Profiles of central nervous system surgical site infections in endoscopic transnasal surgery exposing the intradural space

OBJECTIVE

Despite its efficacy and minimal invasiveness, the clean-contaminated nature of endoscopic transnasal surgery (ETS) may be susceptible to central nervous system surgical site infections (CNS-SSIs), especially when involving intradural exposure. However, the profiles of ETS-associated CNS-SSIs are not fully elucidated.

METHODS

The institutional ETS cases performed between May 2017 and March 2023 were retrospectively analysed. The incidences of CNS-SSIs were calculated, and their risk factors examined.

RESULTS

The incidence of CNS-SSIs was 2.3% (7/305) in the entire cohort and 5.0% (7/140) in ETSs with intradural exposure. All the CNS-SSIs were meningitis and developed following ETS with intradural exposure. The incidences were 0%, 5.6% and 5.8% in ETSs with Esposito grade 1, 2 and 3 intraoperative cerebrospinal fluid leakage, respectively. Among the pre- and intra-operative factors, body mass index (unit odds ratio (OR), 0.62; 95% confidence interval (CI), 0.44-0.89; P<0.01), serum albumin (unit OR, 0.03; 95% CI, 0.0007-0.92; P=0.02), and American Society of Anesthesiologists physical status score (unit OR, 20.7; 95% CI, 1.65-259; P<0.01) were significantly associated with CNS-SSIs. Moreover, postoperative cerebrospinal fluid leakage was also significantly associated with CNS-SSIs (OR, 18.4; 95% CI, 3.55-95.0; P<0.01).

CONCLUSIONS

The incidence of ETS-associated CNS-SSIs is acceptably low. Intradural exposure was a prerequisite for CNS-SSIs. Malnutrition and poor comorbidity status should be recognized as important risks for CNS-SSIs in ETS.

Validation of a self-monitoring device for estimating 24-hour urinary salt excretion

BACKGROUND

The purpose of this study was to investigate the relationship between salt intake and urinary salt excretion and to examine the validity of a self-monitoring device for estimating 24-h urinary salt excretion from overnight urine samples.

METHODS

Twelve young, healthy female volunteers consumed test meals from days 1 to 14 and estimated urinary salt excretion on days 2-15 by using a self-monitoring device. The salt content of the test meals was as follows: 10 g (days 1-5), 6 g (days 6-8), 13 g (days 9-11), 6 g (day 12), 13 g (day 13), and 6 g (day 14).

RESULTS

The average 24-h urinary salt excretion (the ratio of urinary salt excretion to salt intake of the previous day) estimated from the overnight urine samples was as follows: 8.01±1.15 g (0.73±0.11) on days 2-6, 5.86±0.85 g (1.01±0.15) on days 7-9, 9.69±1.64 g (0.74±0.13) on days 10-12, 6.51±1.56 g (1.03±0.25) on day 13, 8.60±3.25 g (0.71±0.14) on day 14, and 6.28±1.31 (1.05±0.22) on day 15. Thus, the salt excretion/salt intake ratio was approximately 0.8 during the high-salt phase and 1.0 during the low-salt phase.

CONCLUSION

The estimation of 24-h urinary salt excretion from overnight urine samples by using a self-monitoring device is a reasonably valid method in this young and healthy female population for detecting daily changes in salt intake.

Regulation of muscle genes by moderate exercise

Moderate-intensity exercise at the lactate threshold (LT) is considered to be a safe and effective training regimen for improving metabolic syndrome. The aim of the current study was to investigate the effects of moderate exercise performed at the LT on skeletal muscle gene expression. 6 healthy men participated in cycle ergometer training at LT, 60 min/d, 5 d/wk for 12 wks. Muscle samples were collected after 5 d of training, and then 2 d after training at wks 6 and 12. Quantitative real-time PCR analysis revealed that the expression of peroxisome proliferator activated receptor co-activated 1alpha was significantly increased at 1 h after the training session on day 5. Moreover, using serial analysis gene expression, we found that moderate training for 6 and 12 wks simultaneously induced the expression of a number of metabolic genes involved in the TCA cycle, beta-oxidation, and electron transport. Furthermore, several genes encoding antioxidant enzymes and contractile apparatus were induced. The expression levels of 233 novel transcripts were also altered in response to moderate exercise. Thus, moderate training at the LT is a sufficient stimulus to induce the expression of numerous genes implicated in the development of metabolic syndrome, transcripts involved in the contractile apparatus, and novel transcripts.

Association between maximal oxygen uptake and the heart rate corrected-QT interval in postmenopausal overweight women

BACKGROUND

Increased aerobic capacity can reduce the incidence of cardiovascular disease and the mortality rate. On the other hand, a prolonged heart rate corrected-QT (QTc) interval is associated with an increased risk of arrhythmias, cardiac sudden death and coronary artery disease.

AIMS

The association of the aerobic capacity and coronary risk factors with QTc interval was investigated in postmenopausal overweight women.

