bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhaled Nitric Oxide for Preterm Infants: A Systematic Review
Authors: Barrington Keith J. , Finer Neil N.
Published: November 2007

OBJECTIVE. Our goal was to determine whether, for preterm newborn infants with respiratory disease, inhaled nitric oxide reduced the rates of death, bronchopulmonary dysplasia, intracranial hemorrhage, or neurodevelopmental disability.

METHODS. We searched Medline, Embase, Healthstar, and the Cochrane Central Register of Controlled Trials using the search terms “nitric oxide,” “clinical trial,” and “newborn” and covering 1985–2006. We also searched abstracts of the Pediatric Academic Societies.

RESULTS. Eleven randomized, controlled trials of inhaled nitric oxide therapy for preterm infants were found. The trials were grouped into 3 categories according to the entry criteria, that is, entry in the first 3 days of life on the basis of oxygenation criteria (early rescue), enrollment after 3 days on the basis of elevated risk of bronchopulmonary dysplasia, and routine use for intubated preterm infants. Early rescue treatment based on oxygenation criteria did not seem to affect mortality or bronchopulmonary dysplasia rates. Routine use for intubated preterm infants showed a barely significant reduction in the incidence of the combined outcome of death or bronchopulmonary dysplasia (relative risk [RR]: 0.91 [95% confidence limits (CLs): 0.84, 0.99]). Later treatment based on the risk of bronchopulmonary dysplasia showed no significant effect on this outcome. Early rescue treatment showed a trend toward increased incidence of severe intracranial hemorrhage, whereas routine use for intubated preterm infants seemed to show a reduction in the incidence of either severe intracranial hemorrhage or periventricular leukomalacia (RR: 0.70 [95% CLs: 0.53, 0.91]).

CONCLUSIONS. Inhaled nitric oxide as rescue therapy for very ill preterm infants undergoing ventilation does not seem to be effective and may increase severe intracranial hemorrhage. Later use of inhaled nitric oxide to prevent bronchopulmonary dysplasia does not seem to be effective. Early routine use of inhaled nitric oxide for mildly sick, preterm infants seems to decrease the risk of serious brain injury and may improve rates of survival without bronchopulmonary dysplasia.
Long-term Immunologic Effects of Broad-Spectrum Aeroallergen Immunotherapy
Authors: Maloney Jennifer M.
Published: November 2007

Limb SL, Brown KC, Wood RA, Eggleston PA, Hamilton RG, Adkinson NF Jr. Int Arch Allergy Immunol. 2006;140:245–251

PURPOSE OF THE STUDY. To evaluate the long-term clinical effects, skin tests, and specific immunoglobulin E (IgE) levels from subjects who had previously received broad-spectrum aeroallergen immunotherapy several years earlier.

STUDY POPULATION. Eighty-two polysensitized subjects who had previously been enrolled onto a randomized, double-blind, placebo-controlled trial of specific immunotherapy for treatment of childhood allergic asthma

METHODS. Eighty-two subjects (78% male; mean age: 23 years) previously enrolled onto a randomized, placebo-controlled trial of immunotherapy for the treatment of childhood allergic asthma were reevaluated in adulthood (mean follow-up interval: 10.8 years) by puncture skin tests and CAP-RAST levels for major aeroallergens. All subjects originally completed at least 18 months (median: 27 months) of maintenance active immunotherapy treatment or placebo injections without subsequent immunotherapy.

RESULTS. At adult follow-up, 36% of all skin tests to treatment allergens among subjects who received immunotherapy (n = 41) had significantly reduced intensity versus 26% of skin tests among placebo recipients (n = 41; P = .03). No significant differences were noted for individual treatment allergens. No significant differences were observed in the long-term changes of serum-specific IgE antibody levels for all or individual treatment allergens between immunotherapy treatment and placebo groups (P = .43). The treatment and placebo groups had a similar acquisition of new skin-test sensitivities from time of randomization in the original childhood trial to debriefing (15% vs 20%; P = .28) and to adult follow-up (30% vs 31%; P = .75).

CONCLUSIONS. Immunotherapy suppresses skin-test sensitivity 8 to 16 years after discontinuation of treatment, but long-term effects on specific IgE levels in serum are not observed. Broad-spectrum immunotherapy does not seem to affect the acquisition of new inhalant sensitivities.

REVIEWER COMMENTS. In this study, allergic-asthmatic children who participated in a double-blind, placebo-controlled immunotherapy trial were reevaluated as adults to determine if immunotherapy had long-lasting effects. This study revealed that asthmatic children who received immunotherapy to multiple allergens for a median of 27 months had limited long-term effects on the results of testing parameters routinely used in allergy practice. The long-term efficacy of immunotherapy and optimal duration of therapy are issues that remain open.
Use of Complementary and Alternative Medicine by Food-Allergic Patients
Authors: Goldsobel Alan B.
Published: November 2007

Ko J, Lee JI, Muñoz-Furlong A, Li XM, Sicherer SH. Ann Allergy Asthma Immunol. 2006;97:365–369

PURPOSE OF THE STUDY. To determine the prevalence of complementary and alternative medicine (CAM) use, the types of CAM modalities used, and opinions regarding CAM in food-allergic patients.

