Economic difficulties and subsequent sleep problems: evidence from British and Finnish occupational cohorts

BackgroundSocial determinants of sleep may prove to be as important as health status. In this study we examined the extent to which persistent and changing economic difficulties are associated with sleep problems in two prospective occupational cohorts.MethodsWe used data from Finnish (baseline 2000–2002; follow-up 2007; n = 6328) and British (baseline 1997–1999; follow-up 2003–2004; n = 5002) public sector employees. Economic difficulties, sleep problems, and a variety of covariates were assessed at baseline and follow-up.ResultsPrevalence of frequent sleep problems at follow-up was 27% and 20% among women and men in the Finnish cohort, and 34% and 27% in the British cohort, respectively. Odds for sleep problems were higher among those with persistent economic difficulties (frequent economic difficulties at baseline and follow-up) compared to those with no difficulties. This association remained after multiple adjustments, including parental and current socioeconomic position, in the Finnish (OR 1.72, 95% CI 1.35–2.18) cohort. Increases in economic difficulties were similarly associated with sleep problems in the Finnish and the British cohort.ConclusionEvidence from two occupational cohorts suggests strong associations between economic difficulty and poor sleep. Awareness of this association will help health care professionals identify and prevent sleep problems.     

Cathepsin K deficiency aggravates lung injury in hyperoxia-exposed newborn mice

Cathepsin K (CatK) is a potent collagenase and elastase and may be involved in the development of neonatal bronchopulmonary dysplasia. The authors evaluated the effects of CatK deletion on neonatal lung development and response to prolonged hyperoxic challenge. CatK deficiency resulted in thinner alveolar walls than wild-type littermates on postnatal day (PN) 7. However, no morphological difference could be detected between CatK-deficient and control groups on PN 14. Exposure to 90% oxygen for 7 days after birth caused intensive CatK expression in the bronchial epithelium and alveolar macrophages of wild-type mice. Hyperoxia caused fatal respiratory distress in both groups of mice. However, whereas ～20% of wild-type mice survived for 2 weeks in hyperoxia, all CatK-deficient mice died within the first 9 postnatal days. Hyperoxia-exposed lungs of CatK-deficient mice contained high number of macrophages and multinucleated giant cells and had increased content of reduced glutathione, indicating intensified pulmonary oxidative stress. These results suggest that CatK is involved in pulmonary development and it may be an important host-defence protease in the oxygen-stressed newborn lung.     

Risk factors of sciatic pain: A prospective study among middle—aged employees

Objective: To study the effects of occupational class, physical and psychosocial working conditions, health behaviours, and pain in the low back and the neck on sciatic pain among middle‐aged employees. Methods: The participants were municipal employees without previous sciatica, aged 40, 45, 50, 55, and 60 years at baseline (n =5261, 80% women). Sciatica was defined as low back pain radiating to the calf or the foot. Data on occupational class, physical and psychosocial working conditions, body mass index, smoking, leisure‐time physical activity, neck pain, local low back pain, and sciatica were obtained from baseline questionnaire surveys in 2000–2002. The question on sciatica was repeated in a follow‐up survey in 2007. Logistic regression analysis was used. Results: In women, manual occupational class (OR 1.3; 95% CI 1.0–1.6 compared with managers/professionals), overweight (1.3; 1.1–1.5), obesity (1.4; 1.1–1.7), smoking (1.5; 1.2–1.7), low leisure‐time physical activity (1.3; 1.0–1.7), previous acute (1.5; 1.3–1.7) and chronic (1.5; 1.1–2.0) local low back pain, and acute (1.20; 1.0–1.4) and chronic (1.5;1.2–1.9) neck pain predicted the onset of sciatica in a multivariable model. In men, semi‐professionals (1.5; 1.1–2.1) and manual workers (2.0; 1.4–2.8) had an increased risk compared with managers/professionals; also acute (1.5; 1.2–2.0) and chronic (2.1; 1.2–3.9) local low back pain predicted sciatica. Conclusions: Manual occupational class in both genders and semi‐professional occupations in men, unhealthy behaviours and previous pain both in the neck and the lower back predicted sciatica, while physical and psychosocial working conditions had no independent effect.     

Endogenous protease inhibitor uptake within the graft during reperfusion in human liver transplantation

Background

In experimental liver transplantation, endogenous protease inhibitors alleviate ischemia–reperfusion (I/R) injury by inhibiting proteolysis and by direct anti-inflammatory actions. We described the kinetics of endogenous protease inhibitors and explored their anti-inflammatory potential during reperfusion and their effects on graft function in human liver transplantation.

Methods

We measured circulating levels of protease inhibitors (secretory leukocyte proteinase inhibitor, SLPI; tissue inhibitor of metalloproteinases-1, TIMP-1) and proteolytic enzymes (elastase; matrix metalloproteinase-9, MMP-9) with ELISA, and neutrophil and monocyte CD11b and l-selectin expression with flow cytometry during liver transplantation in ten patients. To assess changes within the graft during reperfusion, blood samples from portal and hepatic veins were obtained simultaneously.

Results

Circulating SLPI and TIMP-1 levels decreased during surgery. During initial reperfusion, the transhepatic SLPI gradient was ?27 (?35 to ?22) ng/ml, P = 0.005, and TIMP-1 ?510 (?636 to ?362) ng/ml, P = 0.005, indicating graft protease inhibitor uptake. Concomitantly, hepatic phagocyte activation and sequestration as well as elastase and MMP-9 release into the circulation occurred. The transhepatic SLPI gradient correlated with postoperative liver enzymes (ALT R = ?0.648, P = 0.043; ALP R = ?0.661, P = 0.038; bilirubin R = ?0.821, P = 0.004; GGT R = ?0.648, P = 0.043).