SUBJECTS AND METHODS

The subjects included 84 postmenopausal overweight women [age: 58.7+/-6.4 years, body mass index (BMI): 27.9+/-3.3] with coronary risk factors. Electrocardiogram (ECG) was recorded with a standard resting 12-lead ECG after more than 5 minutes of rest. The QTc interval was automatically calculated according to Bazett's formula. A multistage graded submaximal exercise test was performed on an electric bicycle ergometer to determine the estimated maximal oxygen uptake (VO(2)max).

RESULTS

Single correlation analysis showed the QTc interval to be positively associated with hemoglobin A(1)c (HbA(1)c), fasting glucose, fasting insulin, BMI, waist circumference, serum potassium and the number of coronary risk factors, while negatively correlated with VO(2)max. Stepwise multiple regression analysis demonstrated the strong association of the QTc interval with HbA(1)c and VO(2)max (r(2)=0.244, p<0.0001). In both patients with and without metabolic syndrome (n=15, n=69, respectively), the QTc interval was independently associated with the HbA(1)c (r(2)=0.318, p<0.05, r(2)= 0.115, p<0.05, respectively).

CONCLUSIONS

These results suggest that decreased aerobic capacity and glucose intolerance may be independent risk factors for a prolonged QTc interval, while demonstrating no relationship with metabolic syndrome.

Improved cardio-respiratory fitness correlates with changes in the number and size of small dense LDL: randomized controlled trial with exercise training and dietary instruction

OBJECTIVE

To investigate the correlation between lifestyle improvements, in particular increased cardio-respiratory fitness and changes in the blood lipid profile.

METHODS

The participants were 217 residents of Fuji and Yamato Towns, Saga City, with mildly abnormal blood pressure, serum lipids or blood glucose detected at health check-ups in 2003. Participants were randomly allocated to an Intervention (108 subjects) or Control group (109 subjects), matched for age and various conditions. The Intervention group was given exercise advice and prescription and dietary instructions. Cardio-respiratory fitness was evaluated using the work rate at double product breaking point. Changes of lipid parameters were compared before and after intervention, and examined the relationship with cardio-respiratory fitness.

RESULTS

Seventy nine subjects in each group could be followed up for 17 months without requiring pharmacotherapy. Body mass index, waist circumference, systolic blood pressure, homeostasis model assessment insulin resistance, and triglycerides were decreased in the Intervention group. Furthermore, apolipoprotein B levels were lower (p<0.05), and the ratio of LDL cholesterol to apolipoprotein B (LDL/ApoB) was higher (p<0.001). When all subjects were divided into 3 subgroups according to the degree of improvement in cardio-respiratory fitness, LDL/ApoB increased and apolipoprotein B decreased as the degree of improvement increased (p<0.05).

CONCLUSION

Improvement was seen in atherosclerotic risk factors through lifestyle modification. In particular, improved cardiorespiratory fitness was associated with qualitative and quantitative changes in LDLs.

Effects of low intensity exercise therapy on early phase insulin secretion in overweight subjects with impaired glucose tolerance and type 2 diabetes mellitus

This study was designed to evaluate effects of exercise therapy on early phase insulin secretion in overweight subjects with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). The subjects consisted of overweight subjects with normal glucose tolerance (NGT, n=10), IGT (n=10) and DM (n=10) (age: 51.1+/-8.2, 56.3+/-8.8 and 58.5+/-6.2 years, respectively). All of these patients performed exercise therapy at lactate threshold intensity for 12 weeks. Before intervention, area under the glucose curve (AUC(PG)) was higher in DM, IGT and NGT groups, and area under the insulin curve (AUC(IRI)) and the early phase insulin secretion as calculated by insulinogenic index was higher in the NGT group than in either the IGT or DM groups (p<0.05). After exercise therapy, the insulin sensitivity, AUC(PG) and AUC(IRI) improved in three groups (p<0.05, respectively). The insulinogenic index increased in IGT and DM groups (p<0.05, respectively), but the changes in the insulinogenic index showed no significant differences between IGT and DM groups. These results suggest that the ss-cell function in subjects with IGT and DM could therefore improve after exercise therapy. Moreover, AUC(PG), AUC(IRI) and insulin sensitivity were also improved no relation to NGT, IGT and DM.

Gene expression profile of sprinter's muscle

We have characterized the global gene expression profile in left vastus lateralis muscles of sprinters and sedentary men. The gene expression profile was analyzed by using serial analysis of gene expression (SAGE) method. The abundantly expressed transcripts in the sprinter's muscle were mainly involved in contraction and energy metabolism, whereas six transcripts were corresponding to potentially novel transcripts. Thirty-eight transcripts were differentially expressed between the sprinter and sedentary individuals. Moreover, sprinters showed higher expressions of both uncharacterized and potentially novel transcripts. Sprinters also highly expressed seven transcripts, such as glycine-rich protein, myosin heavy polypeptide (MYH) 2, expressed sequence tag similar to (EST) fructose-bisphosphate aldolase 1 isoform A (ALDOA), glyceraldehyde-3-phosphate dehydrogenase and ATP synthase F0 subunit 6. On the other hand, 20 transcripts such as MYH1, tropomyosin 2 and 3, troponin C slow, C2 fast, I slow, T1 slow and T3 fast, myoglobin, creatine kinase, ALDOA, glycogen phosphorylase, cytochrome c oxidase II and III, and NADH dehydrogenase 1 and 2 showed lower expression levels in the sprinters than the sedentary controls. The current study has characterized the global gene expressions in sprinters and identified a number of transcripts that can be subjected to further mechanistic analysis.

