Polycyclic aromatic hydrocarbons in residential dust and risk of childhood acute lymphoblastic leukemia

Several polycyclic aromatic hydrocarbons (PAHs) are known or probable human carcinogens. We evaluated the relationship between PAH exposure and risk of childhood acute lymphoblastic leukemia (ALL) using concentrations in residential dust as an exposure indicator. We conducted a population-based case-control study (251 ALL cases, 306 birth-certificate controls) in Northern and Central California from 2001 to 2007. We collected residential dust using a high volume small surface sampler (HVS3) (n=185 cases, 212 controls) or by sampling from participants' household vacuum cleaners (n=66 cases, 94 controls). We evaluated log-transformed concentrations of 9 individual PAHs, the summed PAHs, and the summed PAHs weighted by their carcinogenic potency (the toxic equivalence). We calculated odds ratios (ORs) and 95% confidence intervals (CI) using logistic regression adjusting for demographic characteristics and duration between diagnosis/reference date and dust collection. Among participants with HVS3 dust, risk of ALL was not associated with increasing concentration of any PAHs based on OR perln(ng/g). Among participants with vacuum dust, we observed positive associations between ALL risk and increasing concentrations of benzo[a]pyrene (OR perln[ng/g]=1.42, 95% CI=0.95, 2.12), dibenzo[a,h]anthracene (OR=1.98, 95% CI=1.11, 3.55), benzo[k]fluoranthene (OR=1.71, 95% CI=0.91, 3.22), indeno[1,2,3-cd]pyrene (OR=1.81, 95% CI=1.04, 3.16), and the toxic equivalence (OR=2.35, 95% CI=1.18, 4.69). The increased ALL risk among participants with vacuum dust suggests that PAH exposure may increase the risk of childhood ALL; however, reasons for the different results based on HVS3 dust samples deserve further study.

Enhanced chemiluminescent assay for measuring the total antioxidant capacity of serum, saliva and crevicular fluid

This paper reports the development of an enhanced chemiluminescent (ECL) assay for measuring the total antioxidant (AO) capacity of serum, saliva and a fluid collectable from the gum margin called gingival crevicular fluid (GCF). The theory behind the assay is explained, and the optimum conditions for the assay, and for storage of reagents and clinical samples is described. Calibration lines were linear (R > or = 0.99; P < 0.0001) and the within batch coefficient of variations for a water soluble vitamin E analogue (Trolox), serum and saliva samples were < 5%. In saliva and GCF, a characteristic AO response not seen in serum of the same patients, was identified. Total peripheral (serum) and local (saliva) AO capacities (mumol/L Trolox) were investigated in patients with (n = 18) and without (n = 16) adult periodontitis. Serum AO status did not differ between groups. Salivary total AO concentrations were lower in the peridontitis (P) group [175 (53) mumol/L] than in the non-periodontitis (NP) group [254 (110) mumol/L1: P < 0.01], as were saliva:serum AO ratio's [0.37 (0.11) versus 0.5 (0.18): P < 0.01]. Periodontitis patients may have a reduced salivary AO concentration, which could result from, or predispose to, the damaging effects of reactive oxygen species (ROS). The potential for ROS production in the oral and periodontal environment may explain the presence of a specific antioxidant in oral fluids that is not detectable in serum. The ECL assay described provides a rapid, simple and reproducible method of measuring total antioxidant defence in small volumes of biological fluids.

The effects of cigarette smoking and alcohol consumption on serum liver enzyme activities: a dose-related study in men

The separate and joint effects of cigarette smoking and alcohol consumption on serum activities of the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) were investigated in 46,775 men attending the BUPA Health Screening Centre in London during the period 1983-1987, after allowing for differences in age, body mass index and exercise level. As expected, all showed a significant positive correlation with alcohol consumption. Cigarette smoking produced a significant increase in GGT activity in all drinking categories bar teetotallers, particularly for those smoking more than 20 cigarettes per day. There were no changes of clinical significance in AST or ALT activities with smoking. We postulate that the combined effects of alcohol and smoking on GGT activity are a result of induction of the enzyme by both alcohol and nicotine. Smoking as well as drinking habits should be taken into account when assessing the significance of an individual's enzyme activities.

