bluuebunny/crossref_metadata_2025 huggingface dataset:
D-Dimers, Thrombin—Antithrombin Complexes, and Risk Factors for Thromboembolism in Hospitalized Patient
Authors: Pottier Pierre , Fouassier Marc , Hardouin Jean-Benoit , Volteau Christelle , Planchon Bernard
Published: September 2008

Introduction There is lack of data about the correlation between hemostatic markers and the clinical and biological risk factors (RFs) for venous thromboembolism (VTE) in medical inpatients without suspicion of acute VTE. Material and methods To evaluate the coagulation activation status in patients with current known RFs for VTE, the authors measured 2 markers of hypercoagulability, thrombin antithrombin (TAT) complexes and D-dimers, at day 1 in 165 patients hospitalized in internal medicine wards without suspected acute VTE. All known RFs for VTE were systematically assessed at admission and classified in a chronological way as permanent or transient. Results Surprisingly, TAT values followed a multimodal distribution. D-dimers showed a normal distribution after a logarithmic transformation ( P = .34, Shapiro—Wilk test). Interestingly, a significant progression in D-dimer levels was found according to the chronological classification of RFs. D-dimer variations on multivariate analysis (not applicable for TAT because of the multimodal distribution) correlated independently with a recent inability to walk and an increase in C reactive protein level more than 10 mg/L. Conclusions ( a) this study is the first to describe the variations of hypercoagulability markers according to a systematic screening of RFs for VTE in inpatients without suspicion of acute VTE, ( b) TAT appeared as a less relevant marker of hypercoagulability than D-dimers in internal medicine inpatients, ( d) the chronological classification of RFs identified clearly groups at risk for the prethrombotic state, and ( d) an increased hypercoagulability state was demonstrated in patients with an association between a recent immobility and increased inflammatory markers.
Measuring Trends in Racial/ Ethnic Health Care Disparities
Authors: Lê Cook Benjamin , McGuire Thomas G. , Zuvekas Samuel H.
Published: September 2008

Monitoring disparities over time is complicated by the varying disparity definitions applied in the literature. This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black—White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic—White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities.
art·I/f/act·ology
Authors: Brogden Lace Marie
Published: September 2008

Contemporary curriculum theorists conceptualize curriculum, schooling, and the teacher as sites of discursive production and as dwelling places for theory. Drawing on memory work around childhood report cards, this article uses commonplace artifacts to reassemble autoethnographic memory. In sifting through memories and artifacts, the author combines notions of archaeology and bricolage with writing as inquiry, proposing art·I/f/act·ology as research method. This approach to autoethnographic research is conceptualized as a way to blend art and reflective practice, generating alternate ways of understanding curriculum as lived.
Negotiating Collaboration Across Differences
Authors: Subedi Binaya , Rhee Jeong-eun
Published: September 2008

Through auto-ethnographic approach, this article extends contemporary debates on the need to further conceptualize and practice collaborative approaches to research. By exploring the complex dimensions of collaboration, this discussion traces the challenges of researching communities one affiliates with, particularly in relation to ethnic, cultural, and “unusual” researcher-researched positional differences. Also, by describing the dilemmas faced in translating languages spoken by respondents, the authors explain how the issues of language and representation complicate the collaborative relationships of research. This discussion proposes that investigators reexamine how they have interacted with participants in everyday contexts and aims to help researchers redefine the meaning of collaborative research across differences.
Domestic Violence and Contraceptive Use in a Rural Indian Village
Authors: Wilson-Williams Lyndsey , Stephenson Rob , Juvekar Sanjay , Andes Karen
Published: September 2008

This study uses qualitative methods to examine how domestic violence affects the use of contraceptives by women in a rural village in India. The study highlights how multilevel factors are linked to a woman's ability to contracept and make fertility decisions in a context where being a wife implies obedience, limited mobility, sexual availability, and high fertility. The authors find that violence is normalized, or considered acceptable, if women do not adhere to expected gender roles. Although women's ability to make autonomous decisions is shown to be limited, the study explores covert strategies used to avoid pregnancy, which also tend to increase women's risk of experiencing domestic violence.
Public Health Reporting: The United States Perspective
Authors: Halpin Linda S. , Barnett Scott D. , Henry Linda L. , Choi Elmer , Ad Niv
Published: September 2008

The release of 2 landmark reports by the Institute of Medicine titled, “To Err Is Human: Building a Safer Health System” and “Crossing the Quality Chasm” were instrumental in the identification of safety and quality issues. Since their release, federal and state programs of public reporting of performance measures have attempted to close the quality gap of care that is inappropriate, not timely, or lacking an evidence base. Cardiac surgery has long been the focus of public scrutiny, and now, as we move from an era of managed care to public reporting, reimbursement for cardiac surgery procedures will be tied to performance. However, the question is whether public reporting and pay for performance will ultimately improve the quality of patient care, safety, and provide the consumer with enough information to make surgeon and institutional choices. Will the cost and focus of achieving perfection with performance standards overshadow any real improvement in clinical outcomes?
Perception and Reporting of Cardiac Surgical Performance
Authors: Klein Andrew A. , Nashef Samer A. M.
Published: September 2008

