bluuebunny/crossref_metadata_2025 huggingface dataset:
Glutamine-Enriched Enteral Nutrition in Very Low-Birth-Weight Infants: Effect on the Incidence of Allergic and Infectious Diseases in the First Year of Life
Authors: Kim Jennifer S.
Published: October 2008

van den Berg A, van Zwol A, Moll HA, Fetter WP, van Elburg RM. Arch Pediatr Adolesc Med. 2007;161(11):1095–1101

PURPOSE OF THE STUDY. To determine the effect of glutamine-enriched enteral nutrition in very low birth weight infants on the incidence of allergic and infectious diseases during the first year of life. The authors hypothesized that glutamine may enhance maturation of the immune response by shifting the fetal T-helper 2 (Th2) response toward Th1 cytokine responses in early infancy, leading to decreased allergic disease later in life.

STUDY POPULATION. Infants with a gestational age of <32 weeks and/or birth weight of <1500 g who were admitted to a level III NICU were randomly assigned to receive enteral glutamine or control (l-alanine) supplementation.

METHODS. Enteral glutamine supplementation (l-glutamine, 0.3 g/kg per day) was administered to the intervention group from 3 through 30 days of life. Validated questionnaires were later sent to the parents of all eligible children, when they were a corrected age of 1 year, to assess the incidence of allergic and infectious diseases during the child's first year of life. Bronchial hyperreactivity was defined by report of at least 3 of the following physician-diagnosed symptoms: dyspnea, wheezing, humming/sawing breath sounds, or nightly dry cough without rhinitis.

RESULTS. Of 90 eligible infants, 77 participated (response rate: 86%). The risk for atopic dermatitis (AD) was lower in the glutamine-supplemented group (odds ratio: 0.13 [95% confidence interval: 0.02–0.97]). However, other outcomes did not differ between the intervention and control groups, such as incidence of bronchial hyperreactivity, upper respiratory tract infections, lower respiratory tract infections, and gastrointestinal infections.

CONCLUSIONS. Glutamine-enriched enteral nutrition in very low birth weight infants decreased the incidence of AD during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of life.

REVIEWER COMMENTS. The sample size was relatively small and was not powered sufficiently, specifically to assess the incidence of bronchial hyperreactivity. Moreover, the corrected age of 1 year is too early for assessing the incidence of development of atopy and infections. Therefore, it is unclear as to whether AD was prevented or simply delayed in onset among this cohort.
Platelet-Activating Factor, PAF Acetylhydrolase, and Severe Anaphylaxis
Authors: Smart Brian A.
Published: October 2008

Vadas P, Gold M, Perelman B, et al. N Engl J Med. 2008;358(1):28–35

PURPOSE OF THE STUDY. To characterize the roles of platelet-activating factor (PAF) and PAF acetylhydrolase, the enzyme that inactivates PAF, in humans.

STUDY POPULATION. The population was a variety of pediatric and adult patients with different levels of allergic disease along with nonallergic controls.

METHODS. Serum PAF levels and activity of PAF acetylhydrolase were measured in 41 patients with anaphylaxis and in 23 control patients. Serum PAF acetylhydrolase activity was also measured in 9 patients with peanut allergy who had fatal anaphylaxis and compared with that in 26 nonallergic pediatric control patients, 49 nonallergic adult control patients, 63 children with mild peanut allergy, 24 patients with nonfatal anaphylaxis, 10 children who died of nonanaphylactic causes, 15 children with life-threatening asthma, and 19 children with non–life-threatening asthma.

RESULTS. Mean serum PAF levels were significantly higher in patients with anaphylaxis than in patients in the control groups and were correlated with the severity of anaphylaxis. The proportion of subjects with elevated PAF levels increased from 4% in the control groups to 20% in the group with grade 1 anaphylaxis, 71% in the group with grade 2 anaphylaxis, and 100% in the group with grade 3 anaphylaxis. There was an inverse correlation between PAF levels and serum PAF acetylhydrolase activity. The proportion of patients with low PAF acetylhydrolase activity increased with the severity of anaphylaxis. Serum PAF acetylhydrolase activity was significantly lower in patients with fatal peanut anaphylaxis than in control patients.

CONCLUSIONS. Serum PAF levels were directly correlated and serum PAF acetylhydrolase activity was inversely correlated with the severity of anaphylaxis. PAF acetylhydrolase activity was significantly lower in patients with fatal anaphylactic reactions to peanuts than in patients in any of the control groups. Failure of PAF acetylhydrolase to inactivate PAF may contribute to the severity of anaphylaxis.

REVIEWER COMMENTS. PAF is 1 of the proinflammatory mediators that are released systemically by the degranulation of mast cells and basophils. Although PAF is not the only mediator that plays a role in anaphylaxis, these results suggest that PAF is very important. Therefore, it may be useful to develop new pharmaceutical agents that block its actions. Additional research is also needed to determine if PAF and PAF acetylhydrolase measurements may be used as a screening tool to select patients at highest risk for fatal anaphylaxis.
Health Plan Notification and Feedback to Providers Is Associated With Increased Filling of Preventer Medications for Children With Asthma Enrolled in Medicaid
Authors: Duplantier John E.
Published: October 2008

Cooper WO, Ray WA, Arbogast PG, Garrison M, Dudley JA, Christakis DA. J Pediatr. 2008;152(4):481–488

PURPOSE OF THE STUDY. To determine if children enrolled in Medicaid managed care that provides asthma-specific communication to providers would be more likely to have adequate asthma-medication filling.

