related to tuberculosis (group A), followed by those patients regularly attending medical facilities for other diseases but consulting because of additional complaints related to tuberculosis (group B), and lowest among patients regularly attending medical facilities but detected by chance while being examined for other diseases (group C). The severer the diseases stage, the higher the proportion of bacillary cases, however, there were no difference in the proportion of bacillary cases among the above three groups including those with risk factors. It is explained by the fact that the ratio of patients with risk factors was high in group C, which masked the higher proportion of bacillary cases among patients with risk factors. 3. As future activities of public health center on tuberculosis control, it is important to give health education to those with risk factors on the fact that the progression of the disease is faster among them in addition to the increased risk of the disease onset, and advise them to attend regular health check and visit medical facilities when they have any symptom related to tuberculosis. 4. Considering the fact that the risk of secondary infection to contacts is higher among smear positive patients than bacilli negative patients, it is needed to examine all contacts of sputum smear positive patients thoroughly. In addition, it is advisable to follow-up contacts of smear negative but culture positive patients with the similar intensity with those for smear positive patients because their risk of secondary infection to contacts was also higher than bacilli negative patients although it was not statistically significant.

Effectiveness of control programs for pneumonia among children in China and Fiji

This article summarizes the implementation and efficacy of the World Health Organization's standard case management program for pediatric pneumonia in three counties in China and in the Western Division of Fiji. The information provided through this program was simple enough to be understood by parents and health care workers with a basic educational background. The program reduced mortality from pneumonia even when implemented through the existing health care system in a relatively poor county in China. The factors important in the success of the program included improved recognition of the signs of childhood pneumonia by parents, earlier presentation of children with these signs to health care facilities, availability of antimicrobial agents at the primary health care level, and rational decisions by health care workers about the use of these agents.

[Characteristics of smoking, drinking, dietary habits, and physical exercise in health behavioral models]

Various kinds of preventive health behaviors are promoted by health education. The extent of behavioral modification achieved, however, obviously differs from individual to individual according to habits, one of the reasons being the characteristics of various health habits are perceived differently. This cross-sectional study examined the association of indices representing health behavior models with smoking, drinking, dietary habits, and physical exercise. The indices and their meaning were as follows; health locus of control (HLC) and saliency of health are thought to cause the most active behavioral change, health norm relatively passive change, and vulnerability to illness the most passive change. The indices and lifestyle (health related practices) were surveyed by a self-administered questionnaire in a rural town in March 1994. The study sample consisted of 1,010 males and 1,055 females aged 20 years or older who responded to all questions related to the indices. Results are as follows: 1) Smoking and alcohol drinking were associated with vulnerability to illness, suggesting that people who quit smoking or alcohol drinking do so because of perception of their association with illness. Alcohol drinking seemed to have a higher magnitude of being associated with becoming ill or with fear of illness than smoking. 2) Consuming green-yellow vegetables and fresh fish, and physical fitness were associated with internal HLC, saliency of health, and health norm. These habits appeared to be easy to modify by active personal behavior choice. 3) Consuming milk, yogurt, boiled beans, tofu, oranges, and other fruits were associated with saliency of health. These habits seemed to relate to personal sense of being "healthy". 4) It seemed that younger people more likely changed their behavior by active self-management, while, older people changed due to their sense of value or norm. While it is important for health education to promote "self-management of health" by active behavioral change, certain habits are more resistant to change despite educational efforts possibly because of their characteristics in health behavioral models. For cases such as these, techniques promoting passive behavioral change should be considered.