Daily Telemonitoring of Exhaled Nitric Oxide and Symptoms in the Treatment of Childhood Asthma

Rationale: Asthma treatment might improve when inhaled steroids are titrated on airway inflammation. Fractional exhaled nitric oxide (FeNO0.05), a marker of eosinophilic airway inflammation, can be measured at home. Objectives: We assessed daily FeNO0.05 telemonitoring in the management of childhood asthma. Methods: Children with atopic asthma (n = 151) were randomly assigned to two groups: FeNO0.05 plus symptom monitoring, or monitoring of symptoms only. All patients scored asthma symptoms in an electronic diary over 30 weeks; 77 received a portable nitric oxide (NO) analyzer. Data were transmitted daily to the coordinating centers. Patients were phoned every 3 weeks and their steroid dose was adapted according to FeNO0.05 and symptoms, or according to symptoms. Children were seen at 3, 12, 21, and 30 weeks for examination and lung function testing. The primary end point was the proportion of symptom-free days in the last 12 study weeks. Measurements and Main Results: Telemonitoring was feasible with reliable FeNO0.05 data for 86% of days, and valid diary entries for 79% of days. Both groups showed an increase in symptom-free days, improvement of FEV1 and quality of life, and a reduction in steroid dose. None of the changes from baseline differed between groups. The difference in symptom-free days over the last 12 weeks was 0.3% (P = 0.95; 95% confidence interval, −10 to 11%). There was a trend for fewer exacerbations in the FeNO0.05 group. Conclusions: Thirty weeks of daily FeNO0.05 and symptom telemonitoring was associated with improved asthma control and a lower steroid dose. We found no added value of daily FeNO0.05 monitoring compared with daily symptom monitoring only

Family-group names for bees (Anthophila)

33 p. ; 26 cm.Includes bibliographical references (p. 17-27).The 173 family-group names for bees (Apoidea: Anthophila) are cataloged in chronological order. For each name the correct author, date, type genus, and combining stem are provided. The following names are considered nomina nuda: Phenacolletini, Ctenioschelini, Chalicodomopsini, Liphanthini, Austropanurgini, and Hoplitini. The authorship of three names (Tapinotaspidini, Hexepeolini, and Ancyloscelidina) is corrected as each was a nomen nudum when first proposed, but has been subsequently made available by other authors. The following new names are proposed herein: Scraptrinae Ascher and Engel, new subfamily (Colletidae); Neffapini Ascher, new tribe (Andrenidae: Panurginae); Afrodasypodini Engel, new tribe (Melittidae: Dasypodainae), Afrodasypoda Engel, new genus; Hesperapina Ascher and Engel, new subtribe (Melittidae: Dasypodainae); Macrogaleina Engel, new subtribe (Apidae: Xylocopinae); and Ancyloscelidina Engel and Michener, new subtribe (Apidae: Apinae). A hierarchical outline of Apoidea classification (inclusive of the digger wasps), indicating the suggested current usage of all available family-group names is appended. The name Anthophila, as proposed by Latreille, is adopted for the bees as a whole

Lung morphology assessment using MRI: a robust ultra-short TR/TE 2D steady state free precession sequence used in cystic fibrosis patients

To evaluate feasibility and diagnostic quality of ultra-short TR/TE two-dimensional (2D) steady state free precession (SSFP) MRI for cystic fibrosis (CF) patients. We performed lung MRI at 1.5 Tesla in 20 CF-patients (6-17 years, 12 males). Axial, coronal, and sagittal sections were acquired in inspiration and expiration with maximum breath-hold time 10 s. MR and CT images were scored using a modified Brody scoring system to assess bronchiectasis, mucous plugging, atelectasis/consolidations, and air trapping. All images were scored by two experienced observers. A complete MR investigation took maximally 15 min. Maximal breath-holds were only 10 s and well tolerated. MRI identified major bronchiectasis, mucous plugging and atelectasis. End-expiratory scans showed patches of parenchyma with reduced signal intensity that may corresponded to areas of trapped air on expiratory CT scans. This MRI protocol based on ultra-short TR/TE 2D SSFP is quick and well tolerated and provides highly relevant imaging features as seen on CT in CF patients. Most importantly, the SNR of the expiratory scans enables to visualize air trapping. The preliminary results of this study suggest MRI as a noteworthy additional imaging tool for routine monitoring of CF patients

Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome

Objective: Treatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolism in humans. We studied endogenous surfactant metabolism in relation to different amounts of exogenous surfactant, administered as rescue therapy for RDS. Design: Prospective clinical study. Setting: Neonatal intensive care unit in a university hospital. Patients: A total of 27 preterm infants intubated and mechanically ventilated for respiratory insufficiency, Interventions: Infants received a 24-hr infusion with the stable isotope [U-C-13]glucose starting 5.3 +/- 0.5 hrs after birth. The C-13-incorporation into palmitic acid in surfactant phosphatidylcholine (PG) isolated from serial tracheal aspirates was measured. Infants received either zero (n = 5), one (n = 4), two (n = 15), or three (n = 3) doses of Survanta (100 mg/kg) when clinically indicated. Measurements and Main Results: Using multiple regression analysis, the absolute synthesis rate (ASR) of surfactant PC from plasma glucose increased with 1.3 +/- 0.4 mg/kg/day per dose of Survanta (p = .007) (mean a SEM). The ASR of surfactant PC from glucose was increased by prenatal corticosteroid treatment with 1.3 +/- 0.4 mg/kg/day per dose corticosteroid (p = .004), and by the presence of a patent ductus arteriosus with 2.1 +/- 0.7 mg/kg/day (p = .01). Conclusion: These data are reassuring and show for the first time in preterm infants that multiple doses of exogenous surfactant for RDS are tolerated well by the developing lung and stimulate endogenous surfactant synthesis