STUDY POPULATION. The study included 4498 children between the ages of 2 and 17 years with moderate-to-severe asthma enrolled in Medicaid in Tennessee and Washington State from 2000 and 2002.

METHODS. Study subjects had (1) an asthma hospitalization or asthma emergency department (ED) visit, (2) high use of asthma medications in the 6 months before their hospitalization or ED visit, and (3) stayed in the same Medicaid health plan from study entry through follow-up. Interviews were conducted with health plans to identify communication strategies used to improve asthma care by providers in the plan. The main outcome measure was guideline-recommended filling of asthma-preventer medications.

RESULTS. In the 365-day follow-up period, children in plans that provided specific feedback to providers about asthma quality and notified providers when children had an asthma-related event had higher rates of filling prescriptions than children in plans with neither (164.6 ± 13 vs 135.3 ± 10.8 days; P < .05). For children with the greatest asthma severity, enrollment in a plan with both features was associated with 27.1 additional days of filling (95% confidence interval: 0.7–53.4 days) during the follow-up period.

CONCLUSIONS. Health plan communication to providers was associated with increased preventer filling in children with moderate-to-severe asthma in 2 state Medicaid programs.

REVIEWER COMMENTS. The children with the higher preventer fill rates only used their medications for less than half of the year. Identification of patients at high risk and frequent follow-up are needed to ensure more regular use of preventer medications. Health plans could assist providers by providing quarterly updates of fill rates for these patients at high risk so that intervention could occur before the patient ends up in the hospital or ED.
Decreased Markers of Atopy in Children With Presumed Early Exposure to Allergens, Unhygienic Conditions, and Infections
Authors: Järvinen Kirsi M.
Published: October 2008

Stelmach I, Smejda K, Jerzynska J, et al. Ann Allergy Asthma Immunol. 2007;99(2):170–177

PURPOSE OF THE STUDY. To compare 2 populations of children with different risk and protective factors for the development of atopy.

STUDY POPULATION. The study group consisted of 415 children living in community foster homes in Lodz, a large industrial city in Poland. The reference group consisted of 500 children who were living with their parents at home and recruited from primary care centers.

METHODS. Questionnaires were completed by parents or guardians. The primary outcome measures were skin-prick test results to 14 environmental and 4 food allergens and specific immunoglobulin E (IgE) in serum. Secondary outcomes included symptoms of asthma and allergic diseases, lung function, parental allergy, and family history, including life conditions in early childhood, and markers of allergy, such as total IgE serum concentration and eosinophil blood cell count. Stool samples were analyzed for parasites.

RESULTS. The analysis included 408 study children and 402 reference children. Atopy was significantly more prevalent in the reference group (25.9%) than in the foster home children (11.3%). More positive skin-prick test results were observed in children from the reference group than in study children. Specific IgE was significantly higher to dust mites, timothy, and mugworth, as were asthma, rhinitis, and atopic dermatitis, in the reference group. To explain this phenomenon, the investigators selected 16 variables that differed in both groups in the first year of life and related them to atopy. They found that the more cumulative features characteristic of the foster home population (poor living conditions), the lower the risk of atopy.

CONCLUSIONS. Extremely unfavorable environmental circumstances, which are characteristic of the foster home population during early childhood, might prevent atopy.

REVIEWER COMMENTS. These data may suggest that many of our recommendations to parents (cleaning, reducing mold, prevention of infections) are not protective against development of atopy. The limitation of the study was lack of a search for the mechanism that is protective of atopy for those living in poor conditions. One factor could be endotoxin exposure in old homes, which was the case for 90% of those in foster homes. Furthermore, parasitic infections, prevalent in poor socioeconomic and poor hygienic conditions and further suggested by high eosinophil blood counts and serum total IgE concentrations in the nonatopic foster home children, were not fully evaluated.
Early Rattles, Purrs and Whistles as Predictors of Later Wheeze
Authors: Mehrotra Anjuli , Lasley Mary V.
Published: October 2008

Turner SW, Craig LCA, Harbor PJ, et al. Arch Dis Child. 2008;93(8):701–704

PURPOSE OF THE STUDY. To determine how different respiratory sounds in 2-year-olds (whistles, purrs, and rattles) characterized as wheeze by parents predicted wheeze and asthma diagnosis at 5 years of age. A better understanding of parental descriptions of respiratory symptoms may lead to a more accurate diagnosis of asthma.

STUDY POPULATION. The study subjects were children followed at 2 time points: at ages 2 and 5 years. They were recruited randomly before birth irrespective of history of parental asthma and allergy.

METHODS. Two thousand pregnant women were recruited randomly at 12 weeks’ gestation, initially as part of a longitudinal birth cohort designed to relate dietary exposure in early life to asthma outcomes in childhood. Parents filled out questionnaires by mail regarding respiratory symptoms when their children were aged 2 and 5 years. Questions included, “Has your child ever suffered from asthma?” and “Has this been diagnosed by a doctor?” Current wheeze was defined as wheezing that has occurred over the last 12 months. If present, parents were asked to categorize the wheeze by sound, describing it as a whistle, rattle, purr, or other sound. If “other sound” was designated, the subjects were excluded from the analysis.

