bluuebunny/crossref_metadata_2025 huggingface dataset:
Sparfloxacin in the treatment of drug resistant tuberculosis or intolerance of first line therapy
Authors: Lubasch A. , Erbes R. , Mauch H. , Lode H.
Published: October 2002

Patients with multiresistant tuberculosis (TB) and patients with intolerance of first line antituberculosis drugs present a major treatment problem. Sparfloxacin is highly active against mycobacteria, but the use is restricted by side effects and the contribution to antituberculosis therapy is unclear. A prospective study has therefore been performed to analyse the efficacy and tolerability of sparfloxacin in cases of resistant TB or intolerance of first line therapy.

Between April 1993 and April 1999, 30 TB patients (28 with pulmonary TB and two with lymph node TB) were treated with combinations of sparfloxacin and at least two other drugs at the Chest Hospital Heckeshorn, Berlin. Sixteen patients were infected by resistant mycobacteria (one single drug resistance (SDR), one polyresistance, and 14 multidrug resistances (MDR); 14 males (age range 23–53 yrs), 2 females (68–74 yrs)). Twelve patients (11 males, one female, 27–80 yrs) had not tolerated first line antituberculosis drugs. Two additional male patients had continuous proof ofMycobacterium tuberculosisin sputum without resistance during therapy

The duration of sparfloxacin therapy during hospitalization ranged 2.5–4 months. Twenty-five patients completed therapy and were cured according to this study's definition. Although sparfloxacin was generally well tolerated, five mild phototoxic reactions and six moderate prolongations of the electrocardiographic QT-interval (30–40 ms compared to baseline ≤450 ms) were registered without clinical symptoms in the patient group.

In summary, sparfloxacin proved an effective and safe alternative antituberculosis drug for complicated tuberculosis.
Oxygen desaturation on the six-minute walk test and mortality in untreated primary pulmonary hypertension
Authors: Paciocco G. , Martinez F.J. , Bossone E. , Pielsticker E. , Gillespie B. , Rubenfire M.
Published: October 2002

There are no reliable predictors of mortality in primary pulmonary hypertension (PPH). This study assessed whether exercise oxygen desaturation and distance achieved during a six-minute walk are associated with mortality in moderately symptomatic patients with PPH.

Thirty-four patients with PPH underwent a pretreatment six-minute walk test, and an invasive haemodynamic assessment of pulmonary vasodilator reserve, to select the best treatment option (epoprostenol in 27 and nifedipine in 7). Median follow-up was 26 months (12 months for the nonsurvivors was 26%), and median survival, >46 months by Kaplan-Maier estimate.

The mean±sd distance walked was 275±155 m and reduction in arterial oxygen saturation (Sa,O2) at maximal distance (ΔSa,O2) was 8.4±4.5%. A distance ≤300 m increased mortality risk by 2.4, and a ΔSa,O2of ≥10 % increased mortality risk by 2.9. OnlySa,O2at peak distance, ΔSa,O2and pulmonary vascular resistance (PVR) were related to mortality. After adjusting for PVR, there remained a 27% increase in risk of death for each per cent decrease inSa,O2.

The six-minute walk distance and exercise oxygen saturation may be helpful in selecting patients with primary pulmonary hypertension for whom transplant listing is appropriate.
Prognostic significance of p53 and bcl-2 abnormalities in operable non-small cell lung cancer
Authors: Laudanski J. , Niklinska W. , Burzykowski T. , Chyczewski L. , Niklinski J.
Published: October 2002

The association of p53 abnormalities and bcl-2 protein expression with clinical data and prognosis in 102 patients with resected non-small cell lung cancer (NSCLC) was investigated.

Deoxyribonucleic acid analysis of exons 5–8 of the p53 gene showed mutations (p53-M) in 47% of resected NSCLC, serum p53 antibodies (p53-Abs) were detected in 25%, p53 protein overexpression (p53-PE) in 54% and bcl-2 protein overexpression (bcl-2-PE) in 48%. A statistically significant association was found between p53-PE, serum p53-Abs and the presence of a p53 gene alteration. No significant associations were found between results of the p53-M, p53-Abs, bcl-2-PE tests and clinicopathological parameters. In the case of the p53-PE test there were significantly fewer positive results for adenocarcinoma than for squamous cell carcinoma and large cell carcinoma.

Survival analysis showed that both p53 abnormalities and negative staining for bcl-2, when analysed separately, were associated with poor overall survival. In a multivariate analysis, only the positive result of the p53-M test remained an independent, statistically significant, unfavourable prognostic factor for survival. When the p53 mutation test was removed from the model, positive results of the p53-PE test and the p53-Abs test became statistically significant, unfavourable prognostic factors.

To conclude, among p53 and bcl-2 abnormalities, only p53 gene mutations seem to have a strong and independent effect on prognosis. When deoxyribonucleic acid sequence information is not available, p53 protein expression and the presence of p53 antibodies in serum may be used to obtain important prognostic information.
Respiratory symptoms in European animal farmers
Authors: Radon K. , Danuser B. , Iversen M. , Jörres R. , Monso E. , Opravil U. , Weber C. , Donham K.J. , Nowak D.
Published: October 2002

Farmers are known to be at high risk for the development of occupational airway disease. The aim of this European study was to determine which airway symptoms predominate in different types of animal farmers (cattle, pigs, poultry, sheep) and to compare the prevalence of symptoms to the general population.

