[Association between parental socioeconomic status and preschoolers' consumption of sugar-sweetened beverages]

Objective: To explore the association between parental socioeconomic status (SES) and preschoolers' consumption of sugar-sweetened beverages (SSB). Methods: In June 2018, all preschoolers from 15 kindergartens were selected from the jurisdiction of Education Commission in Dongcheng District of Beijing by using an equal-proportion stratified cluster sampling method in the study. A self-designed questionnaire was used to investigate the parents of preschoolers to obtain the basic information of preschoolers and parents, the consumption situation of preschoolers' sugar-sweetened beverages and the perception of parents to SSB. A tatol of 3 217 preschoolers were finally included in the analysis. A generalized structural equation model was used to analyze the relationship between preschoolers' consumption of sugar-sweetened beverages and their parents' socioeconomic status and the mediating effect of their cognition of sugar-sweetened beverages. The size of mediating effect was estimated by using deviation correction non-parameter percentile Bootstrap method. Results: The age of 3 217 preschoolers was (4.23±0.67) years, of which 52.6% (n=1 692) were boys, and 77.62% (n=2 497) were SSB consumers. Among the parents of 3 217 preschoolers, fathers and mothers accounted for 24.90% (n=801) and 75.10% (n=2 416), and the M (P₂₅, P₇₅) scores of SES were 66.7 (62.5, 69.5) and 69.5 (64.6, 71.4), respectively. The proportion of parents who took the initiative to learn about their children's consumption of SSB, lacked confidence in restricting preschooler's consumption of SSB and read nutrition labels before purchasing food was 74.08% (n=2 383), 82.90% (n=2 667) and 36.24% (n=1 166), respectively. The generalized structural equation model showed that after adjusting for preschoolers' gender, age, body mass index (BMI) of preschoolers and their parents, preschoolers' consumption of SSB was negatively associated with their parents' SES score [path coefficient (95%CI):-4.69×10^-2 (-6.56×10^-2,-2.69×10^-2) ]. The mediating effect of parents' perception of SSB consumption could explain 48.71% of the total effect [path coefficient (95%CI):-2.28×10^-2 (-3.54×10^-2, -1.10×10^-2)]. Conclusion: The consumption of SSB in preschoolers is negatively associated with their parent's SES, and this relationship is partially mediated by parent's perception of SSB consumption.

[Good Controlled Chylothorax in Gastric Carcinoma]

Chylothorax has been reported to be caused by accidental injuries in half of all cases in Japan, and < 10% of these cases have been associated with malignant tumors, including lymphoma. Chylothorax is a rare complication of gastric carcinoma. We successfully treated a 58-year-old man with gastric carcinoma, chylothorax, and ascites using a combination of talc pleurodesis and a lipid-limited diet. Case: A 58-year-old man with advanced stage of poorly differentiated gastric adenocarcinoma presented to our hospital with complaints of shortness of breath. Whole-body computerized tomographic images suggested massive pleural effusion and ascites. Examination of pleural fluid and ascites revealed elevated serum triacylglycerol levels of up to 913mg/dL with numerous free-floating cancer cells. Malignant chylothorax was diagnosed. A lipid-limited diet and octreotide were started, followed by talc pleurodesis for pleural effusion. The patient with controlled pleurisy died of gastric cancer on day 55 after pleurodesis.

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.

[A case of mumps pneumonia complicated with acute respiratory failure]

A 38-year-old male with swollen parotid glands was admitted to our hospital with dyspnea on effort. Positive serum IgM antibody for mumps supported a diagnosis of mumps. Computed tomography (CT) scan showed a ground-glass appearance in both lower lungs. On the third day of hospitalization, bronchoalveolar lavage demonstrated an elevation of both the total cell (2.0 x 10(6)/cc) and the lymphocyte count (83%), as well as a decrease of the CD 4+/CD 8+ ratio (0.4). Bronchial biopsy specimens revealed infiltration of lymphocytes in both the bronchiolar walls and the alveolar septa. These data were suggestive of mumps pneumonia. The patients suffered acute respiratory failure on the seventh day of hospitalization, which improved after 3 days of high-dose methyl prednisolone therapy. This is the first report of adult mumps pneumonia in Japan. As a result of the examination of the bronchoalveolar lavage and a bronchial biopsy of viral pneumonia which had been reported in the past, mumps pneumonia was a corresponding opinion to other viral pneumonia.

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.