RESULTS. A total of 210 children wheezed as determined by the questionnaire at 2 years of age, and 77% (162) of the parents of these children also returned a questionnaire when the child was 5 years old. Wheeze persisted in 62 of these subjects. At 5 years of age, children with “whistle” at age 2 were more likely to have current wheeze (73% [11 of 15]) with physician-confirmed asthma (67% [10 of 15]). They were also more likely to be on asthma treatment (40% [6 of 15]). This was compared with “rattle,” which only translated to a 34% (33 of 97) incidence of current wheeze at age 5 and 42% (43 of 97) with physician-confirmed asthma, with 11% (11 of 97) on asthma therapy. A description of “purr” at age 2 had similar outcomes to that of rattle. Children with whistle at 2 years of age were more likely to have mothers with asthma, whereas children with rattle and purr were more likely to be exposed to environmental tobacco smoke.

CONCLUSIONS. Parents often interpret any respiratory sound as “wheeze.” When respiratory sounds are further characterized as whistle, rattle, or purr, a parent using the terminology “whistle” to describe his or her child's wheeze was a good predictor of persisting symptoms and was associated with future asthma treatment. Use of terms “rattle” and “purr” did not predict future wheeze particularly well.

REVIEWER COMMENTS. In pediatric medicine, physicians must rely on parents for the history. For children with respiratory symptoms, parents often do not understand or know what “wheeze” means. Having parents use terms such as whistle, rattle, or purr to characterize the noise they hear may help physicians make a diagnosis of asthma, especially if the term whistle is used.
Atopic Sensitization and the International Variation of Asthma Symptom Prevalence in Children
Authors: Kelso John M.
Published: October 2008

Weinmayr G, Weiland SK, Björkstén B, et al. Am J Respir Crit Care Med. 2007;176(6):565–574

PURPOSE OF THE STUDY. The International Study of Asthma and Allergies in Childhood (ISAAC I) found that the prevalence of asthma symptoms varies >15-fold among various countries. ISAAC II was designed to identify why such differences occur.

STUDY POPULATION. Studied were a random sample of 8- to 12-year-old children (n = 54 439) in 22 countries worldwide.

METHODS. Data were collected by parental questionnaires (n = 54 439) and skin-prick tests (n = 31 759). Economic development was assessed by gross national income per capita.

RESULTS. Prevalence of current wheeze (wheeze during the last year) ranged from 0.8% (Ecuador) to 25.6% (Brazil). The prevalence of skin-prick test reactivity ranged from 1.7% (Ghana) to 45.3% (Hong Kong). The association between current wheeze and skin-prick test reactivity was stronger in affluent countries (odds ratio: 4.0 [95% confidence interval: 3.5–4.6]) than nonaffluent countries (odds ratio: 2.2 [95% confidence interval: 1.5–3.3]). The population attributable fraction (PAF), or fraction of current wheeze attributable to skin-prick test reactivity, ranged from 0% (Turkey) to 59.6% (Hong Kong). Overall, the combined PAFs were substantially higher in affluent countries (40.7%) than in nonaffluent countries (20.3%).

CONCLUSIONS. The authors concluded that the link between atopic sensitization and asthma symptoms in children differs strongly between populations and increases with economic development.

REVIEWER COMMENTS. The variation in rates of asthma and allergy around the world are striking, and the fact that the relationship between allergy and asthma seems related to the level of economic development in any given country is fascinating. The authors speculated that this may be a result of exposures or other factors that are different for children in more or less affluent countries that make it more or less likely that allergy would lead to asthma. Such factors could include greater exposure to helminth infections or different commensal bacteria in poorer countries and higher rates of urbanization and obesity in wealthier countries.
Pediatric Prescribing of Asthma Drugs in the UK: Are We Sticking to the Guideline?
Authors: Kelso John M.
Published: October 2008

Cohen S, Taitz J, Jaffé A. Arch Dis Child. 2007;92(10):847–849

PURPOSE OF THE STUDY. Similar to those in the United States, there are asthma-treatment guidelines in the United Kingdom, which were published in 1993 and updated in 1995, 1997, 2003, and 2005. The authors wondered whether the prescribing habits of physicians reflect recommendations in these guidelines.

STUDY POPULATION. The population studies was persons in the United Kingdom National Health Service Information database, which includes all prescriptions dispensed by community pharmacists and dispensing doctors.

METHODS. Prescriptions for children were reviewed for the years 2000–2006.

RESULTS. From 2000 to 2006, the number of prescriptions for bronchodilator syrups decreased 60% from 302 500 to 121 000. The use of steroid-alone inhalers declined 22% from 1 968 000 to 1 525 000, whereas the use of combination steroid/long-acting β-agonist (LABA) inhalers increased sevenfold from 50 000 to 350 000. The percentage of total steroid inhalers prescribed as combination inhalers increased from 2% to 20%.

CONCLUSIONS. The authors concluded that the increase in the number of combination inhalers prescribed is not consistent with the guideline recommendations that combination inhalers should only be introduced in those patients with asthma that is not controlled on adequate doses of inhaled steroids.

REVIEWER COMMENTS. The authors noted that inhaled bronchodilators have fewer adverse effects and that, although the use of the oral bronchodilators has declined, there are still a large number of prescriptions being written for them. On the basis of other studies, they estimated that only 5% to 10% of children with asthma would qualify for treatment with combined inhaled-steroid/LABA inhalers, yet 20% are prescribed such medications. I suspect that these findings would be the same in the United States. It is useful to reinforce that that there is virtually no indication for treatment with oral bronchodilators, and only children whose condition has failed to respond to treatment with low- to medium-dose inhaled steroids alone should be treated with inhaled-steroid/LABA combinations.
Linoleic Acid Metabolites and Transepidermal Water Loss in Children With Atopic Dermatitis
Authors: Lester Mitchell R.
Published: October 2008

Yang YH, Wang LC, Lee JH, Chiang BL. Ann Allergy Asthma Immunol. 2008;100(1):66–73

PURPOSE OF THE STUDY. To investigate whether n-6 essential fatty acid (EFA) deficits account for atopic dermatitis (AD) by affecting transepidermal water loss (TEWL).