Association between silent ST segment depression in exercise electrocardiography and insulin resistance in obese subjects

OBJECTIVES

This study was designed to clarify the association between ST segment depression in exercise electrocardiography (ECG) and insulin resistance in obese subjects.

METHODS

A multistage graded submaximal exercise stress test on the bicycle ergometer was performed under CM5-lead ECG monitoring in 114 obese subjects (39 men and 75 women, mean age 50.9 +/- 12.2 years, mean body mass index 28.6 +/- 3.1 kg/m(2)).

RESULTS

In 27 patients showing ST segment depression at the final exercise intensities (abnormal ST), insulin resistance index by homeostasis model assessment (HOMA-IR) was higher and insulin sensitivity index was lower than in the remaining 87 patients with normal ST segment level (normal ST). The abnormal ST group showed significantly higher plasma glucose and serum insulin levels during the oral glucose tolerance test (OGTT) than the normal ST group. The abnormal ST group showed a significantly higher prevalence of hypertension, impaired glucose tolerance and metabolic syndrome than the normal ST group. Multiple logistic regression analysis showed that insulin resistance as evaluated by fasting insulin, sigma insulin during OGTT, HOMA-IR, insulin sensitivity index, the levels of uric acid, fasting glucose, systolic blood pressure and maximal oxygen uptake were independently associated with ST segment depression.

CONCLUSIONS

These results suggest that insulin resistance may involve pathological ST depression during exercise, as well as previously reported factors such as hyperglycemia, hyperuricemia, hypertension and lower aerobic capacity.

Histochemical characteristics of soleus muscle in angiotensin-converting enzyme gene knockout mice

We examined the histochemical characteristics of soleus muscle in the angiotensin-converting enzyme (ACE) gene (Ace in mice, ACE in humans) knockout mice. Serial sections of soleus muscle of wild-type (Ace+/+, n=20) and heterozygous mutant (Ace+/-, n=24) mice were stained for myosin adenosine triphosphatase activity to identify different muscle fiber types. Capillaries were visualized by amylase-periodic acid-Schiff staining. ACE activity in the serum and gastrocnemius muscle was higher in male mice than in female mice. Female and male Ace+/- mice had markedly lower ACE activity in the serum and the gastrocnemius muscle than did female and male Ace+/+ mice, respectively. In both male and female mice, the composition of fiber types (type I and IIa) did not differ significantly between Ace+/+ and Ace+/- mice. There was no significant gender difference in capillary density. Ace+/- mice had significantly more capillaries around type IIa fibers (5.44 +/- 0.18 vs. 5.01 +/- 0.13, p<0.05) than Ace+/+ mice. The differences in the number of capillaries around type I fibers and in the number of capillaries around per fiber (capillary:fiber ratio) between Ace+/- and Ace+/+ mice were not significant (p<0.1). There was no significant difference in the mean cross-sectional area occupied by one capillary and the number of capillaries per fiber area between Ace+/+ and Ace+/- mice. In conclusion, knockout of the Ace gene in mice increased capillary density, as expressed by the mean number of capillaries around type IIa fibers. This finding suggests a possible mechanism for the cardioprotective effects of ACE inhibitors.

Serial analysis of gene expression in the skeletal muscle of endurance athletes compared to sedentary men

Physical exercise produces several adaptive changes in skeletal muscle. However, the molecular mechanisms of these effects are poorly understood. We performed serial analysis of gene expression (SAGE) to quantify the global gene expression profile in sedentary and endurance-trained muscle. A total of 10869 SAGE tags was sequenced and represented 4727 genes. The genes most expressed in muscle are mainly involved in contraction and energy metabolism. Thirty-three genes were differentially expressed between endurance athletes and sedentary individuals. Four genes such as myosin binding protein C fast-type, glycogen phosphorylase, and pyruvate kinase were expressed less in endurance athletes, whereas eight genes coding for expressed sequence tag similar to (EST) crystallin alpha B, EST myosin light chain 2, EST surfactant pulmonary-associated protein A1, EST thrombospondin, EST fructose-bisphosphate aldolase A, EST cytochrome oxidase 1, NADH dehydrogenase 3, and G8 protein were up-regulated. Most of the up-regulated tags corresponded to novel genes. On the other hand, different isoforms of fructose-bisphosphate aldolase A were also differentially expressed. The current study underlying the most highly expressed genes allows a better understanding of global muscle characteristics in normal and endurance-trained individuals. Moreover, the current data suggest novel candidate genes that may be responsible for enhanced endurance performance.