[Acute myelocytic leukemia and plasmacytoma secondary to chemotherapy and radiotherapy in a long-term survivor of small cell lung cancer]

A 68-year-old man was given a diagnosis of lung cancer of the right upper lobe (small cell carcinoma, T 4 N 2 M 0, stage IIIB) in February 1991. The tumor diminished after chemotherapy and radiotherapy. In February 1992, a partial resection of the lower lobe of the right lung was performed because of the appearance of a metastatic tumor. In September 1994, squamous cell carcinoma developed in the lower part of the esophagus, but disappeared after radiotherapy. In February 1998, a diagnosis of myelodysplastic syndrome was made. Two months later, the patient had an attack of acute myelocytic leukemia and died of cardiac tamponade. An autopsy determined that both the lung cancer and esophageal cancer had disappeared. Acute myelocytic leukemia and plasmacytoma of lymph nodes in the irradiated area were confirmed. These were regarded as secondary malignancies induced by chemotherapy and radiotherapy.

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.

Activation of lavage lymphocytes in lung injuries caused by radiotherapy for lung cancer

PURPOSE

Radiation pneumonitis sometimes extends beyond the irradiated area of a lung and can also affect the opposite lung. Some immunological mechanisms, in addition to simple direct injury of the lungs by radiation, seem to be involved in the onset of radiation pneumonitis. To clarify such mechanisms, the effects of radiation on local inflammatory cells in lungs, in particular, lymphocytes, were examined.

METHODS AND MATERIALS

A comparison was made of bronchoalveolar lavage fluid (BALF) findings from 13 irradiated patients (RT group) and 15 nonirradiated patients (non-RT group) with lung cancer. Patients who later developed radiation pneumonitis (RP group) and those who did not (RP-free group) were also compared. Using a two-color flowcytometer, radiation-induced changes in local inflammatory cells in lungs were analyzed. This included analyses of human leukocyte-associated antigen (HLADR) and intercellular adhesion molecule-1 (ICAM-1) expression on T-cells, which are though to be involved in cell activation and interactions between cells.

RESULTS

The following aspects of BALF were higher in the RT group than in the non-RT group: (a) the percentage of lymphocytes and eosinophiles; (b) the incidence of HLADR-positive CD4+T-cells and HLADR-positive CD8+T-cells; and (c) the incidence of ICAM-1--positive T-cells. The following aspects of BALF were higher in the RP group than in the RP-free group: (a) the total cell counts; (b) the percentage of lymphocytes; and (c) the incidence of ICAM-1-positive T-cells. A significant relationship was seen between the incidence of ICAM-1 expression on T-cells and the number of days from the initiation of radiotherapy to the onset of radiation pneumonitis.

CONCLUSION

These data suggest that irradiation can induce accumulation of activated T-cells (HLADR and ICAM-1--positive T-cells) in the lung. This accumulation may be closely linked to radiation-induced lung injury. It is also suggested that the incidence of ICAM-1--positive T-cells in BALF may serve as a useful clinical marker of radiation pneumonitis.

[Changes in the amounts of elastic and collagenous elements of normal aged and emphysematous lung: use of a model of static pressure-volume relationships]

The possibility of a difference between the amount of elastic and collagenous connective tissues in normal and emphysematous lungs is controversial. I used an equation (MIN, 1995, reference 2) to compute the total amount of connective tissue in the pulmonary parenchyma from static pressure-volume relationships in 44 subjects divided into four groups. For normal nonsmokers, normal smokers, smokers with COPD, and subjects with emphysema, there was a unique relationship between the total, amount of connective tissues (sigma 0 = -0.82 Log(a) + 3.02 r2 = 0.201, p = 0.0029). Age was also significantly related to the modulus of elasticity: it appeared to increase 0.4% per year in nonsmokers and 5.4% per year in smokers with COPD. The ratio of collagen-to-elastin content in the lung parenchyma was taken to be 1.3 (from the results of recent studies), and little difference was found between normal smokers and emphysematous smokers in regard to collagen-elastin catabolism. In both groups the apparent yearly decrease in elastin content was about 1.6%, and the apparent yearly increase in collagen content was about 0.6%. Therefore, the damaging effects of emphysema on parenchymal connective tissues may be analogous to accelerated catabolism of parenchymal connective tissues in normal aging lungs.