STUDY POPULATION. Children between the ages of 2 and 17 years with AD (n = 35), asthma or allergic rhinitis (AS/AR group, n = 35), or no atopic disease (n = 31) were studied. The AD group did not have allergic airway disease.

METHODS. Synthesis of the n-6 EFA from linoleic acid (LA) involves alternating steps of desaturation and elongation with serial conversion to γ-linoleic acid (GLA), dihommo-γ-linoleic acid (DGLA), and arachidonic acid (AA). Fasting blood samples were obtained with immediate serum separation and freezing to prevent changes in fatty acid composition of serum lipids. Analysis of lipid content was performed by gas chromatography/mass spectrometry. Measurement of TEWL on the right volar forearm was reported as loss of grams of water per square meter of skin per hour. Nonparametric tests were used to evaluate differences between the groups.

RESULTS. Although not statistically significant, patients in the AD and AS/AR groups had higher LA and lower AA levels than controls. Patients with AD but not AS/AR had statistically lower GLA (P = .04) and DGLA (P = .03) levels than control subjects. There were no differences between the 2 groups of atopic patients. Ratios of GLA/LA, DGLA/LA, and AA/LA were lower in the AD group than controls (P < .01 for each). However, in the AS/AR group, only the GLA/LA and DGLA/LA ratios were statistically lower than in controls. TEWL had a significant negative correlation with GLA and DGLA (P = .001) and near-significant negative correlation with AA (P = .06). In subjects with AD, TEWL and the Scoring Atopic Dermatitis (SCORAD) index were correlated (P < .001). The SCORAD index had a significant correlation with GLA and DGLA (P < .001) but not AA (P = .06).

CONCLUSIONS. AD is associated with a defect in n-6 EFA metabolism. LA metabolites are involved in the maintenance of the epidermal water barrier.

REVIEWER COMMENTS. Antimicrobial protein defects, filaggrin defects, and fatty acid defects are among the newer areas of research on the underlying pathogenesis of AD. Because human epidermis lacks the capacity to convert LA to GLA or DGLA to AA, it is likely that those LA metabolites are synthesized elsewhere and transported to the epidermis. Serum levels of n-6 EFAs, as reported here, presumably reflect epidermal concentrations. It follows, therefore, that dietary supplementation of GLA or topical application of LA metabolites may have therapeutic benefit.
Cigarette Smoke Exposure Impairs Dendritic Cell Maturation and T Cell Proliferation in Thoracic Lymph Nodes of Mice
Authors: Sharma Hemant P. , Matsui Elizabeth C.
Published: October 2008

Robbins CS, Franco F, Mouded M, Cernadas M, Shapiro SD. J Immunol. 2008;180(10):6623–6628

PURPOSE OF THE STUDY. Airborne antigens are processed and presented by respiratory tract dendritic cells (DCs). The purpose of this study was to determine the consequences of cigarette-smoke exposure on DC function in mice.

METHODS. Mice were exposed to cigarette smoke 5 days per week for 1 month. There was also a control group of mice unexposed to smoke. Mice then underwent intratracheal injection of ovalbumin-fluorescein isothiocyanate (FITC) or ovalbumin and were killed at varying time points thereafter depending on the aspect of DC function being studied (migration, maturation, or T-cell activation). Lung cells were isolated, and the numbers of DCs were determined in exposed and unexposed mice by flow cytometry. Migration of lung DCs to thoracic lymph nodes (TLNs) was assessed by measuring CD11c+FITC+ cells. Maturation of TLN DCs after ovalbumin exposure was then determining by assessing expression of cell-surface costimulatory molecules (CD80, CD86, MHCII, CD40). T-cell proliferation was assessed by measuring T-cell–derived cytokine production by TLN cells in vitro. The staining profile was assessed to measure T-cell proliferation in vivo.

RESULTS. The number of lung DCs was decreased among mice exposed to cigarette smoke. Exposed mice did not exhibit decreased migration of lung DCs to TLNs, as evidenced by similar numbers of TLN CD11c+FITC+ cells as in unexposed mice. Although no differences were observed in migration, smoking suppressed DC maturation in the lymph nodes as demonstrated by decreased cell-surface expression of MHC class II and the costimulatory molecules CD80 and CD86. T-cell proliferation was impaired in smoke-exposed mice, evidenced by reduced interleukin 2 production from CD4 T cells as compared with controls. T-cell proliferation was also decreased in vivo: smoke-exposed mice had a lower percentage of T cells undergoing ≥6 cycles or cell division compared with controls.

CONCLUSIONS. These findings suggest that cigarette smoke is associated with defects in DC maturation and suppressed thoracic lymph node CD4+ T-cell proliferation in mice.

REVIEWER COMMENTS. This study suggests that cigarette-smoke exposure in mice leads to impaired DC maturation and thereby diminished T-cell clonal expansion in the TLNs. The findings imply that, although the T-cell effector program remains intact, fewer cells might be available to perform those duties. The authors asserted that the observed effects on DC function might serve as a potential mechanism for cigarette smoke causing impaired tumor surveillance. In addition, it is suggested that impaired CD4+ T-cell function might predispose patients with obstructive lung disease to infections and exacerbations. Additional studies will help to elucidate the specific mechanisms by which cigarette-smoke exposure exerts its harmful immunologic effects.
Intermittent Therapy for Flare Prevention and Long-term Disease Control in Stabilized Atopic Dermatitis: A Randomized Comparison of 3-Times-Weekly Applications of Tacrolimus Ointment Versus Vehicle
Authors: Spergel Jonathan M.
Published: October 2008

Breneman D, Fleisher AB, Abramovitis A, et al. J Am Acad Dermatol. 2008;58(6):990–999

PURPOSE OF THE STUDY. To examine the usefulness of regular intermittent therapy instead of treating flares for the approach of atopic dermatitis (AD).