A total of 6,156 randomly selected animal farmers in Denmark, Germany (Schleswig-Holstein, Niedersachsen), Switzerland, and Spain completed a questionnaire on respiratory symptoms and farming characteristics in 1995–1997. The prevalence of general respiratory symptoms was compared to the results of the European Community Respiratory Health Survey (ECRHS) obtained in the same regions.

Pig farmers were at highest risk for the development of work-related symptoms. A significant dose-response relationship between daily hours worked inside animal houses and symptoms was established for pig and poultry farmers. Additionally, self-reported nasal allergies (odds ratio (95% confidence interval): 3.92 (3.26–4.71)) and nasal irritation during work (3.98 (3.35–4.73)) were shown to be associated with the development of chronic phlegm. The prevalence of wheezing, shortness of breath, asthma and nasal allergies was signficantly lower among all farmers in the age group 20–44 yrs than among the general population. However, the prevalence of usually bringing up phlegm in winter among farmers was significantly higher than in the general population (9.4 (8.3–10.5%)versus7.5 (6.5–8.5%)).

Individual factors have been shown to be related to the prevalence of chronic phlegm among farmers. Additionally, this study could support the hypothesis that farming could be negatively related to allergic diseases.
The use of positive pressure devices by physiotherapists
Authors: Denehy L. , Berney S.
Published: October 2002

The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included.

The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness.

The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems.

Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.
Outcome of COPD patients with mild daytime hypoxaemia with or without sleep-related oxygen desaturation
Authors: Chaouat A. , Weitzenblum E. , Kessler R. , Schott R. , Charpentier C. , Levi-Valensi P. , Zielinski J. , Delaunois L. , Cornudella R. , Moutinho dos Santos J.
Published: October 2002

The aim of the present study was to compare the evolution of pulmonary haemodynamics and of arterial blood gases in chronic obstructive pulmonary disease (COPD) patients with mild-to-moderate hypoxaemia, with or without sleep-related oxygen desaturation.

COPD patients with daytime arterial oxygen partial pressure in the range 56–69 mmHg were included prospectively. Sleep-related oxygen desaturation was defined as spending ≥30% of the nocturnal recording time with arterial oxygen saturation <90%.

From the 64 patients included, 35 were desaturators (group 1) and 29 were nondesaturators (group 2). At baseline (t0), patients with sleep-related desaturation had a significantly higher daytime (mean±sd) arterial carbon dioxide partial pressure (Pa,CO2) (44.9±4.9 mmHgversus41.0±4.1 mmHg, p=0.001) whereas mean pulmonary artery pressure (mPAP) was similar in the two groups. After 2 yrs (t2) of follow-up, 22 desaturators and 14 nondesaturators could be re-evaluated, including pulmonary haemodynamic measurements. None of the nondesaturator patients became desaturators att2. The difference between the two groups in terms of daytimePa,CO2was still present att2. The mean changes in mPAP fromt0tot2were similar between the two groups, as were the rates of death or requirement for long-term oxygen therapy (American Thoracic Society criteria) during follow-up of up to 6 yrs.

The presence of sleep-related oxygen desaturation is not a transitional state before the worsening of daytime arterial blood gases, but is a characteristic of some chronic obstructive pulmonary disease patients who have a higher daytime arterial carbon dioxide partial pressure. Such isolated nocturnal hypoxaemia or sleep-related worsening of moderate daytime hypoxaemia does not appear to favour the development of pulmonary hypertension, nor to lead to worsening of daytime blood gases.
Diesel exhaust enhances airway responsiveness in asthmatic subjects
Authors: Nordenhäll C. , Pourazar J. , Ledin M-C. , Levin J-O. , Sandström T. , Ädelroth E.
Published: October 2002

Particulate matter (PM) pollution has been associated with negative health effects, including exacerbations of asthma following exposure to PM peaks. The aim of the present study was to investigate the effects of short-term exposure to diesel exhaust (DE) in asthmatics, by specifically addressing the effects on airway hyperresponsiveness, lung function and airway inflammation.

Fourteen nonsmoking, atopic asthmatics with stable disease, on continuous treatment with inhaled corticosteroids, were included. All were hyperresponsive to methacholine. Each subject was exposed to DE (particles with a 50% cut-off aerodynamic diameter of 10 µm (PM10) 300 µg·m−3) and air during 1 h on two separate occasions. Lung function was measured before and immediately after the exposures. Sputum induction was performed 6 h, and methacholine inhalation test 24 h, after each exposure.

Exposure to DE was associated with a significant increase in the degree of hyperresponsiveness, as compared to after air, of 0.97 doubling concentrations at 24 h after exposure (p<0.001). DE also induced a significant increase in airway resistance (p=0.004) and in sputum levels of interleukin (IL)-6 (p=0.048). No changes were detected in sputum levels of methyl-histamine, eosinophil cationic protein, myeloperoxidase and IL-8.

