bluuebunny/crossref_metadata_2025_split huggingface dataset:
The long‐term effect of high‐frequency chest compression therapy on pulmonary complications of cystic fibrosis
Authors: Warwick Warren J. , Hansen Leland G. 
Published: March 2007

AbstractA high‐frequency chest compression (HFCC) device for clearance of mucous secretions from airways was tested in 16 cystic fibrosis (CF) patients with significant improvement in pulmonary function for the HFCC period, which averaged 22 months per patient. The device consists of a variable air pulse delivery system and a non‐stretch inflatable vest worn by the patient to cover the entire torso. The patients perform 30 minute therapy sessions divided into 5 minute periods at each of six frequencies. Individual patient therapy time per day ranged from 30 to 240 minutes. Frequencies used by each patient were determined by measuring air flow at the mouth and calculated volume expired per chest compression during tidal breathing while receiving HFCC at frequencies between 5 and 22 Hz at 1 Hz increments. The frequencies that produced the three highest flows and the three largest volumes were selected for each patient's therapy.Ninety‐four percent of patients' regression line slopes for percent predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) became more positive during self‐administered HFCC therapy as compared to slopes before HFCC therapy, when manual chest physical therapy was used.Two‐sided t‐test showed that the mean slopes were more positive for FVC and FEV1 during HFCC therapy than for the manual chest physical therapy period before HFCC therapy. The significance level for both FVC and FEV1 was at P < 0.001.
Longitudinal serum IgG response to Pseudomonas cepacia surface antigens in cystic fibrosis
Authors: Aronoff Stephen C. , Quinn Francis J. , Stern Robert C. 
Published: March 2007

AbstractIn cystic fibrosis (CF), serum antibody against surface antigens of Pseudomonas aeruginosa is detected only after colonization. Since pulmonary acquisition of P. cepacia usually follows colonization with P. aeruginosa and since P. aeruginosa‐colonized patients with CF have demonstrable antibody against outer membrane proteins of P. cepacia, it appears that acquisition of the latter organism occurs in the presence of specific serum antibody. To test this hypothesis, serum obtained from six P. aeruginosa‐colonized patients 4 and 2 years prior to and 3 months and 2 years after P. cepacia colonization were assayed for total and specific IgG to P. cepacia outer membrane components. Four patients demonstrated 6‐fold or greater increases in specific IgG titers to whole outer membranes following colonization. By immunoblot, all patients had demonstrable serum IgG against the 27‐ and 36‐kDa outer membrane proteins of P. cepacia 4 and 2 years prior to colonization. Immunoblots after P. cepacia acquisition demonstrated an intensification of the 28‐ and 36‐kDa bands and the appearance of antibody to a very low molecular weight compound which was not hydrolyzed by proteinase K and was present in purified LPS. These observations suggest that low serum titers of antibody against two P. cepacia outer membrane proteins are present in patients with CF prior to P. cepacia colonization, and that these antibodies fail to protect for intrinsic or extrinsic reasons.
Outcome of home care for technology‐dependent children: Success of an independent, community‐based case management model
Authors: Fields Alan I. , Coble Deborah Hardy , Pollack Murray M. , Kaufman Joanne 
Published: March 2007

AbstractCase management is important for successful home care of technology‐dependent, respiratory‐disabled children. Traditionally, the medical model of hospital‐based home care and case management has been used for these children. The outcome may be different from when using independent, community‐based home care and case management. We evaluated the results of 28 technology‐dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, communtiy‐based, case management group to coordinate home care. After 26.3 ± 20.6 months of follow‐up, 13 children (46%) remained technology‐dependent, 10 (36%) were technology‐independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies (n = 4), primary pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology‐dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community‐based home care and case management is a reasonable alternative to the hospital‐based model.
Effect of prenatal cocaine on respiration, heart rate, and sudden infant death syndrome
Authors: Silvestri Jean M. , Long Joyal M. , Weese‐Mayer Debra E. , Barkov Gary A. 
Published: March 2007