The effects of cigarette smoking and alcohol consumption on blood lipids: a dose-related study on men

The separate and joint effects of cigarette smoking and alcohol consumption on serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were investigated in 46 750 men attending the BUPA Health Screening Centre in London during the period 1983-1987, after allowing for differences in age, body mass index and exercise level. Drinking alcohol was found to raise both total cholesterol and HDL-C concentrations, in such a way that HDL-C as a percentage of total cholesterol increased with increasing alcohol consumption. LDL-C concentrations increased with increasing alcohol consumption in non-smokers, but decreased in those smoking over 10 cigarettes per day. Drinking had no significant effect on triglycerides except at high levels of consumption. Smoking raised total cholesterol, LDL-C and triglycerides, but lowered HDL-C concentrations. In particular, smoking even small amounts could negate any protective benefit in HDL-C concentrations gained from moderate consumption of alcohol. Assuming a desirable lipid profile to consist of low total cholesterol, LDL-C and triglycerides and a high HDL-C value, this is best achieved for men by being a non-smoking moderate drinker.

The effects of cigarette smoking and alcohol consumption on blood haemoglobin, erythrocytes and leucocytes: a dose related study on male subjects

The objective of this study was to quantify the combined dose related effects of cigarette smoking and alcohol consumption on blood haemoglobin concentration, erythrocytes and leucocytes. The subjects consisted of 17,670 males attending for routine health screening, with an average age of 43 years and a range of 16-91 years. The number of cigarettes smoked each day was divided into six categories, and declared alcohol consumption into seven. Of the 42 different combinations of smoking and drinking groups, five were not reported because they contained less than 30 subjects. Haemoglobin concentration was significantly increased in those smoking more than 10 cigarettes per day. Smoking also increased the PCV. Alcohol had no effect on Hb or PCV. The red cell count was reduced by alcohol consumption, with even the lowest consumption producing a significant decrease. Both smoking and drinking raised the MCV in a linear dose relationship. The marked increase in white cell count with smoking was seen even in subjects smoking 10 cigarettes per day or less. It is suggested that social habits such as smoking and drinking should be considered when interpreting blood haematology values. Changes in haematology results could be used to encourage a healthier lifestyle.

Effect of red wine ingestion on the antioxidant capacity of serum

Aerobic metabolism in biological systems produces reactive oxygen species, and defense against such prooxidants requires antioxidant activity, e.g., predominantly vitamins C and E in serum. Recently, flavonoids (polyphenols occurring widely in plants) have been investigated in vitro for their antioxidant activity; whether they are absorbed after ingestion is not clear. Using a chemiluminescent assay of serum antioxidant capacity (SAOC), we have studied the effects in normal individuals of ingesting red wine, white wine, and high doses of vitamin C. In nine subjects who ingested 300 mL of red wine, the mean SAOC was increased by 18% after 1 h and by 11% at 2 h. The same amount of white wine produced 4% and 7% increases, respectively. The ingestion of 1000 mg (5.7 mmol) of ascorbic acid by four subjects increased their mean SAOC by 22% at 1 h and by 29% at 2 h. An in vitro comparison of red wine, white wine, and various fruit juices showed the high antioxidant capacity of red wine in addition to its ability to increase the antioxidant capacity of serum in vivo. The antioxidant effects of various flavonoids and other polyphenols were also studied.

Effect of red wine ingestion on the antioxidant capacity of serum

Aerobic metabolism in biological systems produces reactive oxygen species, and defense against such prooxidants requires antioxidant activity, e.g., predominantly vitamins C and E in serum. Recently, flavonoids (polyphenols occurring widely in plants) have been investigated in vitro for their antioxidant activity; whether they are absorbed after ingestion is not clear. Using a chemiluminescent assay of serum antioxidant capacity (SAOC), we have studied the effects in normal individuals of ingesting red wine, white wine, and high doses of vitamin C. In nine subjects who ingested 300 mL of red wine, the mean SAOC was increased by 18% after 1 h and by 11% at 2 h. The same amount of white wine produced 4% and 7% increases, respectively. The ingestion of 1000 mg (5.7 mmol) of ascorbic acid by four subjects increased their mean SAOC by 22% at 1 h and by 29% at 2 h. An in vitro comparison of red wine, white wine, and various fruit juices showed the high antioxidant capacity of red wine in addition to its ability to increase the antioxidant capacity of serum in vivo. The antioxidant effects of various flavonoids and other polyphenols were also studied.