The high level of interest in surgical outcomes has led to the publication of mortality rates in the public domain. In cardiac surgery, the availability of quite sophisticated risk assessment has allowed these outcomes to be adjusted for risk. The European System for Cardiac Operative Risk Evaluation is a widely recognized and used risk scoring system and has been used and validated throughout Europe and beyond. The logistic version is now the most commonly applied, but recalibration may be required. The methodology and statistics for measuring risk-adjusted performance are available, and regular audit and performance monitoring should be carried out in all cardiac surgical units. In the United Kingdom, risk-adjusted outcomes are available and regularly updated on the Internet. Presentation of data may be improved by the use of variable life-adjusted display curves. League tables for crude mortality can be misleading and should be avoided. When properly conducted, the measurement of risk-adjusted surgical outcomes should improve quality control and decision making and allow early identification of poor performance. Quality monitoring in medicine is a priority, and similar methods can be employed in other specialties, including anesthesia, by establishing and analyzing risk-stratified outcome data sets.
Masters of Their Conditions II: Intercultural Theatre, Narration and Stage Work with Patients and Healers
Authors: Arpin Jacques
Published: September 2008

What can a healer learn from theatre and performance studies? What can theatre and performance studies bring to healing practices? Both disciplines are distinct in Western societies, at times merged into miscellaneous forms of `art therapy.' What lessons can we learn from traditions that do not separate these competencies and have always integrated them as being naturally complementary? In a consultation of cultural psychiatry, both patients and healers are actively aware of various degrees of merging of art and medicine. Narration, then, cannot be limited to verbal case-history making and verbal therapeutic approaches. Bringing patients and healers on a stage and using all forms of text and performance allow for another way of (re)constructing case histories. Expanding the narrative process opens doors to exploring traditions: their origin, their apprenticeship, their performance and their transmission.
Saudades at the Edge of the Self and the Merits of `Portable Families'
Authors: Sluzki Carlos E.
Published: September 2008

The treatment of a Mexican American patient who was referred due to hallucinations reveals a world of `magic realism' that is far from infrequent in elderly people with a small and dwindling social network — especially if they come from cultures where the boundaries between the inner and the outer world are fuzzy. Respecting these traits allows for the development of treatment approaches that can evolve satisfactorily without disrupting the patient's inscription in this dual world.
Health Seeking for Ambiguous Symptoms in Two Cultural Groups: A Comparative Study
Authors: Karasz Alison , Dempsey Kara
Published: September 2008

This study examined cultural differences in health seeking for medically ambiguous symptoms in women from two culturally diverse communities. Thirty-five South Asian immigrants and 36 European Americans participated in a health history interview. Though the types and relative frequencies of practices were similar across the two groups, the goals and underlying logic supporting practices differed sharply. Among European Americans, practices were focused on the need to increase energy, creativity, and output; among South Asians, practices emphasized storing up strength through increased consumption or reduced expenditure. We conclude that the relationship between conceptual models of cause and cure depends on the `match' of both to broader, unarticulated cultural models of health and illness.
Complementary Treatment of Psychotic and Epileptic Patients in Malaysia
Authors: Razali Salleh Mohd , Yassin Azhar Mohd
Published: September 2008

The objective of this article is to describe and compare the use of traditional/complementary medicine (T/CM) among psychotic (schizophrenia and schizophreniform disorder) and epileptic Malay patients in peninsular Malaysia. There were 60 patients in each group. T/CM consultation was uniformly spread across all levels of education and social status. We could not find a single over-riding factor that influenced the decision to seek T/CM treatment because the decision to seek such treatment was complex and the majority of decisions were made by others. Fifty-three patients (44.2%), consisting of 37 (61.7%) psychotic and 16 (26.7%) epileptic patients had consulted Malay traditional healers (bomoh) and/or homeopathic practitioners in addition to modern treatment; of these, only three had consulted bomoh and homeopathic practitioners at the same time. The use of T/CM was significantly higher in psychotic than in epileptic Malay patients.
Gender-related Stress among Japanese Working Women
Authors: Ogiwara Chikako , Tsuda Hitoshi , Akiyama Tsuyoshi , Sakai Yoshie
Published: September 2008

This article addresses gender-related stresses of working women in Japan. We conducted a study of 399 employees in Japan using the National Institute for Occupational Safety and Health General Job Stress questionnaire. The results suggest that for women the most significant factor related to depression is interpersonal conflict, whereas for men, it is professional matters. In addition, we conducted interviews with Japanese female employees about their occupational stress. Our interviews indicated that for the occupational mental health of working women, the establishment of modified and supportive interpersonal relations within workplace environments may be required because of the gender roles expected of women in a male-dominant socioculture.
Emotions in Leadership Development: A Critique of Emotional Intelligence
Authors: Fambrough Mary J. , Kaye Hart Rama
Published: September 2008

The problem and the solution. In this conceptual article, emotional intelligence (EI) is critiqued, particularly as a resource for leadership development. Ultimately, this article seeks to answer the question: What should human resource development (HRD) professionals know and reflect on as they consider the use of EI instruments and interventions in leadership development? The transmutation of emotions in organizations from negative and irrational to a positive attribute of successful leaders is traced, demonstrating how emotions have traditionally been mobilized in organizations to achieve instrumental goals. The following questions are explored: Is there one accepted model of EI? What are the instruments and measures for EI? Is there a definitive association between EI and leadership effectiveness? What issues are raised by generalizing EI abilities and competencies across cultures or in multicultural contexts? How might EI training enable leaders to abuse power more skillfully to achieve personal or organizational ends? In conclusion, suggested areas of concern for HRD practitioners are raised, and alternative ways to include increased awareness of emotions in leadership development are discussed.
Drug-eluting stent thrombosis
Authors: Stähli Barbara E. , Camici Giovanni G. , Tanner Felix C.
Published: September 2008