Effects of low intensity aerobic training on skeletal muscle capillary and blood lipoprotein profiles

The effects of low intensity endurance training on skeletal muscle capillary density and serum lipoprotein levels were studied in 11 non-obese men (18-25 years). The subjects performed a 6-week training regimen (60 min, 5 times per week) at the lactate threshold (LT). Capillary density was determined in biopsy specimens obtained from the vastus lateralis muscle before and after the training. The number of capillaries per fiber (cap/fiber ratio) before training was 1.97 +/- 0.47, and increased to 2.49 +/- 0.69 after training (p < 0.05). The maximal oxygen uptake (VO2 max) and LT- VO2 increased significantly by 5% (p < 0.01) and 27% (p < 0.01), respectively, whereas no change was observed in body weight. Low density lipoprotein cholesterol (LDL-C) tended to decrease (p = 0.06). The change in the cap/fiber ratio correlated inversely with the change in the ratio of LDL-C to high density lipoprotein cholesterol (HDL-C) (r = -0.61, p < 0.05). It was also, positively associated with the change in HDL2-C (r = 0.82, p < 0.01) and inversely associated with the change in HDL3-C (r = -0.63, p < 0.05). The change in LT- VO2 was inversely associated with the change in LDL-C (r = -0.62, r < 0.05). These results indicate that low intensity training increases capillary density in skeletal muscle, which may explain in part the changes in the lipoprotein profiles.

The I allele of the angiotensin-converting enzyme gene is associated with an increased percentage of slow-twitch type I fibers in human skeletal muscle

The insertion (I) allele of the human angiotensin-converting enzyme (ACE) gene is associated with lower serum and tissue ACE activity, and with greater endurance performance and enhanced mechanical efficiency of trained muscle. We tested the hypothesis that the ACE-I allele may be associated with increased slow-twitch fiber, which is more efficient than fast-twitch fiber in low-velocity contraction, by examining the association between the ACE genotype and skeletal muscle fiber (SMF) types in 41 untrained healthy young volunteer subjects (31 males, 10 females, age 24 +/- 3 years). Skeletal muscle samples were taken from the left vastus lateralis using the needle-biopsy method. Slow-twitch type I fibers and fast-twitch type IIa and IIb fibers were classified histochemically based on staining for myosin adenosine triphosphatase (ATPase) activity at different pH values. Amylase-periodic acid-Schiff staining was used to visualize capillaries around fibers. ACE-II subjects had significantly (p < 0.01) higher percentages of type I fibers (50.1 +/- 13.9%vs 30.5 +/- 13.3%) and lower percentages of type IIb fibers (16.2 +/- 6.6%vs 32.9 +/- 7.4%) than ACE-DD subjects. The linear trends for decreases in type I fibers and increases in type IIb fibers from ACE-II --> ID --> DD genotypes were significant as assessed by an analysis of variance. The ratio of type I:II fibers also differed according to the ACE genotype. A multivariate logistic regression analysis showed that the ACE-I allele had significant additive and recessive (codominant) effects on the increased type I fibers and the ratio of type I:II fibers. No specific pattern of capillarization was observed among the three ACE genotypes. In conclusion, the ACE-I allele was associated with increased type I SMF, which may be a mechanism for the association between the ACE genotype and endurance performance.

Lifestyle-related risk factors for total and cancer mortality in men and women

We conducted a 14-year follow-up study to analyze the hazard ratio (HR) of mortality regarding lifestyle-related factors in Saga Prefecture, Japan. The subjects included 2,170 people, who were randomly selected from men and women aged from 40 to 69 years old, and who also completed the standardized questionnaire on lifestyle in 1983. Information about death and corresponding data were obtained either by mail and/or through the city offices in 1997. We found that a lower body weight, a lower physical fitness level, not consuming a balanced diet, and cigarette smoking to be significantly elevated risks for all-causes of death in males after adjustment by age and health status. In addition, these results did not change even after excluding subjects for early death. The HR of the female subjects who quit smoking was significantly high, although it changed to insignificant after excluding subjects for early death. These results suggested that being underweight might be an index of a positive risk of death, while maintaining a higher physical fitness level, being careful to consume a more balanced diet, and non smoking all appear to be indexes of a negative risk of death. In addition, these results might also be considered good evidence for improving poor health habits in health promotion activities.

