bluuebunny/crossref_metadata_2025 huggingface dataset:
THE 'INVISIBLE' NGO: US EVANGELICAL MISSIONS IN KENYA
Authors: Hearn Julie
Published: September 2002

This article argues that the beginning of the new millennium marks not the end of the missionary era but its high point. Critical changes have taken place in international development policy, resulting in a smaller role for the state and a greater role for non-state agencies, including NGOs. In Kenya, American evangelical missions constitute one of the most important of these groups, but their significance is overlooked, hence they are described as 'invisible'. The article examines the role of missions as implementers of the New Policy Agenda in Kenya, focusing on five organisations and their involvement in such matters as health care, AIDS, family planning and food security. It enriches our understanding of the contemporary role of mission-related Christianity in Africa, and explores the relationship between American evangelical missions and the international aid regime.
AN AMBIGUOUS ADVENTURE: MUSLIM ORGANISATIONS AND THE DISCOURSE OF 'DEVELOPMENT' IN SENEGAL
Authors: Renders Marleen
Published: September 2002

The article explores how the process of appropriating the discourse of 'development' by Muslim organisations and 'NGOs' might be a factor in the construction of new forms/contexts of Muslim political participation in Senegal. By promoting 'Islamic development', Muslim organisations have moved into a discursive field that was previously the fief of the secular state. It is shown how the discourse of 'development' and 'Islam' and the interplay between them are functional in the context of competition and negotiation amongst political actors in Senegal. The result observed is very complex and multifaceted. By claiming 'Islamic development' and playing with the content of these two concepts according to the powerpolitical context, 'Muslim' organisations and personalities claim political space from the 'secular' state as well as from each other.
REORGANISING SOCIAL WELFARE AMONG MUSLIMS: ISLAMIC VOLUNTARISM AND OTHER FORMS OF COMMUNAL SUPPORT IN NORTHERN GHANA
Authors: Weiss Holger
Published: September 2002

During the second half of the twentieth century the contribution of Muslim NGOs in providing basic social welfare became a significant feature in Ghana. However, none of the Muslim NGOs are able to finance their projects themselves but rely on foreign financial assistance. On the other hand, Ghanaian Muslim scholars have argued for the need to develop zakāt, the locally collected obligatory alms, into a fully-fledged welfare system. At the moment, this is not the case. On the other hand, there exists a local tradition of mutual support and tributary relations in Ghana, which is at least by some Muslims identified as being as efficient in providing social welfare. This article discusses the link between communal support and the provision of social welfare through Muslim NGOs and especially zak t in today's Northern Ghana.
CONVERSION TO HISTORY: NEGATING EXILE AND MESSIANISM IN AL-SAMAW'AL AL-MAGHRIBĪ'S POLEMIC AGAINST JUDAISM
Authors: Husain Adnan
Published: September 2002

This article examines the autobiographical narrative and polemical treatise of a twelfth century Jewish convert to Islam. Samaw'al al-Maghribī's writings contend with the problems of reconciling exilic Jewish identity during the diaspora with the dominant Muslim high culture in which Jews participated. In particular, his autobiography reveals the profound importance for his conversion of his identitification with Muslim history as represented in historical literature that promoted an ideological vision of the past. Similarly, his polemic articulates a critique of Judaism and Jewish religious identity in remarkably historicist terms that associate the integrity of religious culture with an independent political power. Educated in Islamicate scientific and philosophical culture, Samaw'al privileges a culturally defined conception of "reason" over genealogical links and identifies with the political success of Islamic civilization. His writings exemplify the dynamic tension within Jewish exilic identity between conversion and messianism as resolutions to the conflicts of minority status. In choosing conversion, he denied the endless wait for the Messiah as an irrational failure to recognize the judgments of history.
VIRTUAL SACRALITY: MAKING MUSLIM SYRIA SACRED BEFORE THE CRUSADES
Authors: Cobb Paul
Published: September 2002

This study uses the Kitāb fadā'il al-shām wa-dimashq (The Book of the Virtues of Syria and Damascus) of 'Alīibn Muhammad al-Raba'ī (d. 1052) as an archive of Muslim traditions about Syria's sacred status that were circulated throughout the early Islamic period (seventh to eleventh centuries). In order to make the claims in these traditions believable, the early Muslim scholars who circulated them invoked both explicit textual authorities and implicit rhetorical techniques. The methods by which these early Muslims claimed Syria as sacred space are briefly compared to strategies used in medieval Europe.
BETWEEN NATIONALISM AND THE SOCIAL SCIENCES: AN EXAMINATION OF MODERN SCHOLARSHIP ON THE 'ABBĀSID CIVIL WAR AND THE REIGN OF AL-MA'MŪN
Authors: Yucesoy Hayrettin
Published: September 2002

This article attempts to examine the modern historical constructions of the 'Abbāsid Civil War, and the reign of the caliph al-Ma'mūn in the early ninth century C.E. This article argues that concepts such as nationalism, sectarianism, historical positivism, center-periphery relations, realpolitik and political pragmatism have created questionable categories into which this era is molded. However, such categories which draw their legitimacy from orientalist, nationalist and social-scientistic discourses reflect, despite their contributions to our knowledge and understanding, more accurately current models than the early Islamic era's own issues. This article hopes then to address the thorny issues of methodological consciousness and identity of the observer.
TRUTH AND CONSEQUENCES: JUAN DE SEGOVIA ON ISLAM AND CONCILIARISM
Authors: Mann Jesse
Published: September 2002