This study indicated that short-term exposure to diesel exhaust, equal to high ambient levels of particulate matter, is associated with adverse effects in asthmatic airways, even in the presence of inhaled corticosteroid therapy. The increase in airway responsiveness may provide an important link to epidemiological findings of exacerbations of asthma following exposure to particulate matter.
The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease
Authors: Dumortier P. , Göcmen A. , Laurent K. , Manço A. , De Vuyst P.
Published: October 2002

Environmental exposure to tremolite and erionite causes endemic diseases of the lung and pleura in Turkey. This study aimed to evaluate the impact of these exposures and further occupational exposures on fibre-related diseases in Turkish immigrants living in Belgium.

The study included 51 males and 17 females that emigrated <1–38 yrs ago. Most of them (n=46) had nonmalignant pleural lesions, one had asbestosis and one had mesothelioma. Environmental asbestos exposure was likely for the majority of patients (60%), but there were also reports of possible occupational asbestos (n=14) and erionite (n=2) exposure.

Tremolite was the main fibre type in bronchoalveolar lavage fluid (BALF). Elevated concentrations of amosite or crocidolite were detected in only two patients. The delay elapsed since the end of the environmental exposure had no influence on the asbestos body or the tremolite fibre concentrations in the BALF of Turkish immigrants.

Most fibre-related diseases in Turkish immigrants are probably due to environmental rather than occupational exposure. Precise information about geographical origin and occupation should be obtained when investigating these patients. Mineralogical analysis of bronchoalveolar lavage fluid gives valuable information on the type and intensity of exposure, especially in patients with both environmental and occupational exposure.
Expression of discoidin domain receptor 1 tyrosine kinase on the human bronchial epithelium
Authors: Sakamoto O. , Suga M. , Suda T. , Ando M.
Published: October 2002

Discoidin domain receptor 1 (DDR1) tyrosine kinases constitute a novel family of receptors characterized by a unique structure in the ectodomain (discoidin-I domain). The DDR1 ligand is the extracellular matrix protein collagen.

To identify receptor tyrosine kinases (RTKs) involved in control of growth and differentiation of human bronchial epithelial (HBE) cells, a polymerase chain reaction-based search for RTKs in HBE cells was performed. DDR1 was the most abundant clone identified. Northern analysis detected a 3.6 kb DDR1 messenger ribonucleic acid (mRNA) expressed in HBE cells and transformed HBE lines, BET-1A and BEAS-2B. In addition, fluorescence-activated cell sorter (FACS) analyses using an anti-DDR1 antibody showed that DDR1 was expressed on HBE cells and two HBE lines.

Immunohistochemical staining using human bronchial tissue demonstrated that DDR1 was mainly expressed at the basolateral cell surface of the bronchial epithelium. Furthermore, immunostaining of type IV collagen, a major component of the basement membrane, clearly showed that the basement membrane was closely attached to the basal surface of the bronchial epithelium.

Since collagen binds to and activates discoidin domain receptor 1 tyrosine kinase, colocalization of discoidin domain receptor 1 and its ligand type IV collagen demonstrates a potential interaction of discoidin domain receptor 1 on the bronchial epithelium with type IV collagen. Further study of this interaction may define the functional significance of the collagen-discoidin domain receptor 1 signalling pathway in health and in disease.
Importance of sleep stage- and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy
Authors: Sériès F. , Marc I.
Published: October 2002

The influence of sleep stage- and body position-dependence of sleep apnoea on treatment efficacy and compliance between conventional continuous positive airway pressure (CPAP) and auto CPAP therapy was evaluated.

Thirty-three newly treated sleep apnoea hypopnoea syndrome (SAHS) patients were randomly allocated to conventional or auto-CPAP therapy. Six patients of each treatment group were classified as having sleep stage- and body position-dependent obstructive breathing abnormalities according to the results of the baseline sleep study.

After 3 weeks of treatment, the Epworth sleepiness score tended to be higher (p=0.08) and the ability to stay awake lower (p=0.02) in patients with dependent breathing abnormalities treated with fixed CPAP, than in the other patients. The effective pressure/time index was significantly lower in sleep stage- and body position-dependent patients treated with fixed CPAP, than in the other patients (p=0.02). The number of hours the machine was turned on and a positive pressure applied, tended to be smaller in dependent patients treated with fixed CPAP than in independent patients of this treatment group and in patients treated with auto-CPAP. A night-to-night variability index (VI) of positive pressure changes was obtained in the auto-CPAP group. This index significantly decreased with time in the dependent patients while it remained unchanged in the independent group.

It is concluded that auto-continuous positive airway pressure may have specific indications in a subset of obstructive sleep apnoea patients with sleep stage- and body position dependent nocturnal breathing abnormalities.
Lung cancer in patients with idiopathic pulmonary fibrosis
Authors: Park J. , Kim D.S. , Shim T.S. , Lim C-M. , Koh Y. , Lee S.D. , Kim W.S. , Kim W.D. , Lee J.S. , Song K.S.
Published: October 2002

Idiopathic pulmonary fibrosis (IPF) was reported to be associated with increased risk of lung cancer as a result of the occurrence of atypical or dysplastic epithelial changes in fibrosis which progressed to invasive malignancy. In that situation, the cancer will develop in the area of major fibrosis. To investigate the direct relationship between fibrosis and cancer development, the real concordance rate of the two lesions in the chest computed tomography (CT) was analysed and compared to the histological types of lung cancer.