STUDY POPULATION. A total of 442 individuals were polled, 95% of whom were parents of food-allergic children. Two groups were evaluated by using an anonymous questionnaire: attendees at a Food Allergy & Anaphylaxis Network conference in 2002 and a convenience sample from the Pediatric Allergy and Immunology practice of Mount Sinai Medical Center (New York, NY). Three hundred eighty individuals filled out questionnaires, equal numbers from both groups.

METHODS. A 19-item questionnaire was constructed to collect data on types, frequency, and opinions of CAM use, severity of food allergy, and demographic information.

RESULTS. Diagnostic modalities considered unproven or disproven (including immunoglobulin G4 testing, kinesiology, electrodermal skin testing, and provocation testing) were used by 22% of the respondents. Chiropractors (10%) were the most common CAM providers, followed by homeopaths (5%), acupuncturists (4%), and herbologists (4%). Of food-allergic CAM users, 33% reported using chiropractic, 33% homeopathy, 17% Nambudripad's allergy-elimination technique, 12% acupressure, 9% massage, 6% acupuncture, and 3% reflexology. Sources of information about CAM included friends (39%), family (28%), the Internet (8%), and television (6%). Only 49% of the participants reported CAM use to their regular physicians. On a scale from 0 (not effective) to 5 (very effective), patients found that CAM therapies were not particularly effective (mean score: 2.08). If available, an herbal therapy of equal efficacy, safety, and cost was preferred as compared with a pharmaceutical drug (37% vs 12%; P = .001).

CONCLUSIONS. Unproven or disproven diagnostic methods and CAM treatments were used by ∼20% of the respondents (most of whom were parents of food-allergic patients). Most of those who used CAM noted poor efficacy, but if given a choice, many would prefer herbal therapies to pharmaceutical drugs.

REVIEWER COMMENTS. Education regarding effective food-allergy tests and additional research on CAM therapies are needed.
Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings
Authors: Randolph Christopher
Published: November 2007

McIntyre CL, Sheetz AH, Carroll CR, Young MC. Pediatrics. 2005;116:1134–1140

PURPOSE OF THE STUDY. To ascertain the incidence of anaphylaxis in schools, characterize the circumstances surrounding anaphylactic episodes, and evaluate practices that are used to manage students with life-threatening allergies.

STUDY POPULATION AND METHODS. School districts in Massachusetts (N = 109) that completed an epinephrine-administration form whenever epinephrine was injected at school. Data were obtained from September 2001 to August of 2003.

RESULTS. Forty-eight school districts noted a total of 159 administrations of epinephrine during the 2-year period of reporting. The individual was not known to have a life-threatening allergy in 24% of the cases. Thirty-one percent of the students who received epinephrine had allergy to multiple antigens, and 25% had allergy to tree nuts or peanuts only. Nineteen percent of the cases occurred outside the school building on a playground or when transporting them to or from school or on field trips. The registered school nurse in the health office administered the epinephrine in most cases. The average time from development of symptoms until epinephrine was delivered was 10 minutes. In 92% of the cases, the student involved was taken to a medical facility using the emergency medical system.

CONCLUSIONS. Anaphylactic reactions in schools, although not frequent, are not uncommon events. A systematic review of anaphylactic events that required epinephrine administration identified opportunities for improvement in the treatment of students with life-threatening allergies.

REVIEWER COMMENTS. The limitation of this study is that it was based on voluntary reporting. There are variations in reporting among regions in the state, but it is not possible to determine if the differences are attributable to reporting practices or actual difference in epinephrine administration. Because there were no unique identifiers for subjects in the study, there is no assurance that allergy events are not recurring repeatedly in the same student. In summary, a thorough program should be in place in the schools to evaluate, treat, and manage students with life-threatening anaphylaxis to foods.
Cardiopulmonary Exercise Testing in Children and Adolescents With Asthma Who Report Symptoms of Exercise-Induced Bronchoconstriction
Authors: Humayun Fawwaz , Leo Harvey L.
Published: November 2007

Joyner BL, Fiorino EK, Matta-Arroyo E, Needleman JP. J Asthma. 2006;43:675–678

PURPOSE OF THE STUDY. To use cardiopulmonary exercise testing (CPET) to establish the cause of exercise limitation in a population of children with asthma who were reporting symptoms of exercise-induced bronchoconstriction (EIB).

STUDY POPULATION. A total of 42 children (aged 7 to 19 years) who continued to report exercise-associated symptoms attributed to asthma despite daily controller therapy were included in the study. There were 22 boys and 20 girls. All patients were receiving daily inhaled corticosteroids and had normal pulmonary function at the time of the study. Patients were excluded if they had underlying cardiac disease, had another chronic lung disease, or were unable to ride the cycle ergometer.

METHODS. Each patient's BMI was calculated, and baseline spirometry was performed. Then, the patients performed cycle ergometry with a ramp protocol to voluntary exhaustion to determine maximal oxygen consumption (V̇o2). Spirometry was repeated at intervals of 5 and 20 minutes. A decrease of 10% in forced expiratory volume in 1 second was considered a positive finding of EIB.

RESULTS. Ten patients (24%) developed EIB after CPET. There were no significant differences in BMI, BMI z score, V̇o2, or initial pulmonary function between the subjects who developed EIB and those who did not.

CONCLUSIONS. Exercise limitation without EIB was found in both obese and nonobese patients, suggesting that poor fitness is a problem independent of body habitus. Including CPET in the management of children with suspected EIB would provide a better understanding of the etiology of their symptoms and facilitate more appropriate treatment.