Serum urate, serum glucose and diabetes

We have studied the relationship between serum glucose and urate in 260,699 men and 214,118 women from Sweden, and 140,084 men and 30,653 women from the UK. We found an increase in mean serum urate with increasing glucose concentrations up to 7.0 mmol/L in men and 9.0 mmol/L in women. Thereafter increasing glucose values were accompanied by a statistically significant decrease in urate concentrations. This fall was particularly marked in younger subjects. We believe this may have important implications for the free radical status of diabetics.

Defects in diagnostic kits for determination of urate in serum

Certain diagnostic kits that measure serum urate by the Barham and Trinder principle of enzymic liberation of oxygen and its combination with chromogens can give results for urate in fresh serum that are approximately 20% lower than results from serum stored at ambient temperature for 72 h. In fresh serum, antioxidants compete with chromogen for liberated peroxyl-oxygen. We postulate that during storage the interfering antioxidant substances are destroyed. In some diagnostic kits, L-ascorbate oxidase is added to the reaction, eliminating some but not all of this effect. We discuss defects of several commercially available kits for determination of serum urate and recommend comparing results of these kits with results from the phosphotungstic acid method as a precaution against falsely low results.

Defects in diagnostic kits for determination of urate in serum

Certain diagnostic kits that measure serum urate by the Barham and Trinder principle of enzymic liberation of oxygen and its combination with chromogens can give results for urate in fresh serum that are approximately 20% lower than results from serum stored at ambient temperature for 72 h. In fresh serum, antioxidants compete with chromogen for liberated peroxyl-oxygen. We postulate that during storage the interfering antioxidant substances are destroyed. In some diagnostic kits, L-ascorbate oxidase is added to the reaction, eliminating some but not all of this effect. We discuss defects of several commercially available kits for determination of serum urate and recommend comparing results of these kits with results from the phosphotungstic acid method as a precaution against falsely low results.

Effect of body mass and other factors on serum liver enzyme levels in men attending for well population screening

Alcohol abuse is usually regarded as the most likely cause of elevated serum liver enzyme values in those attending for well population screening, but we have found increased body weight to be an important contributing factor. We have measured serum levels of alanine amino-transferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) in approximately 21,000 men attending for routine health screening, and related these to behavioural factors such as alcohol consumption, cigarette smoking, exercise level and obesity. The levels of all three enzymes were positively correlated with levels of alcohol consumption. Decreasing levels of physical activity were associated with increases in mean ALT and GGT levels. Cigarette smoking showed only a weak effect on ALT and AST, which became non-significant after multivariate statistical analysis, but increasing consumption of cigarettes was associated with increased mean levels of GGT. In contrast, all three enzymes showed marked increases in mean levels with increasing body mass index (BMI). The effect of obesity was particularly important in the case of ALT: the prevalence of increased ALT values in obese subjects (BMI greater than or equal to 31 kg/m2) was more than eight times that in those with normal weight (BMI less than or equal to 25 kg/m2), even after allowing for the confounding effect of alcohol consumption. This study is concerned solely with male subjects, but we hope to extend the analysis to females in the near future.

The Middle East external quality assessment scheme for clinical chemistry

The establishment and first 7 years' operation of an external quality assessment scheme for clinical chemistry in the Middle East region are described. The scheme utilises specimens distributed previously in the UK, and the performance of participating laboratories is assessed relative to the UK consensus values, taking account of method. Variance Index scoring has been used to quantitate performance, and there has been an improvement in average scores during the operation of the scheme. There are currently 88 participants, though some laboratories which failed to return results regularly were removed from the scheme. The consensus values from the scheme itself have now been validated, and in future the scheme should operate independently.