AbstractWe studied 114 neonates by pneumocardiogram recordings in order to examine the effects of cocaine with and without opiate exposure on neonatal respiration, heart rate, apparent life threatening events (ALTE), and sudden infant death syndrome (SIDS). In full‐term infants exposed to cocaine without opiates we found increased longest apnea duration and more episodes of bradycardia, but decreased periodic breathing and average heart rate than in control full‐term infants. Term infants prenatally exposed to cocaine with opiates also had less periodic breathing. Preterm infants exposed to cocaine with and without opiates had decreased apnea density and periodic breathing compared with preterm controls. Discriminant analysis to determine whether perinatal asphyxia or exposure to other drugs could predict cardiorespiratory abnormalities showed no consistent relationship. In 72 of 114 infants available for follow‐up, no ALTE occurred but two were lost to SIDS. Our data support the hypothesis that prenatal cocaine exposure may perturb, albeit subtly, the maturation of respiratory control, resulting in disruption of postnatal respiration.
Caffeine potentiates airway responsiveness in the neonatal lamb
Authors: Keklikian Esteban N. , Wolfson Marla R. , Shaffer Thomas H. 
Published: March 2007

AbstractIn contrast to its effect on airway smooth muscle in the adult, in vitro studies have shown that caffeine significantly increases active tension in airway smooth muscle in the neonatal lamb. To determine if caffeine has a physiological effect on airway function during early development, we studied the effect of caffeine on acetylcholine‐induced bronchoconstriction in two groups of neonatal lambs. The animals were anesthetized, paralyzed, and maintained normoxic and normocapnic with mechanical ventilation. Pulmonary mechanics were evaluated as indices of airway tone, and functional residual capacity was used as an index of lung volume; heart rate and mean arterial pressure were used to assess cardiovascular status. Acetylcholine‐induced bronchoconstriction was evaluated as percentage changes of airway conductance and lung compliance from baseline, before and 1 hour after administration of normal saline or caffeine, and it was further analyzed with respect to the dose that produced a 20% change in those values (PD20). There were no significant alterations in baseline lung mechanics, lung volume, or mean arterial pressure following saline or caffeine infusion. However, caffeine produced a left shift in the acetylcholine dose‐response curve for conductance and compliance and a significant decrease (−52%; P < 0.001) in PD20 for conductance. There were no significant alterations in any parameter following saline administration. Since caffeine is used commonly for the treatment of apnea of prematurity, it is noteworthy that caffeine increases airway reactivity at clinically relevant doses. These findings raise important issues regarding the use of caffeine for the treatment of apnea of prematurity.
Mucoid Pseudomonas aeruginosa is a marker of poor survival in cystic fibrosis
Authors: Henry Richard L. , Mellis Craig M. , Petrovic Lea 
Published: March 2007

AbstractThe aim of this study was to assess the prognostic significance of mucoid and non‐mucoid isolates of Pseudomonas aeruginosa (muPs and non‐muPs) from the sputa of patients with cystic fibrosis (CF). Eighty‐one children with CF who coughed up sputum daily were recruited and followed over 12 months with frequent sputum cultures. At the end of this observation period they were classified to one of three age‐matched groups. In 50 mPs was isolated on one or more occasions; 19 grew non‐muPs but not muPs, and 12 grew no isolates of Ps aeruginosa. These 81 children and adolescents were followed for a further 8 years or until they died. Twenty‐one (42%) of the muPs patients died compared with two (11%) of the non‐muPs and one (8%) of the no Ps patients (P < 0.01). Stepwise regression indicated that forced expiratory volume in 1 second (FEV1) had the main predictive effect but that age, Shwachman score and muPs also had a predictive effect. Identification of mucoid forms of Ps aeruginosa is an unfavorable prognostic factor but the isolation of non‐mucoid strains does not appear to be any more important than the isolation of other common respiratory pathogens.
Dexamethasone therapy for bronchopulmonary dysplasia: Improved respiratory mechanics without adrenal suppression
Authors: Brundage K. L. , Mohsini K. G. , Froese A. B. , Walker C. R. , Fisher J. T. 
Published: March 2007