Stent thrombosis is a rare complication following stent implantation; if it occurs, however, it is associated with a high morbidity and mortality. Despite reduced rates of restenosis, drug-eluting stents (DES) have not reduced the incidence of stent thrombosis as compared with bare-metal stents (BMS). Patient-, lesion-, and procedure-related factors as well as thrombogenicity of the stent itself are involved in the pathogenesis of stent thrombosis. Furthermore, early cessation of dual antiplatelet therapy correlates with an increased risk of stent thrombosis. This review focuses on clinical evidence and pathophysiological mechanisms of stent thrombosis with DES, particularly highlighting prothrombotic effects of the stent itself.
Staying Alive: The Impact of Media Momentum on Candidacy Attrition in the 1980—2004 Primaries
Authors: Fei Shen
Published: September 2008

This study proposes a “media momentum model,” arguing that the amount of news coverage candidates receive might influence their candidacy potency and duration. The two mechanisms that drive this process are rational choice on the candidates' side and cue taking on the voters' side. Based on data from the primary elections in the past two decades, this study shows that media coverage frequency of presidential candidates during and before their “exhibition season” has significant impact on the length of time they stay in the race before withdrawing from the campaign. Given the notion that choice is at the core of democracy, continued scholarly attention should be paid to the unique explanatory power of media coverage in elections.
PKC-θ selectively controls the adhesion-stimulating molecule Rap1
Authors: Letschka Thomas , Kollmann Veronika , Pfeifhofer-Obermair Christa , Lutz-Nicoladoni Christina , Obermair Gerald J. , Fresser Friedrich , Leitges Michael , Hermann-Kleiter Natascha , Kaminski Sandra , Baier Gottfried
Published: September 2008

The antigen-specific interaction of a T cell with an antigen-presenting cell (APC) results in the formation of an immunologic synapse (IS) between the membranes of the 2 cells. β2 integrins on the T cell, namely, leukocyte function-associated antigen 1 (LFA-1) and its counter ligand, namely, immunoglobulin-like cell adhesion molecule 1 (ICAM-1) on the APC, critically stabilize this intercellular interaction. The small GTPase Rap1 controls T-cell adhesion through modulating the affinity and/or spatial organization of LFA-1; however, the upstream regulatory components triggered by the T-cell receptor (TCR) have not been resolved. In the present study, we identified a previously unknown function of a protein kinase C-θ (PKC-θ)/RapGEF2 complex in LFA-1 avidity regulation in T lymphocytes. After T-cell activation, the direct phosphorylation of RapGEF2 at Ser960 by PKC-θ regulates Rap1 activation as well as LFA-1 adhesiveness to ICAM-1. In OT-II TCR-transgenic CD4+ T cells, clustering of LFA-1 after antigen activation was impaired in the absence of PKC-θ. These data define that, among other pathways acting on LFA-1 regulation, PKC-θ and its effector RapGEF2 are critical factors in TCR signaling to Rap1. Taken together, PKC-θ sets the threshold for T-cell activation by positively regulating both the cytokine responses and the adhesive capacities of T lymphocytes.
Role of the small GTPase Rap1 for integrin activity regulation in endothelial cells and angiogenesis
Authors: Carmona Guillaume , Göttig Stephan , Orlandi Alessia , Scheele Jürgen , Bäuerle Tobias , Jugold Manfred , Kiessling Fabian , Henschler Reinhard , Zeiher Andreas M. , Dimmeler Stefanie , Chavakis Emmanouil
Published: September 2008

Ras-associated protein 1 (Rap1), a small GTPase, attracted attention because of its involvement in several aspects of cell adhesion, including integrin- and cadherin-mediated adhesion. Yet, the role of Rap1 genes and of Rap1 effectors for angiogenesis has not been investigated. Human umbilical vein endothelial cells (HUVECs) express Rap1a and Rap1b mRNA. To determine the contribution of Rap1 activity for angiogenesis, we overexpressed Rap1GAP1, a GTPase-activating protein that inhibits Rap1 activity. Overexpression of Rap1GAP1 significantly blocked angiogenic sprouting and tube-forming activity of HUVECs as well as migration and integrin-dependent adhesion. Silencing of Rap1a, Rap1b, or both significantly blocked HUVECs sprouting under basal and basic fibroblast growth factor-stimulated conditions and reduced HUVEC migration and integrin-dependent adhesion. We found that Rap1a and Rap1b are essential for the conformational activation of β1-integrins in endothelial cells. Furthermore, silencing of Rap1a and Rap1b prevented phosphorylation of tyrosine 397 in focal adhesion kinase (FAK) and vascular endothelial growth factor-induced Akt1-activation. Rap1a−/−-deficient and Rap1a+/− heterozygote mice displayed reduced neovascularization after hind limb ischemia compared with wild-type mice. Silencing of RAPL significantly blocked the Rap1-induced sprouting of HUVECs, suggesting that the angiogenic activity of Rap1 is partly mediated by RAPL. Our data demonstrate a critical role of Rap1 in the regulation of β1-integrin affinity, adhesion, and migration in endothelial cells and in postnatal neovascularization.
UV-C irradiation disrupts platelet surface disulfide bonds and activates the platelet integrin αIIbβ3
Authors: Verhaar Robin , Dekkers David W. C. , De Cuyper Iris M. , Ginsberg Mark H. , de Korte Dirk , Verhoeven Arthur J.
Published: September 2008