An assessment of the sources of dietary salt in a British population

An epidemiological study was conducted in the market town of March, Cambridgeshire, to assess the quantitative importance of cooking and table salt to total dietary salt intake by the use of a fused mixture of lithium carbonate and sodium chloride. Men and women aged 20-60 participated in a 12 day study with sequential 24 h urine collections to assess salt sources over a 7 day period. Total salt consumption estimated from urinary chloride excretion amounted to 10.6 +/- 0.55 (SEM) g in 33 men and 7.4 +/- 0.29 (SEM) g in 50 women. The cooking salt eaten was only 0.45 +/- 0.09 (SEM) g in men and women, with men eating more table salt (0.77 g/day) than women (0.46 g/day). Discretionary sources, i.e. cooking and table salt use, contributed only 15% to the total intake. Salt from manufacturing foods and catering in purchased food therefore provided on average 85% of total salt intake. These results are consistent even when an allowance is made for the slightly poorer pouring quality of the lithium-tagged salt. The importance of food as a source of salt was reflected in the significant relationship between the weight of the individual and the amount of salt eaten (for males P less than 0.05 and for females P less than 0.001). Cooking salt consumption did not relate to the amount of salt derived from purchased food nor did table salt use relate to the amount of salt in cooked foods.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum uric acid, serum glucose and diabetes: relationships in a population study

The relationships between serum uric acid, serum glucose and diabetes have been examined in a survey of 7735 middle-aged men drawn at random from general practices in 24 British towns. There was a positive relationship between serum glucose and serum uric acid concentrations up to about 8.0 mmol/l; at higher levels of glucose, serum uric acid decreased. Uric acid levels were significantly reduced in insulin-dependent diabetics and in those on oral hypoglycaemics and also in 'non-diabetics' with casual glucose levels greater than 10 mmol/l. Both uric acid and glucose concentrations were positively related to body mass index; only uric acid was positively related to alcohol intake. Men on antihypertensive treatment had raised levels of uric acid (significant) and glucose (non-significant). The positive relationship between serum uric acid and serum glucose could not be explained by associations with body mass index, alcohol intake, age, social class, gout or treatment for hypertension. It probably reflects the biochemical interaction between serum glucose and purine metabolism, with increased excretion of uric acid during hyperglycaemia and glycosuria.

External quality assessment of assays of lead in blood

The operation and results of the United Kingdom External Quality Assessment Scheme for Lead in Blood, which currently has about 140 participants within and outside the U.K. are described. The choice of specimens, scheme design, and scoring of performance are discussed, as is the validity of the consensus values used as a basis for the scoring. There has been a continued improvement in performance as assessed by this program, some of which appears to have been stimulated by the introduction of Variance Index scoring. The relative performance of the methods for assaying lead in blood is also examined.

External quality assessment of assays of lead in blood

The operation and results of the United Kingdom External Quality Assessment Scheme for Lead in Blood, which currently has about 140 participants within and outside the U.K. are described. The choice of specimens, scheme design, and scoring of performance are discussed, as is the validity of the consensus values used as a basis for the scoring. There has been a continued improvement in performance as assessed by this program, some of which appears to have been stimulated by the introduction of Variance Index scoring. The relative performance of the methods for assaying lead in blood is also examined.

External quality assessment of serum enzyme activity assays and the effect of calibration on interlaboratory concordance

The design and results of a UK external quality assessment scheme for six enzymes are described, from 21 surveys over a period of 7 years. Improvements in interlaboratory agreement and the adoption of reliable methods are documented. The potential of enzyme calibration materials in further improving numerical concordance between laboratories using different assay conditions, including temperature, is demonstrated and discussed.

An enhanced chemiluminescent enzyme immunoassay for serum carcinoembryonic antigen based on a modification of a commercial kit

A conventional colorimetric peroxidase end-point (ortho-phenylenediamine substrate), used in an enzyme immunoassay for carcinoembryonic antigen, employing plastic beads as solid support, has been replaced by a much faster (30 seconds versus 30 minutes) enhanced chemiluminescent assay for the peroxidase label. Para-iodophenol was used to enhance the light emission from the peroxidase catalysed chemiluminescent reaction between luminol and hydrogen peroxide. Values for precision and carcinoembryonic antigen concentration obtained with the chemiluminescent and colorimetric versions of the immunoassay on 62 serum specimens were in good agreement.

