Alpha1-antitrypsin as a risk for infant and adult respiratory outcomes in a national birth cohort

Reduced alpha1-antitrypsin (AAT) encoded by the gene SERPINA1 is a potential risk for pulmonary disease. We investigated SERPINA1 polymorphism as a risk for infant and adult pulmonary morbidity, and adult respiratory function and its change between 43 and 53 yr. We used data on a British national representative sample (n = 5,362) studied since birth in 1946 to age 53 yr (when n = 3,035), when DNA was first obtained. SERPINA1 Z and, to a lesser extent, S carriers had an increased risk of infant lower respiratory infection compared with those who were neither S nor Z carriers (Z carriers: odds ratio = 2.32, 95% confidence interval = 1.37-3.92; S but not Z carriers odds ratio = 1.58, 95% confidence interval = 1.10-2.28) after adjustment for environmental, socioeconomic, and developmental factors, and breast-feeding. There was no difference in the adult outcomes at 53 yr according to genotype, nor was there any association of genotype with change in forced expiratory volume at 1 s between 43 and 53 yr. Lower alpha1-antitrypsin, as indicated by carrier status for the Z and S alleles, was a risk for infant lower respiratory infection, but not for adult respiratory outcomes.     

Recreational drug use: patterns from a South Wales self-report survey

This study aimed to examine patterns of illicit recreational drug use, alcohol consumption, and smoking in a community-based population sample. A postal questionnaire survey was conducted of people who were selected at random from the Electoral registers of Cardiff and Merthyr Tydfil. Twelve percent of respondents reported illicit recreational drug use in the last year, and 7% in the last month. Among respondents aged under 25 years, 34% (39% of males and 31% of females) had used illicit drugs in the last year, and 19% (23% of males and 17% of females) in the last month. Twenty-one percent of respondents smoked (20% of males and 22% of females). Twenty-seven percent of respondents reported drinking more alcohol than currently recommended sensible limits (36% of males and 21% of females). Among respondents aged under 25 years, 53% of men and 38% of women drank over these limits. Illicit drug use was associated with heavy alcohol consumption and, in particular, with smoking. Smoking and heavy alcohol consumption combined was most strongly associated with illicit drug use. Rates of illicit recreational drug use were higher than have previously been reported for Wales. Illicit drug use and smoking varied with age, sex, work status and geographical location, whereas heavy alcohol consumption varied with age, sex and work status, but not geographical location. Both smoking and alcohol consumption were associated with illicit drug use, with smokers who were also heavy drinkers being those most likely to report illicit drug use.     

Midface reconstruction with the fibula free flap

OBJECTIVE: To evaluate the use, indications, and outcomes of the fibula osteocutaneous free flap when reconstructing the midface. DESIGN: Retrospective review of a case series. SETTING: Tertiary referral center. PATIENTS: We evaluated all patients requiring midface reconstruction after tumor resection between January 1, 1994, and January 1, 2000. Twenty-seven individuals who lacked sufficient retentive surfaces and/or teeth to support a conventional prosthesis were offered vascularized bony reconstruction. INTERVENTIONS: All patients underwent fibular osteocutaneous free flap reconstruction of the midface: 16 primarily, 11 secondarily. MAIN OUTCOME MEASURES: Success of free tissue transfer, perioperative complications, oral diet, speech, type of dental reconstruction, and cosmesis. RESULTS: Twenty-six of 27 flaps survived. Four patients had wound complications managed successfully with local wound care. Fourteen patients achieved a regular diet and 13 patients maintain a soft diet. Eighteen patients had osseointegrated implants placed, and 14 patients used an implant-borne prosthesis. Cosmetic results were judged to be excellent in 14 patients; good in 8; fair in 4; and poor in 1. CONCLUSIONS: Use of the fibula osteocutaneous free flap to reconstruct the midface is highly reliable and our flap of choice for lower maxillary defects requiring bony reconstruction. However, when orbitozygomatic support is the primary objective, the utility of this flap is limited. Because of the complexity of this procedure, the choice of midface reconstruction technique should be individualized for each patient.     

