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Annals of Allergy, Asthma and Immunology, Volume 97, Number 6, December 2006, pp. 794-799(6)
Vascular endothelial growth factor (VEGF) is a potent proangiogenic cytokine, and it also increases vascular permeability. It is well known that VEGF levels are increased in the airway of asthmatic patients. Hypoxia-inducible factor (HIF) induces a rapid and strong increase in VEGF expression.
A cross-sectional survey was undertaken using electronic records, direct interviews, and genotype determination of position 16 and 27 of the ADRB2 gene in DNA from mouthwash samples of 546 children and young asthmatics attending paediatric and young adult asthma clinics in Tayside, Scotland during 2004-05.
International Journal of Pediatric Otorhinolaryngology Volume 71, Issue 1 , January 2007, Pages 19-22
To investigate the relationship between adenotonsillar hypertrophy seen in pediatric obstructive sleep apnea and upper airway allergy to airborne allergens.
Respiratory viral infections profoundly influence the disease activity of wheezing illnesses and asthma in early childhood. Viral bronchiolitis shares many features with asthma and a subset of children develop recurrent wheezing after their initial illness.
Exacerbations of chronic obstructive pulmonary disease (COPD) have a high rate of mortality which gets worse with advancing age. It is unknown whether this is due to age related deficiencies in process of care.
Respirology, Volume 12, Number 1, January 2007, pp. 100-103(4)
Health-care workers (HCWs) are at higher risk of acquisition and transmission of respiratory virus infections. Nosocomial transmission of influenza has been documented but whether this is so for other respiratory viruses has not been assessed.
Several studies have demonstrated that long-acting beta-2-agonists such as salmeterol are beneficial in chronic obstructive pulmonary disease (COPD). A meta-analysis was therefore conducted to review studies in COPD to provide pooled estimates of the effect of salmeterol 50mcg taken twice daily in addition to usual therapy on several clinically relevant endpoints, when compared with placebo/usual therapy.
Respirology, Volume 12, Number 1, January 2007, pp. 117-121(5)
This study investigated whether treating acute exacerbations of COPD (AE-COPD) with levofloxacin modifies the long-term outcome of COPD patients in comparison with standard antibiotic regimens.
Asthma is a complex genetic disorder. Many studies have suggested that chromosome 12q harbours a susceptibility gene for asthma and atopy. Linkage on chromosome 12q24.21-q24.33 was investigated in 167 Danish families with asthma.
Acute chronic obstructive pulmonary disease (COPD) exacerbations use many hospital bed days and have a high rate of mortality. Previous audits have shown wide variability in the length of stay and mortality between units not explained by patient factors. This study aimed to explore associations between resources and organisation of care and patient outcomes
Clinical Microbiology & Infection, Volume 12, Number 12, December 2006, pp. 1214-1220(7)
This study analysed the consequences of deviation from the WHO case definition for the assessment of patients with suspected severe acute respiratory syndrome (SARS) in The Netherlands during 2003.
Xenon-enhanced computed tomography (Xe-CT) measures regional ventilation from changes in lung parenchymal CT density during the multibreath washin/washout of inhaled Xe gas. Because Xe is moderately soluble, vascular uptake and redistribution has been proposed as a confounding phenomenon.
The few studies concerning maximal static mouth respiratory pressures in patients with spinal cord lesions suggest a marked reduction. We studied the correlation of these parameters with the motor level of injury.
The prevalence and severity of chronic cough in the community is uncertain. In a large population of representative normal subjects, we explored the relationship between self-reported cough severity and frequency, and factors known to be related to the aetiology of chronic cough. In particular, we have examined the relative association between cough and symptoms of gastrointestinal disease.
A substantial number of adult patients with asthma are inadequately controlled despite the availability of effective asthma treatment. Patients and physicians seem to overestimate the level of asthma control.
Critical Care Medicine. 34(12):2959-2966, December 2006
To determine prevalence, risk factors, and effect on outcome of multiple-drug-resistant (MDR) bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease.
Journal of Sleep Research, Volume 15, Number 4, December 2006, pp. 430-436(7)
To study dream content in patients with severe obstructive sleep apnea syndrome (OSAS) and its modification with Continuous Positive Airway Pressure (CPAP) therapy.
Exogenous doses of 60 mg/kg 1-antitrypsin (AAT) every 7 days are recommended in patients with severe AAT deficiency. However, long term administration of weekly doses is not well accepted by patients. Using pharmacokinetic simulations, we evaluated whether steady state minimum concentrations of total AAT can be maintained above the threshold of 0.5 g/l with longer intervals between doses.