AbstractThe purpose of the present study was to examine the pattern of changes in respiratory system mechanics induced by dexamethasone (Dex) in infants with bronchopulmonary dysplasia (BPD) and to determine whether dosages that produce these changes induce adrenal suppression. We examined mechanics in seven ventilator‐dependent premature infants (age, 33 ± 4.8 days) with BPD, before and daily during Dex therapy. Dex (0.5 mg/kg/day) was given intravenously for 7 days unless complications necessitated early termination. Respiratory system resistance (Rrs) and compliance (Crs) were measured by the passive expiratory flow‐volume technique during the course of dexamethasone therapy or until extubation. Adrenocorticotrophic hormone (ACTH) stimulation tests were done at baseline and following Dex therapy to evaluate adrenal function. Dex therapy caused a 77 ± 18% increase in Crs (from 0.97 ± 0.09 SEM mL/cmH2O to 1.6 ± 0.16 mL/cmH2O; P < 0.025) and a 33 ± 5% decrease in Rrs (from 0.20 ± 0.02 cmH2O/mL/s to 0.14 ± 0.01 cmH2O/mL/s P < 0.01). Concurrently, ventilator rate, mean airway pressure, and FI all decreased significantly (P < 0.025). Extubation occurred later in infants with the lowest Crs and highest Rrs at baseline. At extubation, all Crs values were greater than 1.33 mL/cmH2O and Rrs values were less than 0.15 cmH2O/mL/s. Systolic blood pressure increased from 61 ± 6.3 mmHg to 84 ± 17 mmHg, 72–96 h after the start of Dex (P < 0.025). There were no episodes of culture‐positive sepsis. Neither basal nor ACTH‐stimulated levels of cortisol were suppressed as a result of Dex therapy (P > 0.05). We conclude that correction of abnormalities of compliance is critical to reducing work of breathing and achieving extubation in this population. In the small number of infants we studied, Dex induced this therapeutic response with minimal side effects and no statistically significant change in adrenal function.
Measurement of bronchial responsiveness in young children: Comparison of transcutaneous oxygen tension and functional residual capacity during induced bronchoconstriction and ‐dilatation
Authors: Wilts M. , Hop W. C. J. , van der Heyden G. H. C. , Kerrebijn K. F. , de Jongste J. C. 
Published: March 2007

AbstractDemonstration of an increased bronchial responsiveness in preschool children may support the diagnosis of asthma. Most young children cannot perform routine lung function tests. Transcutaneous P(Ptc) measurement has been applied successfully in young children, and changes in Ptchave been shown to correlate well with changes in forced expiratory volume in 1 second (FEV1) during bronchoprovocation testing with methacholine. Ptcis, however, an indirect measure of the effect of inhaled spasmogens. As functional residual capacity (FRC) can also be measured by helium dilution spirometry in preschool children, we compared Ptcand FRC during methacholine inhalation challenges and after inhaled terbutaline, in order to determine whether FRC is useful as a more direct measure of induced bronchoconstriction and ‐dilatation than Ptc. We studied 41 allergic asthmatic children (mean age, 5.2 years) who underwent a methacholine bronchoprovocation test; 38 children received terbutaline 1 h after the final methacholine dose. The provocative concentration of methacholine that caused a 20% decrease of Ptcwas determined, and changes in FRC and Ptcafter each methacholine dose step were compared. Similarly, changes in Ptcand FRC before, and 15 and 30 min after, terbutaline were compared. All children had a drop in Ptcafter increasing doses of methacholine; a 20% change was reached in 38 patients. Mean FRC values increased significantly but variably with increasing doses of methacholine, and changes in Ptcand FRC did not correlate. After terbutaline, Ptcincreased slightly but significantly, and FRC again varied unpredictably. In a separate group of 11 children, the effect of terbutaline was assessed directly after the final methacholine dose, when significant bronchoconstriction was still present. In this group, FRC changes were not significant and were not related to the increase in Ptc. Our study suggests that FRC cannot be recommended to monitor the effects of inhaled bronchoconstrictors and bronchodilators in young children. Ptcmeasurement is one of the few convenient and safe methods to be used in children too young to perform conventional tests of lung function during bronchoprovocation testing.
Phospholipid composition and surface‐active properties of tracheobronchial secretions from patients with cystic fibrosis and chronic obstructive pulmonary diseases
Authors: Girod S. , Galabert C. , Lecuire A. , Zahm J. M. , Puchelle E. 
Published: March 2007

