bluuebunny/crossref_metadata_2025 huggingface dataset:
Glomus Jugulare Tumors
Authors: Gerosa Massimo , Visca Anna , Rizzo Paolo , Foroni Roberto , Nicolato Antonio , Bricolo Albino
Published: September 2006

OBJECTIVE:

Glomus jugulare tumors are generally considered slow-growing, benign lesions. However, their pronounced local aggressiveness frequently results in severe neurological deficits. Surgical removal is rarely radical and is usually associated with morbidity. There is increasing evidence that stereotactic radiosurgery, particularly gamma knife radiosurgery (GKR), may play a relevant role as a therapeutic option in these tumors.

METHODS:

Between 1996 and 2005, we used GKR to treat 20 patients bearing growing glomus jugulare tumors, mostly classified as Glasscock-Jackson Grade IV or Fisch Stage D1. Follow-up (mean, 50.85 mo) data was available for 20 patients (four men, 16 women; mean age, 56 yr): eight out of 20 tumors were surgical recurrences, three out of 20 patients had GKR as the primary treatment, and 11 out of 20 patients previously underwent endovascular embolization. Regarding the radiosurgical dose planning, the average tumor volume was 7.03 cm3 (range, 1.5–13.4 cm3) and the mean marginal dose was 17.3 Gy (range, 13–24 Gy).

RESULTS:

Neurological signs and symptoms were unchanged in 13 out of 20 patients. An improvement of cranial nerve function was observed in five patients and hearing deterioration was observed in two patients. Tumor volume was unchanged in 11 out of 20 patients and was slightly (≤ 20%) decreased in eight out of 20 patients. In one unusual case of a bulky cavernous sinus recurrence, neoplastic regression was particularly pronounced.

CONCLUSION:

Despite the constraints of the limited case material, considering the estimated doubling time of these rare tumors (4.2 yr), our preliminary results with GKR at a mid-term follow-up examination suggest an effective tumor growth control with negligible incidence of untoward sequelae.
Visual Outcome of Tuberculum Sellae Meningiomas after Extradural Optic Nerve Decompression
Authors: Mathiesen Tiit , Kihlström Lars
Published: September 2006

OBJECTIVE:

Meningiomas of the tuberculum sellae have a close relationship with the optic apparatus. Even modern series show a 10 to 20% risk of visual deterioration after surgery. We have attempted to improve visual outcome by extradural decompression of the optic canal and anterior clinoid process, followed by intradural release of the optic nerve; this study provides an analysis of visual outcomes with this approach.

METHODS:

Treatment, histopathology, and follow-up data of 29 consecutive patients undergoing surgery for tuberculum sellae meningiomas with initial release of the optic nerve were prospectively collected.

RESULTS:

Radical tumor removal was possible in all 23 patients with primary tumors and in three out of six patients with recurrent tumors. All patients but two of the worst affected with preoperative visual compromise improved from surgery; there were no instances of visual deterioration. Five patients with normal preoperative vision remained intact and visual improvement was 22 (91%) out of 24 patients in the remaining patients. In total, 13 patients (42%) had completely normal vision at follow-up. Mainly patients younger than 60 years experienced complete normalization after surgery. Two patients underwent transsphenoidal surgery for cerebrospinal fluid leaks. Postoperative endocrinological symptoms were temporary diabetes insipidus in one patient and permanent diabetes insipidus in another patient undergoing elective sectioning of the pituitary stalk because of a recurrent tumor with invasive growth into the stalk.

CONCLUSION:

Adding early optic nerve decompression by extradural clinoidectomy and optic canal unroofing to a frontopterional approach seemed to improve visual outcomes because there were no instances of visual deterioration. Simpson Grade 1 to 2 removal was possible in all patients with primary surgery, whereas recurrent cases could only be treated with lower grades of radicality. Radical removal, however, required readiness to reoperate for cerebrospinal fluid leakage at the site of the drilled tumor origin in bone.
Difference in Recovery Potential of Peripheral Nerves after Graft Repairs
Authors: Roganovic Zoran , Pavlicevic Goran
Published: September 2006

OBJECTIVE:

To our knowledge, few studies have been published regarding differences in nerve recovery potentials. In this study, sensory and motor recovery potentials were compared between different nerves.

METHODS:

A prospective study of a homogenous group of 393 graft repairs of the median, ulnar, radial, tibial, peroneal, femoral, and musculocutaneous nerves, with the scoring of motor and sensory recoveries. Sensory and motor recovery potentials, defined on the basis of average scores and rates of useful recovery, were compared between the different nerves, and separately for high-, intermediate-, and low-level repairs.