REVIEWER COMMENTS. This study illustrates how a patient's BMI does not directly correlate with fitness levels. Nonobese individuals can be just as out of shape as obese individuals. Given the trend toward more obesity in this country, it is important to not let any generalizations based on body habitus affect our judgment as physicians. Therefore, when a nonobese individual presents with symptoms similar to EIB, it may be prudent to have them undergo CPET before labeling them as asthmatic.
Effect of Albendazole Treatments on the Prevalence of Atopy in Children Living in Communities Endemic for Geohelminth Parasites: A Cluster-Randomized Trial
Authors: Simons Elinor
Published: November 2007

Cooper PJ, Chico ME, Vaca MG, et al. Lancet. 2006;367:1598–1603

PURPOSE OF THE STUDY. To determine if repeated antihelminthic treatments with albendazole affect the prevalence of atopy and clinical indices of allergy among children who live in parasite-endemic communities.

STUDY POPULATION. Children (N = 2373) attending the second to seventh year of primary education at 1 of 68 rural schools in a tropical and subtropical region of Ecuador.

METHODS. Children were cluster randomized by school to receive albendazole treatment every 2 months for 12 months or no treatment. The primary outcome was the proportion of children with at least 1 positive skin-test result to an environmental allergen after 12 months; secondary outcomes included the proportion of children with reported allergy symptoms, flexural dermatitis, and exercise-induced bronchospasm. No placebo was used, but the investigators who evaluated the children were blinded to their treatment-group assignment.

RESULTS. At baseline, there was an inverse association between geohelminth infection and skin-test reactivity (odds ratio: 0.78; 95% confidence interval: 0.65–0.95). Of children who attended albendazole-allocated schools, 91.5% received all 7 albendazole doses; albendazole treatment by parents was reported for 29.4% of the children allocated to no-treatment schools. After 12 months, the prevalence of geohelminth infection declined from 69.3% to 20.5% in the treatment group and from 74.6% to 65.7% in the no-treatment group. There was no evidence of an increase in the prevalence of atopy among children who received albendazole (17%) compared with those in the no-treatment group (17%; age- and gender-adjusted odds ratio: 0.97; 95% CI: 0.68–1.39). Both groups had similar reported allergy symptoms, flexural dermatitis, and exercise-induced bronchospasm after 12 months.

CONCLUSIONS. After 12 months, the prevalence of atopy did not increase among school-aged children who were treated with albendazole, compared with children who were not treated.

REVIEWER COMMENTS. Management of allergic conditions has increasingly focused on prevention and reduction of risk factors. Small intervention studies have shown increased atopy associated with regular antihelminthic treatment. Although this study was larger, it had a high dropout rate (31%), and antihelminthic treatment of children in the no-treatment group may have biased the results toward the null. It is important to note that the protective effect of geohelminth exposure against atopy may be greater during the first few years of life than by school age. However, these results suggest that treatment of school-aged children with antihelminthics over 12 months does not put them at greater risk of atopy.
Predictors of Early Hospital Readmission for Asthma Among Inner-City Children
Authors: Macy Michelle , Leo Harvey L.
Published: November 2007

Reznik M, Hailpern SM, Ozuah PO. J Asthma. 2006;43:37–40

PURPOSE OF THE STUDY. To identify modifiable predictors of early readmission in inner-city children with asthma.

STUDY POPULATION. All pediatric patients aged 0 to 21 years who were discharged with a primary diagnosis of asthma during the study period were identified from a single hospital. Case patients were those who were readmitted with asthma within 30 days of discharge, and controls were those who were not readmitted. A total of 152 case patients and 293 controls who met the inclusion criteria were used in this study.

METHODS. Medical chart reviews were performed on the selected patients. Information was collected on demographics, variables related to past asthma history, variables related to the index admission, and variables related to discharge from the index admission. The data were evaluated by using conditional logistic regression analyses.

RESULTS. Case patients were more likely to have been hospitalized for asthma in the past 12 months (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.40–3.50), to have visited the emergency department for asthma in the past 12 months (OR: 3.28; 95% CI: 1.55–6.94), to have a history of an ICU admission for asthma (OR: 1.87; 95% CI: 1.26–3.78), to have received a pulmonary consultation during the index admission (OR: 1.87; 95% CI: 1.12–3.10), and to have been prescribed inhaled corticosteroids before the index admission (OR: 1.61; 95% CI: 1.02–2.52). Multivariate analysis revealed that a history of asthma hospitalization within the past 12 months was an independent predictor of early readmission (OR: 1.89; P = .021).

CONCLUSIONS. A history of asthma hospitalization within the past 12 months was associated with early readmission. Modifiable factors such as medical treatment and management during and at discharge from the index admission did not predict early asthma readmission.

REVIEWER COMMENTS. In this largely minority population, with >50% covered by Medicaid, early readmission was increased in those with markers of more severe and persistent asthma. History of an asthma-related emergency department visit in the last year, ICU admission for asthma, or pulmonary consultation was associated with readmission. Children with a prescription for inhaled corticosteroid (ICS) before hospitalization were more likely to require readmission, yet no protective effect was identified for ICS prescription at the time of discharge. On multivariate analysis, early readmission was associated with hospitalization for asthma in the preceding 12 months. Although limited by its retrospective nature, this study indicates that children who frequently use tertiary care for asthma are at increased risk for early readmission and identifies at-risk asthmatic children who may benefit from targeted interventions at hospital discharge.
Aerosol Therapy by Pressured Metered-Dose Inhaler-Spacer in Sleeping Young Children: To Do or Not to Do?
Authors: Kewalramani Anupama , Bollinger Mary E.
Published: November 2007

Esposito-Festen J, Ijsselstijn H, Hop W, van Vliet F, de Jongste J, Tiddens H. Chest. 2006;130:487–492

PURPOSE OF THE STUDY. To determine the feasibility of aerosol administration with a metered-dose inhaler (MDI) spacer in sleeping young children.