Conclusions

The results suggest a relative shortage of protease inhibitors within the liver during reperfusion, which may contribute to the development of graft injury.     

Gastroesophageal reflux patients' defective antioxidative capacity in the proximal esophageal mucosa before antireflux surgery and also after 4-year follow-up

BACKGROUND: Oxidative stress has a role in the pathogenesis of gastroesophageal reflux disease (GERD). AIM: To investigate the redox balance in proximal esophagus before and 6 and 48 months after antireflux surgery. METHODS: In 20 GERD patients and 9 controls oxidative stress by myeloperoxidase activity (MPO activity) and antioxidative capacity of esophageal mucosa by superoxide dismutase activity (SOD), and glutathione content (GSH) was measured from proximal esophageal samples. RESULTS: In proximal esophagus of GERD patients compared to controls', antioxidative capacity appearing as GSH level was significantly decreased (P < 0.001) at all time points and as SOD levels preoperatively (P < 0.001) and 4 years postoperatively (P = 0.01). MPO activity of patients was significantly lower than controls' preoperatively, and 6 months and 4 years postoperatively (P < 0.05). MPO activity remained lower than that of the distal esophagus at 6 months and 4 years (P < 0.01 for both). CONCLUSIONS: In GERD patients, proximal esophageal mucosal antioxidative defense is defective before and after antireflux surgery. Antireflux surgery seems not to change the level of oxidative stress in proximal esophagus, suggesting that defective mucosal antioxidative capacity plays a role in development of oxidative damage to the esophageal mucosa in GERD.     

Gene expression profiling reveals upregulation of Tlr4 receptors in Cckb receptor deficient mice

The cholecystokinin B (2) receptor knockout (Cckbr KO) protects against allodynia induced by chronic constriction injury (CCI). The mechanism of this phenomenon is unknown, but must involve persistent changes in pain modulation and/or inflammatory pathways. We performed a gene expression study in two brain areas (midbrain and medulla) after surgical induction of CCI in Cckbr KO and wild-type (wt) control mice. The patterns of gene expression differences suggest that the immune system is activated in higher brain structures following CCI in the wt mice. The strongest differences include genes related to the MAPK pathway activation and cytokine production. In Cckbr KO mice this expressional pattern was absent. In addition, we found significant elevation of the Toll-like receptor 4 (Tlr4) in the supraspinal structures of the mice with deleted Cckbr compared to wt control mice. This up-regulation is most likely induced by the deletion of Cckbr. We suggest that there is a functional deficiency in the Tlr4 pathway which disables the development of neuropathic pain in Cckbr KO mice. Indeed, real time PCR analysis detected a CCI-induced upregulation of Tlr4 and Il1b expression in the lumbar region of wt but not Cckbr KO mice. Gene expression profiling indicates that elements of the immune response are not activated in Cckbr KO mice following CCI. Our findings suggest that there may be a role for CCK in the regulation of innate immunity.     

Cancer after repair of esophageal atresia: population-based long-term follow-up

Objective

Esophageal atresia (EA) predisposes to gastroesophageal reflux that is associated with intestinal metaplasia and may result in development of adenocarcinoma of the esophagus. To date, the literature has reported 5 cases of esophageal cancer in adult patients treated for EA. The aim of this study was to find out the incidence of esophageal cancer in adult patients with repaired EA.

Patients and Methods

Five hundred two consecutive patients treated for EA from 1949 to 1978 were followed-up for cancer through the files of the population-based countrywide cancer registry from 1967 to 2004. The number of cancer cases observed and person-years at risk were counted, and the expected number of cancer cases estimated from the national cancer incidence rates. The standardized incidence ratios (SIRs) were calculated by dividing the number of cancer cases observed by the expected numbers.

Results

None of the 502 patients were lost to follow-up; 230 patients who died before 1967 younger than the median age of 8 days were excluded from further analysis. The 272 remaining patients (142 males) were eligible for follow-up (median age, 35 years; range, 2 days to 56 years). Three cases of cancer were found (SIR, 1.0; 95% confidence interval, 0.20-2.8). One was lymphoma in small intestine, 1 was leukemia, and 1 carcinoma of the uterus but no cases of esophageal cancer.

Conclusions

Our study is able to exclude long-term risk for esophageal cancer after repair of EA 500-fold higher than that of the normal population. Considering the relatively young age of the survivors, further studies and continued follow-up are warranted to elucidate risk for esophageal cancer and need for endoscopic surveillance after repair of EA.     

The efficacy of magnetic resonance imaging in acute multi-ligament injuries

This study compares MRI with examination under anaesthesia to surgical findings in evaluating soft tissue injuries in acute multi-ligament knee trauma. Pre-operative MRI was done for 44 patients who underwent surgery for grade III ACL and grade III medial collateral ligament (MCL) injury. In 21 cases both ACL and MCL were treated surgically, but in 23 only ACL. Intra-operative and MRI findings were compared. Accuracy of MRI for medial meniscal tears was 88.6%, sensitivity 80%, and specificity 91.2%; accuracy for lateral meniscal tears was 72.7%, sensitivity 55% and specificity 87.5%. Accuracy and sensitivity for severity of ACL tear was 93.2% and of MCL tear 86.4%. In 88.6% of the knees, bone bruises were visible, with anterolateral femoral and posterolateral tibial bone bruise being the most common. MRI revealed no chondral lesion, but arthroscopy revealed 11. In combined ACL–MCL ruptures, the incidence of concomitant injuries is high and the injuries are best detected with MRI.