Impact of hormonal contraceptives vis-à-vis non-hormonal factors on the vitamin status of malnourished women in India and Thailand. World Health Organization: Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Oral Contraceptives

The effects of combined oral contraceptives containing 30 or 50 micrograms ethinyl oestradiol and 150 micrograms levonorgestrel or a 3-monthly injectable preparation depo-medroxyprogesterone acetate (DMPA) on the vitamin status of low-income group women from two urban centres in India (Bombay and Hyderabad) and one rural centre in Thailand (Chiang Mai) were examined in a follow-up study over a period of 1 year. The magnitude of malnutrition in the study population vis-à-vis a middle-income reference group was assessed by comparing the baseline data on the two groups. Effects of time-related variables such as lactation and season were also examined by a cross-sectional analysis of the baseline data on the study population. In all three centres the majority of the study population suffered from biochemical riboflavin and/or pyridoxine deficiency even before initiating contraception. Lactation appeared to have an effect on the vitamin status, which varied among the different populations. Seasonal effects were seen, but showed inconsistent trends in the three centres. Both the oral contraceptive pills and DMPA tended to increase serum vitamin A and blood folate. The thiamin, riboflavin and pyridoxine status of the women who were already deficient did not deteriorate further with the use of hormonal contraception, as judged by enzyme saturation tests. Some deterioration in the riboflavin status of the normal women of Hyderabad was seen with the use of oral pills. Women who were biochemically deficient prior to the use of oral contraceptives tended to show some improvement in B-vitamin status, over the 1-year period of hormonal contraception.

A direct assay for pyridoxal 5'-phosphate using pig heart apo-aspartate transaminase

The development of a simple enzymatic method for the determination of blood and plasma pyridoxal 5'-phosphate (PLP) using pig heart apo-aspartate transaminase (apo-AST) is described. The technique requires three steps: sample extraction using perchloric acid, a binding step in which PLP in the sample extract is attached to the apo-AST and the enzymatic assay of the reconstituted holo-AST. PLP extracts were analysed with and without a known concentration of added PLP to correct for variation in recovery between different specimens. Procedures are outlined for manual and automatic analysis of the PLP extracts. Using the KONE Clinical Analyser after the extraction step, it is possible to measure enzyme activity in 100 specimens (i.e. 400 tubes) in a 5 h period. Results are shown from 185 healthy women aged 20-45 years, in which plasma PLP concentrations ranged from 5 to 165 nmol/L, and 142 men and 56 women in government service aged 17-64 years, whose plasma PLP ranged from 8 to 169 nmol/L. Values less than 20 nmol/L are believed to indicate vitamin B6 deficiency and the method is able to measure 5 nmol/L.

High density lipoprotein cholesterol is not a major risk factor for ischaemic heart disease in British men

The concentration of high density lipoprotein cholesterol (HDL cholesterol) in serum was measured at initial examination in a large prospective study of men aged 40-59 drawn from general practices in 24 British towns. After an average follow up of 4.2 years 193 cases of major ischaemic heart disease had been registered in 7415 men in whom both HDL cholesterol and total cholesterol values had been measured. The mean HDL cholesterol concentration was lower in the men with ischaemic heart disease ("cases") compared with other men, but the difference became small and non-significant after adjustment for age, body mass index, blood pressure, cigarette smoking, and concentration of non-HDL cholesterol. The higher mean concentration of non-HDL cholesterol in "cases" remained highly significant after adjustment for other factors. Men in the highest fifth of non-HDL cholesterol values had over three times the risk of major ischaemic heart disease compared with men in the lowest fifth. Multivariate analysis showed that non-HDL cholesterol was a more powerful predictor of risk than the HDL to total cholesterol ratio. These British findings were compared with six other prospective studies. All the larger studies showed similar results, suggesting that HDL cholesterol is not a major risk factor in the aetiology of ischaemic heart disease.

An examination of the hexokinase method for serum glucose assay using external quality assessment data

Hexokinase methods for serum glucose assay appeared to give slightly but consistently higher inter-laboratory coefficients of variation than all methods combined in the UK External Quality Assessment Scheme; their performance over a two-year period was therefore compared with that for three groups of glucose oxidase methods. This assessment showed no intrinsic inferiority in the hexokinase method. The greater variation may be due to the more heterogeneous group of instruments, particularly discrete analysers, on which the method is used. The Beckman Glucose Analyzer and Astra group (using a glucose oxidase method) showed the least inter-laboratory variability but also the lowest mean value. No comment is offered on the absolute accuracy of any of the methods.