UV-C irradiation has been shown to be effective for pathogen reduction in platelet concentrates, but preliminary work indicated that UV-C irradiation of platelets can induce platelet aggregation. In this study, the mechanism underlying this phenomenon was investigated. Irradiation of platelets with UV-C light (1500 J/m2) caused platelet aggregation, which was dependent on integrin αIIbβ3 activation (GPIIb/IIIa). This activation occurred despite treatment with several signal transduction inhibitors known to block platelet activation. UV-C also induced activation of recombinant αIIbβ3 in Chinese hamster ovary (CHO) cells, an environment in which physiologic agonists fail to activate. Activation of αIIbβ3 requires talin binding to the β3 tail, yet αIIbβ3-Δ724 (lacking the talin binding site) was activated by UV-C irradiation, excluding a requirement for talin binding. The UV-C effect appears to be general in that β1 and β2 integrins are also activated by UV-C. To explain these findings, we investigated the possibility of UV-C–induced photolysis of disulfide bonds, in analogy with the activating effect of reducing agents on integrins. Indeed, UV-C induced a marked increase in free thiol groups in platelet surface proteins including αIIbβ3. Thus, UV-C appears to activate αIIbβ3 not by affecting intracellular signal transduction, but by reduction of disulfide bonds regulating integrin conformation.
Socioeconomic outcome of subjects experiencing asthma symptoms at work
Authors: Larbanois A. , Jamart J. , Delwiche J‐P. , Vandenplas O.
Published: September 2008

The aim of this study was to investigate the socioeconomic outcomes of subjects who experienced work­related asthma symptoms in the absence of demonstrable occupational asthma (OA) and to compare these outcomes with those found in subjects with documented OA.

Subjects (n=157) who were being investigated for work­related asthma, were surveyed. Of these 86 had OA, ascertained by a positive specific inhalation challenge (SIC), and 71 subjects had a negative SIC response. After a median interval of 43 months (range 12–85 months), the subjects were interviewed to collect information on employment status, income changes, and asthma­related work disability.

Rates of work disruption and income loss at follow­up were similar in subjects with negative SIC (46% and 59%, respectively) and in those with OA (38% and 62%). The median loss as a percentage of initial income was 23% in subjects with negative SIC and 22% in subjects with OA. Asthma­related work disability, defined as any job change or work loss due to asthma, was slightly more common in subjects with OA (72%) than in those with negative SIC (54%).

This study shows that, even in the absence of demonstrable occupational asthma, work­related asthma symptoms are associated with considerable socioeconomic consequences.
Induced sputum IL-8 gene expression, neutrophil influx and MMP-9 in allergic bronchopulmonary aspergillosis
Authors: Gibson P.G. , Wark P.A.B. , Simpson J.L. , Meldrum C. , Meldrum S. , Saltos N. , Boyle M.
Published: September 2008

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to the fungusAspergillus fumigatus, causing severe asthma that may progress to bronchiectasis. Sputum neutrophilia can occur in association with sputum eosinophilia and correlates with the degree of bronchiectasis. The mechanisms of sputum neutrophilia in ABPA are not known. The aim of this study was to investigate the role of the chemokine interleukin (IL)-8 in sputum neutrophilia in ABPA.

Induced sputum was obtained from subjects with ABPA (n=29), and compared to nonsensitised asthma (n=9) and healthy controls (n=21). Semiquantitative polymerase chain reaction was used to assess IL-8 gene expression in induced sputum and IL-8 protein was measured by enzyme-linked immunosorbent assay.

Sputum IL-8 protein was significantly higher in ABPA compared to asthma and controls. IL-8 messenger ribonucleic acid/glyceraldehyde-3-phosphate dehydrogenase ratio was elevated in ABPA compared to asthma and controls. Sputum IL-8 correlated with sputum neutrophils, matrix metalloproteinase-9 levels and forced expiratory volume in one second.

Interleukin-8 gene expression and protein release were increased in allergic bronchopulmonary aspergillosis and correlated with airway neutrophilia and airway obstruction. The interleukin-8-mediated neutrophil influx in allergic bronchopulmonary aspergillosis may induce lung damageviarelease of matrix metalloproteinase-9, potentially leading to bronchiectasis.
Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis
Authors: Ziegenhagen M.W. , Rothe M.E. , Schlaak M. , Müller-Quernheim J.
Published: September 2008

The aim of the present study was to determine which bronchoalveolar lavage fluid (BALF) and serological parameters reflect the severity of newly diagnosed pulmonary sarcoidosis.

Seventy-four previously untreated sarcoid patients were categorised into three groups: 10 patients with Löfgren's syndrome, 51 patients with stable disease and 13 patients with progressing disease requiring systemic steroid treatment.