STUDY POPULATION. A total of 383 patients were randomly assigned to the stabilization phase, and 288 patients were controlled on tacrolimus ointment. There were 68 children (aged 2–16 years) and 57 adults (>16 years) in the tacrolimus arm and 37 children and 35 adults in the vehicle arm. Eighty-five percent had moderate AD, and 15% had severe AD.

METHODS. Adult and pediatric patients with moderate-to-severe AD who were clear of disease after up to 16 weeks of treatment with tacrolimus ointment were randomly assigned in a double-blind fashion to 3-times-weekly treatment with either tacrolimus ointment (0.03% or 0.1%) or vehicle for 40 weeks. The primary end point was the number of flare-free treatment days. Relapses were treated with open-labeled tacrolimus.

RESULTS. There were 288 patients who entered the randomization phase. The largest reasons for not finishing the stabilization phase were voluntary patient withdrawal for 95 patients and loss to follow-up for 55 patients. Only 16 (4.2%) patients were withdrawn for lack of efficacy. A total of 125 patients were randomly assigned to tacrolimus, and 72 patients were assigned to vehicle. The mean number of flare-free treatment days was 177 for the tacrolimus group and 134 for the vehicle group (P = .003). Median time to first relapse was 169 days for the tacrolimus group and 43 for the vehicle group (P = .037).

CONCLUSIONS. Maintenance therapy with tacrolimus ointment was associated with significantly more flare-free days compared with vehicle and a significantly longer time until first disease relapse.

REVIEWER COMMENTS. This article examined the possibility of proactive treatment of AD instead of reacting to flares. The principle is similar to the use of maintenance medication for asthma. Similar results were seen with topical fluticasone propionate (Berth-Jones J, Damstra RJ, Golsch S, et al. BMJ. 2003;326[7403]:1367). One significant limitation is that the study only included patients who responded to topical tacrolimus. The question now is whether it can be generalized to all patients with AD or patients not controlled with daily topical therapies.
Sustained Efficacy and Safety of Pimecrolimus Cream 1% When Used Long-term (up to 26 Weeks) to Treat Children With Atopic Dermatitis
Authors: Park Audrey Y. , Spergel Jonathan M.
Published: October 2008

Langley RG, Eichenfield LF, Lucky AW, Boguniewicz M, Barbier N, Cherill R. Pediatr Dermatol. 2008;25(3):301–307

PURPOSE OF THE STUDY. To evaluate the efficacy and safety of pimecrolimus cream 1% (Elidel [Novartis, East Hanover, NJ]) used for 26 weeks in children with atopic dermatitis (AD)

STUDY POPULATION. This was a prospective study of 403 children aged 2 to 17 years with AD (mean age at enrollment: 6.7 years) recruited from multiple academic centers in the United States.

METHODS. Pooled data were assessed from 20-week, open-label (OL) extensions of 2 previously reported 6-week, double-blind (DB) phase studies in which patients were randomly assigned 2:1 to pimecrolimus or vehicle. During the OL phase, all patients were treated with pimecrolimus. During the DB phase, no other AD treatments except emollients were allowed. The efficacy parameters included the Investigator's Global Assessment (IGA), Eczema Area and Severity Index, and severity of pruritus scores. Safety assessment consisted primarily of monitoring adverse events. Patients were evaluated on days 8, 15, 22, 29, 43, 71, 99, 141, and 183.

RESULTS. Overall, 60.3% of the patients had moderately severe AD (IGA: 3) at study entry. Twice as many in the control group discontinued during the DB phase compared with the treated group (25% vs 11.4%). The main reason for the higher discontinuation rate in the control group was unsatisfactory therapeutic effect (15.4% vs 2.6%). Eighty-four percent completed the OL phase with similar rates of completion between the groups. At day 43, 34.8% of the pimecrolimus-treated patients versus 18.4% in the vehicle groups (P < .001) had clear or almost clear (IGA: 0 or 1) disease. Pimecrolimus was significantly more effective (P < .0001) in treating the face and neck compared with the body during both DB and OL phases. In the pimecrolimus group, 56.5% of the patients had mild or absent pruritus by day 43 compared with 33.8% of those in the control group. The incidence of adverse events, including infections and complaints of a burning sensation with application, was not statistically different between groups during either phase of the study.

CONCLUSIONS. Treatment of AD with pimecrolimus was effective, particularly for the face and neck areas, and well tolerated.

REVIEWER COMMENTS. Given the black-box warning and concern with using topical calcineurin inhibitors, this article reemphasized that pimecrolimus is efficacious for children with AD. Particularly, it should be considered for use on the face and neck, which are difficult to treat with higher potency topical corticosteroids because of the risk of local adverse effects such as atrophy. The minimal adverse events associated with pimecrolimus support previous studies that had longer durations of treatment (up to 2 years).
Transient Tachypnea of the Newborn May Be an Early Clinical Manifestation of Wheezing Symptoms
Authors: Lin Joann H.
Published: October 2008

Liem JJ, Huq SI, Ekuma O, Becker AB, Kozyrskyj AL. J Pediatr. 2007;151(1):29–33

PURPOSE OF THE STUDY. To identify risk factors associated with transient tachypnea of the newborn (TTN) and its possible association with wheezing symptoms in early childhood.