The fifteenth-century Spanish theologian Juan de Segovia is known primarily as a leading proponent of late medieval conciliarism and, to a lesser degree, as an advocate of peaceful resolution to Christian-Muslim conflict. Scholars who have studied Segovia's Islamicism have generally emphasized his originality and his progressive approach. As a corrective to this justifiable view, the present article outlines the traditional elements in Segovia's portrayal of Islam, because these elements constitute rather an obstacle to Segovia's own pacifistic approach. In addition, this article suggests a connection between Segovia's Islamicism and his conciliarism that hinges on the notion of truth. It is argued that Segovia's university background provides the crucial context for his understanding of truth, and thus for his views on ecclesiological as well as inter-religious conflict.
Are immunoglobulin E levels associated with early wheezing? A prospective study in Brazilian infants
Authors: Lopez N. , de Barros-Mazon S. , Marluce dos Santos Vilela M. , Condino Neto A. , Ribeiro J.D.
Published: September 2002

The relationship between wheezing or asthma and serum immunoglobulin (Ig)E levels in early life is unclear. The aim of this study was to follow-up the IgE immune response in infants that did, or did not, develop recurrent wheezing during their first year of life.

One-hundred and two randomised term neonates were included, in which IgE levels were quantified in cord blood samples, at 3, 6, 9 and 12 months of age. Specific IgE levels for food and inhalant allergens and the skin-prick test for inhalant allergens were also assessed at 6 and 12 months.

During clinical follow-up, 32 (31%) infants presented with two or more wheezing episodes, while 70 (69%) had no wheezing. Total IgE levels were significantly higher up to 12 months in wheezing infants when compared to nonwheezing group. At 12 months, the specific IgE levels to cow's milk, egg white and mites were higher in infants with recurrent wheezing. There was no influence of family history for atopy on IgE levels. The skin-prick tests were positive in 14% and 23% in wheezing infants at 6 and 12 months, respectively.

These results indicate an early allergic sensitisation in wheezing infants, suggesting an altered immunoregulatory T-cell role in immunoglobulin E production.
Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis
Authors: Lötters F. , van Tol B. , Kwakkel G. , Gosselink R.
Published: September 2002

The purpose of this meta-analysis is to review studies investigating the efficacy of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients and to find out whether patient characteristics influence the efficacy of IMT.

A systematic literature search was performed using the Medline and Embase databases. On the basis of a methodological framework, a critical review was performed and summary effect-sizes were calculated by applying fixed and random effects models.

Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improved functional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMT plus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness.

From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness. The effect on exercise performance is still to be determined.
A randomised clinical trial of nebulised tobramycin or colistin in cystic fibrosis
Authors: Hodson M.E. , Gallagher C.G. , Govan J.R.W.
Published: September 2002

Chronic infection withPseudomonas aeruginosais associated with progressive deterioration in lung function in cystic fibrosis (CF) patients. The purpose of this trial was to assess the efficacy and safety of tobramycin nebuliser solution (TNS) and nebulised colistin in CF patients chronically infected withP. aeruginosa.

One-hundred and fifteen patients, aged ≥6 yrs, were randomised to receive either TNS or colistin, twice daily for 4 weeks. The primary end point was an evaluation of the relative change in lung function from baseline, as measured by forced expiratory volume in one second % predicted. Secondary end points included changes in sputumP. aeruginosadensity, tobramycin/colistin minimum inhibitory concentrations and safety assessments.

TNS produced a mean 6.7% improvement in lung function (p=0.006), whilst there was no significant improvement in the colistin-treated patients (mean change 0.37%). Both nebulised antibiotic regimens produced a significant decrease in the sputumP. aeruginosadensity, and there was no development of highly resistant strains over the course of the study. The safety profile for both nebulised antibiotics was good.

Tobramycin nebuliser solution significantly improved lung function of patients with cystic fibrosis chronically infected withPseudomonas aeruginosa, but colistin did not, in this study of 1-month's duration. Both treatments reduced the bacterial load.
Inspiratory neural drive response to hypoxia adequately estimates peripheral chemosensitivity in OSAHS patients
Authors: García-Río F. , Pino J.M. , Ramirez T. , Alvaro D. , Alonso A. , Villasante C. , Villamor J.
Published: September 2002

The aim of the present study was to examine the relationships between the responses to progressive isocapnic hypoxia and hypoxic withdrawal test in patients with obstructive sleep apnoea-hypopnoea syndrome (OSAHS) and to analyse the determinants of carotid body sensitivity in OSAHS.

Nineteen consecutive OSAHS patients and 13 healthy subjects were selected. Ventilatory (ΔV′I/Sa,O2/BSA) and inspiratory neural drive (ΔP0.1/Sa,O2) responses to progressive isocapnic hypoxia were determined. Peripheral chemosensitivity was evaluated by the hypoxic withdrawal test, which measures the decrease in ventilation caused by two breaths of 100% oxygen (%ΔV′I).