RESULTS:

Sensory recovery potential was similar for all nerves tested (P > 0.05), but motor recovery potential differed significantly. After high-level repairs, motor recovery potential was significantly better for the radial and tibial nerves (useful recovery in 66.7 and 54.5% of patients, respectively), than for the ulnar and peroneal nerves (useful recovery in 15.4 and 13.8% of patients, respectively; P < 0.05). After intermediate-level repairs, motor recovery potential was better for the musculocutaneous, radial, and femoral nerves (useful recovery in 100, 98.3, and 87.5% of repairs, respectively), than for the tibial, median and ulnar nerves (useful recovery in 63.9, 52, and 43.6% of repairs, respectively; P < 0.05). In addition, motor recovery potential was significantly the worst with peroneal nerve repairs (useful recovery in 15.2% of patients; P < 0.05). After low-level repairs, motor recovery potential was similar for all nerves (useful recovery in the range of 88.9–100% of patients and in 56.3% of peroneal nerve repairs).

CONCLUSION:

Sensory recovery potential is similar for the median, ulnar, and tibial nerves. The expression of motor recovery potential depends on the repair level. With low- and high-level repairs, it does not stand out in an obvious way, but it is fully expressed with intermediate-level repairs, classifying nerves into three categories with excellent, moderate, and poor recovery potential.
Posttraumatic Peripherally-induced Dystonia and Multifocal Deep Brain Stimulation
Authors: Capelle Hans-Holger , Grips Eva , Weigel Ralf , Blahak Christian , Hansjörg Baezner , Wohrle Johannes C. , Krauss Joachim K.
Published: September 2006

OBJECTIVE:

We report on the effect of multifocal deep brain stimulation for the treatment of posttraumatic peripherally-induced dystonia.

CLINICAL PRESENTATION:

A 34-year-old woman presented with an 8-year history of painful tonic dystonia starting in her left leg after injury of the third metatarsal bone. She did not benefit from right-sided pallidal stimulation by an electrode misplaced in the globus pallidus externus in another hospital.

INTERVENTION:

Quadripolar deep brain stimulation electrodes were placed in the globus pallidus internus and the ventrolateral thalamus by computed tomographic-guided stereotactic surgery and microelectrode recording contralateral to the side of dystonia. The Burke-Fahn-Marsden motor score of 34 did not improve with chronic pallidal or thalamic stimulation.

CONCLUSION:

Although deep brain stimulation is received with great enthusiasm, it is important to identify its limitations in certain subtypes of dystonia.
Preservation of Facial Nerve Function after Postoperative Vasoactive Treatment in Vestibular Schwannoma Surgery
Authors: Strauss Christian , Romstöck Johann , Fahlbusch Rudolf , Rampp Stefan , Scheller Christian
Published: September 2006

OBJECTIVE:

Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome.

PATIENTS AND METHODS:

Forty-five patients with vestibular schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function.

RESULTS:

Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment.

CONCLUSION:

The study points to a potential effect of vasoactive treatment for facial nerve function after vestibular schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.
When the Bone Flap Hits the Floor
Authors: Jankowitz Brian T. , Kondziolka Douglas S.
Published: September 2006

OBJECTIVE:

There is no published data in the neurosurgical literature describing the incidence, treatment, or outcome of contaminating a bone flap. We reviewed our departmental experience to determine methods of prevention and assess our treatment strategies.

METHODS:

We retrospectively reviewed all incidents of dropped bone flaps during a craniotomy at a single medical center during a 16-year period. In addition, a questionnaire was mailed to neurosurgeons in the United States and abroad asking their own experience and method of management.

RESULTS:

Fourteen incidents of dropped bone flaps occurred during a 16-year period. Follow-up varied from 2 to 176 months. The bone flap was dropped while elevating the bone (n = 4), when handing the bone off the field (n = 4), and during plating (n = 4). The context was unknown in two cases. Management included soaking the flap in betadine and/or antibiotic solution (n = 8), autoclaving (n = 2), or discarding the bone flap and replacing with a mesh cranioplasty (n = 3). The treatment remains unknown in one case. No instances of infection were noted in follow-up. In response to the survey, 66% (33 out of 50) of the polled neurosurgeons had experienced this complication during their practice, and 83% would replace the bone flap after disinfection.

CONCLUSION:

Dropping a bone flap during neurosurgery remains an uncommon but preventable complication. Treatment options include discarding the bone followed by cranioplasty versus replacing the bone after treatment with antibiotic irrigation, betadine, and/or autoclaving. Replacement after disinfection is an appropriate option for contaminated bone flaps that avoids the expense and time of cranioplasty.
Construction of Carbon Frameworks through β-Carbon Elimination Mediated by Transition Metals
Authors: Murakami Masahiro , Makino Masaomi , Ashida Shinji , Matsuda Takanori
Published: September 2006

New catalytic reactions in which transition-metal cyclobutanolates undergo β-carbon elimination have been developed in our laboratory. Rhodium(I) cyclobutanolate generated by the addition of an arylrhodium(I) species to a cyclobutanone undergoes β-carbon elimination to cause ring opening of the four-membered carbocyclic framework. The synthetic potential of the ring-opening process through β-carbon elimination has been demonstrated by its application to a ring-expansion reaction forming a seven-membered ring. Furthermore, a formal alkyne insertion into the cyclobutanone framework is achieved by combining oxidative cyclization of a cyclobutanone and an alkyne on nickel(0) and β-carbon elimination from the resulting nickel(II) cyclobutanolate.
X-ray Analysis of Excited-State Molecular Structure of [AuCl(PPh3)2]
Authors: Hoshino Manabu , Uekusa Hidehiro , Ohashi Yuji
Published: September 2006