STUDY POPULATION. Thirty children (18 boys) from the Netherlands between 6 and 23 months of age were treated with inhalation therapy twice per day for recurrent wheezing in the previous month.

METHODS. Parents were trained to use a metal chamber (NebuChamber) with a face mask to administer 200 μg of budesonide aerosol. A filter was placed between the spacer and face mask to trap and then measure the aerosol inhaled from the spacer. The study included 1 run-in week and 2 test weeks. The families were visited at home 4 times in the 3 weeks. At the 1-week run-in, the parents practiced the procedure with a placebo MDI while the child was awake. In weeks 2 and 3, they administered 1 puff while the child was awake (awake administration), 1 puff before bedtime, and 1 puff while the child was asleep (sleep administration). Parents then were asked to score the child's asthma symptoms and degree of cooperation and the feasibility of administration. Filters were washed, and budesonide amounts were measured by high-performance liquid chromatography and spectrophotometry.

RESULTS. Twenty-one children fully completed the study, and a total of 350 awake-administration filters and 331 sleep-administration filters were collected. The mean filter dose was significantly higher for awake administration (47% ± 26%) than that for sleep administration (16% ± 13%). The median variability dose for awake administration was 50%, whereas it was 110% for sleep administration. Poor cooperation was noted for 29% of the awake administrations. In 69% of the sleep administrations, the child woke up, and in 75% of these cases, the child was distressed. Twenty-two percent of parents reported mask-positioning problems while the child was sleeping. Mean symptoms scores were 1.4 ± 2.2 (0 = no symptoms, 4 = severe symptoms; maximum score = 12 for sum of cough, wheeze, and shortness of breath).

CONCLUSIONS. Administering aerosol therapy during sleep has been suggested as a way to overcome cooperation problems in young children, but this study suggests that this is not the answer.

REVIEWER COMMENTS. The study included 30 children, and only 21 completed the study; a larger study would need to be performed with design modifications. One significant concern about the study design is that the children did not receive active drug during the study because the design required capturing the drug in a filter to determine drug delivery (which may explain the high drop-out rate). Furthermore, the design of the study did not allow for a means to determine clinical efficacy or lung deposition of the drug. In the interim, pediatricians may want to reconsider recommending dosing of aerosolized medications during sleep.
Allergic Rhinitis and Its Consequences on Quality of Sleep: An Unexplored Area
Authors: Adinoff Allen
Published: November 2007

Leger D, Annesi-Maesano I, Carat F, et al. Arch Intern Med. 2006;166:1744–1748

PURPOSE OF THE STUDY. Allergic rhinitis (AR) is common and has been shown to impair social life and sleep. Patients with severe symptoms may have more sleep disturbances than those with a mild form of the disease, but this has never been assessed with a validated tool. The objective of this study was to assess, in patients with AR, whether duration and severity of AR are associated with sleep impairment.

METHODS. A nationwide controlled, cross-sectional epidemiologic study was conducted. A representative sample of 260 French ear, nose, and throat and allergy specialists enrolled 591 patients aged 18 to 50 years with AR of at least 1 year's duration. Sleep disorders, sleep quality, and AR were assessed by using validated tools (Sleep Disorders Questionnaire, Epworth sleepiness scale, and score for allergic rhinitis). The severity of AR was assessed by using the allergic rhinitis and its impact on asthma classification.

RESULTS. All dimensions of sleep were impaired by AR, particularly by the severe type. Sleep was significantly more impaired in patients with severe AR than in those with the mild type. The duration of AR (intermittent or persistent) had no effect on sleep.

CONCLUSIONS. These data underline the close relationship between AR and sleep and highlight the need for clinicians, particularly general practitioners, to be attentive in this respect.

REVIEWER COMMENTS. This was the DREAMS study (Etude Descriptive des Rhinites Allergiques et des Modifications du Sommeneil), and although that is really cute, I am not sure it is truly fair to use the authors’ native French to make an English acronym. Anyway, the main weakness here is that they did not perform sleep studies on the patients. Nonetheless, they used validated instruments (questionnaires) to establish the severity of the AR and its impact on sleep quality. There is no reason to think that similar effects would not also occur in children with AR. The study also points out the importance of understanding the effects of AR on many quality-of-life indicators.
Long-term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma
Authors: Chipps Bradley E.
Published: November 2007

Guilbert TW, Morgan WJ, Zeiger RS, et al. N Engl J Med. 2006;354:1985–1997

PURPOSE OF THE STUDY. To determine the role of inhaled corticosteroid (ICS) in preventing the development of asthma in a group of high-risk children before the development of symptomatic disease or abnormal lung function.

STUDY POPULATION. Subjects were 285 children aged 2 to 3 years at high risk for developing asthma.

METHODS. Subjects were assigned to fluticasone propionate (FP) 88 μg twice per day with a pressurized metered-dose inhaler with spacer or placebo for a 2-year treatment period. The patients were observed without treatment for 1 year.