AbstractAmong the various components of tracheobronchial secretions, lipids and particularly phospholipids have been shown to influence rheological properties of airway secretions in patients with cystic fibrosis. We studied the phospholipid composition of tracheobronchial secretions, collected from patients suffering from cystic fibrosis (CF) and other chronic obstructive pulmonary diseases (COPD), and we analyzed the possible relationship between the phospholipid profile and the wettability of tracheobronchial secretions evaluated by the measurement of contact angle. Although total phospholipid content and contact angle of tracheobronchial secretions were significantly increased (P < 0.01) in CF compared to COPD, no significant relationship existed between these two parameters. The concentrations of the different phospholipid subclasses were not homogeneously modified according to the origin of the secretions. Compared to COPD secretions, the CF secretions were characterized by a significant (P < 0.001) increase in rigidifying fractions such as sphingomyelin and phosphatidylserine/phos‐phatidylinositol and a significant (P < 0.001) decrease in surface‐active fractions, such as phosphatidylcholine and phosphatidylglycerol (PG) (P < 0.001). In the two groups, the surface‐active phospholipid fraction, PG, was negatively correlated to the contact angle of tracheobronchial secretions. These results suggest that a decrease in PG content in CF secretions may be one factor responsible for an increase in their adhesivity to the respiratory mucosa, and, consequently, for mucus stasis and severity of bronchial obstruction in cystic fibrosis. © 1992 Wiley‐Liss, Inc.
Machinal properties of the upper airway wall in children and their influence on respiratory impedance measurements
Authors: Marchal F. , Hauouzi P. , Peslin R. , Duvivier C. , Gallina C. 
Published: March 2007

AbstractThe upper airway wall impedance (Zuaw) may be responsible for a large artifact in the measurement of respiratory system impedance (Zrs) in children. In 17 normal children aged 3.5‐13 years Zuaw and Zrs were estimated by varying transrespiratory pressure directly at the mouth (conventional method:Z1) and around the subject's head (head generator method: Z2) from 4 to 32Hz. Zrs and Zuaw were calculated from Z1 = Zrs · Zuaw/(zrs + Zuaw) and Z2 = Zrs (1 =Zp/Zuaw), where Zp is the impedance of the pneumotachograph. From the real and imaginary part of Z1, Z2, Zrs, and Zuaw, the corresponding resistance, inertance, compliance and resonant frequency were calculated assuming simple REC models. No significant difference was found between the mean ± SE of parameters derived from Zrs (respectively, 6.8 ± 0.4 cmH2O·L−1·s, o.034 ± 0.001 cmH2O·L−1· s2, 10.4 ± 0.8 m. cmH2O·L−1, 9.1 ± 0.3Hz) and Z2 (6.8 ± 0.4 cmH2O·L−1· s, 0.038 ± 0.002 cmH2O·L−1· s2, 10.7 ± 0.7 ml. cmH2O−1, 8.7 ± 0.4 Hz). All but the compliance, derived from Z1 were significantly different (p<0.01) from those derived from Zrs (5.3 ± 0.3 cmH2O·L−1· s, 0.008 ± 0.001 cmH2O·L−1· s2, 11.9 ± 1.2 ml. cmH2O−1, and 20.3 ± 1.6 Hz). Respiratory resistance and compliance correlated significantly with height (r= −0.56 and 0.86, respectively), in contrast to upper airway wall resistance (Ruaw) and compliance (Cuaw). Ruaw (8.6 ± 0.8 cmH2O·L−1·s), Cuaw (1.2 ± 0.2 m· cmH2O−1), and upper airway wall inertance (0.030 ± 0.004 cmH2O·L−1· s2) were close to those obtained by direct measurements in adults. The mechanical properties of the upper airway wall are responsible for a significant error in the measurement of Zrs by the conventional method in normal children. Most of the artifact may be corrected for by applying pressure around the child's head. © 1992 Wiley‐Liss, Inc.
Elastase α‐proteinase inhibitor and lactoferrin concentrations in endotracheal aspirates of ventilated newborns
Authors: Tegtmeyer Friedrich K. , Maacks Susanne , Wood W. Graham , Wiebicke Wolfram 
Published: March 2007