The subjects included 63 patients with combined lung cancer and IPF (IPF-CA), 218 patients with lone IPF, and 2,660 patients with primary lung cancer. All patients were diagnosed at Asan Medical Center during the same period.

The age, percentage of smokers, and the male sex were significantly higher in IPF-CA compared with lone IPF. The odds ratio of smoking was 2.71 compared to nonsmoking IPF controls. In IPF-CA, 56% of the cancer was located in the periphery of the lung and 52% in the upper lobe. The majority of the cancers (64%) were found in the nonfibrotic area at chest CT. The most frequent cell type was squamous cell carcinoma (35%), and there was no significant difference in the cancer cell type between IPF-CA and total lung cancer population.

These findings suggest that in combined lung cancer and idiopathic pulmonary fibrosis patients, the features of the lung cancer are similar to the total lung cancer population.
Changes in bronchial inflammation during acute exacerbations of chronic bronchitis
Authors: Gompertz S. , O'Brien C. , Bayley D.L. , Hill S.L. , Stockley R.A.
Published: October 2002

There are little data describing noncellular changes in bronchial inflammation during exacerbations of chronic bronchitis. The relationship between sputum colour and airway inflammation at presentation has been assessed during an exacerbation in patients with chronic bronchitis and a primary care diagnosis of chronic obstructive pulmonary disease.

Sputum myeloperoxidase, neutrophil elastase, leukotriene B4(LTB4), interleukin-8 (IL-8), sol:serum albumin ratio and serum C-reactive protein were measured in patients presenting with an exacerbation and mucoid (n=27) or purulent sputum (n=42).

Mucoid exacerbations were associated with little bronchial or systemic inflammation at presentation, and sputum bacteriology was similar to that obtained in the stable state. Purulent exacerbations were associated with marked bronchial and systemic inflammation (p<0.025 for all features) and positive sputum cultures (90%). Resolution was related to a significant reduction in LTB4(p<0.01), but no change in IL-8, suggesting that LTB4may be more important in neutrophil recruitment in these mild, purulent exacerbations. In the stable state, IL-8 remained higher in patients who had experienced a purulent exacerbation (2p<0.02).

The presented results indicate that exacerbations of chronic bronchitis, defined by sputum colour, differ in the degree of bronchial and systemic inflammation. Purulent exacerbations are related to bacterial infection, and are associated with increased neutrophilic inflammation and increased leukotriene B4concentrations.
Effects of ventilation, humidity and temperature on airway responsiveness to methacholine in rats
Authors: Arantes-Costa F.M. , Zoriki S. , Santos M.H.C. , Kobata C.H.P. , Vieira J.E. , Martins M.A.
Published: October 2002

Exercise-induced bronchoconstriction is associated with heat and water loss from the airways. It is not known whether these conditions can influence the response to bronchoactive agonists. The effects of different degrees of alveolar ventilation on the pulmonary response to methacholine and the role of humidity and temperature in this response were evaluated.

Wistar rats were anaesthetized, tracheostomized and mechanically ventilated. Increasing doses of methacholine were infused intravenously and respiratory system resistance (Rrs) and elastance (Ers) were measured. The rats were ventilated with dry air at 13°C, dry air at 37°C, humid air at 13°C and humid air at 37°C. These four groups were further divided into three subgroups with a respiratory frequency adjusted to reach a carbon dioxide tension in arterial blood of 30, 40 and 50 mmHg.

Temperature, humidity and level of alveolar ventilation did not influence the position of the dose/response curve to methacholine. However, the maximal changes inErswere significantly lower in the rats ventilated with humid air. In addition, maximal changes inErswere significantly higher in the rats with lower alveolar ventilation. These differences were not observed for maximal values ofRrs.

The pulmonary response to methacholine in normal rats is significantly affected by the humidity of inspired air and the level of alveolar ventilation. This influence is more intense in the small airways and/or distal airspaces. This suggests that exercise or hyperventilation can change the behaviour of airway smooth muscle.
Occupational asthma caused by chloramines in indoor swimming-pool air
Authors: Thickett K.M. , McCoach J.S. , Gerber J.M. , Sadhra S. , Burge P.S.
Published: October 2002

The first series of three workers who developed occupational asthma following exposure to airborne chloramines in indoor chlorinated swimming pools is reported. Health problems of swimmers in indoor pools have traditionally been attributed to the chlorine in the water. Chlorine reacts with bodily proteins to form chloramines; the most volatile and prevalent in the air above swimming pools is nitrogen trichloride.

Two lifeguards and one swimming teacher with symptoms suggestive of occupational asthma kept 2-hourly measurements of peak expiratory flow at home and at work, analysed using the occupational asthma system (OASYS) plotter, and/or had specific bronchial challenge testing to nitrogen trichloride, or a workplace challenge.

Air measurement in one of the pools showed the nitrogen trichloride levels to be 0.1−0.57 mg·m−3, which was similar to other studies. Two workers had peak expiratory flow measurements showing occupational asthma (OASYS-2 scores 2.88 and 3.8), both had a positive specific challenge to nitrogen trichloride at 0.5 mg·m−3with negative challenges to chlorine released from sodium hypochlorite. The third worker had a positive workplace challenge.

