Childhood exposure to environmental tobacco smoke and chronic respiratory symptoms in non-smoking adults: the Singapore Chinese Health Study

BACKGROUND: Childhood exposure to environmental tobacco smoke has been extensively associated with childhood respiratory illness; fewer studies have addressed the effects on adults. METHODS: Childhood environmental tobacco smoke exposure in relation to chronic cough, phlegm, and asthma diagnosis was studied in never smokers from a cohort of Singaporeans of Chinese ethnicity aged 45-74 years at enrollment from 1993 to 1998. From 1999 to 2004 subjects were interviewed regarding environmental tobacco smoke exposure before and after the age of 18 and the presence and duration of current symptoms of chronic cough and phlegm production and asthma diagnosis. RESULTS: Among 35,000 never smokers, fewer had smoking mothers (19%) than fathers (48%). Although few subjects currently lived (20%) or worked (4%) with smokers, 65% reported living with a daily smoker before the age of 18 years. Living with a smoker before the age of 18 increased the odds of chronic dry cough (149 cases, odds ratio 2.1, 95% CI 1.4 to 3.3) and, to a lesser extent, phlegm, after adjustment for age, sex, dialect group, and current and past exposure to smokers at home and at work after the age of 18. Associations strengthened with higher numbers of smokers in childhood. There was no association with asthma or chronic bronchitis. There was evidence to suggest a stronger association among subjects with a lower adult intake of fibre which has previously been found to be protective for respiratory symptoms. CONCLUSIONS: In this large study of non-smokers, living with a smoker in childhood was associated with chronic dry cough and phlegm in adulthood, independent of later exposures to environmental tobacco smoke.     

Circulating endothelial microparticles are associated with vascular dysfunction in patients with end-stage renal failure

Endothelial dysfunction and arterial stiffness are major determinants of cardiovascular risk in patients with end-stage renal failure (ESRF). Microparticles are membrane fragments shed from damaged or activated cells. Because microparticles can affect endothelial cells, this study investigated the relationship between circulating microparticles and arterial dysfunction in patients with ESRF and identified the cellular origin of microparticles associated with these alterations. Flow cytometry analysis of platelet-free plasma from 44 patients with ESRF indicated that circulating levels of Annexin V+ microparticles were increased compared with 32 healthy subjects, as were levels of microparticles derived from endothelial cells (three-fold), platelets (16.5-fold), and erythrocytes (1.6-fold). However, when arterial function was evaluated noninvasively in patients with ESRF, only endothelial microparticle levels correlated highly with loss of flow-mediated dilation (r = -0.543; P = 0.004), increased aortic pulse wave velocity (r = 0.642, P < 0.0001), and increased common carotid artery augmentation index (r = 0.463, P = 0.0017), whereas platelet-derived, erythrocyte-derived, and Annexin V+ microparticle levels did not. In vitro, microparticles from patients with ESRF impaired endothelium-dependent relaxations and cyclic guanosine monophosphate generation, whereas microparticles from healthy subjects did not. Moreover, in vitro endothelial dysfunction correlated with endothelial-derived (r = 0.891; P = 0.003) but not platelet-derived microparticle concentrations. In fact, endothelial microparticles alone decreased endothelial nitric oxide release by 59 +/- 7% (P = 0.025). This study suggests that circulating microparticles of endothelial origin are tightly associated with endothelial dysfunction and arterial dysfunction in ESRF.     

Intra-abdominal and Retroperitoneal Lymphangiomas in Pediatric and Adult Patients

Intra-abdominal and retroperitoneal lymphangiomas are a rare, congenital malformations of the lymphatics, which are found predominantly in children. The aim of this study is to evaluate the clinical features of this tumor, highlighting the differences in adults and pediatric patients. We also evaluate the preoperative diagnosis, radiological features, surgical treatment, and outcome of this rare condition. Between 1990 and 2004, 14 patients who underwent surgical resection of an intra-abdominal lymphangioma were reviewed retrospectively. There were five pediatric patients between fetal age and 17 years of age and nine adults between 31 and 62 years of age. Overall, females outnumbered males in the series, with a male-to-female ratio of 3:4. However, males predominated in the pediatric age group with a male-to-female ratio of 1.5:1. The clinical presentation of children was more acute ranging from 3 days to 2 months. In adults, four patients were asymptomatic, and the remaining five had symptom duration ranging from 2 weeks to a year. The lymphangiomas occurred in the mesentery (n = 4), retroperitoneum (n = 4), omentum (n = 3), pancreas (n = 2), and spleen (n = 1). All the patients underwent total surgical resection with or without organ resection, and there were no recurrences at a median follow-up of 2 years (range; 3 months–13 years). This series demonstrates that abdominal lymphangiomas have a male preponderance and present more acutely in pediatric patients, whereas in adults, female patients predominate and the history is more chronic. Presented orally at the 19th World Congress of the International Society for Digestive Surgery (Yokohama) December 2004     