[Bone mineral density of the calcaneus and related factors in men]

In this cross-sectional study, the bone mineral density of the calcaneus was investigated in healthy young (n = 35, 22-33 years) and middle-aged (n = 49, 45-59 years) men. The relationships among the bone mineral density, body fatness, physical fitness, physical activity in recent and past days, smoking, alcohol, and sex hormones (free testosterone, estradiol, and dehydroepiandrosterone-sulfate; DHEA-S) and sex hormone binding globulin were evaluated. The speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness were measured by ultrasonic measurement. There was no association between age and bone density in each group. In the young group, there was a positive correlation between the body mass index (BMI) and BUA and between the training time during junior high school and BUA, and an inverse correlation between alcohol consumption and SOS after adjustment for the confounding factors using partial correlation analysis. The level of DHEA-S was weakly but not significantly associated with BUA. In the middle-aged group, there was an inverse correlation between the waist to hip ratio and SOS, and between the height of jump and SOS after adjustment for the confounding factors using partial correlation analysis. These results suggest that different factors may affect bone density in the young and middle-aged men. In young men, the higher BMI and the longer training time during boyhood may have a positive effect, and heavy alcohol consumption may have a negative effect on bone density. In middle-aged men, abdominal fat accumulation has a negative effect and leg muscle power has a positive effect on bone density.

Th1-biased immune responses induced by DNA-based immunizations are mediated via action on professional antigen-presenting cells to up-regulate IL-12 production

The efficacy of DNA-based immunization in conferring protective immunity against certain microbial pathogens including human immunodeficiency virus type 1 (HIV-1) has been described. The potential advantage of DNA-based immunization over the traditional vaccines largely results from its capacity to efficiently induce Th1-biased immune responses against an encoded antigen. We describe how Th1-biased immune responses are induced by DNA-based immunization, using a DNA vaccine construct encoding HIV-1 gp160 cDNA and an eukaryotic expression plasmid carrying murine IFN-gamma cDNA. Transfection of an eukaryotic expression plasmid carrying immunostimulatory sequences (ISS) as well as a gene of interest (DNA vaccine) into professional antigen presenting cells (APC) induced transactivation of IL-12 mRNA, which resulted in antigen-specific Th1-biased immune responses against the encoded antigen. Th1-biased immune responses induced by DNA-based immunization were substantially upregulated by a codelivery of an ectopic IFN-gamma expression system, and this augmentation was mediated via action on professional antigen presenting cells to upregulate IL-12 production. Taken together, it appears likely that Th1-biased immune responses induced by DNA-based immunization are mediated via action on professional antigen-presenting cells to produce IL-12. Interestingly, the model provided strikingly resembles that previously described in infection with Listeria monocytogenes, an intracellular Gram-positive bacterium that induces strong Th1-biased immune responses. The result suggests that DNA-based immunization mimics certain aspects of natural infection with microbial organisms like attenuated vaccines, which in turn provides a rationale to the question of why DNA-based immunization so efficiently induces protective immunity against these microbial pathogens.

[Changes in the activity of neutral and acidic isoforms of sphingomyelinase in hepatoma-22, regenerating and ischemic liver]

Activity of neutral and acidic sphingomyelinases (N- and A-SMases) were studied in regenerating liver after partial hepatectomy (during 48 hrs after operation), in ischemic liver during 15, 30 min and 1 and 2 hrs ischemia and during following reperfusion (from 5 min up to 2 hrs), in hepatoma- 22 after 15 days of transplantation and in liver of tumor bearing animals. It was shown that activity of N-SMase is increased in hepatoma-22 and in regenerating liver and it is decreased in ischemic liver. Following reperfusion of ischemic liver area activity of enzyme was found to have returned to baseline in dependence on time of ischemia and reperfusion. Activity of A-SMase is decreased in tumor, is not changed in regenerating liver and increased after long time of ischemia. It was supposed that N-SMase is involved in cell proliferation, but A-SMase is connected with cell damage.

Decreased skeletal muscle capillary density is related to higher serum levels of low-density lipoprotein cholesterol and apolipoprotein B in men

The relationships between skeletal muscle morphology, particularly muscle fiber capillary density, and serum lipid profiles were evaluated in 25 non-obese men aged 18 to 36 years (body mass index [BMI], 22.7 +/- 2.5 kg/m2; body fat, 13.6% +/- 4.0%, maximal oxygen uptake [VO2max], 46.2 < or = 6.3 mL/kg/min). Skeletal muscle samples were taken from the vastus lateralis using the needle-biopsy method. The fiber types (I, IIa, and IIx) and their percent distribution, the indices of capillary density, and the diffusion index expressed as the cross-sectional area occupied by one capillary were determined. Blood samples were drawn from the antecubital vein after a 12-hour fast. Based on Pearson's correlation analysis, the number of capillaries around type IIx fiber correlated inversely with the serum level of low-density lipoprotein cholesterol ([LDL-C] r = -.50, P < .05). The number of capillaries per fiber (cap/fiber ratio), number of capillaries per area (cap/mm2), and capillaries around each fiber type correlated inversely with the serum level of apolipoprotein B ([apo B] r = -.40 to -.54, P < .05 to .01). Further, the diffusion index for each fiber type correlated positively with LDL-C and apo B (r = .42 to .50, P < .05 to .01). Among 14 subjects in whom high-density lipoprotein cholesterol (HDL-C) subfractions were analyzed, a positive correlation was found between cap/mm2 and HDL2-C (r = .64, P < .05). Partial correlation analysis showed that these correlations either remain or improve after adjusting for age, VO2max, and body fatness. These results indicate that skeletal muscle capillary density and diffusion capacity are related to lipid and apolipoprotein concentrations for both type I and type II fibers.