Varied effects of thoracic irradiation on peripheral lymphocyte subsets in lung cancer patients

To investigate the influence of thoracic irradiation on immunological competence in patients with lung cancer, we examined the changes in peripheral blood lymphocyte subsets in 15 patients before and after radiation therapy by two-color flow cytometry techniques. After radiation therapy, the percentage and the absolute number of CD4+CD45RA+ cells (naive T cells) and CD56+ and/or CD16+ cells (NK cells) decreased. The percentage of CD4+human leukocyte antigen-DR(HLA-DR)+ cells (activated CD4T cells) and CD8+HLA-DR+ cells (activated CD8T cells) increased, although the absolute number did not change significantly. Naive T cells may be more selectively damaged than memory T cells by thoracic irradiation, through their recirculation behavior. The reduction of natural killer (NK) cells is disadvantageous for anti-tumor immunity. The percentage of HLA-DR positive T lymphocytes was significantly increased, and thus the possibility of HLA-DR enhancement by irradiation cannot be excluded. Therefore, thoracic irradiation has numerous varied effects on the immunological system of lung cancer patients.

[Use of static pressure-volume relations to estimate the total amount of pulmonary connective tissue--theoretical approach]

There is no accepted way to estimate the amount of connective tissue in the lungs in vivo. I propose an equation for estimating the total amount of pulmonary connective tissue from static pressure-volume relations. The stress-strain relations of pulmonary connective tissue were assumed to be describable by a non-linear exponential function: f = exp(ax)-1, where "f" is stress, "x" is strain, and "a" is Young's modulus of elasticity. The connective tissue elements were assumed to be distributed randomly in orientation within a pulmonary lobule, and the bodies of a pulmonary lobule were assumed to be packed in "equilibrium space division", as proposed by Suwa (1981). Stochastic geometry for elastic elements in the lung was used to obtain a set of equations describing the static pressure-volume relationship, such that P = (0.12 zeta 0/3V0) x [exp(ax)/(1 + x)2] and V = V0 (1 + x)3, where V0 is a reference lung volume in a perfectly relaxed state and zeta 0 is the total amount of connective tissue in the pulmonary parenchyma. This new model can accommodate static pressure-volume relations of human subjects in the range of relatively high lung volumes reported by Turner et al. (J App Physiol 25: 664, 1968), by Corbin et al. (Am Rev Respir Dis 120: 293, 1979), and by Finucane et al. (J App Physiol 26: 330, 1969). In conclusion, the total amount of connective tissue in lung parenchyma can be estimated with this new model of the static pressure-volume relationship at relatively high lung volumes.

Synergic effect of cisplatin, Adriamycin, and cyclophosphamide combination chemotherapy and radiotherapy in non-small cell lung cancer

61 patients with inoperable non-small cell lung cancer were treated by combination chemotherapy with cisplatin, Adriamycin and cyclophosphamide. 23 patients received radiotherapy in addition to the chemotherapy. 49 out of 55 adequately treated patients were evaluable for tumor response. Of 29 patients who received chemotherapy alone, 6 (21%) achieved partial responses. Of 20 patients who received combined chemotherapy and radiotherapy, 16 (80%) achieved complete or partial responses. The median survival time was 18 months for 22 patients treated with combined therapies.

[Aclacinomycin; benefits for the treatment of malignant pleural effusion]

A series of experiments with ACM was performed to evaluate the effect for local treatment of malignant pleurisy from the view points of (1) clinical response, (2) pharmacokinetics following intrapleural administration, and (3) pleural reaction. The results were as follows: (1) In 6 patients with malignant pleural effusion, ACM was intrapleurally administered at a dose of 40 mg. In 4 out of the 5 evaluable cases, an extreme decrease in the pleural fluid volume and suppression of reswelling were observed, including 2 cases found to be negative for tumor cells upon cytodiagnosis. (2) In 5 patients, the pharmacokinetics was studied by using compartment model. The clearance curves of ACM in pleural fluid were described by a two-compartment model. The mean half lives of initial phase and terminal phase were 0.78 hr, and 15.28 hr, respectively. The time to reach the maximal whole blood level was 1 to 2 hrs after pleural administration, followed by a slow decline. (3) The pleural reaction to ACM was studied in rabbits by scanning and transmission electron microscope. At a dose of 4 mg per kg of body weight, the shortened microvilli, the degenerated mesothelial cells and the disappearance of basement membrane were observed. On the basis of these findings, we suggest that ACM might be an agent of choice in the treatment of malignant pleurisy.