Swimming-pool asthma due to airborne nitrogen trichloride can occur in workers who do not enter the water because of this chloramine. The air above indoor swimming pools therefore needs to be assessed and managed as carefully as the water.
Evaluating the effects of asthma therapy on childhood growth: principles of study design
Authors: Price J. , Hindmarsh P. , Hughes S. , Efthimiou J.
Published: October 2002

Inhaled corticosteroids have been established as the most effective treatment for childhood asthma. However, concerns persist regarding their potential effects on growth and, most importantly, final height.

To assess their effects on growth, inhaled corticosteroids can be compared with placebo (type 1 study), nonsteroidal anti-asthma therapy (type 2 study), another inhaled corticosteroid (type 3 study) or “real-life” anti-asthma therapy (type 4 study). Owing to the difficulties in obtaining final height data, several different surrogate measures have often been used: short-term lower leg growth, longer-term statural height growth velocity, childhood height and predicted final height.

This paper discusses the choice of end point, key trial design issues (including selection and number of subjects in the active and control populations) duration of assessments and methods for measuring height and data analysis, in the context of the different study types.

Specific study design recommendations have been developed after consideration of these factors, and these principles will be used to guide the interpretation of previously published growth studies.
Iodixanol inhibits exogenous surfactant therapy in rats with acute respiratory distress syndrome
Authors: Kesecioglu J. , Schultz M.J. , Haitsma J.J. , den Heeten G.J. , Lachmann B.
Published: October 2002

Optimal alveolar distribution of exogenous surfactant is an important determinant of its beneficial effect. This distribution can be determined by suspending surfactant in a radiological contrast medium before intratracheal instillation, followed by radiological imaging. Iodixanol is reported to be a safe contrast medium that causes no lung injury when instilled intratracheally.

In this study, the effects of surfactant suspended in saline were compared with surfactant suspended either in 4:1 saline-iodixanol (64 mg iodine·mL−1) or in 1:1 saline-iodixanol (160 mg iodine·mL−1), on oxygenation and lung mechanics in a rat model of adult respiratory distress syndrome (ARDS) induced by lung lavage.

After the induction of ARDS, surfactant instillation improved oxygenation, total lung volume at inflation with a distending pressure of 35 cmH2O, lung volume at transpulmonary pressure of 5 cmH2O and Gruenwald index. The effects of surfactant suspended in 4:1 saline-iodixanol were similar to those of surfactant alone. However, instillation of surfactant suspended in 1:1 saline-iodixanol resulted in significantly lower values in all measured parameters. Surface tension was the lowest in surfactant suspended in saline alone and addition of iodixanol led to an increase in surface tension in a dose-dependent manner.

In conclusion, iodixanol at the higher dose caused an inhibition of the exogenous surfactant effect, characterized as a lack of improvement in oxygen tension in arterial blood, low total lung compliance, volume at 5 cmH2O end-expiration and Gruenwald index. This effect of iodixanol was probably due to its high surface tension, especially if a high concentration was used. Surfactant suspended in a lower concentration of iodixanol seems a better alternative, allowing for radiological imaging of the distribution of surfactant when intratracheally instilled.
Fluticasone propionate attenuates platelet-activating factor-induced gas exchange defects in mild asthma
Authors: Acuña A.A. , Gabrijelcic J. , Uribe E.M. , Rabinovich R. , Roca J. , Barberà J.A. , Chung K.F. , Rodriguez-Roisin R.
Published: October 2002

Inhaled glucocorticosteroids may reduce airway mucosal oedema in acute asthma. Inhaled platelet-activating factor (PAF) provokes pulmonary gas exchange disturbances, similar to those shown in severe asthma, which may be due to increased airway plasma leakage.

This randomized, double-blind, placebo-controlled, crossover study investigated the effects of high doses of inhaled fluticasone propionate (FP) in 12 patients with mild asthma before and after PAF inhalation. Patients were studied before and 12 h after inhaling FP (6 mg) or placebo (P), and then at 5, 15 and 45 min after PAF challenge.

Compared with vehicle, FP inhaled before PAF improved forced expiratory volume in one second and respiratory system resistance (Rrs), increased peripheral blood neutrophils and reduced eosinophil counts. After PAF, FP enhanced transient neutropenia at 5 min and facilitated the recovery of oxygen tension in arterial blood (FP: 93±4 mmHg; P: 83±4 mmHg) at 45 min, without influencing the increases inRrs.

In conclusion, the improvement of platelet-activated factor-induced oxygen tension in arterial blood disturbances after fluticasone proprionate suggests that inhaled glucocorticosteroids may possess vasoconstrictor properties in the pulmonary circulation.
Evaluating the effects of asthma therapy on childhood growth: what can be learnt from the published literature?
Authors: Price J. , Hindmarsh P. , Hughes S. , Efthimiou J.
Published: October 2002

The difficulties of assessing the effects of asthma therapy on childhood growth were explored in the first part of this review. In this part of the review growth studies with inhaled corticosteroids were selected that included a control group, measured height by stadiometry and were of ≥1 yr duration. The studies were classified as type 1 (placebo control), type 2 (nonsteroidal therapy control), type 3 (comparator inhaled corticosteroid control) or type 4 (“real-life” studies with dose adjustment). The design attributes of these studies were then compared with the recommendations described in the first part of this review. Of the 18 studies identified, 17 were susceptible to one or more important confounding factors. Nevertheless, the outcomes of all 18 studies were mostly consistent.