RESULTS. During the 2-year treatment period, there was significant improvement in symptom-free days for those in the FP group (86.8%–85.9%). Children in the FP group had more episode-free days, decreased exacerbations, and decreased need for extra controller medication. Those in the ICS group had a 1.1-cm decrement in growth after the first 2 years of the study, but this difference decreased to 0.7 cm after the 1-year observation period.

CONCLUSIONS. Although ICS had a significant effect on the burden of asthma during the treatment period, there was no evidence that a long-term effect was carried over to the 1-year observation period.

REVIEWER COMMENTS. The burden of childhood asthma is benefited with administration of ICS, but there is no evidence that long-term disease modification occurs.
Patterns of Global Tobacco Use in Young People and Implications for Future Chronic Disease Burden in Adults
Authors: Simons Elinor
Published: November 2007

Warren CW, Jones NR, Eriksen MP, Asma S; Global Tobacco Surveillance System (GTSS) Collaborative Group. Lancet. 2006;367:749–753

PURPOSE OF THE STUDY. The Global Youth Tobacco Survey assessed current tobacco use and exposure among young teenagers and evaluated susceptibility to starting smoking among nonsmokers.

STUDY POPULATION. Students aged 13 to 15 years (N = 747 603) at 395 sites in 131 countries and the Gaza Strip and West Bank.

METHODS. Students completed questionnaires to assess current tobacco use, cigarette smoking, susceptibility to smoking among nonsmokers, and exposure to secondhand smoke in homes and public places. Susceptibility to smoking was defined as an answer other than “definitely not” when asked if they would smoke a cigarette offered by a best friend or if they thought they would smoke at any time in the next 12 months.

RESULTS. Among all students, 17.3% currently used tobacco products and 8.9% currently smoked cigarettes. Current tobacco-product use was highest in the region of the Americas (22.2%), and current cigarette smoking was highest in the European region (17.9%) and region of the Americas (17.5%). Among students who had never smoked cigarettes, 18.3% reported susceptibility to smoking during the coming year. Susceptibility was highest in the European region (30.5%) and the region of the Americas (24.8%). Measures of use, susceptibility, and exposure were similar for boys and girls. Worldwide, never-smokers were less likely than current smokers to report exposure to secondhand smoke at home (prevalence: 39.1% [95% confidence interval (CI): 36.6–41.6] vs 72.8% [95% CI: 64.0–81.6]) and in public places (prevalence: 49.5% [95% CI: 46.7–52.3] vs 81.2% [95% CI: 74.2–88.2]).

CONCLUSIONS. Although tobacco exposure and susceptibility remain high among young teenagers, this study demonstrated a significant association between lower secondhand cigarette-smoke exposure and never smoking.

REVIEWER COMMENTS. Cigarette smoke is a common respiratory irritant that contributes to exacerbations of childhood asthma and rhinitis. This study provided evidence supporting the association between lower secondhand cigarette-smoke exposure and never smoking among young teenagers, which suggests an additional reason to counsel patients and their families regarding the immediate and long-term risks of exposure to secondhand cigarette smoke and cigarette smoking.
Montelukast Improves Regional Air-Trapping Due to Small Airways Obstruction in Asthma
Authors: Rangsithienchai Pitud A. , Phipatanakul Wanda
Published: November 2007

Zeidler MR, Kleerup EC, Goldin JG, et al. Eur Respir J. 2006;27:307–315

PURPOSE OF THE STUDY. To assess the effects of montelukast on regional air-trapping, airway hyperresponsiveness, and small-airway physiology using quantitative image analysis with high-resolution computed tomography (HRCT).

STUDY POPULATION. Sixteen patients (7 women, 9 men) aged 18 to 65 with no use of inhaled corticosteroids for the past 2 months, a forced expiratory volume in 1 second (FEV1) of >60% predicted, a provocation dose that causes a 20% decrease in FEV1, and a clinical diagnosis of asthma.

METHODS. The study was designed as a randomized, double-blind, placebo-controlled crossover trial. Subjects received either montelukast 10 mg or a placebo given once daily in the evening for 4 weeks. The subjects then crossed over to the alternate treatment for 4 more weeks. Regional air-trapping was assessed by HRCT at residual volume before and after methacholine challenge and was performed at baseline and after each of the drug phases was complete. Other indices of hyperresponsiveness and physiology were measured as well.

RESULTS. Significantly less regional air-trapping was seen on the premethacholine images of patients treated with montelukast. However, no effect on increases in regional air-trapping was seen on the postmethacholine images in these same patients. There were no differences seen in global indices of small-airways physiology between montelukast and placebo. Montelukast resulted in improved quality-of-life scores.

CONCLUSIONS. Montelukast improved small-airways disease in asthmatic subjects, but this improvement can only be detected by HRCT, not by physiologic studies.