When a chloroform solvate crystal of the three-coordinated Au(I) complex [AuCl(PPh3)2]·CHCl3 was irradiated with a mercury lamp at low temperatures, the crystal showed bright green emission from the excited molecules. From X-ray analysis, the unit-cell volume significantly decreased under photoirradiation. The three-dimensional intensity data were collected in the dark (light-off) and under photoirradiation (light-on) at 175, 156, 136, and 84 K. As the temperature decreased, the difference in unit-cell volume between the light-off and -on experiments increased. The molecular structures in the light-off and -on experiments revealed that the Au–P and Au–Cl bonds are significantly contracted by photoirradiation at every temperature. The changes in the other bond lengths were within the experimental errors. The shortening becomes greater as the temperature is lowered. The bond shortening, which causes the decrease in unit-cell volume, is in good agreement with the theoretical assumption that excitation from an anti-bonding orbital to a bonding orbital occurs in the Au(I) complex by photoirradiation.
A Study on Zinc Isotope Fractionation in a Benzo Crown Resin/Acetone System
Authors: Ding Xingcheng , Suzuki Tatsuya , Nomura Masao , Sugiyama Yuichi , Kaneshiki Toshitaka , Fujii Yasuhiko
Published: September 2006

Zinc isotope fractionation has been studied in different cavities of crown ether resins that were synthesized in porous silica beads. Displacement chromatography was performed, as a breakthrough manner, in glass columns by feeding in a zinc chloride solution. From the mass analysis of effluents, the heavier isotopes of zinc were enriched at the beginning of the zinc adsorption band. The front maximum enrichment (1.0168), separation coefficient (8.1 × 10−4), and smaller HETP (0.205 cm) for the isotopic pair 68Zn/64Zn were obtained with the use of the benzo-15-crown-5 resin. Zinc isotope fractionation was obviously affected by the cavity size of the crown ethers.
Synthesis and Structures of Vanadium–Cerium Trinuclear Complexes with Schiff-Base Ligands
Authors: Tsuchimoto Masanobu , Ishii Toshio , Imaoka Takane , Yamamoto Kimihisa , Yoshioka Naoki , Sunatsuki Yukinari
Published: September 2006

A vanadium(V)–cerium(IV) trinuclear complex, [{VVO2(L1)}2CeIV] (1) (H3L1: N,N′-bis-3-ethoxysalicylidene-2-hydroxy-1,3-propanediamine), was prepared by the reaction of [VIVO(acac)2] and [CeIII(acac)3]·3H2O with H3L1 in CH3CN, followed by oxidation of the product in air. The structure of complex 1 was determined by X-ray crystal structure analysis. The complex has a VV–CeIV–VV trinuclear structure with two dioxovanadium(V) moieties on each side of the cerium(IV) moiety. Complex 1 has two L1 ligands to form a trinuclear structure. The basal oxo atoms of the dioxovanadium(V) moieties are coordinated to the cerium atom with Ce–O distances of 2.322(3) and 2.343(3) Å. The apical two non-coordinating oxo atoms are oriented to the same direction to form an endo structure. IR data of complex 1 show V=O stretching bands at 975 cm−1 for the apical non-coordinated oxo atoms and 802 cm−1 for the basal coordinated oxo atoms. The cyclic voltammogram of complex 1 in CH3CN shows a quasi-reversible two-electron redox couple with E1/2 = −0.60 V vs Fc/Fc+.
Versatile Vapochromic Behavior Accompanied by a Phase Change between Charge-Polarization State and Charge-Density-Wave State in a Quasi-One-Dimensional Iodo-Bridged Dinuclear Platinum Mixed-Valence Compound, [{NH3(CH2)5NH3}2][Pt2(pop)4I]·4H2O
Authors: Yamashita Masahiro , Takizawa Kouichi , Matsunaga Satoshi , Kawakami Daisuke , Iguchi Hiroaki , Takaishi Shinya , Kajiwara Takashi , Iwahori Fumiyasu , Ishii Tomohiko , Miyasaka Hitoshi , Sugiura Ken-ichi , Matsuzaki Hiroyuki , Kishida Hideo , Okamoto Hiroshi
Published: September 2006

This communication describes versatile vapochromic behavior that is accompanied by a phase change between charge-polarization (CP) and charge-density-wave (CDW) states with increasing and decreasing temperature in [{NH3(CH2)5NH3}2][Pt2(pop)4I]·4H2O (pop = P2H2O52−) (1).
Benign and Efficient Synthesis of 2-Substituted 4(3H)-Quinazolinones Mediated by Iron(III) Chloride Hexahydrate in Refluxing Water
Authors: Wang Guan-Wu , Miao Chun-Bao , Kang Hui
Published: September 2006

