Frequencies of T cells expressing interleukin-4 and interleukin-5 in atopic asthmatic children. Comparison with atopic asthmatic adults

T-cell-derived cytokines have been implicated in the pathogenesis of asthma and it has been suggested that Th2-type cytokines (interleukin-4 [IL-4], interleukin-5 [IL-5]) are pivotal in the allergic inflammation. However, there are little data on human cytokine production by individual T cells at the protein level, in particular in asthmatic children. In this study we analyzed the cytokine production at the single cell level in peripheral blood from mild atopic asthmatic (AA) children and adults and age-matched atopic nonasthmatic (AN) and nonatopic nonasthmatic (NN) control subjects (n = 9 in each group) using the technique of intracellular cytokine detection by flow cytometry. Comparing asthmatic children with atopic and nonatopic control subjects, an increased percentage of IL-5-producing T cells (AA: median 4.9% [range 1.1 to 8.9%]; AN: 0.3% [0.2 to 0.9%], p = 0.003; NN: 0.4% [0.1 to 3.8%], p = 0.001) was detectable, with a positive correlation to the number of peripheral eosinophils and to bronchial hyperresponsiveness. The frequency of IL-4-producing T cells was increased in both atopic groups compared with nonatopic controls (AA: 1.2% [0.2 to 2.6%], p = 0.011; AN: 0.8% [0.4 to 3.7%], p = 0.007; NN: 0.4% [0.2 to 0.9%]) with a positive correlation to total IgE concentration. In adults there were no differences in IL-5- or IL-4-producing T cells between all three groups. A substantial proportion of T cells coproducing IL-4 and IL-5 was not detectable in children and adults. These findings indicate that in asthmatic children the frequencies of Th2-type-producing T cells are increased and that expression of IL-4 and IL-5 is regulated independently.     

Comparison of therapeutic modalities for mania

The results of sequential therapeutic trials in hospitalized manic patients conducted over a 16-year period are summarized, followed by an analysis of pooled data to assess relative efficacy. No clinically important baseline differences were found in the patients admitted to these studies despite the long time span. They were not overly "difficult to treat" or treatment resistant, and most were discharged to the community. Nearly all outcome measures showed statistically significant differences between groups after 8 weeks of treatment. The best responses occurred in the patients who received a mean series of nine electroconvulsive therapy (ECT) treatments with sparing use of neuroleptics followed by lithium maintenance. The next best outcome was observed with lithium combined with low doses of standard neuroleptics or risperidone. The combination of carbamazepine and lithium had significantly fewer neurological side effects than moderate doses of haloperidol with lithium, with equivalent therapeutic results. Monotherapy with either lithium or carbamazepine was less effective than the combination treatments. Minor differences in study design may contribute to the variance in outcome.     

Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects

A study was undertaken to define the computed tomographic (CT) appearance of the lungs in subjects with uncomplicated asthma and to compare the prevalence of bronchial dilatation at CT in asthmatic and healthy subjects. Clinical features, pulmonary physiologic findings, chest radiographs, and high-resolution CT scans of 48 asthmatic subjects were reviewed. Forty-one (85%) of the 48 asthmatic subjects were undergoing bronchodilator therapy, 28 (58%) were undergoing steroid therapy, and 21 (44%) were cigarette smokers. Twenty-seven healthy control subjects underwent limited high-resolution CT. At selected CT levels, any bronchus with an internal diameter greater than that of the accompanying pulmonary artery was considered dilated. In the asthmatic subjects, 153 (36%) of 429 bronchi evaluated met criteria for bronchial dilatation compared with 37 (26%) of 142 bronchi in the control group (P < .05). Because bronchial dilatation demonstrated at CT did not correlate with clinical data, the authors conclude a bronchus larger in diameter than the adjacent vessel is not sufficient evidence to diagnose cylindric bronchiectasis.     

Chemotherapy for advanced sarcoma: therapeutic decisions and modalities

In patients who have advanced soft tissue sarcoma that is no longer localized, systemic chemotherapy is the most reasonable option for treatment. The decision to treat or to use experimental or conventional agents should be based on the clinical assessment of anticipated net benefit in quality of life as well as the remote possibility of complete remission or even cure. Asymptomatic elderly patients with relatively stable disease might best be treated with watchful waiting; whereas younger excellent-performance-status patients should be offered the opportunity of participating in phase II or phase I studies of newer drugs and intensification regimens. Of the currently available single agents, only doxorubicin (or epirubicin) and ifosfamide show response rates greater than 20%; both show a definite dose-response relationship. Dacarbazine shows particular activity in uterine leiomyosarcomas. Combination chemotherapy regimens such as doxorubicin-ifosfamide show a higher response rate, but may be more toxic. New agents are needed. The current progress in our understanding of the molecular biology of sarcomas, and our expanded comprehension of the mechanism of action of cytotoxic drugs and the biology of drug resistance is cause for optimism.     