STUDY POPULATION. Data were collected from the Population Health Research Data Repository at the Manitoba Centre for Health Policy. This was a retrospective evaluation of 12 763 children who were born at term. In this cohort, children with physician-determined bronchiolitis, acute bronchitis, chronic bronchitis, asthma, or need for prescription asthma medications were identified as having wheezing syndromes.

METHODS. Children diagnosed with TTN at birth were identified, and Cox proportional hazards regression analysis for time to first event of hospitalization, physician visit, or prescription for an asthma medication up to 7 years of age was performed. Hazard ratios were compared with those of healthy newborns.

RESULTS. A total of 308 (2.4%) of the study children developed TTN. Risk factors for development of TTN included maternal asthma, birth weight of ≥4500 g, male gender, and urban location. Infants with TTN at birth had a significantly increased risk of having a wheezing disorder in early childhood (adjusted hazard ratio: 1.17 [95% confidence interval: 1.02–1.34]).

CONCLUSIONS. TTN is associated with the development of wheezing syndromes in early childhood.

REVIEWER COMMENTS. TTN is generally believed to resolve in 2 to 5 days with no increased risk of pulmonary complications. The findings in this study suggest otherwise, with maternal asthma a risk factor for development of TTN. Nevertheless, the spectrum of wheezing disorders is broad, especially in this study where they evaluated onset of symptoms before 7 years of age, and not every young child with wheezing eventually develops childhood asthma. Additional studies to examine the association between TTN and wheezing before the age of 3 years may help determine if TTN plays a critical role in early pulmonary development.
Characterisation and comparison of avian Pasteurella multocida strains by conventional and ERIC-PCR assays
Authors: Sellyei Boglárka , Varga Zsuzsanna , Ivanics Éva , Magyar Tibor
Published: October 2008

Sixty-one avian strains of
Pasteurella multocida
were characterised and compared by biochemical tests, capsular PCR typing and ERIC-PCR. The strains were recovered from various avian species (goose, duck, Muscovy duck, turkey, chicken and pheasant) and represented different geographic locations in Hungary. Forty-two strains (69%) were identified as
P. multocida
subsp.
multocida
and 19 strains (31%) as
P. multocida
subsp.
septica
. The strains were grouped into 7 different biovars (1, 2, 3, 4, 5, 6 and 7). The most prevalent biovars were 1 (25%), 3 (21%) and 6 (21%). Most of the duck isolates (90%) belonged to biovar 1 or 6. The most frequent capsular type was A (93.5%). Type F represented only a small number (6.5%) of the strains. Other capsular types were not identified. From the 61 isolates 24 different fingerprint patterns were generated by ERIC-PCR assay. Based on cluster analysis the strains could be grouped into four larger and four mini-clusters that showed considerable correlation with the geographical origin and the host species. The results indicate that ERIC-PCR may be a suitable technique for studying the host adaptation of
P. multocida
and the epidemiology of fowl cholera.
Detection of a novel bat gammaherpesvirus in Hungary
Authors: Molnár Viktor , Jánoska Máté , Harrach Balázs , Glávits Róbert , Pálmai Nimród , Rigó Dóra , Sós Endre , Liptovszky Mátyás
Published: October 2008

This paper describes the detection of a novel herpesvirus in a Serotine bat (
Eptesicus serotinus
) in Hungary. The rescued animal showed signs of icterus and anorexia and died within a day, in spite of immediate supportive therapy. Autopsy confirmed the clinical picture by the major lesions observed in the liver. Histopathology revealed vacuolar degeneration in the hepatocytes and leukocytosis in the sinusoidal lumina. By electron microscopy, hydropic degeneration and apoptotic cells with a pycnotic nucleus were found in the liver. Bacteriological examinations gave negative results. As part of a routine screening project, detection of adeno-and herpesviruses from homogenised samples of the liver, lungs and small intestines was attempted by nested polymerase chain reaction (PCR) assays. The adenovirus PCR ended with negative results. The herpesvirus PCR resulted in an amplification product of specific size. The nucleotide sequence of the amplicon was determined and analysed by homology search and phylogenetic analysis. A novel herpesvirus was identified, which seemed to be most closely related to members of the genus
Rhadinovirus
within the subfamily
Gammaherpesvirinae
. The causative role of the detected rhadinovirus in the fatal condition of the Serotine bat could not be proven, but it is most likely that reactivation from a latent infection allowed the detection of the virus by PCR.
Poxvirus infection in Hungarian great tits ( Parus major ): Case report
Authors: Palade Elena , Biró Nóra , Dobos-Kovács Mihály , Demeter Zoltán , Mándoki Míra , Rusvai Miklós
Published: October 2008

From a total of 1819 great tits (Parus major) ringed in 2007 in Pilis Mountains, Hungary, 15 birds presented nodular proliferative lesions on different areas of the head and eyelids, suggesting a poxvirus infection. Three birds were submitted for analysis. The presence of avipoxvirus infection was confirmed by histopathology, electron microscopy (EM) and a polymerase chain reaction (PCR) based technique. Nucleotide sequence analysis of a 428 base pairs (bp) fragment of the viral 4b core protein gene revealed 100% identity between two of the Hungarian isolates (PM9 HUN, PM33 HUN) and two great tit poxvirus strains isolated in Norway in 1973 (GTV A256, GTV A311). The third Hungarian isolate (PM34 HUN) was more closely related to a different Norwegian isolate (GTVA310) than to the Hungarian isolates. The nucleotide sequence analysis of a shorter fragment of the viral 4b core protein (227 bp) gene revealed 100% identity between the Hungarian isolates, the same Norwegian isolates and a great tit poxvirus strain detected in Austria in 2007.
Rapid real-time PCR assay for detecting Salmonella in raw and ready-to-eat meats
Authors: Patel Jitu , Bhagwat Arvind
Published: October 2008