Condensation of aldehydes with anthranilamide in refluxing water using iron(III) chloride hexahydrate as an oxidiant afforded 2-substituted 4(3H)-quinazolinones in good yields (77–93%). This method provides several advantages such as being environmentally friendly, having a simple work-up procedure, and affording high yields.
Stabilization of Polystyrene Thin Films against Dewetting by Silsesquioxane-terminated Polystyrene Additives
Authors: Miyamoto Kyota , Hosaka Nao , Otsuka Hideyuki , Takahara Atsushi
Published: September 2006

A polyhedral oligomeric silsesquioxane (POSS)-containing initiator for nitroxide-mediated radical polymerization was synthesized to prepare organic–inorganic hybrid polymers (PS-POSS), which are polystyrene (PS) with a POSS end group. PS-POSS were well dispersed in PS thin films and provided thermal stability to films against dewetting.
Comparison of Optical Properties and Doping Behavior of –[(p-C6H4)mNH]n– (m = 1–4) Type Polymers
Authors: Horie Masaki , Yamaguchi Isao , Yamamoto Takakazu
Published: September 2006

Poly(p-oligophenylene amine)s, –[(p-C6H4)mNH]n– (m = 2–4), receive electrochemical and chemical oxidation similar to polyaniline (m = 1). In the electrochemical oxidation (or p-doping) in aqueous media and acetonitrile, the oxidation of the polymer with m = 3 occurs at higher potentials by about 1.0 and 0.6 V, respectively, compared with that of polyaniline.
A Novel Method for Fabricating Chemically Defined Patterns as Standard Samples for Surface Chemical Imaging
Authors: Akiyama Miki , Fujita Mitsuhiro , Fujihira Masamichi
Published: September 2006

To produce micrometer scale chemical patterns, a new method is developed. In this method, silica beads are used as a mask of an underneath substrate. We produced the patterns with CH3- and COOH-terminated regions and compared them with similar patterns prepared by the microcontact printing (μCP) method. The advantage of this technique over μCP is that monolayers with higher chemical purity can be patterned: thus it provides ideal and well-defined standard samples for surface chemical imaging such as chemical force microscopy.
Fabrication of Magnetic Luminescent Nanocomposites via Adsorption–Precipitation of Metal Ions on Sulfonated Iron Oxide Nanoparticles
Authors: Mak Sou-Yee , Chen Dong-Hwang
Published: September 2006

A novel magnetic luminescent nanocomposite has been fabricated by the adsorption of CdII ions on the sulfonated Fe3O4 nanoparticles and the subsequent precipitation with sodium sulfide. The adsorption isotherm of CdII ions on the sulfonated Fe3O4 nanoparticles was investigated, and the product was characterized by TEM, HRTEM, EDX, XRD, UV–vis, and PL.
An operator related to the Cosserat spectrum. Applications
Authors: Simader Christian G. , Weyers Stephan
Published: September 2006

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Einsatz variierter Anregung zur Verbesserung des Informationsgewinns aus den Signalen von Einzelsensoren (Varied Excitation for the Improving of Information Extraction from Signals of Single Sensors)
Authors: Kanoun Olfa
Published: September 2006

Bei Sensorsystemen mit variierter Anregung wird zwar ein einzelnes Sensorelement genutzt, aber mehrere Signale werden ausgewertet. Die Anregung kann eine Veränderung der Messgröße oder eine zusätzliche sog. steuernde Größe sein, wie z. B. Strom oder Frequenz. Der Zusammenhang zwischen Sensorsignal und Anregung kann genutzt werden für die Trennung verschiedener Mechanismen, die unterschiedlich auf die Anregung reagieren, Veränderungen in der Abhängigkeit des Sensorsignals von der Anregung können festgestellt und damit ein Selbsttest oder eine Selbstkalibrierung realisiert werden. Diese Art von Sensorsystemen, die mit dem Begriff Sensorsysteme mit variierter Anregung (Varied Input Sensor Systems: VIS) bezeichnet wurde, schließt die Lücke zwischen Einzelsensoren und Multi-Sensor-Systemen. Besondere Sorgfalt muss dem Entwurfsprozess gewidmet werden, um eine robuste und störungsfreie Funktion zu gewährleisten.
Merkmalerfassung und Messunsicherheit bei Infrarot-Gassensoren (Signal Value Determination and Measurement Uncertainty of Infrared Gas Sensors)
Authors: Zhelondz Olga , Horn Michael
Published: September 2006

Die Messunsicherheit der Messung von Gaskonzentrationen mit Infrarot-Gassensoren hängt stark von der Methode der Merkmalerfassung ab, mit der aus den periodischen, stark durch Driften und Rauschen gestörten Signalen an den Ausgängen der Infrarot-Detektoren konzentrationsabhängige Werte berechnet werden. Die bestehenden Methoden zur Merkmalerfassung sind sehr empfindlich gegenüber solchen Störungen. Der dargestellte Ansatz unter Nutzung von A-priori-Wissen über die Form des Nutzsignals unterdrückt diese Störungen wirksam und liefert gleichzeitig mit den konzentrationsabhängigen Nutzsignalen ein Gütekriterium für die Qualität der Messungen.
„Multisignal“-Sensorik am Beispiel von Witterungssensoren auf der Basis temperaturabhängiger Widerstände (Weather Sensor Based on Temperature-Dependent Resistors Using “Multi-signal”-Analysis)
Authors: Ruser Heinrich , Horn Michael
Published: September 2006

