Incidence and risk factors for chronic pain after elective caesarean delivery under spinal anaesthesia in a Chinese cohort: a prospective study.

BACKGROUND: China has one of the highest rates of caesarean delivery in the world. The aim of this study was to investigate the incidence and risk factors for chronic pain after caesarean delivery in a Chinese cohort. METHODS: Patients undergoing elective caesarean delivery with a Pfannenstiel incision under spinal anaesthesia were recruited prospectively at a Chinese tertiary women's hospital. The State Trait Anxiety Inventory was measured before surgery. Postoperative analgesia was provided by intravenous patient-controlled analgesia for 48 hours. Postoperative acute pain scores and analgesic consumption were assessed. After 3, 6 and 12 months, patients were interviewed by telephone regarding whether pain was present, and if present, the intensity, frequency, location and impact of the pain. RESULTS: In total 786 patients completed this study. The incidence of pain at 3, 6 and 12 months was 12.2%, 3.8% and 0.8% respectively. Of patients with pain at 3 months, most patients experienced pain daily (43.7%) or with intervals of a day or more between pain (41.7%), with intensity overall described as mild to moderate. The most common sites of pain were the incision or nearby (56.3%), and the low back (36.4%). Risk factors for pain at 3 months included previous caesarean delivery and higher analgesic consumption at 24 h and 48 h postoperatively. CONCLUSION: Chronic pain after elective caesarean delivery under spinal anaesthesia occurs infrequently, especially in the long-term, in a Chinese population. Patients with a previous caesarean delivery and higher analgesic use were at increased risk.

Evaluation of allergenicity of constituents of myoga using the murine local lymph node assay.

Myoga (Zingiber Myoga Roscoe) is a perennial plant with a pungent smell from its flower buds. It is native to East Asia and has been reported to cause allergic contact dermatitis. The purpose of this study is to assess the allergenicity of myoga related to its major chemical components, alpha-pinene, beta-pinene, limonene, limonene oxide and beta-phellandrene, which are supposed to be the causative agents of contact dermatitis among myoga cultivators. We performed a toxicity study of the volatile constituents of myoga using the local lymph node assay (LLNA), in which limonene, limonene oxide and beta-phellandrene had positive responses and the EC3 was 35.8%, 8.22%, and 0.54%, respectively. EC3 for both alpha-pinene and beta-pinene was over 100%. Both chemicals failed to induce positive responses in the LLNA. While the maximization rating of limonene, limonene oxide and phellandrene were evaluated as moderate, extreme, and extreme respectively, alpha-pinene and beta-pinene were evaluated as weak in the previously reported GPMT. The usage of LLNA was also confirmed by comparing with previously reported GPMT results to detect the allergenicity of myoga constituents. The actual risk of humans developing an allergy to myoga constituents depends on many factors. The concentration of the compounds, the frequency and duration of exposure and the condition of the skin are supposed to be important factors.

The effect of group-based lifestyle interventions on risk factors and insulin resistance in subjects at risk for metabolic syndrome: the Tabaruzaka Study 1.

AIM: The aim of this study was to evaluate the efficacy of two group-based lifestyle interventions in ameliorating the risk factors of metabolic syndrome (MS) and insulin resistance. METHODS: Ninety-eight subjects who had at least one component of MS were randomized into standard intervention (SI) (4-month intervention; n = 50) and extended intervention (EI) (10-month intervention; n = 48) groups, and 39 subjects were followed up for a control group. The effects of intervention were evaluated after 10, 22 and 34 months. RESULTS: At month 10, the standard and EI groups showed improved body mass index (BMI) (SI, -0.28; EI, -0.47; control, -0.09), high-density lipoprotein (HDL) cholesterol, fasting plasma glucose and A1c and a decreased mean number of components of MS (SI, -0.37; EI, -0.51; control, 0.08). At month 34, the effects on BMI (SI, -0.66; EI, -0.60; control, -0.05) and HDL-cholesterol were sustained for both the intervention groups. In controls, the increases in fasting plasma glucose and the mean number of components of MS from the baseline to month 34 were greater than those in the standard and EI groups. Whole body insulin sensitivity index and hepatic insulin resistance index were also improved at month 10. CONCLUSIONS: Group-based lifestyle intervention could be an efficient way to prevent MS. Its effects were sustainable, at least in part, for 2 years. These effects may be mediated by an improvement in insulin sensitivity.