Radiographic modalities for diagnosis and treatment planning in implant dentistry

Early in the development of implant technology it became apparent that conventional dental imaging techniques were limited for evaluating patients for implant surgery. During the treatment planning phase, the recipient bed is routinely assessed by visual examination and palpation, as well as by periapical and panoramic radiology. These two imaging modalities provide a two-dimensional image of mesial-distal and occlusal-apical dimensions of the edentulous regions where implants might be placed. When adequate occlusal-apical bone height is available for endosteal implants, the buccal-lingual width and angulation of the available bone are the most important criteria for implant selection and success. However, neither buccal-lingual width nor angulation can be visualized on most traditional radiographs. Although clinical examination and traditional radiographs may be adequate for patients with wide residual ridges that exhibit sufficient bone crestal to the mandibular nerve and maxillary sinus, these methods do not allow for precise measurement of the buccolingual dimension of the bone or assessment of the location of unanticipated undercuts. For these concerns, it is necessary to view the recipient site in a plane perpendicular to a curved plane through the arch of the maxilla or mandible in the region of the proposed implants. Implant dentists soon recognized that, for optimum placement of implants, cross-sectional views of the maxilla and mandible were the ideal means of providing necessary pre-operative information. Today, the two most often employed and most applicable radiographic studies for implant treatment planning are the panoramic radiograph and tomography. Although distortion can be a major problem with panoramic radiographs, when performed properly they can provide valuable information, and are both readily accessible and cost efficient. To help localize potential implant sites and assist in obtaining accurate measurements, it is recommended that surgical stents be used with panoramic radiographs. In simple cases, where a limited number of implants are to be placed, panoramic radiography and/or tomography may be used to obtain a view of the arch of the jaw in the area of interest. For complex, cases, where multiple implants are required, the CT scan imaging procedure is recommended. Because of its ability to reconstruct a fully three dimensional model of the maxilla and mandible, CT provides a highly sophisticated format for precisely defining the jaw structure and locating critical anatomic structures. The use of CT scans in conjunction with software that renders immediate "treatment plans" using the most real and accurate information provides the most effective radiographic modality currently available for the evaluation of patients for oral implants. To follow patients after implant surgery, DSR can be helpful by addressing the limitations of other radiographic modalities in detecting postoperative changes. By eliminating unchanged information, DSR allows the clinician's eye to focus on actual changes that have occurred between the recordings of two images.     

Imaging modalities for study of the distal ulnar region

Judicious use of diagnostic imaging maximizes the diagnostic capabilities of the surgeon treating the distal radio-ulnar joint (DRUJ). A good clinical history and clinical examination are necessary to direct the selection of appropriate imaging studies. Plain radiographs are almost always the first imaging examination. More advanced imaging techniques are costly and may provide only limited information. This article discusses imaging modalities useful for assessment of the DRUJ and the area around it.     

Analysis of prescriptions for psychotropic drugs in a psychiatric hospital

OBJECTIVE: To determine the usefulness of different urodynamic data and their relationship. METHODS: 105 adult males with prostatism were evaluated urodynamically. Data were obtained utilizing the Abrhams and Griffiths and the Schaeffer models. RESULTS: Our results show that the urinary flow rate correlates directly with bladder contractibility and inversely with the urethral resistance parameters. CONCLUSIONS: The urethral resistance was produced by two independent factors: a factor which resists initiation of voiding, measured by the opening pressure according to the Schaeffer model; a second factor which opposes maintenance of voiding, measured by the PURR curvature of the Schaeffer model and by the slope of the Abrhams and Griffiths model. Bladder contractibility was related to pressure at maximum flow rate of the Schaeffer model.     

Effect of compliance for chronic asthmatic children.

Compliance to a theophylline regimen by 11 male and 11 female chronically asthmatic 7–12 yr olds was assessed by a riboflavin tracer method. Ss who took 80% or more of their prescribed medication were considered compliant; Ss who took less were considered noncompliant. Results indicate that noncompliant Ss experienced significantly more wheezing, greater variability in peak flow rates, and lower overall scores than compliant Ss. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A roadmap for HLA-A, HLA-B, and HLA-C peptide binding specificities

The characteristics of the circadian rhythm of locomotor activity in the crayfish Procambarus clarkii during ontogeny under constant darkness and light-dark (LD 12:12) conditions were studied in 132 juvenile crayfish, aged 10-140 days, divided in four groups. All animals were individually monitored with a motor activity recording system. Activity was quantitatively and qualitatively analyzed. All ages showed a circadian rhythm, although the probability of its appearance increased with age. Period values oscillated between 25.0 h in group I (2-4-week-old animals) and 24.3 h in group IV (16-20-week-old animals with more than 6 molts), but always with a high standard deviation. Groups II (5-10-week-old animals) and IV showed a statistically significant bimodal nonrandom synchrony of phases. The activity/ rest relationship diminishes as development progresses and is most uniform in group IV. We discuss the possibility that the pacemaker system responsible for this rhythm might be present from the moment of eclosion, but the coupling strength of this system with the effectors might change along development. The results presented in this work seem to indicate that the central pacemakers responsible for the activity and the ERG rhythm are not the same.     