Im Beitrag werden einfache Witterungssensoren, z. B. an automatisch geöffneten Fenstern, auf der Basis von Kaltleitern und einfachen Pt-100-Widerstandsthermometern vorgestellt, welche ihre Informationen aus einer „Multisignal”-Auswertung beziehen. Ein Aufbau, bestehend aus drei Kaltleiter-Elementen, dient zur Bestimmung der Windrichtung und der Windgeschwindigkeit, wobei das Ergebnis der in die Signalauswertung einbezogenen Optimierungsprozedur eine Aussage über die Qualität der Messungen liefert und damit eine Monitoring-Funktion für den Sensorzustand darstellt. Bei periodischer Anregung des Pt-100-basierten Witterungssensors werden aus der Auswertung der thermischen Impedanz mittels einer Gütefunktion die Windstärke und die Umgebungstemperatur sowie die Zustände Regen, Schnee bzw. Eis mit ausreichender Genauigkeit bestimmt. Während des Betriebs werden dabei auch die Modellparameter und damit die Messunsicherheit des Sensors überwacht. Dadurch können Driften, z. B. durch zunehmende Verschmutzung oder Alterung, erkannt und korrigiert werden.
Koeffizienten und Ausgleichsrechnung: Die Messunsicherheit nach GUM. Teil 2: Der quadratische Fall (Coefficients and Adjustment Calculations: Measurement Uncertainty under GUM. Part 2: The Quadratic Case)
Authors: Matus Michael , Kolaczia Wilhelm
Published: September 2006

Die Bestimmung der Grundwerte eines Widerstandsthermometers ist ein typisches Beispiel, bei dem die eigentlichen Messgrößen durch eine Ausgleichsrechnung aus einer veränderlichen Anzahl von Messdaten gewonnen werden. Die notwendige Angabe der Messunsicherheit (nach GUM) solcher Größen bereitet den Anwendern erfahrungsgemäß große Schwierigkeiten. In dieser Arbeit werden für Praktiker GUM-konsistente Formeln für die Messunsicherheit der Koeffizienten einer Ausgleichsparabel abgeleitet.
Use of Exhaled Nitric Oxide Measurements to Guide Treatment in Chronic Asthma
Authors: Chipps Bradley E.
Published: September 2006

Purpose of the Study.

To determine if measurement of exhaled nitric oxide (FeNO) adds to guideline-driven asthma management for patients with chronic asthma.

Study Population.

A total of 110 patients (aged 12–75 years) with chronic asthma on inhaled corticosteroids (ICSs) for at least 6 months using stable doses for 6 weeks were initially evaluated. Exclusion criteria included ≥4 courses of oral prednisone in the previous 12 months, admission to the hospital because of asthma in the previous 6 months, ICU admission at any time in the past, or >10 pack-years (an average of 1 pack of cigarettes smoked per day for >10 years) of cigarette smoking.

Methods.

This was a single-blind, placebo-controlled study. In phase 1 the ICS dose was adjusted on the basis of FeNO or guidelines-based algorithms. When the optimal dose was determined, patients were managed for 12 months.

Results.

There were 46 patients in the FeNO group and 48 patients in the guideline group who completed the study. The final ICS dose for fluticasone was 370 μg/day (95% confidence interval [CI]: 263–477 μg) in the FeNO group and 641 μg/day (95% CI: 526–756 μg; P = .003) in the guideline group. The rate of exacerbations per patient per year was 0.49 (95% CI: 0.31–1.49) in the FeNO group, compared with 0.9 (95% CI: 0.31–1.49; P = .27) in the guideline group. There was no difference in the number, frequency, or time of first exacerbation between groups. There was no significant difference in nighttime awakenings, bronchodilator use, percent symptom-free days, or number of oral corticosteroid courses. There also was no difference in percent sputum eosinophils or pulmonary-function tests.

Conclusions.

With the use of FeNO, control of asthma can be obtained with a lower ICS dose.

Reviewer Comments.

The values for FeNO differ from other studies because a flow rate of 250 mL/second was used instead of 50 mL/second. The control group had downward titration of dose on the basis of symptoms, which was achieved only in a minority of patients. This may have magnified the observed difference in the ICS dose. This and subsequent studies suggest that markers of airway inflammation are becoming accepted as important surrogate markers of asthma control.
The Association of Prolonged Breastfeeding and Allergic Disease in Poor Urban Children
Authors: Phipatanakul Wanda
Published: September 2006

Purpose of the Study.

To determine the association between allergic disease in children and prolonged breastfeeding.

Study Population.

A random sample (n = 861) of 15% of households from 2 poor suburbs of Cape Town, South Africa.

Methods.

Parents completed a validated International Study on Asthma and Allergies in Childhood questionnaire on allergic diseases for children aged 6 to 14 years. Other questions included breastfeeding duration, maternal smoking, and parental allergy. Results were adjusted for possible confounders and possible clustering within the household.

Results.