Effect of cigarette smoking, pulmonary inflammation, and lung disease on concentrations of carcinoembryonic antigen in serum and secretions

A specific radioimmunoassay for carcinoembryonic antigen was used to investigate aspects of its measurement in lung disease. The results confirm that serum carcinoembryonic antigen concentrations are higher in healthy smokers and patients with chronic obstructive bronchitis than in healthy non smokers (p less than 0.01). Corticosteroid treatment reduced the concentration in nine patients with bronchitis (p less than 0.05). Other inflammatory lung diseases (bronchiectasis, pneumonia, fibrosing alveolitis) are not associated with a raised serum carcinoembryonic antigen concentration. The sputum concentrations were about 100 times those found in serum and there was a positive correlation (r = 0.611 2p less than 0.01) between the concentrations in sputum and serum in patients with bronchitis. No preferential rise in sputum concentration was found in current smokers or patients with lung carcinoma (n = 16). A higher ratio of carcinoembryonic antigen to albumin concentration (p less than 0.05) was, however, found in lavage fluid obtained from the tumour site than in fluid from "normal" lung in the same patients, suggesting an increase in carcinoembryonic antigen secretion in the vicinity of the tumour. Despite this "local" effect the sputum concentration does not, however, appear to be a useful marker of lung carcinoma and the measurement could not be used as a screening test.

Enhanced luminescent quantitation of horseradish peroxidase conjugates: application in an enzyme immunoassay for digoxin

A p-iodophenol-enhanced luminescent end-point has been incorporated into a commercially available heterogeneous competitive enzyme immunoassay for digoxin based on a horseradish peroxidase-digoxin conjugate. The luminescent end-point could be completed in less than 1 min and significantly reduced overall assay time. Results for the assay obtained using enhanced luminescence showed good agreement with those obtained using a colorimetric end-point (correlation coefficient 0.98). Both assays gave acceptable precision within the therapeutic range. The incubation time for the luminescent immunoassay was reduced to 15 min and still gave differentiation between sub-therapeutic, therapeutic and toxic levels of digoxin.

A rapid chemiluminescent enzyme-linked immunosorbent assay for cytomegalovirus immunoglobulin G antibodies using instant photographic film

A rapid and convenient chemiluminescent enzyme-linked immunosorbent assay (ELISA) for IgG antibodies to cytomegalovirus has been developed which uses low cost equipment. Assays were carried out on transparent microtitre plates and used an anti-human IgG horseradish peroxidase conjugate. Bound peroxidase was detected chemiluminescently using a p-iodophenol-luminol-peroxide reagent. Light emission from the wells of the microtitre plate was detected on instant photographic film (ASA 20,000) held in a specially designed shutter type camera. The semi-quantitative technique was tested in a routine laboratory for a period of 7 wk and the results obtained compared well (95.3% agreement) with those obtained by a conventional colorimetric ELISA using an alkaline phosphatase label.

Risk factors for ischaemic heart disease: the prospective phase of the British Regional Heart Study

Risk factors for major ischaemic heart disease (acute myocardial infarction or sudden death) have been investigated in a prospective study of 7735 men aged 40-59 years drawn from general practices in 24 British towns. After a mean follow-up of 4.2 years, there have been 202 cases of major ischaemic heart disease. Univariate estimates of the risk of ischaemic heart disease show that serum total cholesterol, HDL-cholesterol and triglyceride concentrations, systolic and diastolic blood pressures, cigarette smoking, and body mass index are all associated with increased risk of ischaemic heart disease. Evidence of ischaemic heart disease at initial examination is also strongly associated with increased risk of subsequent ischaemic heart disease. All these factors were then considered simultaneously using multiple logistic models. Definite myocardial infarction on electrocardiogram and recall of a doctor diagnosis of ischaemic heart disease remained predictive of subsequent major ischaemic heart disease, after allowance for all other risk factors. Serum total cholesterol, blood pressure, and cigarette smoking each remained as highly significant independent risk factors whereas overweight, above average levels of HDL-cholesterol and serum triglyceride were not predictive of risk after allowance for the above factors. Men with and without pre-existing ischaemic heart disease were examined separately in the same way (using multiple logistic models). The strength of association between the principal risk factors and subsequent major ischaemic heart disease was reduced in the men with pre-existing ischaemic heart disease, only age and serum total cholesterol remaining highly significant. Overall the levels of the major risk factors commonly encountered in British men have a marked effect on the risk of ischaemic heart disease. Modification of these risk factors in the general population constitutes an important national priority.

