Inhalation characteristics of asthma patients, COPD patients and healthy volunteers with the Spiromax® and Turbuhaler® devices: a randomised, cross-over study.

BACKGROUND: Spiromax® is a novel dry-powder inhaler containing formulations of budesonide plus formoterol (BF). The device is intended to provide dose equivalence with enhanced user-friendliness compared to BF Turbuhaler® in asthma and chronic obstructive pulmonary disease (COPD). The present study was performed to compare inhalation parameters with empty versions of the two devices, and to investigate the effects of enhanced training designed to encourage faster inhalation. METHODS: This randomised, open-label, cross-over study included children with asthma (n = 23), adolescents with asthma (n = 27), adults with asthma (n = 50), adults with COPD (n = 50) and healthy adult volunteers (n = 50). Inhalation manoeuvres were recorded with each device after training with the patient information leaflet (PIL) and after enhanced training using an In-Check Dial device. RESULTS: After PIL training, peak inspiratory flow (PIF), maximum change in pressure (∆P) and the inhalation volume (IV) were significantly higher with Spiromax than with the Turbuhaler device (p values were at least <0.05 in all patient groups). After enhanced training, numerically or significantly higher values for PIF, ∆P, IV and acceleration remained with Spiromax versus Turbuhaler, except for ∆P in COPD patients. After PIL training, one adult asthma patient and one COPD patient inhaled <30 L/min through the Spiromax compared to one adult asthma patient and five COPD patients with the Turbuhaler. All patients achieved PIF values of at least 30 L/min after enhanced training. CONCLUSIONS: The two inhalers have similar resistance so inhalation flows and pressure changes would be expected to be similar. The higher flow-related values noted for Spiromax versus Turbuhaler after PIL training suggest that Spiromax might have human factor advantages in real-world use. After enhanced training, the flow-related differences between devices persisted; increased flow rates were achieved with both devices, and all patients achieved the minimal flow required for adequate drug delivery. Enhanced training could be useful, especially in COPD patients

Early bronchopulmonary involvement in Crohn disease: a case report

BACKGROUND: Bronchopulmonary manifestations of Crohn disease have been rarely described in children, including both subclinical pulmonary involvement and severe lung disease. CASE PRESENTATION: A 6.5-year-old girl is described with early recurrent bronchopulmonary symptoms both at presentation and in the quiescent phase of Crohn disease. Pulmonary function tests (lung volumes and flows, bronchial reactivity and carbon monoxide diffusing capacity) were normal. Bronchoalveolar cytology showed increased (30%) lymphocyte counts and bronchial biopsy revealed thickening of basal membrane and active chronic inflammation. CONCLUSIONS: Clinical and histological findings in our young patient suggest involvement of both distal and central airways in an early phase of lung disease. The pathogenesis of Crohn disease-associated lung disorders is discussed with reference to the available literature. A low threshold for pulmonary evaluation seems to be advisable in all children with CD

Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis

<p>Abstract</p> <p>Aim</p> <p>We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis.</p> <p>Methods</p> <p>Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephrine or 2.5 mgr nebulized albuterol. Computerized quantification of wheezing and crackles (PulmoTrack^®) and a clinical score were performed prior to, 10 minutes post and 30 minutes post treatment. Results were analyzed with Student's t-test for independent samples, Mann-Whitney U test and Wilcoxon test.</p> <p>Results</p> <p>15 children received albuterol, 12 received epinephrine. The groups were identical at baseline. Satisfactory lung sounds recording and analysis was achieved in all subjects. There was no significant change in objective quantification of wheezes and crackles or in the total clinical scores either within the groups or between the groups. There was also no difference in oxygen saturation and respiratory distress.</p> <p>Conclusion</p> <p>Computerized lung sound analysis is feasible in young infants with RSV bronchiolitis and provides a non-invasive, quantitative measure of wheezing and crackles in these infants. </p> <p><b>Trial registration number</b>: ClinicalTrials.gov NCT00361452</p

Use of hyghly reactive rice husk ash in the production of cement matrix reinforced with Green coconut fiber