REVIEWER COMMENTS. Although montelukast improved distal airway function, it is noted that at baseline, the patients in the montelukast group showed a greater degree of air-trapping, and this difference cannot be excluded as having an effect on the findings. One question that this study raised is why montelukast's beneficial effects are only measurable with HRCT and not by physiologic means. The authors alluded to the poor sensitivity of physiologic indices and their large degree of intrasubject test variability. They also refer to the inhomogeneous pattern of small-airway involvement and the greater reliability of computer-derived quantitative image analysis versus qualitative radiographic techniques. Sample size was also limited in this study, which involved only mildly asthmatic subjects, indicating that further and expanded studies need to be performed. Montelukast's inability to reduce hyperresponsiveness to methacholine should also be investigated further.
Suppression of IFN-Gamma Production in Atopic Group at the Acute Phase of RSV Infection
Authors: Wang Julie
Published: November 2007

Kaneko H, Matsui E, Asano T, et al. Pediatr Allergy Immunol. 2006;17:370–375

PURPOSE OF THE STUDY. Several studies have suggested that respiratory syncytial virus (RSV) bronchiolitis induces a change in the cytokine-production profile in childhood. The authors of this study sought to determine if the RSV-induced cytokine production was affected by the patient's atopic background.

STUDY POPULATION. Fourteen children between 1 month and 14 years of age who were admitted to the hospital with RSV infection and divided into 2 groups: those who were nonatopic and those who were atopic.

METHODS. Interferon-γ (IFN-γ) and interleukin 4 (IL-4) in the supernatant of peripheral blood mononuclear cells was measured after culture for 24 hours in the presence of phytohemagglutinin, IL-12, or IL-18.

RESULTS. In RSV-infected infants with atopic diseases, IFN-γ production from IL-12–or especially IL-18–stimulated peripheral blood mononuclear cells was subtotally suppressed in the acute phase, whereas in RSV-infected infants without atopic diseases, IFN-γ production was not suppressed in the acute phase.

CONCLUSIONS. The IFN-γ suppression observed in the atopic group was not caused by the immaturity of the infants’ immune system, because reduced IFN-γ production to RSV was not observed in the infants in the nonatopic group. IFN-γ suppression in regard to RSV infection might be caused by some genetic factor involved in the development of atopic disease, such as IL-18 signal cascade.

REVIEWER COMMENTS. Several studies have suggested a link between RSV infection and the development of persistent wheezing later in childhood. However, a causal role for RSV infection in early life in the development of asthma is not clear. The results of this study indicate that there may be a genetic predisposition to T-helper 2–type immune responses to RSV in atopic children, which may play a role in the development of recurrent wheezing in this subset of children.
Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome
Authors: Wang Julie
Published: November 2007

Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Pediatr Allergy Immunol. 2006;17:351–355

PURPOSE OF THE STUDY. This prospective study was undertaken to determine if the atopy patch test (APT) is able to predict the results of the oral food challenge (OFC) for food protein–induced enterocolitis syndrome (FPIES). The APT involves placement of food in a Finn chamber (metal cap) left on the skin for 48 hours and evaluated for rash in the subsequent days after removal.

STUDY POPULATION. Nineteen patients aged 5 to 30 months who had suspected FPIES on the basis of clinical history.

METHODS. The infants underwent APT to the suspected foods. After APT was performed, the subjects underwent OFC to determine if FPIES was present. The results of APT and OFC were compared and used to calculate sensitivity and specificity of the APT.

RESULTS. APT predicted the results of OFCs in 28 of 33 instances. There were 16 cases of FPIES confirmed by OFCs. In all 16 cases of FPIES, the APT result was positive to the suspected food. However, the APT was positive in 5 instances in which the OFC result was negative. All 12 patients with a negative APT result had a negative OFC result to the suspected food.

CONCLUSIONS. APT seems to be a promising diagnostic tool for the diagnosis of FPIES.

REVIEWER COMMENTS. FPIES is a non–immunoglobulin E (IgE)-mediated food allergy in which affected infants develop gastrointestinal symptoms hours after ingestion of the offending food. Current allergy skin and serum tests are not useful for diagnosing this disorder, because they test for food-specific IgE levels that are often negative in FPIES. A diagnostic OFC is the gold standard. The role for APT in diagnosing other non–IgE-mediated food hypersensitivities has been investigated. The results of this study suggest that APT may have some utility in guiding the diagnosis and management of FPIES.
Are We Overprescribing Antireflux Medications for Infants With Regurgitation?
Authors: Khoshoo Vikram , Edell Dean , Thompson Aaron , Rubin Mitchell
Published: November 2007

OBJECTIVE. Our goal was to evaluate the diagnosis and treatment of infants with persistent regurgitation who were referred to a pediatric gastroenterology service.

METHODS. The records of 64 infants with persistent regurgitation and without any neurodevelopmental abnormalities, underlying illness, or cigarette smoke exposure were evaluated for diagnostic workup and treatment. Forty-four infants underwent extended esophageal pH monitoring.

RESULTS. Only 8 of 44 pH studies showed abnormal acid reflux. Forty-two of these 44 infants were already on antireflux medications. Other etiologies included hypertrophic pyloric stenosis (4) and renal tubular acidosis (1). Discontinuation of medication did not result in worsening of symptoms in most infants with normal pH studies.