Total BALF cell count, percentage of alveolar lymphocytes and lymphocyte CD4/CD8 ratio were not associated with severity of disease. Interestingly, a significant increase in percentages of BALF neutrophils (5.2±1.1%) and eosinophils (1.7±0.6%) was observed in sarcoid patients with progressing disease. Elevated percentages of these two cell types were the only BALF parameters associated with a more frequent necessity for systemic steroid therapy. This association between an elevated percentage of BALF neutrophils and the necessity for steroid treatment was observed in advanced as well as early sarcoidosis (radiological types I and II). Serum levels of soluble interleukin‐2 receptor and neopterin were significantly elevated in progressing disease compared to stable disease or Löfgren's syndrome.

The present results demonstrate that increased percentages of neutrophils (>3.0%) and eosinophils (>1%) in bronchoalveolar lavage fluid from newly diagnosed pulmonary sarcoidosis is associated with a significantly higher risk of necessity for steroid therapy and may be helpful markers of progressive disease. Furthermore, of the serological parameters investigated, only serum levels of soluble interleukin‐2 receptor and neopterin were associated with disease severity.
Endogenous endothelins and nitric oxide in hypoxic pulmonary vasoconstriction
Authors: Hubloue I. , Biarent D. , Kafi S. Abdel , Bejjani G. , Kerbaul F. , Naeije R. , Leeman M.
Published: September 2008

The effects of endothelin receptor blockade on the pulmonary circulation have been reported variably, possibly in relation to a more or less important associated release of endogenous nitric oxide (NO). The aim of this study was to test whether endothelin antagonism would inhibit hypoxic pulmonary vasoconstriction, and if it would not, then would it do so after NO synthase inhibition.

Hypoxic pulmonary vasoconstriction (HPV) was evaluated in anesthetised dogs by the increase in the mean pulmonary artery pressure (Ppa) minus occludedPpa(Ppao) gradient in response to hypoxia (inspiratory oxygen fraction of 0.1) at constant pulmonary blood flow.

Bosentan, an endothelin A and B receptor antagonist, did not affect baselinePpa,Ppaoor systemic arterial pressure (Psa) and did not alter HPV (n=8). The NO synthase inhibitor NG­nitro‐l‐arginine (l‐NA) did not affect baselinePpaandPpao, but increasedPsaand enhanced HPV (n=12). The addition of bosentan in these dogs did not affect baselinePpaorPpao, but decreasedPsaand inhibited HPV. Exhaled NO was decreased byl‐NA and by bosentan and abolished byl‐NA+bosentan (n=9).

The authors conclude that endogenous nitric oxide is released by, and opposes the vasoconstricting effects of, endothelinsin vivo, reducing systemic blood pressure and limiting hypoxic pulmonary vasoconstriction.
Organising pneumonia caused by transtuzumab (Herceptin) therapy for breast cancer
Authors: Radzikowska E. , Szczepulska E. , Chabowski M. , Bestry I.
Published: September 2008

The case of a 49-yr-old female, who developed fever, effort dyspnoea and cough, with patchy migratory bilateral pulmonary infiltrates 6 weeks after starting transtuzumab therapy, following breast-conserving surgery with adjuvant chemoradiotherapy and hormone therapy for breast carcinoma, is reported here.

Chest radiograph and thin section computed tomography demonstrated alveolar opacities with air bronchogram in both lungs. A lung biopsy was performed in a nonirradiated area of the contralateral lung and revealed a typical histological pattern of organising pneumonia (previously known as bronchiolitis obliterans organising pneumonia). Transtuzumab therapy was discontinued and subsequent gradual clinical and radiological improvement was observed. After 3 months, complete resolution of symptoms and radiographical abnormalities were noted.

This is the first case report that suggests that transtuzumab therapy might induce the development of lung infiltrates with the histological appearance of organising pneumonia.
Bronchoalveolar lavage fluid findings in children with hypersensitivity pneumonitis
Authors: Ratjen F. , Costabel U. , Griese M. , Paul K.
Published: September 2008

Bronchoalveolar lavage (BAL) has been shown to be useful in the diagnosis of hypersensitivity pneumonitis (HP) in adults, the typical constellation being lymphocytosis with a decrease in the CD4/CD8 ratio. Only limited data exist for the diagnostic value of BAL cytology in paediatric patients with this disorder.

Children aged 6–15 yrs (n=9) with acute HP were studied. BAL was performed before initiation of anti­inflammatory treatmentviaa flexible bronchoscope in the middle lobe with 3 mL·kg body weight−1normal saline warmed to body temperature; BAL cytology and lymphocyte surface markers were compared with age­matched controls.

The percentage of lymphocytes was significantly increased in all patients with HP. No significant differences were observed in the CD4/CD8 ratio between children without lung disease and those with HP. Increased expression of human leukocyte antigen­DR was found in seven of eight children with HP, whereas natural killer cells were elevated in five of eight children. Every patient had at least one of these two alterations in BAL fluid in addition to lymphocytosis.

It was concluded that while lymphocytosis is generally present in children with hypersensitivity pneumonitis, the CD4/CD8 ratio is not increased in these patients. Assessing natural killer cells and human leukocyte antigen­DR expression appears to be a helpful adjunct in the diagnosis of paediatric patients with this disorder.
Longitudinal changes in the nature, severity and frequency of COPD exacerbations
Authors: Donaldson G.C. , Seemungal T.A.R. , Patel I.S. , Lloyd-Owen S.J. , Wilkinson T.M.A. , Wedzicha J.A.
Published: September 2008

Exacerbations are an important feature and outcome measure in chronic obstructive pulmonary disease (COPD), but little is known about changes in their severity, recovery, symptom composition or frequency over time.