Withdrawal response and ventilatory and inspiratory neural drive responses to hypoxia were lower in OSAHS patients than in control subjects. In patients with OSAHS, %ΔV′Icorrelated significantly with ΔV′I/Sa,O2/BSA and with ΔP0.1/Sa,O2. On stepwise multiple linear regression analysis, a strong correlation between %ΔV′Iand ΔP0.1/Sa,O2was found. Moreover, %ΔV′I, ΔV′I/Sa,O2/BSA and ΔP0.1/Sa,O2were significantly correlated with minimum arterial oxygen saturation and with arousal index.

Obstructive sleep apnoea-hypopnoea syndrome patients have a strong relationship between peripheral chemosensitivity and respiratory response to hypoxia, suggesting that hypoxic stimulation of central chemoreceptors is minimally relevant in obstructive sleep apnoea-hypopnoea syndrome. Moreover, sensitivity of the carotid body in patients with obstructive sleep apnoea-hypopnoea syndrome is related to sleep disruption and to nocturnal hypoxia.
Arousability in sleep apnoea/hypopnoea syndrome patients
Authors: Dingli K. , Fietze I. , Assimakopoulos T. , Quispe-Bravo S. , Witt C. , Douglas N.J.
Published: September 2002

Sleep disruption and daytime sleepiness in obstructive sleep apnoea/hypopnoea syndrome (OSAHS) patients result from recurrent apnoeas/hypopnoeas and arousals from sleep. Around 30% of apnoeas/hypopnoeas are not terminated by visible cortical arousals. The current authors tested the hypotheses that arousal induction is linked to sleep stage, oxygen desaturation, event type, event duration and time of occurrence during the night.

Fifteen patients with OSAHS of varying severity were studied and all their apnoeas/hypopnoeas were evaluated.

Eight of 15 patients had apnoeas/hypopnoeas in all sleep stages, and all their 610 apnoeas/hypopnoeas were analysed in the between stages comparison; data from all 15 patients were included in other comparisons. Thirty-four per cent of apnoeas/hypopnoeas during slow wave sleep (SWS) were associated with arousal, significantly less than the 77% during nonrapid eye movement (NREM) 1 and 2 and 62% during rapid eye movement (REM) sleep. Arousal induction was not affected by oxygen desaturation, event type, duration or time of the night. The apnoea/hypopnoea index was 39·h−1in NREM 1 and 2, significantly higher compared to 17·h−1in REM or to 11·h−1in SWS sleep.

In conclusion, apnoeas/hypopnoeas in slow wave sleep are associated with fewer cortically apparent, visually detected arousals.
Asthma in children exposed to nitrogen dioxide in ice arenas
Authors: Thunqvist P. , Lilja G. , Wickman M. , Pershagen G.
Published: September 2002

Very high concentrations of nitrogen dioxide (NO2) have been measured in arenas using combustion engine-powered resurfacing machines. This study was performed to compare the occurrence of asthma in children playing ice hockey in arenas using propane-powered machines and in children attending arenas using electric machines.

Children regularly playing hockey in the arenas (nine propane, six electric) were sent a questionnaire, including questions on allergic disease and risk factors. Measurements of NO2were performed with passive diffusion samplers during 3 consecutive days.

The mean NO2concentration in the propane arenas was 276 µg·m−3(range 28–1015 µg·m−3) and 11 µg·m−3(2–30) in the electric arenas. Questionnaires were answered by 1,536 children (78%), with an overall prevalence of asthma of 16%. The odds ratio (OR) for asthma was 0.9 (95% confidence interval (CI) 0.7–1.2) comparing propane arenas to electric. However, children in propane arenas with higher than median concentration of NO2reported more wheezing (OR 1.4, 95% CI 1.0–1.9) and nasal symptoms (OR 1.7, 95% CI 1.3–2.3) than children in propane arenas with lower concentrations.

In conclusion, children playing ice hockey in indoor arenas have a high prevalence of asthma, but it appears unlikely that increased exposure to combustion products, including nitrogen dioxide, is a major contributor to this excess risk.
Increased expression of nuclear factor-κB in bronchial biopsies from smokers and patients with COPD
Authors: Di Stefano A. , Caramori G. , Oates T. , Capelli A. , Lusuardi M. , Gnemmi I. , Ioli F. , Chung K.F. , Donner C.F. , Barnes P.J. , Adcock I.M.
Published: September 2002

The expression of nuclear factor (NF)-κB is an indicator of cellular activation and of inflammatory mediator production. The aim of the present study was to characterise the expression and localisation of p65, the major subunit of NF-κB, in the bronchial mucosa of patients with chronic obstructive pulmonary disease (COPD), and to examine the relationship between p65 expression and disease status.

Bronchial biopsies were obtained from 14 smokers with COPD, 17 smokers with normal lung function and 12 nonsmokers with normal lung function. The number of p65 positive (+) cells was quantified by immunohistochemistry and the expression of p65 in bronchial biopsies from the three groups was examined by Western blotting (WB).

Smokers with normal lung function and patients with COPD had increased numbers of p65+ cells in the epithelium and increased p65 nuclear expression. In COPD patients the number of epithelial p65+ cells correlated with the degree of airflow limitation. WB analysis showed an increase in p65 in smokers with normal lung function and COPD patients (p<0.05).