A real-time PCR assay was evaluated for the rapid detection (10 h) of
Salmonella
in meats using molecular beacon probes available as a commercial kit (iQ-Check, Bio-Rad laboratories). Raw (chicken, pork) and ready-to-eat (RTE) meats were artificially contaminated with
Salmonella enterica
serovar Typhimurium at the estimated level of 2 to 4 cells per 25 g. After 8 h of pre-enrichment in buffered peptone water, a molecular beacon-based PCR assay was performed to detect contamination in raw and RTE meats. The sensitivity and accuracy of the assay were compared with the conventional USDA microbiological procedure. Comparative evaluation of the USDA procedure with the rapid PCR assay for meat samples (n = 63) revealed 1 false negative pork sample with the PCR assay. All uninoculated controls (n = 34) but one sample were negative by both the 10-h PCR assay and the USDA procedure. Developing rapid pathogen detection methods with shorter pre-enrichment times (8-h) and real-time data monitoring capabilities will benefit the industry in preventing recall of contaminated meats by stopping the contaminated products from being introduced into the marketplace.
Clinical efficacy of neural therapy for the treatment of atopic dermatitis in dogs
Authors: Bravo-Monsalvo Adriana , Vázquez-Chagoyán Juan , Gutiérrez Lilia , Sumano Héctor
Published: October 2008

The aim of this trial was to assess the clinical efficacy of neural therapy (NT) when treating canine atopic dermatitis. Eighteen dogs (no control group), with at least a 12-month history of having nonseasonal atopic dermatitis, were included. No medication with either glucocorticoids or cyclosporin was allowed during the trial. One set of NT was given by injecting an intravenous dose of 0.1 mg/kg of a 0.7% procaine solution, followed by 10 to 25 intradermal injections of the same solution in a volume of 0.1–0.3 mL per site. Dogs were given 6–13 sets of NT during the therapy. The dermatological condition of each patient was evaluated before and after the treatment using two scales: the pruritus visual analogue scale (PVAS) and the canine atopic dermatitis extent and severity index (CADESI). The reduction of pruritus was statistically significant using a Wilcoxon matched-pairs signed-ranks test (P < 0.001). No adverse side effects were observed. NT seems to be an effective alternative to control signs related to canine atopic dermatitis.
Phytates reduce uptake of leucine and glutamate but not lysine and glucose from the intestinal lumen of chickens: Short communication
Authors: Onyango Edward , Asem Elikplimi , Adeola Olayiwola
Published: October 2008

An investigation into the influence of phytates on the
in situ
absorption of amino acids (lysine, glutamate and leucine) and glucose from the intestinal lumen of 3-week-old chickens was carried out. Birds were anaesthetised and the intestines exteriorised. Uptake of 5 mM of each nutrient over a 4-min period was measured in the presence of four phytate concentrations (0, 50, 250 and 500 mM). Five birds were used for each nutrient at each concentration of phytate tested. Leucine uptake decreased linearly (P < 0.001) and that of glutamate showed a tendency to decrease (P = 0.055) as the phytate concentration increased. Absorption of lysine and glucose were unaffected by the presence of phytate. In conclusion, phytate in the small intestinal lumen exerted a depressive effect on the absorption of specific free amino acids from the lumen. Its depressive effect was greatest for leucine followed by glutamate, and phytate had little effect on the absorption of lysine.
Role of deformation twin on texture evolution in cold-rolled commercial-purity Ti
Authors: Zhong Yong , Yin Fuxing , Nagai Kotobu
Published: October 2008

Texture evolution of a commercial-purity titanium (CP-Ti) during cold rolling was studied by means of x-ray diffraction (XRD) and electron back-scattered diffraction (EBSD). Twinning was identified to significantly contribute to deformation up to reductions of about 50%. Based on initial texture of the material investigated and twinning modes available in hexagonal close-packed (HCP) structures, the measured texture evolution can be interpreted in terms of (i) compressive twinning ({11¯22}〈11¯2¯3〉) within the two dominant initial texture components B ({0001}〈10¯10〉±40°TD) and E ({0001}〈11¯20〉±40°TD) and (ii) followed by tensile twinning ({10¯12}〈10¯1¯1〉) in the then-favorably reoriented twinned part. Reduction of grain size at high deformation inhibits further twinning and results in a stable texture evolution driven exclusively by dislocation slip. During cold rolling, the crystals of the initial texture component B first rotate to orientation M ({01¯10}〈2¯1¯12〉) by compressive twinning (primary), and then orientation M rotates to orientation D ({0001}〈11¯20〉) by tensile twinning (secondary). Meanwhile, the crystals of the initial component E first rotate to the orientation M′ ({14¯53}〈6¯5¯13〉) by compressive twinning (primary), and then orientation M′ rotates to the orientation A ({0001}〈10¯10〉) by tensile twinning (secondary). At higher deformation level, twinning was significantly depressed by strongly refined grain size, which resulted in the elimination of the transient texture components caused by slip. These results are useful for the prediction and control of the texture in titanium.
Temperature increases caused by shear banding in as-cast and relaxed Zr-based bulk metallic glasses under compression
Authors: Jiang W.H. , Liu F.X. , Liao H.H. , Choo H. , Liaw P.K. , Edwards B.J. , Khomami B.
Published: October 2008