[A survey of allergic diseases among elementary school children in Saga Prefecture. The first report. Prevalence and past history]

This study was carried out to determine the prevalence of several allergic diseases among elementary school children in Saga prefecture. A questionnaire was distributed to the parents of 2,795 children in 12 elementary schools located in urban, seaside and mountainous areas. The response rate was 92.8%. The prevalence rate of allergic diseases among school children was 24.6% (24.5% for boys and 21.5% for girls). The common types of allergic diseases among boys were allergic rhinitis (11.3%), atopic dermatitis (9.7%), and bronchial asthma (5.7%), and those among girls were atopic dermatitis (9.7%); allergic rhinitis (6.5%), and bronchial asthma (3.7%). Analysis by residential area of the children, showed that the prevalence rate of allergic diseases in total was increased in the order of mountainous (20.8%), seaside (24.1%) and urban area (28.7%). The most common type of allergic diseases was atopic dermatitis in urban and mountainous area, while allergic rhinitis was most common in seaside area.

High blood pressure and muscle morphology/metabolism--causal relationship or only associated factors?

As muscle tissue constitutes a main target organ for glucose metabolism and is responsible for the development of insulin resistance, it seems plausible to elucidate the relationship between blood pressure and muscle morphology and metabolism. The association between blood pressure and capillarization/morphology of the vastus lateralis muscle and metabolic variables was evaluated in 24 perimenopausal obese women [body mass index (BMI) 34.9 +/- 1.1; waist-hip ratio (WHR) 0.90 +/- 0.02]. The muscle enzyme activity of lipoprotein lipase (LPL), citrate synthase and glycogen synthase was determined. There was a significant negative correlation between the percentage of type I fibres and relative fibre area of type I on the one hand and systolic and diastolic blood pressure on the other. There was a negative correlation between the capillary density (i.e. number of capillaries/muscle fibre) and a positive correlation between the diffusion distance (fibre area supplied by one capillary) and diastolic blood pressure. The activities of LPL and citrate synthase were positively correlated with the percentage of type I and negatively correlated with the percentage of type II muscle fibres. The activity of LPL was also negatively correlated with plasma glucose and the insulin/C-peptide ratio. The insulin/C-peptide ratio was positively correlated with the percentage of type II muscle fibres. In stepwise multiple regression analyses, 20-30% of the variation in systolic and diastolic blood pressure could be explained by the variables of muscle fibre distribution. Excluding muscle morphological variables from the regression model, the insulin/C-peptide ratio accounted for 13% of the variation in systolic and diastolic blood pressure. The results of the study show the close association between muscle morphology and blood pressure. It remains to be elucidated whether this association indicates a causal relationship.

Small doses of triiodothyronine can change some risk factors associated with abdominal obesity

OBJECTIVE

To elucidate whether the administration of small doses of triidothyronine (T3) can increase concentrations of sex hormone binding globulin (SHBG) in obese women with different types of obesity and to evaluate the potential metabolic benefits of such treatment.

DESIGN

Daily administration of 20 micrograms of T3 during six weeks while maintaining habitual food intake and physical activity.

SUBJECTS

Seventy premenopausal obese women (age: 41.2 +/- 1.5 y mean +/- s.e.m., body mass index (BMI): 34.4 +/- 0.7).

MEASUREMENTS

Plasma concentrations of SHBG, lipids, insulin, thyroid hormones, sex hormones, blood glucose and insulin sensitivity (by euglycemic insulin clamp in 12 patients) at base line after six weeks of treatment.

RESULTS

Six weeks treatment with small doses of T3 resulted in a significant increase in plasma SHBG. The increase of SHBG was higher in abdominal obesity and not associated with a significant change in body weight, plasma insulin concentration, insulin/glucose ratio of plasma insulin sensitivity (glucose disposal during insulin clamp). In patients with initially high SHBG the significant increase of insulin removal (as judged from the increase of c-peptide/insulin ratio) was observed. Treatment resulted in a reciprocal increase of T3, decrease of thyroxine (T4), and a more than double increase of T3/T4 ratio.

CONCLUSIONS

Administration of small doses of T3 can increase the concentration of SHBG without changing insulin concentrations or sensitivity. As there was a significant decrease (by 36%) of T4 and parallel increase of T3 with a clear increase of T3/T4 ratio it seems possible that rather than lack of thyroid hormones a lower peripheral deiodination of T4 might be a factor contributing to the low SHBG concentration in abdominal obesity. Treatment with small doses of T3 may be considered to ameliorate some of the risk factors associated with abdominal obesity, particularly in some subgroups of obese women with a relative resistance to thyroid hormones possibly dependent on decreased peripheral deiodination of thyroxine.