Bronchial biopsies in smokers with normal lung function and chronic obstructive pulmonary disease patients show increased expression of p65 protein, predominantly in the bronchial epithelium. Disease severity is associated with an increased epithelial expression of nuclear factor-κB.
iNOS depletion completely diminishes reactive nitrogen-species formation after an allergic response
Authors: Koarai A. , Ichinose M. , Sugiura H. , Tomaki M. , Watanabe M. , Yamagata S. , Komaki Y. , Shirato K. , Hattori T.
Published: September 2002

Nitric oxide (NO) shows proinflammatory actions mainlyviareactive nitrogen species (RNS) formation through superoxide- and peroxidase-dependent mechanisms. The purpose of this study was to examine the role of inducible NO synthase (iNOS) in RNS production, airway hyperresponsiveness, and inflammation after allergen challenge.

Ovalbumin (OVA)-sensitised, iNOS-deficient and wild-type mice were used. RNS production was assessed by nitrotyrosine (NT) immunoreactivity in the airways. Airway inflammation and responsiveness were evaluated by eosinophil accumulation and methacholine (i.v.) challenge, respectively.

In wild-type mice, OVA-inhalation challenge increased iNOS immunoreactivity in airway epithelial cells as well as iNOS protein measured by Western blotting. The total amounts of nitrite and nitrate in bronchoalveolar lavage (BAL) fluid were increased, and NT immunoreactivity was also observed abundantly in airway inflammatory cells. In iNOS-deficient mice, both iNOS expression and NT formation were completely abolished, and the total amounts of nitrite and nitrate in BAL fluid were significantly decreased. In contrast, OVA-induced airway eosinophil recruitment and hyperresponsiveness were observed almost equally in wild-type and iNOS-deficient mice.

These data suggest that reactive nitrogen species production after allergic reaction occurs totallyviainducible nitric oxide synthase-dependent pathways. Allergen-mediated airway eosinophil recruitment and hyperresponsiveness appear to be independent of reactive nitrogen species production.
Neutrophil survival is prolonged in the airways of healthy infants and infants with RSV bronchiolitis
Authors: Jones A. , Qui J.M. , Bataki E. , Elphick H. , Ritson S. , Evans G.S. , Everard M.L.
Published: September 2002

Large numbers of neutrophils in the airway of infants infected by respiratory syncytial virus (RSV) are recruited by chemokines, such as interleukin-8, and specific inflammatory molecules can delay apoptosis increasing their longevity. The aim of this study was to investigate whether airway secretions in RSV bronchiolitis contain factors that influence neutrophil apoptosis.

Nasal lavage fluid (NLF) was obtained from 24 infants with RSV bronchiolitis (31 infant controls and 12 adults). Neutrophils isolated from healthy adult volunteers were incubated with the NLF in Dulbecco modified Eagle medium (DMEM) for 24 h, and apoptosis and necrosis were quantified using Hoechst 33342 and propidium iodide viability dyes. The presence of putative factors that delay neutrophil apoptosis was investigated using inhibitors to leukotriene-B4, lipopolysaccharide and the IL-8 receptor CXCR2, and blocking antibodies to granulocyte-monocyte colony-stimulating factor. Characterisation of NLF involved tests of thermal instability, proteolysis, deoxyribonuclease digestion and molecular filtration.

NLF from infants with RSV bronchiolitis and controls significantly delayed neutrophil apoptosis, whereas NLF from healthy adults did not. None of these inhibitor molecules blocked this delay in apoptosis but activity was heat liable and >3 kDa.

The study showed that nasal lavage fluid from infants significantly delays neutrophil apoptosis. The speculation is that the prolonged survival of neutrophils in the infant airway contributes to the characteristic accumulation of neutrophils in the airways of infants with respiratory infections.
Asthma characteristics in cleaning workers, workers in other risk jobs and office workers
Authors: Zock J.P. , Kogevinas M. , Sunyer J. , Jarvis D. , Torén K. , Antó J.M.
Published: September 2002

Several studies have demonstrated an excess risk for asthma among cleaning workers. The aim of this analysis was to compare clinical, immunological and functional characteristics associated with asthma in cleaners and other occupational groups.

Cleaners, workers exposed to high molecular weight (MW) agents, workers exposed to low MW agents, and office workers were identified from an international community-based epidemiological study. Influence of sex, smoking, age and atopy on the relationships with asthma was investigated. Rates of respiratory symptoms, bronchial hyperresponsiveness, atopic sensitisation and lung function were compared between asthmatics from the four groups (case-case analysis).

The risk for asthma in workers exposed to low MW agents was higher among nonatopics than among atopics. Case-case analysis showed no major differences in asthma characteristics between cleaners and workers exposed to high or low MW agents. Asthmatic cleaners had less atopy, more chronic bronchitis and a lower lung function as compared to office workers.

Asthma in cleaning workers showed many similarities with that in workers known to be at risk for occupational asthma. Atopic sensitisation did not seem to play an important role in cleaning-related asthma.
A comparison of serial computed tomography and functional change in bronchiectasis
Authors: Sheehan R.E. , Wells A.U. , Copley S.J. , Desai S.R. , Howling S.J. , Cole P.J. , Wilson R. , Hansell D.M.
Published: September 2002

In bronchiectasis the morphological determinants of (marginal) fluctuations in pulmonary function tests are uncertain. The aim of the present study was to evaluate serial computed tomography (CT) changes in relation to pulmonary function trends in patients with bronchiectasis.