The effects of appreciative inquiry interviews on staff in the U.K. National Health Service

PURPOSE: To obtain preliminary data on the short- and medium-term effects and personal acceptability of appreciative inquiry (AI) in staff development in health care. DESIGN/METHODOLOGY/APPROACH: AI is a non-problem-solving management approach focusing on developing current successes into the future through reflection at individual and group level. Individual one-hour interviews were undertaken with nursing staff on a national paediatric liver in-patient ward. They were asked to recount stories based on their experiences of successful delivery of health care, with active listening, followed by reflection on the process. A total of 32 staff members took part with only two refusals. Data were written and analysed by an open coding method. Follow up was obtained two years later using a written, open question method. FINDINGS: The process was emotional-but well received. Staff described quality in interpersonal interactions, preventing errors and engaging their personal values in their work. No improvement in recruitment or retention was shown but a high level of sickness absence fell significantly during the period of the project. Two years later, significant positive effects were recalled and attributed to the interviews by many respondents. AI appears a cost-effective way of connecting professionals' motivation toward quality in their work with strategic intentions. RESEARCH LIMITATIONS/IMPLICATIONS: The interviewer was a medical consultant and ward manager, implying either that the interviews could have worked as a form of managerial supervision or improvements could be a Hawthorne effect. Other unknown influences were likely to be occurring on the ward during the study period. PRACTICAL IMPLICATIONS: Short AI interventions on an individual basis can change sickness absence, at least while the interventions are continuing. It is an important tool for staff motivation with the potential for connecting strategic with micro-operational levels. AI is an approach to NHS management with wide application including appraisal, personal development and mentoring. It can be a positive introduction to reflective practice. ORIGINALITY/VALUE: AI is gaining recognition for its value in staff and service development in health care. The paper shows service and personal effects, cost-effectiveness and illustrates how to use AI for these purposes.     

Cardiovascular tissues contain independent circadian clocks

Acute cardiovascular events exhibit a circadian rhythm in the frequency of occurrence. The mechanisms underlying these phenomena are not yet fully understood, but they may be due to rhythmicity inherent in the cardiovascular system. We have begun to characterize rhythmicity of the clock gene mPer1 in the rat cardiovascular system. Luciferase activity driven by the mPer1 gene promoter is rhythmic in vitro in heart tissue explants and a wide variety of veins and arteries cultured from the transgenic Per1-luc rat. The tissues showed between 3 and 12 circadian cycles of gene expression in vitro before damping. Whereas peak per1-driven bioluminescence consistently occurred during the late night in the heart and all arteries sampled, the phases of the rhythms in veins varied significantly by anatomical location. Varying the time of the culture procedure relative to the donor animal's light:dark cycle revealed that, unlike some other rat tissues such as liver, the phases of in vitro rhythms of arteries, veins, and heart explants were affected by culture time. However, phase relationships among tissues were consistent across culture times; this suggests diversity in circadian regulation among components of the cardiovascular system.     

Altered cerebral glucose utilization following blood-brain barrier opening by hypertonicity or hypertension

The blood-brain barrier (B-BB) in conscious rats was opened to Evans blue dye by carotid infusion of a 1.8 m arabinose solution or by acute unilateral carotid hypertension, following which [¹⁴C]2-deoxy-d-glucose was injected intravenously. Rats were killed 45 min later, and autoradiographs were made from frozen brain sections. Focal areas of increased optical density, or “hot spots,” were noted in brain regions when the B-BB was opened but were absent when B-BB integrity was unaffected. These hot spots, which represented accumulations of brain radioactivity, were not prevented by diet-induced hypokalemia or by systemic pretreatment with high doses of phenoxybenzamine or propranolol. Their cause remains unclear, but their induction by both hypertensive and osmotic B-BB opening suggests that B-BB damage, regardless of cause, can markedly disturb cerebral metabolism.     

Ultrasonographic identification of dilated intrahepatic bile ducts and their differentiation from portal venous structures.

The appearance of dilated intrahepatic bile ducts was evaluated on ultrasonograms of 50 patients with proven extrahepatic biliary obstruction. Five characteristic changes allowed differentiation between biliary and portal venous systems. These changes included: 1) alteration in the anatomic pattern adjacent to the main right portal venous segment and the main portal vein bifurcation. 2) Irregular walls of dilated bile ducts. 3) Stellate confluence of dilated bile ducts. 4) Acoustic enhancement by dilated bile ducts. 5) Peripheral location of dilated bile ducts. Many patients exhibited more than one of these findings. Parasagittal scans of the main right portal vein were the most sensitive for detection of intrahepatic ductal dilatation. Recognition of the characteristic changes and knowledge of the portal venous anatomy makes it possible to diagnose extrahepatic biliary obstruction with a high degree of confidence.