CONCLUSIONS. The majority of infants who were prescribed antireflux drugs did not meet diagnostic criteria for gastroesophageal reflux disease.
Mindfulness of Breathing in the Samyukta-agama
Authors: Anālayo Ven.
Published: November 2007

The present article supplies an annotated translation of the sixteenfold instructions on mindfulness of breathing in the Chinese Samyukta-agama. These instructions show how mindfulness of breathing fulfi ls the four satipatthanas and leads to the development of the seven bojjhangas, thereby leading to knowledge and liberation. The translation is followed by a comparison with its Pali counterpart, the Ananda-sutta in the Samyutta-nikaya.
Dharanis of Mahavyutpatti #748
Authors: Pagel Ulrich
Published: November 2007

This paper aims to identify the sources of a list of twelve dharanis included in Rubric 748 of the Mahavyutpatti. It produces evidence connecting this group with three similar dharani enumerations transmittted in the Ratnamegha, Tathagatagunajñanacintyavisayavataranirdesa and Tathagatamahakarunanirdesa. The exposition of the Tathagatamahakarunanirdesa is particularly valuable since it preserves one of the earliest and most detailed discussions of dharani practice in Mahayana sutras. The Ratnamegha is closest to the Mahavyutpatti and thus the most likely source for its list.
The Self Possessed: Deity and Spirit Possession in South Asian Literature and Civilization, Frederick M. Smith
Authors: Mayer Robert
Published: November 2007

The Self Possessed: Deity and Spirit Possession in South Asian Literature and Civilization, Frederick M. Smith (New York: Columbia University Press, 2006), 13 illus., pp. xxvii+701, $60.00/£35 (cloth), ISBN: 0-231-13748-6
Cambodian Buddhism: History and Practice, Ian Harris
Authors: Thompson Ashley
Published: November 2007

Cambodian Buddhism: History and Practice, Ian Harris (Honolulu, HI: University of Hawai’i Press, 2005), 352pp, $62/£39.95, ISBN 0824827651
Zen Classics: Formative Texts in the History of Zen Buddhism, eds Steven Heine & Dale S. Wright
Authors: Kieschnick John
Published: November 2007

Zen Classics: Formative Texts in the History of Zen Buddhism, eds Steven Heine & Dale S. Wright (Oxford: Oxford University Press, 2006), viii + 283 pp, £14.99, ISBN 0-19-517525-5
Movement and Habitat Use of Stocked Juvenile Paddlefish in the Ohio River System, Pennsylvania
Authors: Barry Patrick M. , Carline Robert F. , Argent David G. , Kimmel William G.
Published: November 2007

In 2002 and 2003 we released a total of 66 hatchery-reared, juvenile paddlefish Polyodon spathula (249–318 mm eye-to-fork length) in Pennsylvania's upper Ohio River system and tracked them with radiotelemetry in two different pools of the Ohio and Allegheny rivers to determine (1) poststocking survival, (2) whether release site influences survival, (3) dispersal distance and direction of movement, and (4) habitat selection. Survival was fair (mean = 78% in 2002 and 67% in 2003) for 0.23–0.43-kg paddlefish after 9 weeks. In 2003, fish stocked in the upstream half of the pool had a greater survival (100%) after 63 d than those stocked in the downstream half (44%). Within 4 d of stocking, 77% of juvenile paddlefish were located in tailwaters, and fish found these habitats regardless of stocking location. Habitat measurements at all postdispersal locations had median depths of 5.2 and 6.1 m in 2002 and 2003, respectively, and median near-surface velocities of 0.17 and 0.12 m/s. Fish selected tailwater habitats and avoided habitats with disturbance from commercial barge traffic in both years.
Stress Response and Avoidance Behavior of Fishes as Influenced by High-Frequency Strobe Lights
Authors: Richards Nathan S. , Chipps Steven R. , Brown Michael L.
Published: November 2007

We examined the effects of strobe lights on plasma cortisol concentrations and avoidance behavior across a broad range of fish taxa. Representative fish taxa from five families were evaluated and included: Centrarchidae (largemouth bass Micropterus salmoides), Cyprinidae (fathead minnow Pimephales promelas), Ictaluridae (channel catfish Ictalurus punctatus), Percidae (yellow perch Perca flavescens), and Salmonidae (Chinook salmon Oncorhynchus tshawytscha). Mean (±SE) plasma cortisol concentrations for channel catfish (89 ± 22 ng/mL), yellow perch (81 ± 39 ng/mL), and Chinook salmon (173 ± 27 ng/mL) increased significantly compared with those in control groups (50 ± 11, 3.0 ± 1.9, and 102 ± 35 ng/mL, respectively) after 1 h of exposure to strobe lights. After 7 h of exposure, plasma cortisol levels were similar to those in control groups for all fish taxa. Fathead minnow showed no detectable response to strobe lights at either 1 or 7 h of exposure. Behavior experiments showed that the mean distance moved from the strobe light varied significantly between test and control fish and was highest for largemouth bass (mean distance after 1 h = 8.3 m), followed by Chinook salmon (7.3), yellow perch (7.3), and channel catfish (5.1). In contrast, avoidance behavior by fathead minnow exposed to strobe lights did not differ from that of controls. Although a significant increase in plasma cortisol level was useful for predicting an avoidance response, relative change in cortisol concentration was a poor indicator of sensitivity of individual fish taxa to strobe lights. Direct observations of avoidance behavior revealed that largemouth bass, Chinook salmon, and yellow perch were more sensitive to strobe lights than channel catfish and fathead minnow. Lack of both a cortisol response and avoidance behavior by fathead minnow indicates low sensitivity of this species to strobe lights and warrants further investigation into the effectiveness of strobe lights on cyprinids.
The Effect of Chemical Treatments on Red-Rim Melania Melanoides tuberculata, an Exotic Aquatic Snail that Serves as a Vector of Trematodes to Fish and Other Species in the USA
Authors: Mitchell Andrew J. , Hobbs Melissa S. , Brandt Thomas M.
Published: November 2007