The relationships between pulmonary function indices and CT scans in 48 adult patients with bronchiectasis were evaluated at baseline and at follow-up, at a median interval of 28 months (range 6–74 months). Two independent observers semiquantitatively scored CT features of bronchial and small airways disease.

At initial assessment, the severity of airflow obstruction was linked primarily to the extent of mosaic attenuation. However, serial changes in pulmonary function indices were only associated with serial changes in mucous plugging scores. Alterations in mucous plugging on serial CT were associated with changes in the severity of bronchiectasis and bronchial wall thickness. Greater severity of all three morphological abnormalities at baseline CT were predictive of significant declines in forced expiratory volume in one second, with severe bronchial wall thickness being the most adverse prognostic determinant.

Variations in mucous plugging on computed tomography correlate with minor fluctuations in pulmonary function tests in bronchiectasis. However, the severity of bronchial wall thickness is the primary determinant of subsequent major functional decline.
Exhaled NO and assessment of anti-inflammatory effects of inhaled steroid: dose-response relationship
Authors: Jones S.L. , Herbison P. , Cowan J.O. , Flannery E.M. , Hancox R.J. , McLachlan C.R. , Taylor D.R.
Published: September 2002

Exhaled nitric oxide (eNO) is an easily measured marker of airway inflammation. This study was undertaken to evaluate the usefulness of serial eNO in investigating the dose-response relationship for inhaled beclomethasone (BDP), and to compare eNO with other markers of airway inflammation.

Following withdrawal of inhaled corticosteroid (ICS) therapy, 65 patients entered a double-blind, parallel-group, placebo-controlled trial of 50, 100, 200 or 500 µg·BDP·day−1for eight weeks. eNO and spirometry were performed weekly and a hypertonic saline challenge with sputum induction was performed at the beginning and end of treatment.

The relationship between the dose of ICS and changes in eNO and forced expiratory volume in one second (FEV1) was linear at 1 week and at the end of treatment. A linear dose-response relationship was also seen for sputum eosinophils. Changes in eNO correlated significantly with changes in sputum eosinophils. Changes in the provocative dose of saline causing a 15% fall in FEV1saline did not differ across the treatment groups nor did they correlate with changes in other measurements.

Exhaled nitric oxide may be used to assess the dose-response relationship for the anti-inflammatory effects of inhaled beclomethasone. The relationship found in this study was linear over the dose range 0–500 µg·day−1soon after commencing therapy and continued over time.
Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial
Authors: Thys F. , Roeseler J. , Reynaert M. , Liistro G. , Rodenstein D.O.
Published: September 2002

The aim of the present study was to clarify whether the known effects of noninvasive positive-pressure ventilation (NPPV) in patients with respiratory failure are real or due to placebo effects and whether early application of NPPV in the emergency department leads to rapid improvement of the patients condition and outcome.

A prospective randomised placebo-controlled study was conducted in 20 patients with severe acute respiratory failure (ARF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute pulmonary oedema, not improving under conventional medical therapy and on the edge of intubation. Patients received either conventional medical therapy plus two-level NPPV (bi-level NPPV) or conventional medical therapy plus “placebo” NPPV.

The main outcome measures involved the need for endotracheal intubation in the bi-level NPPV arm and in the placebo arm after crossing over to active NPPV. Morbidity, length of stay, mortality and the effect of the ventilatory mode on clinical, arterial-blood gas parameters, and the sternocleidomastoid muscles electromyogram (EMG) activity were also measured.

The 10 patients in the active NPPV group rapidly improved and none needed intubation. Placebo NPPV resulted in no change in the clinical condition of patients that continued to worsen and the 10 patients were crossed over to active NPPV. Three patients were intubated. No differences in terms of morbidity, length of stay or mortality between the two groups were observed. Active NPPV (but not placebo NPPV) led to a rapid and significant improvement in the clinical parameters, pH and the carbon dioxide tension in arterial blood and to a decrease in respiratory frequency and sternocleidomastoid EMG activity.

Early application of bi-level noninvasive positive-pressure ventilation in patients with severe acute respiratory failure, due to chronic obstructive pulmonary disease and acute pulmonary oedema, leads to a rapid improvement in clinical status and blood gases. Noninvasive positive-pressure ventilation had no placebo effect.
Adenovirus-mediated E2F-1 gene transfer in nonsmall-cell lung cancer induces cell growth arrest and apoptosis
Authors: Kuhn H. , Liebers U. , Gessner C. , Schumacher A. , Witt C. , Schauer J. , Kovesdi I. , Wolff G.
Published: September 2002

Since overexpression of E2F-1 has been shown to induce apoptosis, the ability of adenovirus-mediated transfer of E2F-1 to inhibit tumour growth in nonsmall-cell lung cancer cell lines was investigated.

Three cell lines with various genomic status were infected with AdE2F. Cell proliferation and viability were determined by trypan blue exclusion. Apoptosis induction was assessed by flow cytometry and poly-adenosine diphosphate-ribose-polymerase cleavage assay.In vivo, the effect of E2F-1 on tumour growth was determined in severe combined immunodeficiency (SCID) mice.