Fibroblastic focus (FF) is the typical histopathological feature of idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP). A study was undertaken to analyse FF at diagnosis, to analyse the histopathological findings at necropsy, and to examine their association with the course of the disease.
Asthma exacerbations are an exaggerated lower airway response to an environmental exposure. Respiratory virus infection is the most common environmental exposure to cause a severe asthma exacerbation. Airway inflammation is a key part of the lower airway response in asthma exacerbation, and occurs together with airflow obstruction and increased airway responsiveness.
A systematic review was undertaken to evaluate the efficacy of tiotropium, a long acting anticholinergic drug, on clinical events, symptom scales, pulmonary function, and adverse events in stable chronic obstructive pulmonary disease (COPD).
New England Journal of Medicine Volume 355:2609-2615 December 21, 2006 Number 25
Of the options available, the VA system offers the most comprehensive services for soldiers with TBI and "polytrauma" - including teams of specialists, mental health counseling for PTSD and social workers to support families, and an individualized treatment plan. Yet, like about 80% of soldiers recently discharged after returning from Iraq, Pepper and Emme have not enrolled as patients in the VA system.
Children who have experienced a perinatal stroke often develop normal language function, but the neurobiologic mechanisms underlying this plasticity remain unclear. In this study, we used fMRI to compare, at two ages, the functional neuroanatomy of a child with perinatal stroke with that of age-appropriate cohorts of typically developing children. Although the data for this child are similar to the control group, there are age-dependent differences.
We followed 419 patients with a first, unprovoked, primarily or secondarily generalized tonic-clonic seizure, randomized to immediate antiepileptic treatment or to treatment only in the event of seizure recurrence.
Neurologists have a professional opportunity, an ethical responsibility, and sound clinical and economic reasons for engaging in efforts to improve patient safety. Better communication with patients and other providers, closer follow-up of consultation cases, and more focused supervision of trainees will help to reduce current patterns of error and misunderstanding.
Over the last two decades, there has been a rapid expansion in the number and types of available antiepileptic drugs (AEDs), but there is increasing concern amongst parents and carers about their unwanted side effects.
Magnetic Resonance Imaging Volume 24, Issue 9 , November 2006, Pages 1167-1178
The purpose of this study was to design the steps necessary to create a tumor volume outline from the results of two automated multispectral magnetic resonance imaging segmentation methods and integrate these contours into radiation therapy treatment planning.
This article presents a case of bilateral posterior dislocations of the crystalline lens in a patient with epilepsy who presented with reduced vision and anisocoria 2 weeks after having sustained head injuries during a seizure.
A quarter of all patients presenting to emergency departments are children. Although there are several large, well-conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children.
Clinical trials from as early as the late 1970s have proven the efficacy of aspirin to prevent stroke in patients with a previous stroke. Doses as low as 30 mg per day and as high as 1300 mg per day have been shown to reduce stroke risk by 15-20%, regardless of cause.
Loss of motor function is common after stroke and leads to significant chronic disability. Stem cells are capable of self-renewal and of differentiating into multiple cell types, including neurones, glia, and vascular cells.
Acute distal aortic dissection rarely causes spinal cord ischemia presenting with paraplegia or paraparesis. Spinal cord involvement has poor outcomes, and there is no established effective treatment for this disorder. In this report we describe the acute conservative treatment of two cases of paraplegia/paraparesis due to acute type B aortic dissection.
Recanalization remains a major drawback in the endovascular treatment of intracranial aneurysms. Here, we report on our preliminary clinical experience with a new bioactive coil.
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1785-e1788
Several large outbreaks of enterovirus 71 infections have occurred in Taiwan during the past decade. Brainstem encephalitis was the most common neurologic complication. This study was designed to determine the long-term cognitive and motor outcomes of children with enterovirus 71 brainstem encephalitis.
Neurosurgery. 59(5) SUPPLEMENT:S3-163-S3-177, November 2006
NEUROENDOVASCULAR EMBOLIZATION REPRESENTS a critical component of the multidisciplinary management of cerebral arteriovenous malformations. Safe and effective embolization may be performed only in the context of a well-designed, rational treatment plan that is fundamentally based on a clear understanding of the natural history of the lesion, as well as the cumulative risks of multimodality treatment. This article outlines the role of neuroendovascular embolization in arteriovenous malformation therapy with a specific emphasis on decision making in the context of formulating a treatment plan.
This article is a comprehensive review of aphasia treatment studies for the purpose of investigating the relationship between time postonset of aphasia and response to treatment for aphasia in chronic patients at 1 year after symptom onset.