Phenols as enhancers of the chemiluminescent horseradish peroxidase-luminol-hydrogen peroxide reaction: application in luminescence-monitored enzyme immunoassays

Certain phenol derivatives, including p-iodophenol and p-phenylphenol, enhance light emission from the horseradish peroxidase-catalyzed oxidation of cyclic diacyl hydrazides such as luminol. The light emission decays slowly (glowing for several minutes) and its intensity may be greater than 1000-fold that of the unenhanced reaction. The enhanced system enables rapid, sensitive assay of peroxidase conjugates. We describe its application in immunoassays for human choriogonadotropin, digoxin, and factor VIII-related antigen. Luminescent quantification of peroxidase labels has been directly incorporated into immunoassays based on beads, tubes, or microtiter plates, used in conjunction with photodetectors such as photomultiplier tubes or instant photographic film. Enhancement with phenol derivatives exceeds that achieved with 6-hydroxybenzothiazole derivatives and depends on pH and enhancer concentration. Emission spectra of phenol-enhanced and unenhanced reactions are remarkably similar, suggesting that the enhancers do not act as more efficient emitters but exert their action earlier in the complex reaction between peroxidase, oxidant, and luminol.

Phenols as enhancers of the chemiluminescent horseradish peroxidase-luminol-hydrogen peroxide reaction: application in luminescence-monitored enzyme immunoassays

Certain phenol derivatives, including p-iodophenol and p-phenylphenol, enhance light emission from the horseradish peroxidase-catalyzed oxidation of cyclic diacyl hydrazides such as luminol. The light emission decays slowly (glowing for several minutes) and its intensity may be greater than 1000-fold that of the unenhanced reaction. The enhanced system enables rapid, sensitive assay of peroxidase conjugates. We describe its application in immunoassays for human choriogonadotropin, digoxin, and factor VIII-related antigen. Luminescent quantification of peroxidase labels has been directly incorporated into immunoassays based on beads, tubes, or microtiter plates, used in conjunction with photodetectors such as photomultiplier tubes or instant photographic film. Enhancement with phenol derivatives exceeds that achieved with 6-hydroxybenzothiazole derivatives and depends on pH and enhancer concentration. Emission spectra of phenol-enhanced and unenhanced reactions are remarkably similar, suggesting that the enhancers do not act as more efficient emitters but exert their action earlier in the complex reaction between peroxidase, oxidant, and luminol.

A rapid luminescently monitored enzyme immunoassay for IgE

A novel halophenol-enhanced luminol-peroxide luminescent detection method for horseradish peroxidase has been tested in an enzyme immunoassay for IgE. The luminescent enzyme immunoassay was reproducible (within-batch CV, 3.9-13.2%) and values obtained on serum samples showed good agreement with those obtained by colorimetric enzyme immunoassay. The major advantages of the luminescent detection method are that it is rapid, 30 s compared with 30 min for the colorimetric assay using o-phenylenediamine, and the luminescent signal is intense and stable for several minutes.

Enhanced luminescence enzyme immunoassay for factor VIII related antigen

A sandwich enzyme immunoassay for plasma factor VIII related antigen has been developed which exploits a para-iodophenol enhanced chemiluminescent reaction to detect the horseradish peroxidase label. The assay entailed 15 min incubations with sample and with conjugate and had a detection limit of 0.12 mU. It showed good within batch precision (coefficient of variation = 2.95-5.8%) and results on a series of 57 specimens agreed with results obtained by immunoelectrophoresis (correlation coefficient = 0.97).