Parent-offspring resemblance for reading performance at 7, 12 and 16 years of age in the Colorado Adoption Project

BACKGROUND: The study aimed to conduct the first analysis of CAP parent-offspring resemblance for reading performance in children aged 7, 12 and 16 years, and to assess the etiology of individual differences in reading performance of children at 16 years of age. METHOD: The Reading Recognition subtest of the Peabody Individual Achievement Test was administered to children in the Colorado Adoption Project (CAP) at 7, 12 and 16 years of age, and to their adoptive and nonadoptive parents when the children were 7 years of age. RESULTS: Resulting parent-offspring correlations in adoptive families were not significant at any age, but correlations between scores of nonadoptive control parents and their offspring were significant at all three ages. CONCLUSIONS: Results obtained from behavioral genetic model-fitting analyses of data from parents and their children tested at age 16 are consistent with results of studies of twins and siblings indicating that individual differences in reading performance are due substantially to genetic influences. In contrast, environmental transmission from parents to offspring was negligible, suggesting that environmental influences on individual differences in the reading performance of children are largely independent of parental reading performance.     

Closing the loop: a spatial analysis to link observed environmental damage to predicted heavy metal emissions

In many cases, the link between industrial emissions and damage to the environment can only be inferred. The Environment Agency of the United Kingdom imposes emissions limits on industrial sites so that predicted concentrations and deposition rates remain below standard thresholds. Estimates of appropriate critical levels and loads are usually based on laboratory results and rarely estimate synergistic effects between pollutants or consider biological adaptation or selection in the target receptor organisms. The Avonmouth smelter has been emitting zinc and other heavy metals since 1929. It has been the subject of a number of detailed and synoptic studies, especially the impact on soil invertebrates. Damage was assessed using both physiological and ecological measurements. Two methods of spatial analysis were investigated, namely interpolation using standard geographical information system (GIS) operators and atmospheric dispersal modeling using an off-the-shelf model. Both methods can be used to compute contours (isolines) of predicted biological effect. Correlation results show that dispersal modeling is at least as good as kriging but requires much less data. This article demonstrates the usefulness of GIS and dispersal models as tools in decision making to determine the most suitable sampling sites in the assessment and monitoring of the impact of contamination around major point sources.     

Cigarette smoking and cognitive decline in midlife: evidence from a prospective birth cohort study

OBJECTIVES: The authors investigated the effects of cigarette smoking on midlife cognitive performance. METHODS: Multiple regression was used to test the association between cigarette smoking and changes in cognitive test scores among male and female members of the British 1946 birth cohort aged between 43 and 53 years. RESULTS: Smoking was associated with faster declines in verbal memory and with slower visual search speeds. These effects were largely accounted for by individuals who smoked more than 20 cigarettes per day and were independent of sex, socioeconomic status, previous (adolescent) cognitive ability, and a range of health indicators. CONCLUSIONS: The present results show that heavy smoking is associated with cognitive impairment and decline in midlife. Smokers who survive into later life may be at risk of clinically significant cognitive declines.     

Effect of antiproliferative agents on vascular function in normal and in vitro balloon-injured porcine coronary arteries

Local infusion of antiproliferative agents following coronary balloon angioplasty is used in vivo. This study examined the effects of the antiproliferative agents paclitaxel (5-beta, 20-Epoxy-1,2-alpha,4,7-beta,10-beta,13-alpha-Hexahydroxy-Tax-11-en-9-one 4,10-Diacetate 2_Benzoate 13-Ester with (2R,3S)-N-Benzoyl-3-Phenylisoserine; 10 and 50 microM), farnesyl protein transferase inhibitor III (FPT III, (E,E)-2-[2-Oxo-2-[(3,7,11-trimethyl-2,6,10-dodecatrienyl) oxy] amino] ethyl] phosphonic acid, (2,2-dimethyl-1-oxopropoxy) methyl ester, sodium); 10 and 25 microM), perillyl alcohol (4-isopropenyl-cyclohexenecarbinol; 1 and 2 mM) and Van 10/4 (Decahydro-1,1,4,7-tetramethyl-1H-cycloprop[e]azulen-4-o-[2-(3-methylpent-2-enoyl)-fucopyranoside]; 10 and 25 microM) on normal and in vitro balloon-injured porcine coronary arteries. Short-term (30 min) incubation had no effect on contraction or relaxation. Overnight incubation with 25 microM Van 10/4-attenuated contraction while perillyl alcohol abolished contractility completely. Endothelium-dependent relaxation was significantly attenuated by the higher concentration of paclitaxel, FPT III and Van 10/4. Stretch injury significantly enhanced sensitivity to 3-morpholinosydnonimine (SIN-1) while attenuating relaxation to calcimycin. Drug incubation (15 min) had no effect on these responses. In conclusion, paclitaxel, FPT III and Van 10/4 have no detrimental effects on vascular function after short-term administration to normal or stretch-injured arteries.     