[Pharmacokinetics of a new antitumor antibiotic, neothramycin, after intrapleural administration]

In 5 patients with malignant pleural effusion, neothramycin (NTM) was intrapleurally administered at a dose of 30 mg in 3 cases and 40 mg in 2 cases and the pharmacokinetics was studied by using compartment models. The results were as follows: 1) Pleural levels of NTM were described by a mono-exponential equation and the half-life ranged from 3.45 to 6.48 hr. 2) The time to reach the maximum plasma level was 1 to 2 hr after pleural administration. The maximum levels were 54 to 106.4 ng/ml with the 30 mg dosage and 74.7 to 79.2 ng/ml with the 40 mg dosage, followed by a slow decline, with T1/2 ranging from 6.54 to 17.80 hr. 3) The elimination half-life of NTM in the plasma after intrapleural administration was much longer than that after intravenous administration. This phenomenon can be explained by a "flip-flop model": in this case, the rate of transfer from the pleural space to the plasma was much slower than that of the elimination from the plasma. 4) The parameters, K1 and K2, which were obtained by the deconvolution method, seemed to reflect the transfer of NTM between the pleural space and the plasma. 5) In 3 out of the 4 evaluable cases, an extreme decrease in the pleural fluid volume and suppression of reswelling were observed, including a case found to be negative for tumor cells upon cytodiagnosis.

[Pharmacokinetics and pleural reaction of doxycycline after intrapleural administration]

Tetracycline has been used for the local treatment of malignant pleurisy ever since of Robinson (1972) reported its effectiveness. In this report, we try to elucidate possible mechanisms of action of this drug from the viewpoints of (1) pharmacokinetic analysis following intrapleural administration, and (2) pleural reaction. The results were as follows: (1) In 5 patients with malignant pleural effusion, 500 mg of doxycycline was injected into the pleural cavity and pharmacokinetic analysis was performed. The clearance curve of doxycycline in pleural fluid was described by either a one-compartment model or a two-compartment model. The mean half life of slow space was 33.3 hr, which suggested delayed excretion of this drug from pleural space. (2) The direct effect of doxycycline on pleura was studied in rabbits. At a dose of 10 mg per kg of body weight, the mesothelial cells became cuboid and contained vacuoles in their cytoplasma. With increasing dose up to 40 mg per kg, the changes in mesothelial cells were enhanced. In submesothelial tissue, edema and cellular infiltration were noticed. Three weeks later, normalization of mesothelium was observed, being followed by connective tissue proliferation. These findings may support the efficacy of tetracycline for local treatment of malignant pleurisy.

[Combination chemotherapy of primary adenocarcinoma of the lung using adriamycin, ACNU, and vindesine]

Since July 1980, thirty patients with inoperable adenocarcinoma of the lung have been treated with ANV. Induction chemotherapy (Adriamycin 35 mg/m2 i.v. days 1 and 22, ACNU 2 mg/kg i.v. day 1, vindesine 2 mg/m2 i.v. days 1, and 22) was given for 2 courses (or 1 course) at 3-week intervals. Maintenance chemotherapy was performed with reduced doses and elongated intervals. Characteristics of 30 patients were as follows: 13 males and 17 females; mean age 55 (range 32-77); mean PS 1.6, prior chemotherapy 3 cases; tumor involving bone (53%), brain (20%) and cervical node (23%). Of 27 patients who received no prior chemotherapy, 2 patients were unmeasurable because of pleural effusion. After one course of induction chemotherapy, 7 out of 25 patients achieved PR (response rate: 28%), 5 MRS (20%), 10 NCS, and 3 PDS. When patients were divided into the youngers (32-59 years old, mean 47) and the older (60-77 years old, mean 67), the youngers showed apparently higher response rate (6/17, 35%) than the olders (1/8, 13%). When patients were divided into three groups by the grade of cell differentiation, response rates were 0/5 (0%) in the well differentiated group, 2/6 (33%) in the moderately differentiated group, and 5/11 (45%) in the poorly differentiated group. The median survival time for all patients was 9 months; the younger 8 months, the older 9 months, well differentiated 11 months, moderately differentiated 9 months, and poorly differentiated 7 months. Survival time of responders was not significantly (P greater than 0.05) longer than that of non-responders. Toxicities were mild: leucopenia (less than 4,000) found in 85%, thrombocytopenia (less than 100,000) in 8%, anorexia in 54%, nausea and vomiting in 39%, and alopecia in 82%.