[Effects of aerobic capacity and body fat accumulation on the insulin response after an oral glucose load]

The effects of aerobic capacity and body fat accumulation on the insulin response after an oral glucose load were investigated in 21 college students. The subjects were divided into three groups based on their insulin response after an oral glucose load: the first group showed a hyper and prolonged insulin response; HI (n = 6), the second group showed a lower insulin response; LI (n = 6), and the third group consisted of other subjects; MI (n = 9). The maximal oxygen consumption in the HI group (29.6 +/- 3.3 ml/kg/min) was significantly lower than that in the LI group (42.5 +/- 3.1 ml/kg/min, P < 0.05). Although no significant difference was observed in the body mass index between the HI (24.6 +/- 1.9) and LI groups (22.2 +/- 0.4, p > 0.05), the body fat and the waist-to-hip ratio were significantly higher in the HI group (25.3 +/- 3.1%, 0.87 +/- 0.03) than in the LI group (12.9 +/- 0.7%, 0.76 +/- 0.01, P < 0.05). All subjects in the LI group performed regular exercise, while none of the subjects in the HI group performed any regular exercise. These results suggest that an inactive life style, decreased aerobic capacity and increased body fat accumulation all appear to result in an increased insulin response after a glucose load.

[Bone mineral density by ultrasonic measurement in pre- and postmenopausal women--relationship with sex hormones and nutritional states]

In this cross-sectional study we evaluated the relationships of the sex hormones, estradiol (E2), free testosterone (free T), dehydroepiandrosterone-sulfate (DHEA-S), sex hormone-binding globulin (SHBG) and nutritional status to bone density assessed by ultrasonic measurements. The subjects were 16 premenopausal (38-50 years) and 28 postmenopausal (47-86 years) women living in a rural area in Yamaguchi Prefecture in Japan. They were healthy and did not smoke or drink. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (SI) were used as the indices to evaluate ultrasonic bone density (UBD) for the calcaneus. In premenopausal women, the concentration of free T was negatively associated with BUA. The DHEA-S concentration had a significant negative correlation with BUA after adjustments for age and body mass index (BMI). Daily intakes of fat, animal fat, animal protein, calcium (Ca) and vitamin B2 (Vit B2) were positively associated with UBD. In postmenopausal women, although DHEA-S positively correlated with SOS, BUA and SI, the significance disappeared after adjustments for age and BMI. The protein intake was positively associated with BUA. Multiple regression analysis for SOS, BUA and SI as dependent variables was performed. Independent variables were age, BMI, E2, free T, DHEA-S, SHBG and daily intakes of animal fat, animal protein, Vit B2 and Ca. In premenopausal women, the animal fat intake contributed significantly and positively to the variations of SOS and SI. The intake of Vit B2 had a significant positive correlation, and the level of DHEA-S had a significant negative correlation with BUA. In postmenopausal women, age and BMI contributed significantly to the variations of SOS, BUA and SI, while the nutritional variables and the sex hormones were not found to be significant. In conclusion, different factors predicting UBD were suggested for pre- and postmenopausal women. In premenopausal women, daily intakes of animal fat and Vit B2 might be effective to maintain higher bone density. Further investigations are still needed to clarify the relationship between DHEA-S and UBD.

Relationship between plasma concentrations of beta-carotene and alpha-tocopherol and life-style factors and levels of DNA adducts in lymphocytes

beta-Carotene and alpha-tocopherol have been thought to reduce risk of lung cancer. Whether beta-carotene and alpha-tocopherol influence human DNA adducts, indicators of biologically effective doses of carcinogens, has been seldom studied. In this cross-sectional study, we measured plasma beta-carotene and alpha-tocopherol in 192 healthy men and DNA adducts in lymphocytes in 104 of the subjects. Because genetic polymorphism of cytochrome P-4501A1 (CYP1A1) and glutathione S-transferase M1 (GSTM1) has been associated with interference in formation of reactive intermediates and detoxification of polycyclic aromatic hydrocarbons, we also obtained data concerning genetic polymorphism of CYP1A1 and GSTM1. In multiple regression analysis, parameters such as alcohol consumed per day, high-density lipoprotein cholesterol, Quetelet index, and cigarettes smoked per day were correlated inversely, whereas age, plasma alpha-tocopherol, and intake frequency of fruits were correlated positively with plasma beta-carotene concentration. DNA adduct levels of high plasma beta-carotene or alpha-tocopherol groups were not significantly different from the DNA adduct levels of low plasma beta-carotene or alpha-tocopherol groups among current smokers or nonsmokers. In variant states of CYP1A1 or GSTM1 polymorphism, after controlling for effect of cigarettes smoked per day, no significant correlation was found between plasma beta-carotene or alpha-tocopherol and DNA adduct levels. These results indicated that alcohol consumption, cigarette smoking, and plasma alpha-tocopherol have a close relationship with plasma beta-carotene. The plasma beta-carotene and alpha-tocopherol were not likely to influence the level of DNA adducts in lymphocytes.