Enhancement of the horseradish peroxidase-catalyzed chemiluminescent oxidation of cyclic diacyl hydrazides by 6-hydroxybenzothiazoles

6-Hydroxybenzothiazole, 2-cyano-6-hydroxybenzothiazole, and 2-(6-hydroxy-2-benzothiazolyl)thiazole-4-carboxylic acid (dehydroluciferin) dramatically enhance light emission from the horseradish peroxidase conjugate catalyzed oxidation of luminol, isoluminol, N-(6-aminobutyl)-N-ethyl isoluminol, and 7-dimethylaminonaphthalene-1,2-dicarboxylic acid hydrazide by either peroxide or perborate. Light emission is enhanced by up to 1000-fold, which is an improvement over the enhancement previously observed using firefly luciferin (4,5-dihydro-2-(6-hydroxy-2-benzothiazolyl)thiazole-4-carboxylic acid). Enhancement is influenced by enhancer concentration and pH. Spectral scans of light emitted in enhanced and unenhanced reactions are similar, suggesting that aminophthalate products, and not the enhancers, are the emitters.

Biochemical and haematological response to alcohol intake

In a clinical survey of 7735 middle-aged men, alcohol consumption has been related to 25 biochemical and haematological measurements obtained from a single blood sample. Most measurements showed some association with alcohol consumption, gamma-glutamyl transferase (GGT) being the most strongly associated. Lead, mean corpuscular haemoglobin (MCH), mean corpuscular volume, high-density lipoprotein-cholesterol (HDL-C), urate and aspartate transaminase also showed substantial associations with alcohol intake. Using a discriminant analysis technique, a simple score based on five variables (GGT, HDL-C, urate, MCH and lead) provided the best discrimination between heavy drinkers (e.g. more than three pints of beer daily) and occasional drinkers, but still failed to identify more than half of the heavy drinkers. This combined score may prove a useful measure of an individual's biochemical/haematological response to alcohol consumption for use in epidemiological and clinical studies of alcohol related disorders. The use of such indices should complement but not replace measures of alcohol intake derived from questionnaires.

Blood lead concentration, blood pressure, and renal function

Blood lead concentrations were related to blood pressure and indicators of renal function in a clinical survey of 7735 middle aged men from 24 British towns. There was no overall evidence that blood lead concentrations were associated with systolic or diastolic blood pressure (r = +0.03 and +0.01, respectively). In the 74 men with a blood lead concentration of 1.8 mumol/l (37.3 micrograms/100 ml) or more there was some suggestion of increased hypertension, but this did not reach significance. Blood lead concentration did not have any relation with serum creatinine concentration. Moderate increases in blood lead concentration were associated with small increases in mean serum urate concentration and small decreases in mean serum urea concentration; these associations were both reduced when alcohol consumption was taken into account. There is no indication that exposure to lead at concentrations commonly encountered in British men is responsible for impaired renal function or increased blood pressure.

The investigation of proteinuria in pregnancy using iso-dalt analysis

Urinary protein excretion has been investigated using the iso-dalt technique in pregnant patients with hypertension and proteinuria, without hypertension but with proteinuria and without either hypertension or proteinuria. This high resolution electrophoretic technique has shown a great variation in the pattern of protein excreted by these patients, particularly those with hypertension. These showed an increased number of protein species in the urine, some of unknown identity. Two urines from this group appeared to contain no detectable albumin. Currently this technique is inappropriate for the routine analysis of urine proteins. However, further studies may determine the diagnostic value of these changes in urine excretion and allow the development of more specific assays.

Iron deficiency in a Northern Thai population: the effects of iron supplements studied by means of plasma ferritin estimations

Iron deficiency is a common problem, particularly in developing countries, but traditional laboratory methods of detecting this condition are unreliable. The prevalence of iron deficiency in a Northern Thai population (pre-school, school children, adult women) has been assessed by means of plasma ferritin concentrations. The results were compared with prevalences based on blood haemoglobin concentrations. Estimations of prevalences based on plasma ferritin values were 10-24% in non-vegetarian and 49-71% in vegetarian groups, whilst those based on blood haemoglobin were 11-21% (non-vegetarian) and 24-50% (vegetarian). Dietary supplementation with iron produced dramatic rises in plasma ferritin in all of the groups studied. The effects on blood haemoglobin concentration and haematocrit were less marked. These results highlight the extent of iron deficiency in a Thai population and demonstrate the sensitivity of plasma ferritin as a test for detecting this condition and assessing the response to dietary supplementation.