In this study 132 patients (91 male; median age 68.4 yrs and median forced expiratory volume in one second (FEV1) 38.4% predicted) recorded daily symptoms and morning peak expiratory flow.

Patients were monitored for a median of 918 days and 1,111 exacerbations were identified. Patients with severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) category III, n=38) had an annual exacerbation frequency of 3.43·yr−1, 0.75·yr−1higher than those with moderate COPD (GOLD II, n=94). Exacerbation frequency did not change significantly during the study. At exacerbation onset, symptom count increased to 2.23, relative to a baseline of 0.36 set 8–14 days previously, and this increase rose by 0.05·yr−1. Recovery to baseline levels in symptoms and FEV1took longer (0.32 and 0.55 days·yr−1). Sputum purulence at exacerbation became more prevalent over time by 4.1%·yr−1from an initial value of 17%.

The results of this study suggest that over time, individual patients have more symptoms during exacerbations, with an increased chance of sputum purulence and longer recovery times.
The cost-effectiveness of nCPAP treatment in patients with moderate-to-severe obstructive sleep apnoea
Authors: Mar J. , Rueda J.R. , Durán-Cantolla J. , Schechter C. , Chilcott J.
Published: September 2008

The demand for diagnostic and therapeutic services for obstructive sleep apnoea syndrome (OSAS) showed marked growth during the 1990s. This paper analyses the long-term cost-effectiveness of nasal continuous positive airway pressure (nCPAP) treatment in comparison to conventional null treatment.

A Markov model was used to represent the natural history of OSAS based upon published evidence. Utility values came from a survey of OSAS patients. Data on health costs were collected from hospitals in the Basque Country, Spain.

The incremental cost-effectiveness ratio of nCPAP treatment is <6,000 Euros per quality-adjusted life year. On disaggregated analysis, nCPAP treatment accounts for 86% of incremental costs; 84% of incremental effectiveness is attributable to improved quality of life.

Treatment of obstructive sleep apnoea syndrome with nasal continuous positive airway pressure has a cost-effectiveness that is in line with that of other commonly funded treatments such as antihypertensive drugs. The key clinical benefit of nasal continuous positive airway pressure treatment is improvement in the quality of life of patients with obstructive sleep apnoea syndrome. This benefit is also precisely the one for which the evidence base is strongest. The remaining uncertainties concerning the impact of nasal continuous positive airway pressure on long-term mortality have only a relatively small impact on the economics of treatment.
Urban traffic and pollutant exposure related to respiratory outcomes and atopy in a large sample of children
Authors: Nicolai T. , Carr D. , Weiland S.K. , Duhme H. , von Ehrenstein O. , Wagner C. , von Mutius E.
Published: September 2008

Conflicting results have been reported for the relationship between traffic exposure and inception of atopy. The effect of traffic on the prevalence of asthma and atopy at school age was investigated in a representative population.

Random samples of schoolchildren (n=7,509, response rate 83.7%) were studied using the International Study of Asthma and Allergies in Childhood phase­II protocol with skin­prick tests, measurements of specific immunoglobulin E and lung function. Traffic exposure was assessedviatraffic counts and by an emission model which predicted soot, benzene and nitrogen dioxide (NO2).

Traffic counts were associated with current asthma, wheeze and cough. In children with tobacco­smoke exposure, traffic volume was additionally associated with a positive skin­prick test. Cough was associated with soot, benzene and NO2, current asthma with soot and benzene, and current wheeze with benzene and NO2. No pollutant was associated with allergic sensitisation.

High vehicle traffic was associated with asthma, cough and wheeze, and in children additionally exposed to environmental tobacco smoke, with allergic sensitisation. However, effects of socioeconomic factors associated with living close to busy roads cannot be ruled out.
Long­term noninvasive ventilation in children and adolescents with neuromuscular disorders
Authors: Mellies U. , Ragette R. , Dohna Schwake C. , Boehm H. , Voit T. , Teschler H.
Published: September 2008

The aim of the current study was to investigate the long­term impact of nocturnal noninvasive (positive­pressure) ventilation (NIV) on sleep, sleep­disordered breathing (SDB) and respiratory function in children and adolescents with progressive neuromuscular disorders (NMD).

Thirty patients (12.3±4.1 yrs) with various inherited NMD were treated with NIV for ventilatory insufficiency (n=14) or symptomatic SDB (n=16). Patients were prospectively followed with sleep studies, spirometry and peak inspiratory muscle pressure. Ten patients were studied before and after 3 nights withdrawal from NIV.

NIV normalised nocturnal gas exchange in all patients and diurnal gas exchange in patients with ventilatory insufficiency. The effects persisted over 25.3±12.7 months. Nocturnal transcutaneous partial pressure of carbon dioxide improved from (baselineversuslatest control) 7.1±1.3 to 5.5±0.6 kPa (53.7±9.9 to 41.6±4.8 mmHg), diurnalcarbon dioxide arterial tension from 6.3±1.6 to 5.4±0.5 kPa (47.5±11.9 to 40.6±3.6 mmHg).