At recommended doses, beclomethasone dipropionate and budesonide demonstrated a small degree of growth suppression over 1–2 yrs (study types 1 and 2), but there was little evidence of such an effect with fluticasone propionate. Studies comparing different inhaled corticosteroids at recommended doses indicated more rapid growth with fluticasone propionate than with beclomethasone dipropionate or budesonide. However, none of the inhaled corticosteroids appeared to affect final height.

In conclusion, the results from the majority of published growth studies with inhaled corticosteroids must be interpreted with a degree of caution owing to their potential susceptibility to important confounding factors. Further well-designed studies are needed to establish whether different inhaled corticosteroids have different effects on growth in the long term.
Where to perform noninvasive ventilation?
Authors: Elliott M.W. , Confalonieri M. , Nava S.
Published: October 2002

Noninvasive positive-pressure ventilation (NPPV) has been shown to be a means of reducing the need for endotracheal intubation, which when effective reduces the complication rate and improves outcome. Because paralysis and sedation are not needed and because the patient is not necessarily dependent upon a machine for respiration, ventilation outside the intensive care unit (ICU) is an option. A number of studies have shown that NPPV for acute exacerbations of chronic obstructive pulmonary disease (COPD) can be effective in the non-ICU environment, though usually in patients with less severe exacerbations. However, there have been no direct comparisons of the application of NPPV in different locations.

The likelihood of success of the technique is an important factor in deciding where NPPV should be performed. Ready access to invasive ventilation is important when NPPV is not indicated from the outset or fails after an initial trial. In acute exacerbations of COPD, NPPV is less likely to be successful the more severe the exacerbation, as measured by the severity of acidosis. Good tolerance of NPPV, which translates into an improvement in pH and a fall in respiratory rate, predicts a successful outcome and is a useful way of monitoring progress.

NPPV has been shown to be cost effective both in the ICU and when performed on general wards. A dedicated intermediate care unit with particular expertise in noninvasive modes of ventilation may provide the best environment, both in terms of outcome, but also cost effectiveness.

The ideal location for noninvasive positive-pressure ventilation will vary from country to country and indeed from hospital to hospital, depending upon local factors. However, the most important factor is that staff be adequately trained in the technique and be available throughout the 24-h period.
Maximal response plateau to methacholine as a reliable index for reducing inhaled budesonide in moderate asthma
Authors: Prieto L , Gutierrez V , Morales C
Published: October 2002

Although some studies suggest that asthma deteriorates after reducing inhaled steroids, results of long-term studies indicate that this might not be true for all patients. The aim of this study was to determine the utility of the detection of a plateau on the concentration-response curves to inhaled methacholine as a marker for safely reducing the dose of inhaled budesonide in asthmatic patients who are well-controlled with a moderately high dose of this inhaled steroid. A total of 46 patients with moderate asthma, well-controlled for at least 6 months by treatment with 800 microg budesonide daily, were included in the study. Subjects were treated for a 2-week run-in period with their usual dose of budesonide. At the end of the run-in, all subjects were challenged with methacholine (0.095-200 mg x mL(-1)). Plateau responses, median effective concentration values, slopes and provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1) values were measured. For the subsequent 12 weeks, patients were treated in an open design with budesonide at a reduced dose (200 microg once daily), and were asked to record their peak expiratory flow (PEF) in the morning and in the evening. In addition, asthma symptoms and use of rescue terbutaline were recorded in diaries. Plateaus were present in 24 patients, whereas 22 subjects showed concentration-response curves without evidence of a plateau. Ten patients in the nonplateau group deteriorated after reducing inhaled budesonide, compared to one patient in the plateau group (p = 0.002). In the nonplateau group, FEV1 decreased from a baseline value of 3.28+/-0.19 L to 2.94+/-0.20 L at week 12 (p<0.0001). Likewise, morning PEF decreased from 419+/-19 L x min(-1) at baseline to 394+/-19 L x min(-1) at week 12 (p = 0.02). By contrast, these variables remained unchanged in the plateau group. In conclusion, in asthmatic patients, well-controlled with a moderately high dose of budesonide, the detection of a plateau on the concentration-response curve to inhaled methacholine may be used as a marker for safely reducing the corticosteroid dose.
STRAIN‐WAVE SHAPES IN ROCK NEAR EXPLOSIONS
Authors: Duvall Wilbur I.
Published: October 2002

The shapes of displacement, velocity, acceleration and strain‐wave pulses in solid elastic media near a spherical cavity in which the applied pressure pulse is of the general form [Formula: see text] have been calculated. The computed strain‐wave pulse shapes at various distances from the cavity are compared with typical experimentally recorded strain‐wave pulses and are shown to have similar characteristics. The shapes of the wave pulses, that is, the rise time, pulse width, etc., are shown to be functions of the applied pressure pulse, the distance from the cavity and the properties of the solid medium.
CHANNEL WAVES AS A TOOL OF APPLIED GEOPHYSICS IN COAL MINING
Authors: Krey Theodore C.
Published: October 2002