Using an infrared camera, the temperature evolution of as-cast and relaxed bulk metallic glasses during compression was measured. Substantial variations in the temperatures of both glasses during plastic deformation were observed, which are conjectured to result at least partially from shear-banding phenomena. The relaxed glass has a larger temperature rise than the as-cast glass, which can be attributed to a reduction in the free volume. The larger temperature increase in the relaxed glass may be responsible for the observed work softening. The relaxed glass also has a higher maximum temperature than the as-cast, which can be attributed to a stronger strain-rate dependence of the temperature rise rate, and a shorter dissipation time scale for the heat due to conduction. The experimental data follow the well-known model behavior, and suggest the possibility of a statistical correlation between the fluctuations of strain rates and the rates of the temperature variation.
Fabrication and properties of aligned multiwalled carbon nanotube-reinforced epoxy composites
Authors: Cheng Qunfeng , Wang Jiaping , Jiang Kaili , Li Qunqing , Fan Shoushan
Published: October 2008

A method to fabricate continuous and aligned multiwalled carbon nanotube (CNT)/epoxy composites is presented in this paper. CNT/epoxy composites were made by infiltrating an epoxy resin into a stack of continuous and aligned multiwalled CNT sheets that were drawn from super-aligned CNT arrays. By controlling the amount and alignment of the continuous multiwalled CNT sheets, a CNT/epoxy composite with high content of well-dispersed CNTs can be obtained. Differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) results show that the thermal stability of these CNT/epoxy composites was not affected by the addition of CNTs. The mechanical properties and electrical properties of the CNT/epoxy composites were dramatically improved compared to pure epoxy, suggesting that the CNT/epoxy composites can serve as multifunctional materials with combined mechanical and physical properties.
Enhancement of plasticity in Ti-rich Ti–Zr–Be–Cu–Ni–Ta bulk glassy alloy via introducing the structural inhomogeneity
Authors: Park Jin Man , Kim Do Hyang , Kim Ki Buem , Fleury Eric , Lee Min Ha , Kim Won Tae , Eckert Jürgen
Published: October 2008

The effect of microstructural inhomogeneities with different length scale on the plasticity of (Ti45Zr16Be20Cu10Ni9)100–xTax (x = 0, 5, and 10) bulk glassy alloys has been studied. The formation of specific heterogeneous microstructures with a different type of structural inhomogeneity, i.e., short-/medium-range ordered clusters or micrometer-scale ductile dendrites combined with a glassy matrix, evolved by appropriately tuning the alloy chemistry, improves the room temperature plasticity up to ∼12.5% and ∼15%, respectively. The pronouncedly enhanced plasticity is mainly attributed to the retardation of shear localization and multiplication of shear bands by controlling the plastic and failure instabilities otherwise responsible for premature failure.
Morphology of Si nanocrystallites embedded in SiO2 matrix
Authors: Teodorescu V.S. , Ciurea M.L. , Iancu V. , Blanchin M-G.
Published: October 2008

The nanostructure of Six(SiO2)1–x films deposited on quartz substrate, where x varies from 0 to 1, was determined by high-resolution transmission electron microscopy in the sample regions with x ≈ 0.1, 0.2, 0.5, and 0.75. In the Si0.5(SiO2)0.5 region, the formation of a Si nanocrystallite network was established. At high concentrations of Si nanocrystallites, nanotwins and stacking faults occurred in the crystallites. Large Si crystallites appeared at x ⩾ 0.5 in the quartz substrate under the interface, while the film presented nanopores over the interface. The mechanisms for the formation of the nanocrystallites were discussed and correlated with the film properties.
Structure-induced effects on the selective wet thermal oxidation of digital AlxGa1–xAs alloys
Authors: Suarez I. , Condé M. , Bouscayrol L. , Fontaine C. , Almuneau G.
Published: October 2008

A thorough study of the selective wet oxidation in digital AlxGa1–xAs alloys is presented. We report experimental results and physical interpretation on the oxidation kinetics within those ranges of the AlGaAs composition (x = 0.95 to 1) and layer thickness (20 to 50 nm) of interest for oxide-aperture vertical-cavity surface-emitting laser (VCSEL) application. We demonstrate the high controllability of the oxidation reaction between different Al compositions; made different thanks to the use of digital alloys. Unlike standard alloys, we measured an invariability of the oxidation rates in the studied thickness range (20–50 nm), implying a better control of the fabrication process. The dependence of the reaction rate with the temperature is expressed as an Arrhenius law. Two activation energies (1.2 and 0.55 eV) have been derived for composition ranges of x = 0.95–0.98 and x = 0.99–1, respectively, revealing that two different mechanisms are involved depending on the Al content and the superlattice structure of the digitally-grown AlGaAs.
Effect of various deposition parameters on the co-deposition behavior of cobalt antimony in citric-based solution
Authors: Cheng H. , Hng H.H. , Ma J. , Xu X.J.
Published: October 2008

Direct current (dc) electrodeposition was used to co-deposit cobalt and antimony in citric-based solutions. Growth behavior of Co–Sb alloy thin films was systematically studied under various deposition conditions. Effects of deposition parameters (i.e., deposition potential, cobalt sulfate concentration, and pH value) on the microstructure, chemical, and phase composition of the deposited materials were also studied and are discussed in detail.