Of the 861 children included in the study, allergic disease in general and hay fever in particular were significantly less frequent in those with prolonged (>6 months) breastfeeding. There was a significant linear inverse association between breastfeeding duration and allergic disease in children without allergic parents but not in children with an allergic predisposition.

Conclusions.

These results from a developing country suggest a protective effect of prolonged breastfeeding on the development of allergic disease, particularly hay fever, in children born to nonallergic parents. This protective effect was not found in children with an allergic predisposition.

Reviewer Comments.

The results of this study found a significant protective effect of prolonged breastfeeding on the prevalence of allergic disease, which was most pronounced for hay fever. An interesting observation in this study was the inverse association of breastfeeding duration and risk of allergic disease in children without an allergic predisposition. The history of allergy in either parent seemed to neutralize the protective effect of prolonged breastfeeding. This has not been observed in studies regarding the prevention effect of breastfeeding in Westernized countries, where protection was stronger when the family risk was higher. This study suggests that although breastfeeding seems to be protective in the development of allergies, family history and genetics may provide an overriding factor, at least in this study population.
Asthma as a Risk Factor for Invasive Pneumococcal Disease
Authors: Chipps Bradley E.
Published: September 2006

Purpose of the Study.

To determine if asthma is a risk factor for invasive pneumococcal disease.

Study Population.

Patients 2 to 49 years of age in a Tennessee Medicaid program (TennCare) with >1 year of continuous enrollment during the study period (1995–2002). For each patient with invasive pneumococcal disease, 10 age-matched controls were chosen. A total of 11 counties in Tennessee with a population of 2.8 million participated in the study. Asthma was defined as ≥1 inpatient diagnoses (admission or emergency department visit), ≥2 outpatient diagnoses, or use of asthma-related medications. High-risk asthma was defined as an admission for asthma, an emergency department visit, long-term use of oral steroid, or use of ≥3 short-acting β agonists per year.

Methods.

Invasive pneumococcal disease was defined as isolation of strep pneumonia from a normally sterile site (eg, blood, cerebrospinal fluid, pleural fluid, surgical aspirate, joint fluid, and/or bone). The organisms were serotyped.

Results.

A total of 635 patients with invasive pneumococcal disease and 6350 controls were identified. A total of 18% (114 patients) with asthma had an invasive infection compared with 8.1% (516 patients) in the control group. Patients with asthma had increased risk of invasive disease (odds ratio: 2.4; 95% confidence interval: 1.9–3.1). In patients with high-risk asthma, the annual risk for invasive disease was 4.2 of 10 000 compared with 2.3 of 10 000 in the low-risk asthma group and 1.2 of 10 000 in the control group.

Conclusions.

Asthma is an independent risk factor for invasive pneumococcal disease.

Reviewer Comments.

The risk of invasive disease did not depend on comorbid conditions or advancing age. This is the first study to show the association and, if upheld with further data, will significantly affect our recommended immunization strategy for patients with asthma.
Infantile Eczema at One Month of Age Is Associated With Cord Blood Eosinophilia and Subsequent Development of Atopic Dermatitis and Wheezing Illness Until Two Years of Age
Authors: Maloney Jennifer M. , Sicherer Scott H.
Published: September 2006

Purpose of the Study.

To determine if a correlation exists between the prevalence of neonatal skin eruptions at 1 month of age and the later development of atopic dermatitis. In addition, the authors sought to determine if the presence of cord blood eosinophils correlated with the development of later skin disease.

Study Population.

One hundred five newborn infants born by normal vaginal delivery in Mitoyo General Hospital (Kagawa, Japan) from May 1987 to March 1989.

Methods.

The cord blood eosinophil count was measured at the time of delivery. The neonates were examined at 1 (all subjects) and 24 (98 subjects) months of age by a doctor who was unaware of the cord blood eosinophil count. The subjects’ histories of allergic symptoms or physician-diagnosed wheezing bronchitis or asthma during the first 8 years of life were also determined by direct examination or interviews with the guardians (67 subjects). The age of each subject at the onset of the allergic symptoms was determined. Skin eruptions at 1 month of age were classified into 4 categories: (1) infantile eczema; (2) seborrheic dermatitis; (3) intertrigo; or (4) diaper dermatitis. The diagnosis of atopic dermatitis was made according to the criteria by Hanifin and Rajka (Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Arch Dermatol Venereol. 1980;92:44–47), and each rash was defined carefully by appearance.

Results.

At 1 month of age, infantile eczema, seborrheic dermatitis, intertrigo, and diaper dermatitis were diagnosed in a total of 29, 7, 14, and 24 neonates, respectively. No associations (such as family history of allergic disease or mode of feeding) were found for the prevalence of these eruptions. Neonates with infantile eczema had a significantly higher number of eosinophils in the cord blood (P < .0001). In contrast, no such tendency was found for any other skin eruption. In neonates with infantile eczema at 1 month of age, the diagnosis of atopic dermatitis had been made significantly earlier, and the prevalence of wheezing illness was significantly higher compared with infants who did not have infantile eczema.

Conclusions.