Case study of volatile organic compounds in indoor air of a house before and after repair where sick building syndrome occurred.

A housewife in her late thirties, mother of two children, had an indefinite complaint about the indoor air quality of her house. Inspectors from a public health center treating the housewife's complaint quantified formaldehyde (FA) in high concentration exceeding Japanese national guideline of FA in some rooms of the house. We also determined FA and total volatile organic compounds (TVOCs) in higher concentrations more than the national guidelines. Remodeling of the house was performed to improve the air quality as follows. Vinyl wallpaper was exchanged to plant made paper, plywood made doors were exchanged to pure wood made doors, plywood stairs were covered with plant cork and so on. After remodeling the house, we measured the concentrations of FA and TVOCs again. The concentrations of the chemicals in the indoor air decreased which approve effectiveness of the remodeling. Moreover complaints of the housewife lessened. This also proved the effectiveness of the remodeling. Four years after the inspection, we visited the house again and found that the concentration of FA in the house was still lower than that of national guideline. The housewife was evaluated in a good healthy condition by her answers to our questions related to indoor air quality, daily life, physical condition, and so on.

Occupational allergic contact dermatitis from mioga (Zingiber mioga rosc.) in greenhouse cultivators.

UNLABELLED: Mioga (Zingiber mioga Rosc.) is a member of the ginger family (Zingiberaceae), which is native to tropical Asia. In Japan, the young flower buds are used as a spice, and hand dermatitis suspected as being an allergy to mioga has been recognized in mioga greenhouse cultivators. To investigate the extent of the problems and the causes of dermatitis, 20 householders cultivating mioga in their greenhouses were asked to participate in a questionnaire study. Consecutive patch tests were performed on some subjects with dermatitis. Self-reported questionnaires were distributed to the main cultivator in each household who attended a lecture of mioga cultivation methods held at an agriculture cooperative association in the area. Some subjects who answered as presenting or having had hand dermatitis were patch tested for mioga (as is), four kinds of mioga extracts, and three kinds of natural rubber gloves. RESULTS: 35 cultivators from 16 households answered the questionnaire. Eight of the 35 subjects (22.9 percent) answered that they had experienced hand dermatitis since they started mioga cultivation. Four of the 8 subjects were patch tested. Two of the 4 subjects showed allergic reactions to mioga (as is) and the extracts. The other two cases showed irritation to mioga (as is). The first two cases also showed allergic reactions to natural rubber gloves. To our knowledge, there is no previous report of allergic contact dermatitis from mioga.

Subjective symptoms of medical students exposed to formaldehyde during a gross anatomy dissection course.

The purpose of this study is to investigate the safety of and to try to find the best plan to cope with exposure to FA for students during a gross anatomy dissection course. The FA exposure level and subjective symptoms was estimated. The relationship between exposure to FA and subjective symptoms of irritation were discussed for times; before, in the beginning period, in the middle period, and upon completion of the Anatomy Dissection Course. The geometric means of FA concentration were 32.7 micrograms/m3 (before), 891.3 micrograms/m3 (beginning), 763.3 micrograms/m3 (middle), and 238.9 micrograms/m3 (completion), respectively. Among them, FA-related symptoms were observed in 61.1 percent; 28.0 percent fell strong stress during the course, and 27.4 percent complained that their normal life situation was affected. Our results indicate that such subjective symptoms during the anatomy dissection course were related to the period spent in the anatomy dissection room. Our study suggests that shortening the time of each anatomy dissection practical class and reduction of the number of cadaver tables could help to reduce symptoms.

[A Japanese language version of the health-promoting lifestyle profile].