The red-rim melania Melanoides tuberculata, a subtropical and tropical snail, is a nonindigenous species that has become established and is spreading in the United States. Of concern is the potential of the red-rim melania to displace native snail populations and to transmit trematodes that cause serious problems. One of these, a fish gill trematode, Centrocestus formosanus, has negatively affected U.S. commercial and wild fish stocks, including some endangered species. The snail has an operculum that can protect it from desiccation and can remain viable for days on dry fisheries equipment. Thus, contaminated fisheries equipment is suspected as one of the ways the snail is being moved from place to place. A study was conducted to find chemical treatments that would kill 100% of the red-rim melania. Thirteen different chemicals and chemical combinations were evaluated at different concentrations and for various exposure periods. Roccal-D-Plus, Hydrothol 191, niclosamide, and Virkon showed promise in 24-h exposures at concentrations of 20 mg/L active ingredient (AI), 80 mg/L AI, 2 mg/L, and 1,600 mg/L AI, respectively. Additionally, Roccal-D-Plus killed all snails exposed to 2,000 mg/L for 1 h and to 600 mg/L for 16 h. Roccal-D-Plus has a history of use as a disinfectant for fishery equipment.
An Efficient Smolt Trap for Sandy and Debris-Laden Streams
Authors: Scace Justin G. , Letcher Benjamin H. , Noreika John
Published: November 2007

Tripod weir and box traps are traditionally used to capture and enumerate out-migrating salmonid smolts in short-term studies and in streams where temporary or portable traps are the only practical option. Although traditional traps can be effective when conditions are ideal, they are often unable to withstand high-discharge events in streams containing a large amount of debris or sandy substrates. We created a rotary-screw trap and resistance board weir hybrid design that we evaluated along with a tripod weir and box trap, both in a 6.1-m-wide flume and in the field. The new design outperformed the tripod weir in both situations. The tripod weir failed in 10 min in the flume trial, whereas the new design was still operating at the conclusion of an 8-h trial under the same conditions. The new design operated continuously in the field during a high-discharge event that caused the tripod weir to fail. The new design also required less frequent cleaning than the tripod weir. The trap efficiency of the new design was estimated by using passive integrated transponder (PIT) tag antennas and radiotelemetry. The trap was 80% efficient (n = 40) in capturing migrating PIT-tagged individuals detected at an antenna upstream of the trap and 87.5% efficient (n = 48) at recapturing fish that had been tagged and released upstream. With its high efficiency and increased resiliency over the tripod weir, the new trap design will benefit management and research efforts in streams where traditional traps are unsuitable.
Attitudes towards earth building for Zambian housing provision
Authors: Hadjri K. , Osmani M. , Baiche B. , Chifunda C.
Published: November 2007

Zambian cities are experiencing a massive influx of people from rural areas resulting in high demand for housing and the growth of squatter settlements. Insufficient use of low-cost traditional construction techniques in the Zambian residential construction industry has resulted in expensive housing stock for the majority of the poor. There is therefore an urgent need to assess alternative building materials and techniques that are both affordable and sustainable. This research examines the viability of earth as a building material and associated construction techniques for urban housing provision in Zambia. Attitudes towards earth building among end-users, designers, contractors and government regulators were assessed using quantitative and qualitative research approaches. The study concludes that urban residents associate earth houses with poverty and low socio-cultural status; construction professionals are reluctant to specify and select earth materials due to their technical and performance limitations; and government regulators acknowledged that there are currently no appropriate earth building standards and codes in place. Nevertheless, Zambian designers and contractors expressed their willingness to use the material if its performance is improved. Furthermore, government reported that new codes of practice and standards could be developed if stimulated by research findings.
Structural behaviour of reinforced-concrete continuous deep beams with web openings
Authors: Yang K.-H. , Ashour A. F.
Published: November 2007

Ten reinforced-concrete continuous deep beams with openings were tested to failure. The main variables investigated were the shear span-to-overall depth ratio, and the size and location of openings. Two failure modes influenced by the size and location of web openings regardless of the shear span-to-overall depth ratio were observed. The normalised load capacity of beams having a web opening area ratio of 0·025 within exterior shear spans was approximately similar to that of their companion solid beams. Continuous deep beams having web openings within interior shear spans exhibited a higher load capacity reduction with the increase of the opening size, similar to simply supported deep beams with web openings. Formulae based on the upper bound analysis of the plasticity theory were proposed to predict the load capacity of continuous deep beams with web openings. Comparisons between the measured and predicted load capacities showed a good agreement.
Pozzolanic activity tests as a measure of pozzolans' performance. Part 2
Authors: Gava G. P. , Prudêncio L. R.
Published: November 2007

Part 1 of the current paper demonstrated the lack of agreement between the results obtained from different standard pozzolanic activity tests. This can be explained by the significant differences observed in the recommended test procedures that, in some cases, allow variations in parameters which have a remarkable influence on the pozzolanic reaction. Given this fact, the part of the research programme presented here was conducted to verify the actual influence of several different parameters on the consistency and compressive strength of mortar specimens. These parameters included water/cementitious materials ratio, pozzolan type and content, type of cement, age and presence of water-reducing admixtures. It was found that the performance exhibited by pozzolans in these tests did not correlate with that obtained in standard pozzolanic activity index tests shown in the first part of this research.