Infantile eczema, but not other skin eruptions, precedes the development of atopic dermatitis and wheezing illness during early infancy. This may be secondary to the activation of eosinophils before birth.

Reviewer Comments.

Patients with infantile eczema are at increased risk for atopic disease. The measurement of cord blood eosinophils may aid in predicting which infants will develop infantile eczema and, in addition, may have diagnostic utility in predicting which patients are at risk for the development of further allergic disease.
Immediate Allergic Reactions to Cephalosporins and Penicillins and Their Cross-Reactivity in Children
Authors: Wang Julie
Published: September 2006

Purpose of the Study.

To evaluate the frequency of anaphylactic reactions to cephalosporins and penicillins and their cross-reactivity in a pediatric population.

Study Population.

A prospective survey was conducted in a group of 1170 children with suspected immediate allergic reactions to cephalosporins and/or penicillins, which were examined during a period of 8 years.

Methods.

In vivo (skin tests and challenges) and in vitro tests (for specific immunoglobulin E) were performed with a standard concentration of penicillins and cephalosporins.

Results.

When 1170 children with a clinical history of allergy to penicillins and/or cephalosporins were tested in vivo for immediate hypersensitivity to β-lactams, 58.3% of cases overall were found to be skin- or challenge-test–positive. Among them, 94.4% of patients were positive to penicillins and 35.3% to cephalosporins. The frequency of positive reactions in the in vivo testing was in the range of 36.4% to 88.1% for penicillins and from 0.3% to 29.2% for cephalosporins. However, 31.5% of the penicillin-allergic children cross-reacted to some cephalosporin. If a child was allergic to a cephalosporin, the frequency of positive reactions to penicillin was 84.2%. The cross-reactivity between cephalosporins and penicillins varied between 0.3% and 23.9%. The cross-reactivity among different generations of cephalosporins varied between 0% and 68.8%, being the highest for first- and second-generation cephalosporins and 0% for third-generation cephalosporins.

Conclusions.

The frequency of immediate allergic reactions to cephalosporins is considerably lower compared with penicillins, and the degree of cross-reactivity between cephalosporins and penicillins depends on the generation of cephalosporins, being higher with earlier-generation cephalosporins. The cross-reactivity among cephalosporins is lower compared with cross-reactivity between penicillins and cephalosporins.

Reviewer Comments.

Penicillins and cephalosporins are common antibiotics inducing immunoglobulin E–mediated reactions in children. This large pediatric prospective study revealed that more than half of the children with a history of drug reaction to penicillin and/or cephalosporins were skin- or challenge-test–positive, unlike adults in whom the majority of those with a history of penicillin allergy are found to be skin test–negative. Almost one third of penicillin-allergic children are sensitized to cephalosporins. However, this sensitization was only to first- and second-generation cephalosporins; there was no cross-reactivity seen with third-generation cephalosporins. Interestingly, there was less cross-reactivity among the different cephalosporins. The results of this study can help guide antibiotic choices for penicillin-allergic children.
Identification of a Universal Group B Streptococcus Vaccine by Multiple Genome Screen
Authors: Shreffler Wayne G.
Published: September 2006

Purpose of the Study.

To apply comparative genomic techniques for the development of a universally protective group B Streptococcus (GBS) vaccine.

Methods.

The genome sequences of 8 GBS strains were compared to identify shared and strain-restricted genes. Computer algorithms were used to identify putative surface or secreted proteins. Candidates were cloned and expressed recombinantly in Escherichia coli. Purified proteins initially alone and then in combination were used to immunize groups of female mice. Immunized animals were then mated, and resulting offspring were challenged at <48 hours of age with virulent GBS. Protection was also correlated with specific antibody binding.

Results.

Genomic analysis identified 1811 shared genes representing ∼80% of the genome of each strain. Of these, 589 proteins were predicted to be surface or secreted proteins (396 shared, 193 variable), and 312 of them were successfully expressed as soluble fusion proteins from E coli. Systemic screening of all 312 of these proteins revealed that 4 were capable of significant protection of GBS-challenged offspring of immunized mothers. One of these 4, Sip, was a previously described shared gene, whereas 3 were variably present in the genomes from different strains. As expected, in experiments with single-antigen vaccination, there was no protection when challenged with strains that lack the gene encoding the vaccine protein. However, protection was also variable and even absent in some strains when the gene was known to be present. However, using all 4 antigens in combination, the authors demonstrated protection against a panel of 12 challenge strains representing all 9 major pathogenic GBS serotypes ranging from 59% to 100%.

Conclusions.

Multistrain genome analysis and screening represents an effective new approach for the identification of vaccine candidates that single-strain analysis would miss.

Reviewer Comments.

Vaccine strategies taking into account the enormous variability at the genomic and proteomic levels that many pathogens have evolved are the best hedge against a mere “arms race” in which temporary vaccine efficacy gives way to the emergence of antigenic variants. This is a novel application of such a rational strategy. However, the extent of the challenge is underscored by the identification of only 4 targets despite a comprehensive approach. Furthermore, 3 of 4 are not part of the “core” conserved genome and are, therefore, likely to be nonessential. It remains unproven whether targeting of so few surface proteins of an encapsulated organism would prove to be a good long-term strategy. Nevertheless, this approach seems likely to be at least complementary to efforts directed to polysaccharides for encapsulated organisms.
Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection: A Randomized, Controlled Trial
Authors: Adinoff Allen
Published: September 2006

Purpose of the Study.

Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions. This study evaluated the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection.

Study Population.

A randomized, controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting to a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics).

Methods.

Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of the patients in each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics).

Results.

A total of 562 patients (70%) returned complete diaries, and 78 (10%) provided information about both symptom duration and severity. Cough rated at least “a slight problem” lasted a mean of 11.7 days (25% of the patients had a cough lasting ≥17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed prescription, 0.75 days; 95% confidence interval: −0.37–1.88; immediate prescription, 0.11 days; 95% confidence interval: −1.01–1.24) or other primary outcomes. Compared with those in the immediate-antibiotic group, slightly fewer patients in the delayed-prescription and control groups used antibiotics (96%, 20%, and 16%, respectively; P < .001), fewer patients were “very satisfied” (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P < .001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics: 0.19; delayed prescription: 0.12; immediate prescription: 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet: 0.11; mean attendances for leaflet: 0.17; P = .02).

Conclusions.

No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics.

Reviewer Comments.

This is good that we do not need yet another patient-information leaflet. I have always liked the “delayed-offer” approach, because it is a compromise to the patient, and most of the time they get better and never need the drug.
Racial and Ethnic Differences in Asthma Diagnosis Among Children Who Wheeze
Authors: Randolph Christopher
Published: September 2006

Purpose of the Study.

To determine if racial and ethnic differences in documented pediatric asthma prevalence relate to true prevalence differences or a different probability of receiving the diagnosis.

Study Population.

The study population was 3- to 17-year-old children of non-Hispanic white, non-Hispanic black, Puerto Rican, and Mexican ethnicity taken from a continuous survey administered by the National Center for Health Statistics.

Methods.

The results for children aged 3 to 17 years in the 1999 National Health Interview Survey were analyzed for those with reported wheezing. Asthma diagnosis was evaluated for racial and ethnic differences while controlling for age, gender, parental education, single-parent household, residence, insurance, health care, and parent-reported severity of symptoms.

Results.

Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04–1.63) for Puerto Rican, 1.22 (95% CI: 1.03–1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94–1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children.

Conclusions.

These findings do not support the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children.

Reviewer Comments.

This study suggests that minority children with wheezing severity measured by National Health Interview Survey guidelines are not underdiagnosed. These results suggest that public health endeavors should be directed toward better management and control.
Screening for Children’s Exposure to Environmental Tobacco Smoke in a Pediatric Primary Care Setting
Authors: Smart Brian A.
Published: September 2006

Purpose of the Study.

To develop a brief screening tool to accurately predict environmental tobacco smoke (ETS) exposure.

Study Population.

A total of 291 healthy children aged 2 weeks to 3 years. These children were recruited from a primary care center that provides care to a low-income population. Exclusion criteria included history of birth at <36 weeks’ gestation, asthma, other chronic pulmonary disease, or cardiac disease.

Methods.

The primary caregivers of the children in the study filled out a questionnaire that included items on demographics, smoking status of individuals living in the children’s homes, number of cigarettes smoked per day, and the locations in which individuals smoked. Primary caregivers also gave samples of their own and their children’s hair for measurement of levels of cotinine.

Results.

A total of 7 subjects (2%) had hair cotinine levels of <0.01 ng/mg, 99 subjects (34%) had levels of <0.3 mg/ng, 68 (23%) had midrange levels of 0.3–0.7 ng/mg, and 124 (43%) had levels of >0.7 mg/ng. Factors associated with higher cotinine levels included maternal smoking, the presence of other smokers in the home, and where persons other than the mothers smoke (ie, in the home or outside the home). Interestingly, the reported location of mothers’ smoking (indoors versus outdoors) was not associated with cotinine levels in the hair. The investigators used this information to create a model questionnaire to predict ETS exposure. Three questions were selected: does the mother smoke, do others in the home smoke, do others who smoke remain inside the home or go outside. Using this model, children of mothers who smoke and are also exposed to others who smoke inside the home have an 81% chance of having high exposure to ETS. In contrast, children of mothers who do not smoke and are not exposed to others who smoke have a 64% chance of low exposure to ETS.

Conclusions.

It was possible to derive a simple and valid screening tool to identify children at risk for ETS exposure, but this tool still needs to be tested prospectively.

Reviewer Comments.

We all struggle with our patients’ exposure to ETS in the home. Part of the struggle has to do with obtaining accurate information about exposures. The screening tool described in this study needs to be tested prospectively, but it may prove to be highly useful. Of interest is the finding that it did not matter, in terms of levels of cotinine in children’s hair, whether their mothers smoked indoors or reported that they limited themselves to outdoor smoking. We may speculate that this finding has to do with inaccurate reporting (shame about smoking indoors) or to the large amount of particulate residue that remains on smokers after they smoke.