NIV improved respiratory disturbance index, arousals from sleep, nocturnal heart rate and sleep architecture. Vital capacity decreased in five adolescents with Duchenne muscular dystrophy −183±111 mL·yr−1but remained stable in 25 children with other conditions (8±78 mL·yr−1). Three nights withdrawal of NIV in 10 previously stable patients resulted in prompt deterioration of SDB and gas exchange back to baseline but could be instantly normalised by resumption of NIV.

Noninvasive (positive­pressure) ventilation has favourable long­term impact on nocturnal and diurnal gas exchange and sleep and in patients with non­Duchenne neuromuscular disorders on vital capacity as well. It is indicated in children and adolescents with symptomatic sleep­disordered breathing or ventilatory insufficiency due to neuromuscular disorders.
Peripheral airway involvement in asthma assessed by single-breath SF6and He washout
Authors: Gustafsson P.M. , Ljungberg H.K. , Kjellman B.
Published: September 2008

The aim of the study was to assess how deep into the acinar region the airway response to cold dry-air hyperventilation challenge (CACh) reaches in subjects with asthma of different severity.

Peripheral airway function was measured using a single-breath sulphur hexafluoride (SF6) and helium (He) washout test and overall airway function by forced expiratory volume in one second (FEV1) at rest, after CACh and β2-therapy in 55 adults with a history of asthma. The normalised phase-III slopes (SnIII) for SF6and He were used to assess peripheral airway obstruction and the (SF6-He) SnIIIdifference to indicate where obstruction occurred. While a greater HeversusSF6slope increase indicates a response close to the acinar entrance, the reverse indicates a response deeper into the acinar airspaces.

Twelve subjects had a major fall in FEV1(≥20%) after CACh, 16 a minor fall (10–19%), and 27 did not react. Resting He and SF6SnIIIwere significantly greater in major responders with respect to minor and nonresponders, while resting FEV1did not differ between the three groups. The major responders showed marked increases of He and SF6SnIIIafter CACh, with greater increase for He resulting in a negative (SF6-He) SnIIIdifference.

To conclude, airways close to the acinar entrance participate in the overall airway response to cold-air challenge in asthmatic adults with marked airway hyperresponsiveness to cold, dry air.
Health and socioeconomic impact of work-related asthma
Authors: Vandenplas O. , Toren K. , Blanc P.D.
Published: September 2008

There is accumulating evidence that the workplace environment contributes significantly to the general burden of asthma. The purpose of this review is to explore the respiratory health and socioeconomic consequences of work-related asthma by addressing a series of controversial issues: 1) what is the natural history of occupational asthma and in what ways does ongoing exposure to the causal agent impact clinical outcomes?; 2) how does the natural history of irritant-induced asthma differ in its health outcomes from immunologically-mediated occupational asthma?; 3) do working conditions have a significant impact on asthma regardless of the aetiology of the disease?; 4) what is the scope of work disability from work-related-asthma in social and economic terms?; 5) what is the clinician's role in reducing the respiratory health consequences of work-related asthma? 6) to what extent do existing compensation and other social insurance schemes successfully address occupational asthma and work-aggravated asthma?
Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III data
Authors: Arif A.A. , Delclos G.L. , Lee E.S. , Tortolero S.R. , Whitehead L.W.
Published: September 2008

The prevalence of asthma has been on the increase in the USA and worldwide. To understand the worsening epidemiological trends of asthma, this study analysed the data from the third National Health and Nutrition Examination Survey (NHANES III) to determine the prevalence and risk factors for asthma and wheezing among US adults.

This analysis used data from 18,825 US adults aged ≥20 yrs who had participated in the NHANES III project. After excluding subjects with physician­diagnosed emphysema, a total of 18,393 subjects were included in the final analysis.

The prevalence of current asthma (asthma) was 4.5% and the prevalence of wheezing in the previous 12 months (wheezing) was 16.4%. Mexican­Americans exhibited the lowest prevalence of asthma when compared with other race/ethnic groups. Multiple logistic regression analysis showed that Mexican­Americans were less likely to report asthma when compared to non­Hispanic whites. Low education level, female sex, current and past smoking status, pet ownership, lifetime diagnosis of physician­diagnosed hay fever and obesity were all significantly associated with asthma and/or wheezing. No significant effect of indoor air pollutants, as derived from the use of household heating/cooking appliances, on asthma and wheezing was observed in this study.

In conclusion, this study observed racial/ethnic differences in the prevalence of asthma and wheezing and identified several important risk factors that may contribute to development and/or exacerbation of asthma and wheezing. Contrary to earlier reports, the proxy measures of indoor air pollution used in this study were not found to be associated with increased risk of asthma and wheezing.
Long-term changes in adult asthma prevalence
Authors: Brogger J. , Bakke P. , Eide G.E. , Johansen B. , Andersen A. , Gulsvik A.
Published: September 2008

There has been an increase in asthma prevalence among children. Little evidence is available regarding long-term changes in asthma prevalence in adults.

Two cross-sectional studies were performed among adults aged 15–70 yrs in Oslo, Norway, in 1972 and again in 1998–1999 (n=39,998). A postal self-completed questionnaire was used. Exactly the same questions and survey methods were used in both studies. In 1998–1999, additional telephone follow-up was included for postal nonresponders.