The development and initial psychometric evaluation of a Japanese version of the Health-Promoting Lifestyle Profile II (HPLP II) is described. The 52-item instrument was translated into Japanese and was found to be culturally relevant and reliable in a pilot study. The Japanese version was then administered to adiverse but predominantly Japanese group of 337 subjects residing in northern Japan. The Japanese version of the HPLP II was evaluated using factor analysis and reliability measurement. Six factors similar to those isolated previously during psychometric assessment of the English language version were extracted. Those six dimensions comprise the HPLP II subscales of: 1. Health responsibility, 2. Spiritual growth, 3. Physical activity, 4. Interpersonal relations, 5. Nutrition, and 6. Stress management. The alpha reliability coefficient for the total scale was 0.94 and the 2-week retest reliability was 0.91; the alpha coefficients for the subscales ranged from 0.70 to 0.87. The Japanese language version of the HPLP II appears to have sufficient validity and reliability for use by researchers who wish to describe the health-promoting components of lifestyle among the Japanese population and to explore differences and similarities in the health-promoting lifestyle of Japanese and American subjects or those of other ethnic groups. Further evaluations of measurement with different populations appears warranted. This instrument will enable researchers to investigate patterns and determinants of health-promoting lifestyle, as well as the effects of interventions to alter the lifestyle.

Community-based analysis of the factorial structures of the recent increase in low birthweight infants.

This study was conducted to determine whether the regional factors were related to the increase in the percentage of low birthweight (LBW: <2,500g) infants in Kumamoto Pref., and to establish a tentative structure model for predicting low birthweight infants. Analyses for frequency of LBW infants between 1974 and 1997, and a multiple regression model and covariance structure model were conducted using data from the vital statistics between 1992 and 1997 and regional indicators concerned with LBW infants from official registered statistical data between 1992 and 1997. The 72 regional factors were clustered into four groups linked with agricultural areas such as Urban, Flat, Hilly and Mountainous areas. The recent increase in the incidence of LBW infants resulted from the increase in moderate-LBW (MLBW: 2,000-2,500 g) infants of full term-LBW infants. There was a steady annual increase in the Urban agricultural area LBW infants since 1992. The two structure analyses revealed that the Urban area had a marked effect on the increase in LBW infants, whereas, farm villages in Hilly or Moutainous areas had less effect on the increase in LBW infants. These findings suggest that the regional factors relating to the mothers' life-style or regional environments play a key role in the etiology and prevention of LBW, and will be a useful in the analyses using official registered material.

Determinants of life satisfaction among Japanese agricultural workers.

The purpose of this study was to investigate the factorial structure of life satisfaction in agricultural workers. One hundred and sixty-five (87 males and 78 females) agricultural workers mainly engaged in plastic greenhouse cultivation in southern Japan, ranging in age from 19 to 72 years (mean = 44.3 years), completed a questionnaire. Scores of life satisfaction showed a higher tendency in males than in females, and those in elders were higher than in younger people. Conversely, females showed higher stress scores than males, and younger people's score were higher than the elders. Multiple regression analysis was performed to analyze the factorial structure of satisfaction. It is suggested that the level of life satisfaction is positively related to social support, and is negatively related to the impact of stressful life events, globally perceived stress and subjective symptoms of ill health. Stress levels depended on factors concerning the psychological demands of work, work posture, work hours and work environment. Different factorial structures were observed between female and male workers. Findings from this study suggest that a strong social support network may assist in enhancing life satisfaction. Furthermore, the ill health and stress experienced in agricultural work were associated with a reduced life satisfaction.

Does electrical stimulation of the sciatic nerve prevent suspension-induced changes in rat hindlimb bones?

Osteoporosis due to mineral loss is a major health problem resulting from long-term spaceflight. The development of a suitable countermeasure is essential because an advanced decrease in bone density could be irreversible. Therefore the current study was performed to test our hypothesis that the loading of bones by electrical stimulation-induced muscle contraction may prevent the mineral loss caused by gravitational unloading and bone growth will be maintained. During 10 d of hindlimb suspension, electrical stimulation at 1, 50, or 100 Hz was administered through the left sciatic nerve at the gluteal region of rats with approximately 300 g body weight. The dry weight, mineral content, and mineral density in hindlimb bones were analyzed. The dry weight and mineral content of femur and tibia-fibula in hindlimb-suspended rats tended to be less than in the age-matched cage controls. However, these detrimental effects were prevented by stimulation at 50 and 100 Hz. A positive effect of stimulation was seen even in the nonstimulated limb, although greater effect was induced in the stimulated limb. It is suggested that loading by stimulation-induced muscle contraction at higher frequencies is beneficial for the maintenance of bone growth or the prevention of mineral loss, or both, during hindlimb suspension in rats.