The current experiments showed that overexpression of E2F-1 suppressed tumour cell growth. The population of apoptotic cells was dramatically increased 96 h after infection with AdE2F. Inhibition of cell growth and induction of apoptosis was not dependent on genomic status. Moreover, treatment of implanted tumours in SCID mice with AdE2F inhibited tumour growth.

These data suggest that adenovirus-mediated E2F-1 gene therapy may be effective in the treatment of nonsmall-cell lung cancer.
Achieving guideline-based asthma control: does the patient benefit?
Authors: Bateman E.D. , Frith L.F. , Braunstein G.L.
Published: September 2002

Asthma management guidelines define asthma control, but the outcome criteria used do not include the patient's own assessment of their health. The objective of the present study was to determine the association between the achievement of asthma control, as defined by the Global Initiative for Asthma (GINA) guidelines, and patient-assessed asthma-related quality of life (QOL), particularly whether maximal or near-maximal QOL scores were attainable.

Clinical data from three studies that compared salmeterol/fluticasone propionate combination therapy (SFC) with other treatments in patients with persistent asthma were retrospectively analysed. Achievement of asthma control was determined over an 8-week period in each study according to six parameters derived from the GINA guideline treatment goals. Asthma Quality of Life Questionnaire (AQLQ) scores (a 7-point scale, where 1=severe impairment and 7=no impairment) were analysed by treatment group for well-controlled and not well-controlled patients.

The analysis showed that, across a range of severities, well-controlled asthma patients had consistently higher AQLQ scores at endpoint and larger AQLQ improvements from baseline, than patients who were not well controlled. For many well-controlled patients, endpoint scores approached 7, indicating little or no impact of asthma on their QOL. However, AQLQ scores of not well-controlled patients also improved substantially in some treatment groups, particularly the SFC group.

These results suggest a relationship between the achievement of guideline-based asthma control and improvements in quality of life to levels where there is little or no impact of asthma on quality of life. Guideline-based asthma control is therefore beneficial to the patient and should be tested in prospective studies.
Postprandial effects on twitch transdiaphragmatic pressure
Authors: Man W.D-C. , Luo Y-M. , Mustfa N. , Rafferty G.F. , Glerant J-C. , Polkey M.I. , Moxham J.
Published: September 2002

Twitch transdiaphragmatic pressure (Pdi,tw), measured following magnetic stimulation of the phrenic nerves, is used to assess diaphragm strength, contractility and fatigue. Although the effects of posture, lung volume and potentiation onPdi,tware well described, it is not known whether the degree of gastric filling affects the measurement.

Pdi,twwas recorded in seven healthy volunteers on two occasions with antero-lateral magnetic stimulation of the phrenic nerves. On the first occasion, the subjects had fasted for at least 8 h, whilst on the second occasion, measurements were made after each subject had eaten a substantial meal sufficient to produce a feeling of satiation.

Mean postprandial unpotentiated and potentiatedPdi,twwere significantly greater than corresponding fastingPdi,twin all seven volunteers (29.8versus25.7 cmH2O and 38.9versus34.4 cmH2O, respectively). This was due to a significantly increased gastric pressure component (1.10versus0.84 and 0.94versus0.78, respectively), and reduced abdominal compliance (36versus62 mL·cmH2O−1). Twitch oesophageal pressure was preserved (15.0versus15.4 cmH2O).

The postprandial state increases twitch transdiaphragmatic pressure, and this should be taken into account when using twitch transdiaphragmatic pressure to follow-up patients or to assess the effects of interventions on diaphragm contractility.
Noninvasive ventilation in chronic obstructive pulmonary disease, bronchiectasis and cystic fibrosis
Authors: Wedzicha J.A. , Muir J-F.
Published: September 2002

Although long-term oxygen therapy (LTOT) improves survival, it has little effect on hypoventilation and other outcomes in patients with hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD).

Recent studies have shown that the use of noninvasive positive-pressure ventilation, when used in combination with LTOT in selected stable COPD patients, controls hypoventilation and improves daytime arterial blood gases, sleep quality, health status and may have a benefit in reducing exacerbation frequency and severity. Patients who show the greatest reduction in overnight carbon dioxide tension in arterial blood with ventilation are most likely to benefit from long-term ventilatory support.

Some benefits have also been shown in patients with chronic respiratory failure due to bronchiectasis and cystic fibrosis, though survival is inferior in this patient group.

As most studies of noninvasive positive-pressure ventilation in chronic obstructive pulmonary disease have been relatively short term, large multicentre studies with survival, exacerbations and hospital admissions as the primary end points are required to evaluate longer term effects.
Outdoor air pollution, climatic changes and allergic bronchial asthma
Authors: D'Amato G. , Liccardi G. , D'Amato M. , Cazzola M.
Published: September 2002