Desaturation during swallowing may help to identify aspiration in stroke patients. This study investigated pulse oximetry, bedside swallowing assessment (BSA), and videofluoroscopy as tests for detecting aspiration after stroke.
Respirology, Volume 12, Number 1, January 2007, pp. 34-41(8)
COPD is a multifactorial disease influenced by genetic and environmental factors, and gene-by-environmental interactions. There is considerable variability in the degree of airflow obstruction, moreover only 10-15% of chronic smokers develop COPD.
Journal of the American Academy of Child & Adolescent Psychiatry. 45(12):1494-1502, December 2006
This study tested a multilevel biobehavioral family model proposing that negative family emotional climate contributes to child depressive symptoms, which in turn contribute to asthma disease severity. Parent-child relational insecurity is proposed as a mediator.
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1715-e1720
The prevalence of asthma and asthma-related mortality has increased in recent years. Data suggest an association between psychiatric symptoms in the caregiver and asthma-related hospitalizations in the child. We examined the prevalence of psychiatric symptoms and disorders and their relationship to asthma-related service utilization in caregivers of children hospitalized for asthma.
Respirology, Volume 12, Number 1, January 2007, pp. 127-136(10)
Long-term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication.
The impact of ventilatory support on the natural history of neuromuscular disease (NMD) has become clearer over the last 2 decades as techniques have been more widely applied. Noninvasive ventilation (NIV) allows some patients with nonprogressive pathology to live to nearly normal life expectancy, extends survival by many years in patients with other conditions (eg, Duchenne muscular dystrophy), and in those patients with rapidly deteriorating disease (eg, amyotrophic lateral sclerosis) survival may be increased, but symptoms can be palliated even if mortality is not reduced.
American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 9-15, (2007)
To assess whether impaired neuromuscular transmission predisposes individuals to inspiratory upper airway collapse, we assessed supraglottic airway diameter and volume by respiratory-gated magnetic resonance imaging, upper airway dilator muscle function (genioglossus force and EMG), and changes in lung volume, respiratory timing, and peripheral muscle function before, during, and after partial neuromuscular blockade in healthy, awake volunteers.
The American Journal of Cardiology Volume 98, Issue 12 , 15 December 2006, Pages 1652-1655
In this study, myocardial performance index (MPI) was used to identify pulmonary embolism (PE) in patients with echocardiographic signs of pulmonary hypertension. One hundred patients with echocardiographic signs of pulmonary hypertension were enrolled in this study after informed consent was obtained.
The correlation between obesity and severity of obstructive sleep apnea (OSA) is well established in adults, but data are inconsistent in children. We hypothesized that there is a significant correlation between the degree of obesity and the severity of OSA in children.
Cognitive impairment frequently occurs in elderly COPD patients, but little is known about its prognostic implications. We aimed at evaluating the prognostic role of cognitive impairment in patients with severe COPD.
The purpose of this study was to determine whether quantitative pulmonary perfusion parameters obtained from 3D dynamic contrast-enhanced MR perfusion data can be used to assess the severity of primary pulmonary hypertension (PPH) as indicated by pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP).
Upper airway (UA) patency during inspiration is determined by the balance between dilating forces generated by UA dilator muscle activity and collapsing forces related to the decreased intraluminal pressure that accompanies flow generated by inspiratory muscle activity. It is possible that the relative strengths of UA dilator and inspiratory pump muscles could be an important determinant of the susceptibility to UA collapse during sleep (ie, obstructive sleep apnea [OSA]).
The extent to which patients with obstructive lung disease receive recommended processes of care is largely unknown. We assessed the quality of care delivered to a national sample of the US population.
American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 62-68, (2007)
We tested the hypothesis that antioxidant treatment modulates the ventilatory response to carbon dioxide in healthy humans, either during unloaded breathing or after strenuous resistive breathing.
American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 16-21, (2007)
To investigate the associations between maternal complications and procedures in pregnancy and at birth and the risk of various wheezing phenotypes in young children.
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1822-e1830
In settings with limited assessment tools, we sought to determine whether early clinical signs and symptoms and blood oxygen saturation would predict amoxicillin treatment failure in children with severe pneumonia (as defined by the World Health Organization).
Asthma patients’ perceptions of triggers have been explored in a largely unstructured fashion in the past. We therefore developed and validated a questionnaire of commonly perceived asthma triggers.
Respirology, Volume 12, Number 1, January 2007, pp. 111-116(6)
The major cost of managing community-acquired pneumonia (CAP) relates to the duration i.v. antibiotic use and length of hospital stay (LOS). Guidelines on early switch to oral antibiotics and early discharge from hospital may help to achieve a unified approach to managing CAP. The aim of this study was to assess the benefits and safety of these guidelines in an Australian respiratory medicine unit.