AbstractBacterial colonization of the tracheo‐bronchial tree is common and an established risk factor for infection in ventilated newborns. Elastase, a highly active proteinase, and lactoferrin, an iron‐binding protein and potential modulator of the inflammatory process, are both major constituents of either azurophilic or primary granules of neutrophilic granulocytes, released by activation of these cells during the inflammatory response. Since both elastase, complexed with its major inhibitor alpha1‐proteinase inhibitor (Eα1‐Pl), and lactoferrin (Lf) are indicators of granulocyte activation during bacterial infection, they may indicate infectious inflammation at the tracheobronchial site. To study whether these substances in a single suction probe may serve this purpose, we obtained 82 tracheo‐bronchial aspirates routinely from 16 ventilated newborns with a median gestational age of 31.5 (range, 25–39) weeks for laboratory analysis and bacterial cultures. Systemic inflammatory response by differential white blood cell count and C‐reactive protein (CRP) was monitored simultaneously. © 1992 Wiley‐Liss, Inc.The median Eα1‐PI level was significantly elevated in culture‐positive aspirates (1,005 μg/L: range, < 30–29,240 μg/L) in contrast to culture‐negative samples (158 (μg/L; range, < 30‐1,408 μg/L). In addition to a diagnostic sensitivity of 77%, Eα‐PI offered a high specifity of 88%, a positive predictive value of 97%, and a negative predictive value of 73%. In contrast, median Lf concentration (10.6; range, 0.3–58.3 mg/L vs. 11.7; range, 1.6–158 mg/L) showed no correlation with culture results. Of the culture‐positive aspirates 36% corresponded with systemic signs of an acute inflammatory response, such as elevated l/T‐ratio and CRP. As confirmed by serial measurements in a representative preterm neonate we suggest that an elevated Eα‐PI concentration in tracheo‐bronchial aspirates is a helpful additional indicator of local inflammation before it is detectable by a systemic inflammatory response.
Pediatric asthma deaths in Victoria: The mild are at risk
Authors: Robertson Colin F. , Rubinfeld Abe R. , Bowes Glenn 
Published: March 2007

AbstractPrevious reviews of pediatric asthma mortality have mostly been from hospital‐based clinic populations and suggest that only those with severe asthma are most at risk. This report summarizes an investigation, by interviewer‐administered questionnaire, into the circumstances surrounding the death in all patients aged 20 years or less who died from asthma in the State of Victoria over a 3 year period from May 1, 1986. © 1992 Wiley‐Liss, Inc.During this period, 51 deaths due to asthma were reported. Thirty‐three percent of these were judged to have a history of trivial or mild asthma, and 32% had no previous hospital admission for asthma. However, 36% were judged to have had severe asthma, 43% were taking regular inhaled beclomethasone or sodium cromoglycate, and 10% were taking regular oral steroids. Twenty‐two percent had a previous admission to an ICU. Death occurred outside hospital in 40 (78%) subjects. In the final attack 63% had sudden onset and collapse within minutes, 12% were found dead, and 25% had acute progression of an established attack. The investigators assessed 39% of the deaths to have had potentially preventable elements. The preventable factors included: inadequate assessment or therapy of prior asthma (68%), poor compliance with therapy (53%), and delay in seeking help (47%).The majority of subjects in this survey could not be classified as “high risk.” Therefore, clinicians should ensure that all young patients with asthma are aware of optimal maintenance management, can recognize deteriorating asthma, and follow a clear individualized crisis plan.
Fine needle aspiration biopsy cytology as an adjunct in the diagnosis of childhood sarcoidosis
Authors: Wakely Paul E. , Silverman Jan F. , Holbrook C. Tate , Fairman R. Paul , Daeschner Charles W. , Joshi Vijay V. 
Published: March 2007

AbstractFine needle aspiration biopsy cytology performed in three children with sarcoidosis expedited clinical investigation and diagnosis of their disease. Each patient had a different clinical presentation; in two of them lymphoma was part of the initial differential diagnosis. Aspiration cytology in all cases revealed collections of epithelioid histiocytes, and multinucleate foreign body‐type giant cells, without accompanying necrosis or acute inflammation. A diagnosis of non‐caseating granulomas consistent with sarcoidosis was made in all aspirates. Special stains for identification of organisms performed on the smears of one case, and culture of aspirate material from one case were negative. Subsequent serum angiotensin converting enzyme levels in all patients were elevated. Chest x‐ray films in all patients showed mediastinal and hilar lymphadenopathy. One patient had an interstitial pulmonary infiltrate. All patients responded to steroid therapy. Fine needle aspiration biopsy can be a useful diagnostic tool in the evaluation of children with suspected sarcoidosis. © 1992 Wiley‐Liss, Inc.