Developmental typology of trajectories to nighttime bladder control: epidemiologic application of longitudinal latent class analysis

The authors aimed to characterize developmental trajectories to nighttime continence by applying two latent class models-longitudinal latent class analysis (LLCA) and latent class growth analysis (LCGA)-to data on nighttime bed-wetting from a population-based birth cohort, the Medical Research Council 1946 National Survey of Health and Development cohort. Data on a binary outcome (wetting in the past month vs. not wetting) were available for children at six ages (4, 6, 8, 9, 11, and 15 years) assessed in 1950, 1952, 1954, 1955, 1957, and 1961. For 3,272 children with complete data (62.5% of the cohort), results of sequential model comparisons (T classes vs. T + 1 classes) and chi-square goodness-of-fit tests were evaluated using parametric bootstrapping. At least four trajectory classes (LLCA and LCGA) were identified. Associations between class membership and the prevalence of related measures were examined using a confirmatory latent class analysis approach. Inclusion of 1,483 children with partially incomplete data (n = 4,755; 90.9% of the cohort) enabled the authors to refine trajectories further: normal development (prevalence = 84.0%); delayed acquisition of bladder control ("transient" (8.7%) and "persistent" (1.8%)), capturing primary enuresis; chronic bed-wetting (2.6%), or experiencing night wetting until age 15 years; and a final trajectory (relapse = 2.9%) capturing secondary or onset enuresis. This empirically based, typologic approach to analysis of extensive longitudinal data in a general population sample provides an alternative perspective to that offered by traditional diagnostic criteria.     

Assessing the accuracy of hospital admission and discharge diagnosis of traumatic brain injury in a New Zealand hospital

AIMS: To investigate the accuracy of admission and discharge coding of traumatic brain injury (TBI) in a New Zealand hospital. METHOD: Prospective study of all patients over fifteen years of age admitted to Hutt Hospital over a six-month period with an actual or potential diagnosis suggesting TBI. RESULTS: During the six month period of study, 65 patients with the diagnosis of TBI were admitted to Hutt Hospital. Of these, 21 (32.3%) met the criteria for diagnosis of TBI ('Definite TBI'). A further eighteen patients, not admitted with a diagnosis of TBI, met the TBI criteria. Only 14/39 (35.9%) of 'Definite TBI' cases were identified at both admission and discharge. Discharge diagnosis of TBI identified correctly 26/39 (66.7%) of definite cases, with 34/60 (56.7%) cases with a discharge diagnosis of TBI not meeting our criteria for the diagnosis of TBI. Six out of 39 'Definite TBI' cases (15.4%) were not identified by either admission or discharge diagnosis. Thirty of the 65 patients (46.2%) admitted to hospital with the diagnosis of TBI showed clinical evidence of having taken alcohol, although only 12 had blood alcohol concentration measured. CONCLUSIONS: The admission and discharge diagnoses of TBI were not accurate when compared to a standard definition of TBI. For hospital discharge data to have any value, agreement on an operational diagnosis of TBI needs to be made, which should include measurement of the blood alcohol concentration. A suggestion for a diagnostic strategy is presented, along with ICD-10-AM codes that could be used to improve the current situation.     

C-reactive protein (CRP) in early diagnosis of neonatal septicemia.

The usefulness of CRP in early detection of neonatal septicemia/meningitis and urinary tract infection was studied in a neonatal unit using a semiquantitative latex-agglutination as a rapid screening method, and electroimmuno assay as reference method for CRP determination. In 94% of non-infected infants CRP was less than or equal to 15 mg/l and 82% had CRP less than 10 mg/l up to 3 days of age. After 3 days of age 96% had CRP less than 10 mg/l. The initial CRP level was increased in 16 out of 18 patients (89%) with bacterial septicemia. Low CRP was seen in one patient with total agranulocytosis and septicemia from Streptococcus type B and in one patient with Staphylococcus albus sepsis. A rise in CRP was also seen in very pre-term infants with septicemia. Increased initial CRP was uncommon in neonatal urinary tract infection (2 of 9), but a rise was seen in 3 additional patients. A comparison between CRP, total neutrophil blood cell count and band neutrophil count as diagnostic parameters was in favour of CRP at this early stage of infection. CRP is of definite value as an aid in early diagnosis of neonatal septicemia and bacterial meningitis.