The crude prevalence of ever having had a doctor's diagnosis of asthma increased from 3.4 to 9.3%. The prevalence of wheezing increased from 17.8 to 25.8% and attacks of breathlessness from 12.6 to 16.7%. After controlling for smoking, the risk of asthma among those aged <40 yrs had tripled. The increase in asthma was 50% greater in females than males. The prevalence of symptoms increased less than asthma diagnosis. Wheezing increased by 50% in those aged <40 yrs, with smaller increases at greater ages. The increase in symptoms was seen among both asthmatics and nonasthmatics.

There has been a large increase in the prevalence of asthma diagnosis and asthma-like symptoms in adults. The increase is less pronounced among those aged >40 yrs.
C-reactive protein levels in community-acquired pneumonia
Authors: García Vázquez E. , Martínez J.A. , Mensa J. , Sánchez F. , Marcos M.A. , de Roux A. , Torres A.
Published: September 2008

The diagnostic value of C-reactive protein (CRP) admission serum levels as an indicator of the aetiology of community-acquired pneumonia (CAP) was evaluated.

A cohort of 1,222 patients with CAP was assessed. CRP levels were analysed in 258 patients with a single aetiological diagnosis.

The mean CRP values in patients with pyogenic, atypical, viral andLegionella pneumophilapneumonia were: 16 mg·dL−1, 13 mg·dL−1, 14 mg·dL−1and 25 mg·dL−1, respectively. CRP levels were not significantly different among patients outcome research team (PORT) groups (19 mg·dL−1in groups I–II, 16 mg·dL−1in group III and 16 mg·dL−1in groups IV–V. A cut-off point of 25 mg·dL−1had a sensibility, specificity, positive predictive value and negative predictive value of 0.6, 0.83, 0.3, and 0.94, respectively. After controlling for age and PORT score, the odds of having a CRP level >25 mg·dL−1was 6.9 times higher in patients withL. pneumophilapneumonia than in those with non-L. pneumophilapneumonia.

Patients withLegionella pneumophilapneumonia had higher C-reactive protein levels than those with pneumonia of any other aetiology, independently of severity of infection. Being a cheap and readily available test, C-reactive protein may be a useful adjunctive procedure in the diagnosis of community-acquired pneumonia.
Effect of intravenous hydrocortisone on nocturnal airflow limitation in childhood asthma
Authors: Landstra A.M. , Boezen H.M. , Postma D.S. , van Aalderen W.M.C.
Published: September 2008

Low endogenous cortisol levels appear to contribute to the pathophysiology of nocturnal asthma. Lower cortisol levels are associated with lower forced expiratory volume in one second (FEV1) levels in children with asthma. The aim of the present study was to identify whether substitution of low serum cortisol with intravenous hydrocortisone decreases 24-h FEV1variation and/or indirect measures of airway inflammation.

Hydrocortisone was given over 24 h in a double-blind randomised crossover design to 26 subjects. FEV1was measured every 4 h during 24 h; blood eosinophils and airway responsiveness to methacholine and adenosine 5′-monophosphate (AMP) were measured at 04:00 h and 16:00 h.

Cortisol levels increased during the night and morning hours. FEV1values were higher at all time points in children with nocturnal asthma (n=10; 24-h FEV1variation ≥15%) which was significant at 08:00 h, unlike in the non-nocturnal asthma (NA−) group (n=16). Numbers of eosinophils (109·L−1) at 04:00 h decreased in the asthma group (median 0.61 (range 0.05–1.42)versus0.52 (0.05–1.79)). Provocative dose causing a 20% fall in FEV1(PD20) methacholine did not change, whereas PD20AMP improved only at 16:00 h in the NA− group (72.0 (0.13–144.0)versus144.0 (2.25–144.0) mg·mL−1).

These results show that substitution of lower endogenous 24-h values of cortisol contribute to higher forced expiratory volume in one second values and a decrease of blood eosinophils as an inflammatory marker in more severe airway obstruction.
Determinants of altered quality of life in patients with sleep-related breathing disorders
Authors: Sforza E. , Janssens J.P. , Rochat T. , Ibanez V.
Published: September 2008

Recent reports have suggested that altered quality of life and well-being are reported by patients with sleep-related breathing disorders (SRBD). There seems to be no data available in the literature on factors underlying these behavioural consequences. In this study, health-related quality of life (HRQL) scores were examined in SRBD patients in order to establish which factors are implicated in these disturbances.

The study group consisted of 130 patients: 49 snorers and 81 patients with obstructive sleep apnoea. The Medical Outcome Survey Short Form-36 questionnaire was administered the morning after the sleep study and scores for the eight dimension scores were obtained. Patient's data were compared to normative sex- and age-matched data.

In comparison with normal values, scores for all HRQL dimensions were decreased in SRBD patients, with a greater impact on subscores for “vitality”, “physical role”, “social functioning”, “mental health” and “role emotional” dimensions. While impairment in physical function was mostly influenced by sleep stage and obesity, subjective daytime sleepiness mainly affected the other dimensions.

The authors conclude that the altered health-related quality of life of sleep-related breathing disorder patients is a multifactorial phenomenon depending on the interaction of sleep stages, daytime sleepiness and obesity, with no significant contribution of sleep fragmentation, hypoxaemia and apnoea recurrence.