Specific desensitization of the epidermal growth factor receptor by pp60v-src.

BALB/c 3T3 cells infected with a temperature-sensitive mutant (LA90) of RSV have been used to investigate possible heterologous interactions between the pp60v-src tyrosyl kinase and the epidermal growth factor (EGF) and bradykinin receptors. The LA90 pp60v-src exhibits a very rapid activation t1/2 (less than 5 min) of protein kinase activity on decreasing the temperature from 40 degrees C to 35 degrees C. This change in temperature was also found to induce a very rapid decrease in the affinity for 125I-EGF of receptors on the RSV-LA90-infected cells but not of those on control parental cells. However, no significant changes were detected in the binding of 3H-bradykinin to either cell line. Two separable processes control the desensitization of the EGF receptor by pp60v-src, both of which are independent of protein kinase C. The first is rapid and transient, while the second is sensitive to cycloheximide and persists long after inactivation of pp60v-src.

Muscle protein catabolism in diabetes: 3-methylhistidine excretion in the spontaneously diabetic "BB" rat.

The muscle protein lost in uncontrolled diabetes may be due to decreased synthesis, increased catabolism, or to any combination of alteration in these rates that results in net loss. Differing methods of examining these rates in vivo and in vitro have given conflicting results. We assessed the rate of catabolism of proteins containing 3-methylhistidine (3-MH) by measurement of its urinary excretion in spontaneously diabetic "BB" Wistar rats. Prior to overt diabetes, rates of excretion were appropriate to the age of the rats (1.46 +/- 0.15 mumole/day), with 34%-47% as the nonacetylated form. Accompanying diabetes there was an increase in urine urea nitrogen of two to threefold over 4-14 days, and an increase in ammonium nitrogen of sixfold. 3-MH excretion doubled by 4 days, and 81%-96% was excreted as the nonacetylated form. Subcutaneous insulin in doses sufficient to improve glycosuria and hyperglycemia was associated with normalized total 3-MH excretion (N-acetyl 3-MH plus 3-MH) but a greater proportion than normal appeared in the nonacetylated form. These results suggest that muscle protein catabolism increased with insulin deficiency and that this defect can be corrected by therapy. Both untreated and treated diabetic rats appear to have a limited capacity for acetylation of 3-MH prior to its excretion.

The short-term effects of protein intake on 3-methylhistidine excretion.

The urinary excretion of 3-methylhistidine is used as a convenient index of muscle protein catabolism. Histidine is methylated in peptide linkage within muscle protein, and is quantitatively excreted when the protein is catabolized. 3-Methylhistidine would be expected to be present in ingested muscle protein, and unless altered in the digestive process, to be excreted as a function of intake. We studied its excretion at four levels of mixed protein intake, in separate groups of obese subjects, on the 1st day of altered input, with and without concurrent energy provision. A significant (P less than 0.001) linear relationship between protein intake and 3-methylhistidine excretion was observed, with a mean excretion of 198 mumoles/day at 0 intake, and an increment of 1.34 mumoles/g of ingested protein. There was no relationship between its excretion and the concurrent nitrogen balance. Thus, estimates of muscle protein catabolism with this method require that muscle protein be absent from the diet or its contribution quantified.

The spontaneously diabetic Wistar rat (the "BB" rat): the significance of transient glycosuria.

A longitudinal study of thirteen rats with transient and intermittent episodes of glycosuria was undertaken, to further characterize the "BB" diabetic syndrome. "Chemical diabetes" (normal fasting glycemia, abnormal GTT) was observed in five rats, accompanied by the same dramatic insulitis previously reported in this syndrome, in two of the three pancreases examined. Progression from "chemical" to overt diabetes occurred in one of these rats. Two other patterns of presentation were observed. Periods of complete remission occurred in four rats with diabetes considered sufficiently severe to warrant previous treatment with insulin. Four additional rats with previous glycosuria (untreated) showed no abnormalities on followup. It is not known whether hyperglycemia accompanied the glycosuria in these rats, and renal glycosuria has not been excluded. Thus, the "BB" diabetic syndrome exists in not only the overt and "chemical" forms, but may also present with transient glycosuria, followed by a variety of subsequent progressions.