Both the prevalence and severity of respiratory allergic diseases such as bronchial asthma have increased in recent years. Among the factors implicated in this “epidemic” are indoor and outdoor airborne pollutants. Urbanisation with its high levels of vehicle emissions and Westernised lifestyle parallels the increase in respiratory allergy in most industrialised countries, and people who live in urban areas tend to be more affected by the disease than those of rural areas. In atopic subjects, exposure to air pollution increases airway responsiveness to aeroallergens. Pollen is a good model with which to study the interrelationship between air pollution and respiratory allergic diseases. Biological aerosols carrying antigenic proteins, such as pollen grains or plant-derived paucimicronic components, can produce allergic symptoms. By adhering to the surface of these airborne allergenic agents, air pollutants could modify their antigenic properties. Several factors influence this interaction,i.e., type of air pollutant, plant species, nutrient balance, climatic factors, degree of airway sensitisation and hyperresponsiveness of exposed subjects. However, the airway mucosal damage and the impaired mucociliary clearance induced by air pollution may facilitate the penetration and the access of inhaled allergens to the cells of the immune system, and so promote airway sensitisation. As a consequence, an enhanced immunoglobulin E-mediated response to aeroallergens and enhanced airway inflammation favoured by air pollution could account for the increasing prevalence of allergic respiratory diseases in urban areas.
Primary pulmonary lymphoma
Authors: Cadranel J. , Wislez M. , Antoine M.
Published: September 2002

Three distinct entities are now covered by the definition of primary pulmonary clonal lymphoid proliferation. The aim of this review is to describe the pathophysiological, diagnostic, prognostic and therapeutic aspects of these three entities.

Low-grade pulmonary B-cell lymphoma is the most frequent form of primary pulmonary clonal lymphoid proliferation. It arises from mucosa-associated lymphoid tissue. It is usually indolent and appears in the form of a chronic alveolar opacity. The prognosis is excellent, but treatment is controversial (simple monitoring, surgery or single-agent chemotherapy). High-grade pulmonary B-cell lymphoma is far rarer and usually occurs in individuals with an underlying disorder (e.g.immunodeficiency). The prognosis is poor and therapeutic options depend on the underlying disorder.

The inclusion of lymphomatoid granulomatosis in the definition of primary pulmonary lymphomas is controversial. The clonal nature of the proliferation is very rarely demonstrated and extrapulmonary involvement is frequent (upper airways, skin, kidneys, central nervous system,etc.). The prognosis is extremely variable, with some authors reporting complete remission with steroids and cyclophosphamide and others reporting failure of combination chemotherapy.
Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study
Authors: Prescott E. , Almdal T. , Mikkelsen K.L. , Tofteng C.L. , Vestbo J. , Lange P.
Published: September 2002

An association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) has been found in a number of studies. The prevalence and prognostic importance of weight change in unselected subjects with COPD was examined.

Subjects with COPD, defined as forced expiratory volume in one second/forced vital capacity <0.7 in the Copenhagen City Heart Study and who attended two examinations 5 yrs apart, were followed for 14 yrs for COPD-related and all-cause mortality.

The proportion of subjects who lost >1 unit BMI (∼3.8 kg) between the two examinations was significantly associated with level of COPD, reaching ∼30% in subjects with severe COPD. After adjusting for age, smoking habits, baseline BMI and lung function, weight loss was associated with higher mortality in both persons with and without COPD (rate ratio (RR) for weight loss >3 BMI units 1.71 (95% confidence interval (CI): 1.32–2.23) and 1.63 (95% CI 1.38–1.92), respectively). Weight gain was associated with increased mortality, but not significantly so in subjects with COPD. Risk of COPD-related death increased with weight loss (RR 2.14 (95% CI 1.18–3.89)), but not with weight gain (RR 0.95 (95% CI 0.43–2.08)). In subjects without COPD or with mild-to-moderate COPD, the effect of weight change was the same irrespective of initial weight. In subjects with severe COPD, there was a significant risk ratio modification (p=0.045) between effect of baseline BMI and weight change: in the normal-to-underweight (BMI<25), best survival was seen in those who gained weight, whereas for the overweight and obese (BMI≥25), best survival was seen in stable weight.

A high proportion of subjects with chronic obstructive pulmonary disease experienced a significant weight loss, which was associated with increased mortality. The results support further intervention studies that aim at avoiding weight loss in normal-to-underweight chronic obstructive pulmonary disease patients.
Effects of nedocromil and salbutamol on airway reactivity in children with asthma
Authors: Pfleger A. , Eber E. , Weinhandl E. , Zach M.S.
Published: September 2002

Nedocromil and salbutamol are effective drugs in preventing exercise-induced asthma (EIA). The aim of this study was to compare the protective effects of both drugs and a combination of both drugs against cold dry air-induced bronchoconstriction, using cold dry air challenges (CACh) as a surrogate for exercise.

Twenty-five atopic children (mean age 13.7, range 8–18 yrs) with EIA participated in the study. Lung function tests were performed before medication, 30 min after medication and just before CACh, and 3 and 15 min after the challenge on four consecutive days. CACh consisted of a 4-min isocapnic hyperpnoea of −10°C, absolutely dry air. Treatment consisted of nedocromil (two puffs of 2 mg) plus placebo, salbutamol (two puffs of 100 µg) plus placebo, the combination of both drugs, and placebo alone, in a random order.

Both active drugs were significantly more protective than placebo and the combination showed an additive effect. Mean maximum postchallenge decrease in forced expiratory volume in one second after placebo was 27±8.1%, 12±9.5% after nedocromil, 8±10.4% after salbutamol, and 4.5±6.7% after the combination of both drugs, respectively.