[EN] This study evaluated the influence of partial replacement of Portland cement by rice husk ash (RHA) to enable the use of green coconut husk fiber as reinforcement for cementitious matrix. The use of highly reactive pozzolanic ash contributes for decreasing the alkaline attack on the vegetable fiber, originated from waste materials. The slurry dewatering technique was used for dispersion of the raw materials in aqueous solution, followed by vacuum drainage of water and pressing for the production of pad composites, as a simplified simulation of the Hatschek process for industrial manufacture. Five formulations were evaluated, two of them without any mineral additions. One of the mixtures served as a reference (without green coconut fibers) and the remaining ones were reinforced with the green coconut fibers (5% by weight of binder) and with the content of Portland cement replacement by RHA equal to 0, 30, 40 and 50%. The composites were analyzed at 28 days of age and after aging by immersion in warm wáter (65 &#9702;C), which lasted for 28 additional days. Physical and mechanical tests were applied for assessment of the performance of composites. Thermogravimetric analysis was used to observe the consumption of portlandite and chemically combined water content in the hydrated products for pastes presenting the same levels of Portland cement replacement by RHA (i.e., 0 50%) and with the water/binder ratio kept constant and equal to 0.5. The mechanical performance evaluated by bending test after 28 days reached the MOR of 15.7 MPa after the accelerate aging, for the composites reinforced with the green coconut fiber and with high levels of Portland cement replacement by RHA demonstrating that the use of Green coconut fiber for reinforcement can be very promising for the production of binary cement based matrix. The thermogravimetry showed that the replacement of Portland cement by the RHA helped in maintaining the mechanical behavior of the green coconut fiber in the composite subjected to the accelerated aging tests, and resulted in improved mechanical performance, providing a lightweight composite.To the Fundacao de Amparo Pesquisa do Estado de Sao Paulo (FAPESP) for financial support and ICITECH Universitat Politecnica de Valencia for facilitating the research development. To the Federal Agency CNPq, Brazil for grants provided to the USP team. Project 3018/2009 financed by Generalitat Valenciana, COMBURES project financed by Centro de Cooperacion al Desarrollo de la Universitat Politecnica de Valencia (ADSIDEO COOPERACIO) and Maicerias Espanolas DACSA S.A. for supplying RHA samples.Pereira, C.; Savastano, HJ.; Paya Bernabeu, JJ.; Santos, SF.; Borrachero Rosado, MV.; Monzó Balbuena, JM.; Soriano Martínez, L. (2013). Use of hyghly reactive rice husk ash in the production of cement matrix reinforced with Green coconut fiber. Industrial Crops and Products. 49:88-96. https://doi.org/10.1016/j.indcrop.2013.04.038S88964

Sex differences in the associations between L-arginine pathway metabolites, skeletal muscle mass and function, and their responses to resistance exercise, in old age

This work was supported by the Biotechnology and Biological Sciences Research Council (BB/J015911/1) and was registered at clinicaltrials.gov (ClinicalTrials. gov Identifier: NCT02843009). Supplementary email included with articlePeer reviewedPostprin

Differentiation of Bacillus pumilus and Bacillus safensis using MALDI-TOF-MS

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) despite being increasingly used as a method for microbial identification, still present limitations in which concerns the differentiation of closely related species. Bacillus pumillus and Bacillus safensis, are species of biotechnological and pharmaceutical significance, difficult to differentiate by conventional methodologies. In this study, using a well-characterized collection of B. pumillus and B. safensis isolates, we demonstrated the suitability of MALDI-TOF-MS combined with chemometrics to accurately and rapidly identify them. Moreover, characteristic species-specific ion masses were tentatively assigned, using UniProtKB/Swiss-Prot and UniProtKB/TrEMBL databases and primary literature. Delineation of B. pumilus (ions at m/z 5271 and 6122) and B. safensis (ions at m/z 5288, 5568 and 6413) species were supported by a congruent characteristic protein pattern. Moreover, using a chemometric approach, the score plot created by partial least square discriminant analysis (PLSDA) of mass spectra demonstrated the presence of two individualized clusters, each one enclosing isolates belonging to a species-specific spectral group. The generated pool of species-specific proteins comprised mostly ribosomal and SASPs proteins. Therefore, in B. pumilus the specific ion at m/z 5271 was associated with a small acid-soluble spore protein (SASP O) or with 50S protein L35, whereas in B. safensis specific ions at m/z 5288 and 5568 were associated with SASP J and P, respectively, and an ion at m/z 6413 with 50S protein L32. Thus, the resulting unique protein profile combined with chemometric analysis, proved to be valuable tools for B. pumilus and B. safensis discrimination, allowing their reliable, reproducible and rapid identification.Dr. Kasthuri Venkateswaran, Dr. Irene Ouoba, Dr. Joseph W. Kloepper, Dr. Cecilie From and Dr. Maria Morea are gratefully acknowledged for providing isolates FO-36bT, SAFN-027, SAFN-037, KL-052, 51-3C and 82-2C; Bs31; SE 49 (AP3) and SE 52 (AP7); FEL 55, UNG22 and MIL46, respectively. Raquel Branquinho was supported by a PhD fellowship (Ref. SFRH/BD/61410/2009) and Clara Sousa by a post-doctoral fellowship (Ref. SFRH/BPD/70548/2010), from FCT (Fundacao para a Ciencia e Tecnologia, Portugal). Hugo Osorio acknowledges the funding from QREN-FEDER through the Operational Program ON. 2 - O Novo Norte. IPATIMUP is an Associate Laboratory of the Portuguese Ministry of Science, Technology and Higher Education and is partially supported by the Portuguese Foundation for Science and Technology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competin