Over the last 25 years, teenage smoking has been decreasing across Europe, particularly in wealthier countries and those with strong tobacco control legislation and regulation. We examine trends in 30-day smoking among adolescents in Ireland and Europe from 1995-2020. Ireland has participated in 7 data collection waves of ESPAD (European Schools Project for Alcohol and Other Drugs) between 1995 and 2019, during which time more than 500,000 students completed questionnaires on substance use, including cigarette smoking. In 2019, some 100,000 students participated in ESPAD and, in Ireland, 1,967 students, born in 2003, were surveyed from a stratified random sample of 50 Irish schools. We compare prevalence and gender differences in the Irish and European samples at different time points from 1995 to 2019. In Ireland and across Europe, total prevalence of 30-day smoking decreased significantly between 1995 and 2019. Ireland’s decrease (from 41% to 14%) was more dramatic than the European average (32% to 20%). Ireland’s current prevalence is lower than the European average. However, while there was a decline of 5% in the European average between 2015 and 2019, Ireland’s decreasing trend reversed, accounted for by an increase in male smoking from 13% to 14%. Trend analyses of current smoking prevalence between 1995-2019 show that decreases in teenage smoking in Europe during this time were neither homogenous nor uni-directional. In Ireland, after two decades of consistent decreases, smoking increased in 15-16-year-olds in 2019 for the first time in 25 years. Further focused action is urgently needed to achieve Ireland’s targeted prevalence of 5% by 2025 and to address geographical and gender disparities in teenage smoking prevalence in Europe.

Smoking is higher among lower social-economic groups (SES). Parental educational attainment, as a proxy for SES, has been found to be inversely associated with teenage substance use, with lower parental education associated with higher risk of substance use, including smoking. In Ireland, repeated multivariable analyses have not established a link between parental education and smoking. This study examined parental educational attainment and teenage smoking and e-cigarette use. A nationally stratified random sample of 50 schools in Ireland was surveyed in 2019, part of the European School Survey Project on Alcohol and other Drugs (ESPAD), with 3,495 students aged 15, 16, and 17. Multivariable logistic regression analyses were performed using Stata version 16. In Ireland, teenage e-cigarette ever-use increased from 23% (2015) to 37% (2019) and current use from 10% (2015) to 18% (2019). Both teenage e-cigarette ever-users and current users were more likely to have higher-educated parents. Children of university-educated mothers had significantly higher odds of e-cigarette ever-use (AOR=3.46; 95% CI:1.40–8.54) while children of university-educated parents had significantly higher odds of e-cigarette current use (maternal higher education: AOR=27.54, 95% CI:1.50–505.77, paternal higher education: AOR=2.44, 95% CI:1.00–5.91). Unlike cigarette smoking, higher parental education is not a protective factor for e-cigarette use. Rather, children of higher-educated are more likely to be e-cigarette users. Ireland has a high proportion of younger university-educated parents who may benefit from targeted health education interventions about e-cigarette use and teenager health and smoking.

Children whose parents smoke are more likely to become smokers than those whose parents do not smoke, but association with teenagers’ e-cigarette use is uncertain. We examine whether childhood exposure to parental smoking (primary caregiver) increases the risk of subsequent teenage smoking and e-cigarette use at age 17/18. We use data from 6,216 teenagers and their parents/caregivers from Waves 1-3 of the longitudinal Growing up in Ireland (GUI) Cohort 98’ Study. Parental smoking was assessed at baseline (2008, children age 9 years) and at wave 2 (2012/2013, children age 13 years). Data on teenage smoking and e-cigarette use at 17/18 years were collected in wave 3 (2017/2018). Logistic regression analysis was used to examine the impact of caregivers’ smoking on teenage smoking and e-cigarette use, controlling for confounding variables. After adjusting for other exposures known to be associated with teenage substance use, exposure to primary caregiver smoking at waves 1 and 2 was associated with higher odds of teenage ever-smoking (AOR:1.51, 95% CI:1.32 to 1.72 for wave 1 and AOR:1.48, 95% CI:1.30 to 1.69 for wave 2), current smoking (AOR:1.51, 95% CI:1.29 to 1.78 for wave 1 and AOR:1.54, 95% CI:1.31 to 1.79 for wave 2), and e-cigarette ever-use (AOR:1.55, 95% CI:1.35 to 1.78 for wave 1 and AOR:1.53, 95% CI:1.34 to 1.75 for wave 2). 17-18 year-olds exposed at ages 10 and 14 to parental smoking were more likely to report higher ever- and current smoking, and e-cigarette ever-use. The finding that exposure to parental smoking in childhood and early teens increases the risk of teen e-cigarette use as well as smoking is new, and suggests a need for interventions aimed at parents who smoke.

Despite a high initial response rate to first-line platinum/paclitaxel chemotherapy, most women with epithelial ovarian cancer relapse with recurrent disease that becomes refractory to further cytotoxic treatment. We have previously shown that the E3 ubiquitin ligase, EDD, a regulator of DNA damage responses, is amplified and overexpressed in serous ovarian carcinoma. Given that DNA damage pathways are linked to platinum resistance, the aim of this study was to determine if EDD expression was associated with disease recurrence and platinum sensitivity in serous ovarian cancer. High nuclear EDD expression, as determined by immunohistochemistry in a cohort of 151 women with serous ovarian carcinoma, was associated with an approximately two-fold increased risk of disease recurrence and death in patients who initially responded to first-line chemotherapy, independently of disease stage and suboptimal debulking. Although EDD expression was not directly correlated with relative cisplatin sensitivity of ovarian cancer cell lines, sensitivity to cisplatin was partially restored in platinum-resistant A2780-cp70 ovarian cancer cells following siRNA-mediated knockdown of EDD expression. These results identify EDD as a new independent prognostic marker for outcome in serous ovarian cancer, and suggest that pathways involving EDD, including DNA damage responses, may represent new therapeutic targets for chemoresistant ovarian cancer.