A well‐known difficulty in coal mining is the unexpected occurrence of minor faults, by which the seams are displaced by only one or a few meters. It is practically impossible to predict such faults from geophysical surveys on the surface of the earth. However, as coal normally has a very low velocity and, also, only a small density compared to the neighboring rocks, channel waves along the seams are theoretically possible as will be shown. Such channel waves have been successfully produced and recorded by underground seismic work within a German coal mine. Moreover, a reflection from a known minor fault could clearly be observed.
Radon transform wave field separation for vertical seismic profiling data
Authors: Moon Wooil , Carswell Allan , Tang Roger , Dilliston Chris
Published: October 2002

The data obtained by the vertical seismic profiling (VSP) method require unique processing before interpretation. An important step is the separation of upgoing and downgoing signals by application of an f-k velocity filter and muting of the direct wave. Similarly, if the VSP section is transformed to the p-τ plane, the upgoing and downgoing wave fields become separable because they map to different p-τ quadrants according to their dips. This allows either wave field to be reconstructed by application of the inverse Radon transform after windowing in the p-τ plane. Results obtained by the Radon transform wave field separation (RTWS) method are similar to those obtained by f-k velocity filtering. However, by implementing an amplitude‐ratio testing filter in the forward slant stack, the quality of the reconstructed wave field is much improved. For a specific range of p-stack values in the forward transform, this filter sorts and removes the unwanted events from the desired ones by testing their consistency in stack amplitudes. Synthetic examples of separating the upgoing wave field from a full VSP wave field by both methods are presented.
Generalized compact gravity inversion
Authors: Barbosa Valeria Cristina F. , Silva João B. C.
Published: October 2002

Extending the compact gravity inversion technique by incorporating a priori information about the maximum compactness of the anomalous sources along several axes provides versatility. Thus, the method may also incorporate information about limits in the axes lengths or greater concentration of mass along one or more directions. The judicious combination of different constraints on the anomalous mass distribution allows the introduction of several kinds of a priori information about the (arbitrary) shape of the sources. This method is particularly applicable to constant, linear density sources such as mineralizations along faults and intruded sills, dikes, and laccoliths in a sedimentary basin. The correct source density must be known with a maximum uncertainty of 40 percent; otherwise, the inversion produces thicker bodies for densities smaller than the true value and vice‐versa. Because of the limitations of the inverse gravity problem, the proposed technique requires an empirical technique to analyze the sensitivity of solutions to uncertainties in the a priori information. The proposed technique is based on a finite number of acceptable solutions, presumably representative of the ambiguity region. By using standard statistical techniques, each parameter is assigned a coefficient measuring its uncertainty. The known hematite and magnetite ore body shape, in the vicinity of Iron Mountain, MO, was reproduced quite well using this inversion technique.
Magnetotelluric delineation of the Trillabelle massive sulfide body in Sudbury, Ontario
Authors: Livelybrooks D. , Mareschal M. , Blais E. , Smith J. T.
Published: October 2002

A magnetotelluric (MT) survey was carried out on the western flank of the Sudbury Structure (Ontario, Canada) over a recently discovered ore body to test the potential of the method as a reconnaissance tool for deep mineral exploration. The observed responses exhibit a large phase anomaly (exceeding 75° in some places) centered over the ore body, which is interpreted as arising from a combination of 3-D induction and current channeling. Impedance decomposition methods were used to define frequency ranges in which the response is quasi 2-D with geologically plausible strike values. Two‐dimensional rapid relaxation inversions of the data, where appropriate, generated quantitative models in good agreement with known parameters of the ore body. Two‐dimensional inversions, however, cannot replicate either the size or the peculiar nature of the observed phase anomaly. Therefore 3-D modeling trials were undertaken, which best explain the MT responses in terms of 3-D induction within the Trillabelle body coupled with current channeling through neighboring faults. An important conclusion of these trials is that isolated, deep, highly conductive ore bodies may not be observable using MT. Prospects for their detection appear to improve when they are linked with regional, current gathering features such as conductive faults, or a larger‐scale, alteration or dissemination halo.
THE PRODUCTION OF ELASTIC WAVES BY EXPLOSION PRESSURES. I. THEORY AND EMPIRICAL FIELD OBSERVATIONS
Authors: Sharpe Joseph A.
Published: October 2002

A solution to the problem of the wave motion produced when a pressure of arbitrary form is applied to the interior surface of a spherical cavity in an ideally elastic medium is derived. This solution is shown to be in qualitative agreement with a number of field observations of the effect of shot‐point conditions on the characteristics of reflection seismograph recordings.
Applying predictive control to a fossil-fired power station
Authors: Rossiter J. A. , Neal P. W. , Yao L.
Published: October 2002

Traditionally PID control has been used for the control of boiler plant on large fossil-fired power stations. With the requirement for such plant to operate ‘exibly rather than as base-load stations the duties imposed on the control loops have become more onerous. This paper presents the results of investigations into the potential of generalized predictive control as an alternative to PID. Due to limitations on computational load inherent in many power plant control systems, the constraint handling facility had to be modified. A suitable algorithm is developed and illustrated on a high order nonlinear test case. The algorithm is then implemented on coal-fired plant and is seen to give a marginal improvement in the accuracy of the control, but with much reduced control activity.
Clinical outcomes of on-pump coronary bypass using heparin-bonded circuits and reduced anti-coagulation compare favorably with off-pump approach
Authors: O’Gara Paul J , Natarajan Vijay , Lilly Kevin , Husain Ali , Shapira Oz M , Shemin Richard J
Published: October 2002