The direct costs to the NHS of discontinuing and switching prescriptions for hypertension

There is much evidence to suggest that the treatment of hypertension reduces the risk of cardiovascular diseases and that it is cost-effective in most patients. However, the effectiveness of treatment relies on compliance and maintenance of treatment. Each pharmacological agent differs in terms of side effects. The existence of side effects can result in poor compliance and switching between treatments. A number of studies have reported high discontinuation rates for anti-hypertensive therapies. This potentially imposes costs on the health service. The aim of this study is to use the MEDIPLUS data set to consider the cost arising from switching and discontinuation of therapy. The analysis will assess the resource costs in terms of extra GP visits and hospitalisations arising from individuals switching and discontinuing treatments. The total costs of hypertension were estimated to be around 76.5 m pound sterling per annum, of which 26.9 m pound sterling can be attributed to patients who switch or discontinue therapy.     

A study of treatment modalities for nonresectable primary liver cancer

This paper reports the results of multimodality treatment in 200 patients with nonresectable primary liver carcinoma (PLC) from April 1964 to July 1993. PLC was verified histologically in all cases. They were divided into two groups according to the methods of treatment. In group 1, 115 cases received anticancer agents by hepatic artery infusion (HAI). The 1- and 2-year survival rate was 10.4% and 1.7%, respectively and only one patient survived 65 months. In group 2, 85 cases received multimodality treatments by various combinations of hepatic artery chemoembolization (HACE), hepatic artery ligation (HAL), microwave coagulation (MIC) of tumor and ethanol injection into tumor (EIT). The 1-, 2-, 3- and 5-year survival rate was 34.1%, 21.2%, 12.0% and 6.7%, respectively. Five patients had been alive for 41 to 63 months and second-stage hepatic resection performed in another 6 patients. The results suggest that multimodality treatment is an effective approach to improve the long-term survival of patients with nonresectable PLC.     

Treatment modalities for hypertensive patients with intracranial pathology: options and risks

Several reliable surgical procedures aimed to control the vertigo associated with Meniere's disease exist. Vestibular preservation and ablative procedures are available with the latter divided between hearing preservation and destructive operations. Factors to consider prior to choosing a surgical option include the age, health, and employment status of the patient; the degree of hearing loss in the involved ear; and the status of the contralateral ear.     

The evaluation of a computer program for the filling of repeat prescriptions

Four women who had been following a "healthy" diet based on carrots and citrus fruits for some time presented with yellow-tinged skin. All four patients had high carotene levels in the blood, and three were also found to have slightly increased vitamin A levels. The other laboratory test results were normal. They were prescribed diets that did not contain carotene-rich foods, and both skin colour and laboratory tests returned to normal.     

Diagnostic methods and treatment modalities of dry eye conditions

One may view dry eye conditions as a group of diseases in which the ocular surface is adversely affected. Tear film instability invariably leads to some degree of cellular surface damage over the cornea and conjunctiva. In turn, ocular epitheliopathy may adversely affect tear film stability. The clinical presentation of the disease may not yield a clue as to its etiology. In recent years considerable progress was made both in the diagnosis and the treatment of the disease and promising studies are planned or are underway. The diagnostic techniques can be divided into four groups. The first is concerned with the clinical presentation. The second is concerned with the bulk properties of the aqueous tears including dynamic characteristics, composition, and colligative properties. The third is tear-film related and includes the film break-up time, evaporation rate, and lipid abnormality. The fourth is concerned with the ocular surface and includes vital staining, impression cytology, and surface microscopy. The most promising attempts are being made in the second group by attempting to elucidate the role of enzyme and enzyme activator activity and inhibitor contents as well as the tear protein profiles and correlating them with the specific disease states. The treatment modalities belong to three major groups aside from surgical intervention; the supplementation, preservation, and the stimulation of tears. The modern version of tear supplementation is expected to include the topical use of efficacious aqueous formulations that typically contain film stabilizing polymers, nutrients, and/or--in the future--biochemically active ingredients such as enzyme activators and inhibitors.