The relationships of testosterone, estradiol, dehydroepiandrosterone-sulfate and sex hormone-binding globulin to lipid and glucose metabolism in healthy men

We investigated the relationships of plasma sex hormones (free testosterone; free T, estradiol; E2 dehydroepiandrosterone-sulfate; DHEA-S) and sex hormone-binding globulin (SHBG) levels to lipid and glucose metabolism cross-sectionally in 212 apparently healthy men aged from 18 to 59 years. A multiple linear regression analysis for lipid and glucose parameters with age, body mass index (BMI), percent body fat (%fat), waist to hip ratio (WHR), estimated maximal oxygen uptake (VO2max), alcohol and cigarette consumption, sex hormones, and SHBG, respectively, as independent variables, was performed. DHEA-S was indicated as one of the independent predictors of both high density lipoprotein cholesterol (HDL-C), with a positive relation, and of triglyceride and total cholesterol/HDL-C ratio, with a negative relation, while SHBG was one of the predictors of both HDL-C, with a positive relation, and of fasting insulin, with a negative relation. The E2 level was found to be negatively related to both low density lipoprotein cholesterol and fasting blood glucose. These findings thus suggest that the higher levels of SHBG, DHEA-S and E2 within physiological ranges in healthy men may partially help to maintain a desirable profile of the plasma lipid and glucose metabolism.

The effect of endurance training on the relationships between sex hormone binding globulin, high density lipoprotein cholesterol, apoprotein A1 and physical fitness in pre-menopausal women with mild obesity

The purpose of the present study was to investigate the relationships of change in high density lipoprotein cholesterol (HDL-C) with changes in sex hormone binding globulin (SHBG), physical fitness and spontaneous dietary intake before and after endurance training. Ten pre-menopausal obese women (32 to 49 years) who had never smoked or regularly drunk alcohol participated in this study. Physical training at an intensity of lactate threshold was performed for six months at a frequency of three times per week for 60 minutes using a cycle ergometer. Together with a reduction in body weight (-4.1 kg; P < 0.05) and with increases in maximal oxygen uptake (VO2max = +3.4 ml/kg/min or +0.09 l/min; P < 0.05), the training induced some changes in both plasma lipid and lipoprotein. Although the total cholesterol (total-C), triglyceride, HDL2-C and apoprotein A1 (Apo A1) levels did not change, significant increases in HDL-C and HDL3-C, and significant reductions in Apo B, total-C/HDL-C ratio and fasting insulin concentrations were found after training. SHBG levels tended to increase after endurance training, but the changes were not significant. No alteration was observed in spontaneous dietary intake after training. A significant correlation (r = 0.648) was observed between the change in VO2 max(l/min) and the change in SHBG. In addition, changes in both VO2 max(l/min) and SHBG were significantly associated with changes in HDL-C, HDL2-C and Apo A1. The changes in dietary intake did not correlate with the changes in SHBG, VO2max, HDL-C, HDL2-C and Apo A1.(ABSTRACT TRUNCATED AT 250 WORDS)

[The relationships of sex hormone binding globulin (SHBG) with high density lipoprotein cholesterol and fasting insulin in healthy men]

The relationships of sex hormone binding globulin (SHBG) with high density lipoprotein cholesterol (HDL-C) and fasting insulin (IRI) were investigated in healthy employed men (n = 235). In simple correlation analysis, the SHBG was positively related to total cholesterol and HDL-C, and negatively related to IRI. There were no relationships among SHBG, triglyceride and fasting blood glucose. In multiple linear regression analysis, SHBG was one of determinant of HDL-C, but not IRI. From these results, it was suggested that SHBG was one of the determinants of HDL-C level in healthy men.

Laryngeal epithelial changes on effects of smoking and drinking

The human larynx is essential not only for speech, but also for swallowing and respiration. Its tissues are affected by the presence of alcohol and cigarette smoke. In this report we present our findings on the effects of smoking and drinking on histological changes in laryngeal tissue. The larynges studied were those of autopsy patients: cases with damaged tissue were excluded. We studied the larynges of 84 men (non-smoker and non-drinker, 22 cases; smoker and drinker, 62 cases) and 48 women (non-smoker and non-drinker, 40 cases; smoker and drinker, 8 cases) between the ages of 12 and 88. The squamous metaplasia of laryngeal epithelium was examined using the gross staining method (Pyronin Y) of STELL et al. (J. Laryngeal. Otol. 86: 589-594, 1972). The squamous epithelium is unstained, whereas the respiratory epithelium is a brilliant red. The area of metaplasia in the supraglottic region increased with aging, tobacco and alcohol consumption. Microscopic changes of the laryngeal epithelium were investigated using the hematoxylin-eosin staining method. The thickness of epithelium of the supraglottic region and vocal cord increased with age. There is a significant difference in the thickness of the epithelium of the supraglottic region and vocal cords of smoking and drinking patients, when compared with the same tissues of non-smokers and non-drinkers. Furthermore, there is a significant difference in those tissues of the supraglottic region of heavy smokers, when compared with light smokers, but no significant difference when compared with drinkers. However, there is no significant difference in the thickness of vocal cord tissues when comparing light smokers and drinkers on the one hand, and heavy smokers and drinkers on the other.