These results suggest that both drugs protect against exercise-induced asthma. Although not as effective as salbutamol and combined medication, nedocromil can give sufficient protection for many patients.
Cardiac diastolic function and hypercapnic ventilatory responses in central sleep apnoea
Authors: Solin P. , Jackson D.M. , Roebuck T. , Naughton M.T.
Published: September 2002

Hyperventilation is the key factor contributing to the development of idiopathic nonhypercapnic central sleep apnoea (ICSA), where left ventricular systolic function is normal. ICSA is reported to occur in 20% of patients with left ventricular diastolic dysfunction, in whom elevated pulmonary vascular pressures and resultant increased pulmonary vagal afferent traffic may contribute to hyperventilation. The contribution of the two potential mechanisms responsible for the hyperventilation seen in the following ICSA was measured: 1) left ventricular diastolic dysfunction-induced pulmonary hypertension; and 2) increased peripheral and central hypercapnic ventilatory responses (HCVR).

The pulmonary artery pressure, left ventricular diastolic function and chemosensitivity to hypercapnia were measured during wakefulness in 16 subjects with ICSA.

All subjects had systolic pulmonary artery pressures <3.99 kPa (<30 mmHg) and only four had diastolic dysfunction. All subjects had elevated peripheral and central HCVR compared with historical normal control subjects. Diastolic dysfunction correlated with increasing age but not with HCVR or markers of central sleep apnoea severity.

Idiopathic nonhypercapnic central sleep apnoea is likely to be dependent upon raised hypercapnic ventilatory responses, and not pulmonary hypertension due to left ventricular diastolic dysfunction.
Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma
Authors: Chenuel B. , Haouzi P. , Olivier P. , Marie P.Y. , Chalon B. , Borrelly J.
Published: September 2002

The aim of this study was to determine whether perfusion-scintillation scanning, used as a predictive pre-operative index of lung functionality in patients with lung cancer, is affected by the level of pulmonary blood flow (PBF).

Twenty patients with primary lung cancer underwent spirometry and a radionuclide-perfusion scan (macroaggregated albumin particles labelled with99mTechnetium) both at rest and during the last minute of a ramp-like increase in work rate until exhaustion.

On average, the perfusion of the lung with the tumour was significantly reduced by the same magnitude at rest and during exercise (mean±sd: −9±6%versus−10±4% of the cardiac output), regardless of the extent of the tumour. However, subject-by-subject analysis revealed that in two patients, a larger decrease in the perfusion of the lung with the tumour was observed during exercise than at rest (−11% and −17%, respectively). This leads to an underestimation of predictive postoperative functional parameters if resting values are used in these patients.

The use of perfusion scintigraphy at rest therefore gives a clear picture of the functionality of the lung before resection in most patients requiring surgery.
Risk factors for bronchial hyperresponsiveness in late childhood and early adolescence
Authors: Ernst P. , Ghezzo H. , Becklake M.R.
Published: September 2002

The prevalence of asthma and bronchial hyperresponsiveness (BHR) tends to decrease in male children but increase in female children in the transition from childhood to adolescence. Hormonal factors may be involved in the natural history of asthma during this period.

In a prospective study of Montreal school children, the authors examined the determinants of BHR according to the child's pubertal status; 156 male children and 168 female children without a prior diagnosis of asthma were followed for an average of 4.6 yrs.

Average age at follow-up was 13.4 yrs and 59% had reached puberty. The prevalence of BHR at follow-up was similar among pre- and postpubertal male children (25.0%versus29.2%),while BHR was more common among post- compared with prepubertal female children (33.1%versus14.2%). There were no differences in the determinants (measured in childhood) of BHR at follow-up according to pubertal status. The major determinant of BHR was a positive skin test to dust-mite antigen. BHR was also linked to exposure to gas cooking and the presence of exercise-induced bronchospasm.

In conclusion, the results of this study do not support a change in asthma phenotype with the onset of puberty. Pre- and postpuberty, the major determinant of bronchial hyperresponsiveness was skin sensitivity to mite allergen.
Longitudinal changes of body mass index, spirometry and diffusion in a general population
Authors: Bottai M. , Pistelli F. , Di Pede F. , Carrozzi L. , Baldacci S. , Matteelli G. , Scognamiglio A. , Viegi G.
Published: September 2002

The aim of this study was to evaluate the effects of body mass index (BMI) changes over an 8-yr follow-up, on longitudinal changes of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and carbon monoxide diffusing capacity of the lung (DL,CO) indices in a general population sample of North Italy.

To avoid including weight changes possibly related to physical growth, only the 1,426 adults (>24 yrs, 46% males) with complete follow-up were selected. Median linear regression models were applied to estimate the medians of change (computed as follow-up minus baseline values) of VC, FVC, FEV1andDL,COindices, as functions of changes of BMI over the follow-up period, separately by sex, after considering several potential confounders and effect modifiers.

The extent of lung function loss tended to be higher among those who, at baseline, reported greater BMI values. Males experienced larger losses than females (20 and 16 mL FEV1median reduction for a BMI unit increase in males and females, respectively). Conversely, longitudinal changes of BMI caused a slight and nonsignificant increase inDL,COvalues in both sexes.

Over an 8-yr follow-up, the detrimental effect of gaining weight might be reversible for many adults as most of those who reduced their body mass index values also increased their lung function. Overweight patients with ventilatory impairment should be routinely encouraged to lose weight for improving their lung function.