Recent work suggests that between 50 and 75% of small-cell lung cancer (SCLC) tumours have specific high-affinity binding sites for somatostatin. This study evaluated the potential role of the radiolabelled somatostatin analogue, [111In]pentetreotide, in the detection and staging of SCLC in patients prior to and after chemotherapy using scintigraphic imaging techniques. Thirteen patients were studied prior to chemotherapy. Following standard staging six patients had limited stage disease and seven extensive disease. [111In]pentetreotide imaging led to the detection of all primary sites of disease, including a primary site of disease not detectable with chest radiograph or computerised tomography (CT) of the thorax. Five of ten metastatic sites detected by standard staging were also imaged. Furthermore, a cerebellar metastasis was detected in a patient thought to have disease confined to the right hemithorax. This was subsequently confirmed with a CT brain scan. Following chemotherapy [111In]pentetreotide imaging detected residual intrathoracic disease in two of three patients with complete remissions by standard staging and in two patients who had had a partial response to chemotherapy. These results suggest that [111In]pentetreotide imaging may have a role to play in the clinical evaluation of patients with SCLC. Specifically, this technique may be of particular value in detecting residual intrathoracic disease in patients thought to be in complete remission by conventional staging methods.

Neuroendocrine tumours are characterised by the expression of high affinity binding sites for somatostatin. The detection of bronchial carcinoid tumours through scintigraphic imaging is described in two patients using the novel radiolabelled somatostatin analogue indium-111 pentetreotide.

Pleural aspergillosis is rare, usually occurring in seriously ill adults against a background of tuberculosis and chronic bronchopleural fistulas.'We present a case occurring in a child that differs in many respects from previously reported cases. Case reportA 14 year old boy complained of malaise, anorexia, a dry cough, and right sided chest discomfort of three weeks' duration.He was referred for a chest radiograph, which showed a large right sided hydropneumothorax with cav- itation at the apex of the right lung.The chest radiograph taken after insertion of a chest drain is shown in figure 1.He had been in good health until aged 11 years, when two weeks after BCG vaccination he was admitted to hospital with a severe right sided pneumonia with associated cavitation, ab- scess formation, and a small pleural effusion.At that time routine cultures, Ziehl-Neelsen stains, and culture for Mycobacterium tuberculosis were negative.A presumptive diagnosis of staphylococcal pneumonia was made and he responded to ampicillin and cloxacillin; pleural intubation was not performed.His sweat sodium concentration was normal.He was well during the next 18 months, serial radiographs showing residual pneumatocoeles in the right upper lobe and apical segment of the right lower lobe.During the next two years, after discharge from regular attendance at the paediatric clinic, he had remained reasonably well.On examination he was thin and pale, but afebrile and in no acute distress.His trachea was deviated to the left and there was stony dullness on percussion over the right mid and lower chest zones.General examination revealed no other abnormality.The haemoglobin concentration was 13 g/dl and the white cell count 7-4 x 109/l with a normal differential count.A Mantoux test gave a strongly positive reaction at 1 TU strength.Fluid removed by pleural aspiration was cloudy, cytological examination showing 85% polymorphonuclear leucocytes and no malignant cells.The protein concentration was 36 g/l.Gram stains, Ziehl-Neelsen stains, and cultures for pyogenic organisms and for M tuberculosis from various sites were repeatedly negative.Closed pleural biopsy showed histiocytes but no granu- lomas, fungi, or acid fast bacilli.No fungal elements were

Serious complications of pneumococcal pneumonia have become uncommon. This has been attributed to decline in pneumococcal infection (van Roy et al. 1971; Foy et al. 1975), but in this country it is more likely to be due to effective antibiotic therapy. We report a case of pneumococcal pneumonia with severe complications (including a very unusual one) which probably arose through antibiotic failure.

We have studied arterial PO2, PCO2, and hydrogen ion and electroencephalogram during sleep in 10 patients with stable severe chronic respiratory failure. As a group the patients slept badly. Sleep was associated with a worsening of hypoxia and no significant change in PCO2 and H+. Two patients were restudied, receiving oxygen therapy overnight. Both had improved sleep but one, who had an intact hypoxic drive to breathing, developed marked hypercapnia and acidosis when his PO2 was restored to normal during sleep; the other, who had no hypoxic drive to breathing, developed no more hypercapnia or acidosis during sleep when breathing oxygen than when breathing air. Oxygen therapy may improve sleep disturbance in these patients, but its effect on the drive to breathing during sleep should be considered if severe hypercapnia and acidosis are to be avoided.

Intravenous infusion of salbutamol 10 mug/min in seven healthy subjects significantly increased their ventilatory responses to inhaled CO2 in both hypoxia and hyperoxia. These changes in chemical control of breathing are unlikely to be significant when the drug is used in severe asthma but may benefit patients with acute exacerbations of chronic ventilatory failure. The infusion also increased heart rate, which was most pronounced when hypoxia was combined with hypercapnia. The infusion produced an average fall in plasma potassium from 3-99 to 3-10 mmol/l, which was associated with an increase in plasma glucose and serum insulin, suggesting that this arose from a shift of potassium from the extracellular to the intracellular space. Routine monitoring of plasma potassium and the electrocardiogram is indicated when an intravenous salbutamol infusion is used to treat severe asthma as the drug may predispose to cardiac dysrhythmias.