Coronary artery bypass grafting (CABG) without cardio-pulmonary bypass (CPB), or off pump, has gained popularity by avoiding the postoperative morbidity related to the use of CPB. Previously, we have demonstrated that CABG done on pump using heparin-bonded cardiopulmonary bypass circuits (HBC) with a lower anti-coagulation protocol (LAP) attenuates these effects, reduces homologous blood product requirement, and improves clinical outcome when compared with conventional CPB circuits. Our purpose in this study was to compare off-pump CABG clinical outcomes to on-pump CABG using HBC with LAP. We retrospectively analysed preoperative and postoperative variables of all primary CABG ( n= 1214) performed at this institution from 1 January 1997 to 28 July 2000. These patients were divided into the on-pump ( n= 1152) and off-pump groups ( n= 62). HBC with LAP were used in all on-pump CABG cases. There was no statistical difference in preoperative comorbid risk factors except percentage of females (on pump, 30% vs. off pump, 44%; p= 0.02) and body surface area (on pump, 1.94± 0.25 ml vs. off pump, 1.85± 0.22 ml; p= 0.02). There was no difference in intraoperative and postoperative complications, risk-adjusted mortality, total blood product usage, or length of stay. The mean number of distal anastomoses performed was significantly different (on pump, 3.5± 0.82 vs. off pump 1.8± 0.82; p < 0.001). Despite similar preoperative risk factors, clinical outcomes and homologous blood requirements were not statistically different between the off-pump and on-pump groups. These endpoints should not be the only criteria to justify performing off-pump CABG.
Neuroprotection during cardiac surgery: strategies to reduce cognitive decline
Authors: Whitaker D C , Stygall J , Newman S P
Published: October 2002

Although the population receiving cardiac surgery is older and therefore more prone to cognitive deterioration, these difficulties have declined over the last ten years. It is likely that the multiple changes introduced to cardiac surgery over time have had a cumulative benefit in protecting the brain. The most likely causes of cognitive difficulties are microemboli delivered to the brain during surgery, altered cerebral perfusion and an inflammatory response. The interventions that have been implemented can be divided into those which have attempted to reduce the potential causes of damage and those aimed at reducing the impact by attempting to protect the brain. The evidence for three main types of intervention (equipment, techniques and drugs) is reviewed in this paper. Although many interventions are available only a few have shown a clear benefit. Progress in the future will require larger studies to address this multifactorial problem.
A comparative study of Mini-Mental Test, Clock Drawing Task and Cognitive-FIM in evaluating functional outcome of elderly hip fracture patients
Authors: Adunsky A , Fleissig Y , Levenkrohn S , Arad M , Noy S
Published: October 2002

Objective: To compare the clock drawing task with other cognitive tests used for the prediction of discharge functional outcome, in elderly hip fracture patients.

Design: Cohort study. Setting: A department of geriatric-orthopaedic rehabilitation of a tertiary hospital.

Patients: One hundred and forty-three consecutive patients undergoing inpatient comprehensive rehabilitation following hip fracture. Measurements: Cognitive status was assessed by the Clock Drawing Task, Mini-Mental State Examination (MMSE) and the Cognitive-FIM (cognFIM). Functional status outcome was evaluated by the Functional Independence Measure (FIM), using absolute and relative parameters of ef”cacy and ef”ciency.

Results: Correlation coef”cients (Pearson correlation) between the three cognitive tests resulted in values ranging from 0.607 to 0.732 ( p < 0.001). Similar correlation coef”cients were observed for all cognitive tests when correlated with relative ef”cacy and ef”ciency outcome parameters ( p < 0.001), but not with absolute outcome parameters.

Conclusions: Clock Drawing Test is similar to Mini-Mental and Cognitive-FIM with respect to the evaluation of functional status outcome following rehabilitation of hip fractures. The similar correlations with functional outcome parameters as well as the simplicity of administration favour the use of either Clock Drawing Task or MMSE in the initial assessment of elderly patients with hip fractures.
Measuring perceived activity limitations in lower extremity Complex Regional Pain Syndrome type 1 (CRPS I): test-retest reliability of two questionnaires
Authors: Perez Roberto SGM , Roorda Leo D , Zuurmond Wouter WA , Bannink Ilse IMJ , Vranken Jan H , de Lange Jaap J
Published: October 2002

Objective: To assess the test–retest reliability of two questionnaires for measuring activity limitations in patients with Complex Regional Pain Syndrome type 1 (CRPS I) of the lower extremity.

Design: Patients filled out the Walking Stairs Questionnaire and the Questionnaire Rising and Sitting Down twice during a one-week period.

Setting: Outpatient pain clinic of a university hospital.

Patients: Twenty-one outpatients with CRPS I of the lower extremity.

Results: The Walking Stairs Questionnaire and the Questionnaire Rising and Sitting Down were reliable in terms of test–retest reliability as expressed by Spearman's r (range 0.79–0.90 and 0.85–0.89 respectively) and the ICC (range 0.78–0.84 and 0.84–0.87 respectively).

Conclusion: Both questionnaires form a reliable tool for measuring activity limitations of patients with CRPS I of a lower extremity.