The Role of Histamine in the Pathophysiology of Asthma and the Clinical Efficacy of Antihistamines in Asthma Therapy

Mast cells play a critical role in the pathogenesis of allergic asthma. Histamine is a central mediator released from mast cells through allergic reactions. Histamine plays a role in airway obstruction via smooth muscle contraction, bronchial secretion, and airway mucosal edema. However, previous clinical trials of H1 receptor antagonists (H1RAs) as a treatment for asthma were not successful. In recent years, type 2 innate immunity has been demonstrated to be involved in allergic airway inflammation. Allergic asthma is defined by IgE antibody-mediated mast cell degranulation, while group 2 innate lymphoid cells (ILC2) induce eosinophilic inflammation in nonallergic asthma without allergen-specific IgE. Anti-IgE therapy has demonstrated prominent efficacy in the treatment of severe allergic asthmatics sensitized with specific perennial allergens. Furthermore, recent trials of specific cytokine antagonists indicated that these antagonists were effective in only some subtypes of asthma. Accordingly, H1RAs may show significant clinical efficacy for some subtypes of allergic asthma in which histamine is deeply associated with the pathophysiology

Visualization of X-ray radiography technical process by Hierarchical task analysis (HTA)

Optimal X-ray images are obtained from correct image positioning by radiological technologists. However, guidance for new radiological technologists is not always adequate, and new methods are required for facilitating correct image positioning. In this study, we attempted to visualize and organize the skill of image positioning by radiological technologists using hierarchical task analysis (HTA). Regarding acquisition of frontal and lateral images of the wrist joint, cervical vertebrae, and elbow, knee, and ankle joints, the actions used to acquire images taken by a radiological technologist from initiation to completion of the process of each acquisition were regarded as the target range. The HTA included three hierarchies: the goal of acquisition as the highest hierarchy, tasks that were the minimum descriptions necessary for acquisition as the second hierarchy, and subtasks representing the concrete acquisition procedure as the lowest hierarchy. The total numbers of tasks and subtasks in all HTA constructions for the 10 goals were 85 and 226, respectively. Only the highest hierarchy was needed for skilled technologists, while the middle and lowest hierarchies were needed for beginning technologists. Therefore, visualization at different technical levels employing a single construction model may be possible. Our study presents effective expression of tacit knowledge for radiological technologists

Model Analysis for Optimal Allocation of Pediatric Emergency Center

Optimal allocation of Pediatric Emergency Centers was simulated using both Min-Sum model and Min-Max model, based on the travel distance and child population of Hokkaido prefecture, Japan. Our result should be helpful to select the optimal number and allocation of PECs in the actual scene of decision making, where the financial restriction exists.AMIA 2006 Annual Symposiu

Efficacy of 'drive and retrieve' as a cooperative method for prompt endovascular treatment for acute ischemic stroke

Background Outcomes of endovascular treatment for acute ischemic stroke depend on the time interval from onset to reperfusion. Although the centralized 'mothership' method is considered preferable, the required transportation time increases the risk that a patient with a stroke may not receive intravenous or endovascular therapy. In contrast, 'drive and retrieve' describes a system wherein doctors from comprehensive stroke centers travel to primary stroke centers and provide endovascular treatment for acute ischemic stroke. Objective To describe the drive and retrieve system and verify the effects of this new collaboration on outcomes in patients with acute ischemic stroke among facilities. Methods This non-randomized, single-arm study retrospectively analyzed patients who met the inclusion criteria for endovascular treatment provided through a drive and retrieve system. Among the 122 patients treated by this system, we analyzed the time of onset to recanalization as the primary outcome. We also analyzed the efficacy of the drive and retrieve system using geographic information system analysis. Results The median time from onset to recanalization was 229 min (IQR 170-307 min, 95% CI 201 to 252 min). The upper limit of the 95% CI for the time from onset to recanalization was shorter than the median times reported in two previous trials. Geographic information system analysis revealed an upward trend in the population coverage rate in each secondary medical area after the drive and retrieve method was introduced. Conclusion The drive and retrieve method may be an effective form of cooperation between facilities located within 1 hour of a comprehensive stroke center