The distal airways are likely to contribute to asthma pathobiology and symptoms but have rarely been specifically evaluated in relation to systemic oral therapy. We hypothesized that treatment with montelukast, an oral cysteinyl-leukotriene receptor antagonist, would improve both proximal and distal lung physiology in patients with mild asthma.
The present requirement for "at facility" polysomnograms requires many residents in mountain communities to descend in elevation for sleep testing, which may cause misleading results regarding the severity of obstructive sleep apnea (OSA).
To evaluate whether the incidence of recurrent venous thromboembolism (VTE) events after therapy differs for patients treated with long-term low-molecular-weight heparin (LMWH) or oral anticoagulant therapy (OAT).
Overactivation of nuclear factor kB (NF-kB) orchestrates airway eosinophilia, but does not dampen airway hyperresponsiveness in asthma. NF-kB repression by arsenic trioxide (As2O3) contributes to apoptosis of eosinophils (EOS) in airways.
Adult-derived bone marrow stem cells are capable of reconstituting the haematopoietic system. However there is ongoing debate in the literature as to whether bone marrow derived cells have the ability to populate other tissues and express tissue specific markers. The airway has been an organ of major interest and was one of the first where this was demonstrated.
Survival remains an issue in pulmonary hypertension, a chronic disorder that often affects aged human adults. In young adult mice and rats, chronic 50% hypoxia (11% FIO2 or 0.5 atm) induces pulmonary hypertension without threatening life. In this framework, oral dehydroepiandrosterone was recently shown to prevent and reverse pulmonary hypertension in rats within a few weeks.
Giant bullae can be complicated by respiratory tract infection in the setting of emphysema. Herein we describe a technique of palliative decompression of the bullae that gives time to treat acute pulmonary infection prior to definitive surgical treatment.
Respirology, Volume 12, Number 1, January 2007, pp. 93-99(7)
The present study was performed to examine the occurrence of dynamic hyperinflation following hyperventilation in COPD patients and former smokers without COPD, and the efficacy of short-acting anticholinergic agents (SAAC) and B2-agonists (SABA) for lung hyperinflation following metronome-paced hyperventilation in COPD.
To determine whether parents' observation, clinical examination, and lateral upper airway radiograph are useful in detecting clinically significant obstructive sleep apnea
(OSA) in children.
Pharmacogenetics offers the potential to optimize treatment for individual patients by using genetic information to improve efficacy or avoid side effects. While there are a number of examples in which the approach is already in routine clinical usage, exploitation of this approach in asthma is still under development. A number of examples of possible pharmacogenetic approaches that may prove of value in the management of asthma are discussed.
The aim of this study was to examine the relationship between EBC cys-LTs (LTE4) levels and bronchial hyperreactivity in children with mild asthma in order to evaluate the clinical utility of measuring EBC cys-LTs levels.
Journal of Pharmacy and Pharmacology, Volume 58, Number 11, November 2006, pp. 1553-1557(5)
Non-invasive ventilation (NIV) is used to treat acute respiratory failure. Nebulised drugs can be delivered concurrently with NIV or during breaks from ventilatory support. We hypothesised that the amount of nebulised salbutamol inhaled when delivered via bi-level ventilation would be no different to the amount available directly from the same nebuliser.
Airflow limitation is found in some patients with sarcoidosis, and it is associated with a poor prognosis. The aim of this study was to investigate clinical and radiographic indices associated with airflow limitation in patients with sarcoidosis.
The mechanism responsible for chronic hypercapnic respiratory failure (HRF) in patients with COPD remains unclear. In this study, we tested the hypothesis that chronic HRF in patients with COPD is associated with low-frequency fatigue (LFF) of the diaphragm.
Home mechanical ventilation (HMV) and long-term oxygen therapy (LTOT) are the two treatment alternatives when treating respiratory insufficiency in patients with kyphoscoliosis. We aimed to study the effect on survival with regard to HMV or LTOT alone in patients with respiratory insufficiency due to kyphoscoliosis.
Although the treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) has been shown to be effective, nightly adherence to treatment remains poor. The objective of this study was to examine the degree to which various levels of PAP therapy adherence normalized verbal memory function after 3 months of therapy in patients with OSA who were memory-impaired prior to the initiation of PAP therapy.
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2418-2423
Although bronchiolitis is the leading cause of hospitalization for infants, there are limited data describing the epidemiology of bronchiolitis hospitalizations, and the associated cost is unknown. Our objective was to determine nationally representative estimates of the frequency of bronchiolitis hospitalizations and its associated costs.
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