Vespa crabro immunotherapy versus Vespula-venom immunotherapy in Vespa crabro allergy: a comparison study in field re-stings

Background: In ascertained allergic sensitization to Vespa crabro (VC) venom, the European guidelines still consider venom immunotherapy (VIT) with Vespula (VE) venom sufficient to achieve an adequate protection against VC. However, antigen 5 immunoblotting studies showed that a genuine sensitization to VC venom may exist. In such cases, a specific VC venom would be preferable for VIT treatment. Since in the last few years, VC venom extracts became available for diagnosis and desensitization, we assessed the efficacy and safety of VIT with a VC-VIT, compared to VE extract. Methods: Patients stung by VC, and carefully diagnosed for specific sensitization and indication to VIT underwent a 5-year course of immunotherapy with either VE or VC extracts. The severity of reactions at the first sting (pre-VIT) and after field re-stings (during VIT) were compared. Results: Eighty-three patients, treated with VE extract and 130 patients treated with VC extract completed the 5-year course of VIT. Only a fraction of those patients (43,8%) were field-re-stung by VC: 64 patients on VC VIT and 69 on VE VIT. In the VC VIT group, reactions at re-sting were: 50 negative, 12 large local reactions, 4 systemic reactions (Muller grade I). In this group the VC VIT efficacy was 93,8%. In the VE VIT treated group the reactions at VC re-sting were: 51 negative, 10 large local reactions and 9 systemic reactions (5 Muller I, 3 Mueller III, 1 Muller IV). In this group the overall efficacy of VIT was 87,0%. The difference in efficacy between the two groups was not statistically significant, as previously reported in literature. Nonetheless, field sting systemic reactions Muller III and IV were recorded only in those patients receiving VE VIT. Conclusion: This observation suggests that in patients with ascertained VC-induced allergic reactions a specific VC VIT, where available, would be more adequate, at least concerning the safety profile

Sublingual immunotherapy for asthma.

BACKGROUND: Asthma is a common long-term respiratory disease affecting approximately 300 million people worldwide. Approximately half of people with asthma have an important allergic component to their disease, which may provide an opportunity for targeted treatment. Sublingual immunotherapy (SLIT) aims to reduce asthma symptoms by delivering increasing doses of an allergen (e.g. house dust mite, pollen extract) under the tongue to induce immune tolerance. However, it is not clear whether the sublingual delivery route is safe and effective in asthma. OBJECTIVES: To assess the efficacy and safety of sublingual immunotherapy compared with placebo or standard care for adults and children with asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/) and reference lists of all primary studies and review articles. The search is up to date as of 25 March 2015. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs), irrespective of blinding or duration, that evaluated sublingual immunotherapy versus placebo or as an add-on to standard asthma management. We included both adults and children with asthma of any severity and with any allergen-sensitisation pattern. We included studies that recruited participants with asthma, rhinitis, or both, providing at least 80% of trial participants had a diagnosis of asthma. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results for included trials, extracted numerical data and assessed risk of bias, all of which were cross-checked for accuracy. We resolved disagreements by discussion.We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs) using study participants as the unit of analysis; we analysed continuous data as mean differences (MDs) or standardised mean differences (SMDs) using random-effects models. We rated all outcomes using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and presented results in the 'Summary of findings' table. MAIN RESULTS: Fifty-two studies met our inclusion criteria, randomly assigning 5077 participants to comparisons of interest. Most studies were double-blind and placebo-controlled, but studies varied in duration from one day to three years. Most participants had mild or intermittent asthma, often with co-morbid allergic rhinitis. Eighteen studies recruited only adults, 25 recruited only children and several recruited both or did not specify (n = 9).With the exception of adverse events, reporting of outcomes of interest to this review was infrequent, and selective reporting may have had a serious effect on the completeness of the evidence. Allocation procedures generally were not well described, about a quarter of the studies were at high risk of bias for performance or detection bias or both and participant attrition was high or unknown in around half of the studies.One short study reported exacerbations requiring a hospital visit and observed no adverse events. Five studies reported quality of life, but the data were not suitable for meta-analysis. Serious adverse events were infrequent, and analysis using risk differences suggests that no more than 1 in 100 are likely to suffer a serious adverse event as a result of treatment with SLIT (RD 0.0012, 95% confidence interval (CI) -0.0077 to 0.0102; participants = 2560; studies = 22; moderate-quality evidence).Within secondary outcomes, wide but varied reporting of largely unvalidated asthma symptom and medication scores precluded meaningful meta-analysis; a general trend suggested SLIT benefit over placebo, but variation in scales meant that results were difficult to interpret.Changes in inhaled corticosteroid use in micrograms per day (MD 35.10 mcg/d, 95% CI -50.21 to 120.42; low-quality evidence), exacerbations requiring oral steroids (studies = 2; no events) and bronchial provocation (SMD 0.69, 95% CI -0.04 to 1.43; very low-quality evidence) were not often reported. This led to many imprecise estimates with wide confidence intervals that included the possibility of both benefit and harm from SLIT.More people taking SLIT had adverse events of any kind compared with control (OR 1.70, 95% CI 1.21 to 2.38; low-quality evidence; participants = 1755; studies = 19), but events were usually reported to be transient and mild.Lack of data prevented most of the planned subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS: Lack of data for important outcomes such as exacerbations and quality of life and use of different unvalidated symptom and medication scores have limited our ability to draw a clinically useful conclusion. Further research using validated scales and important outcomes for patients and decision makers is needed so that SLIT can be properly assessed as clinical treatment for asthma. Very few serious adverse events have been reported, but most studies have included patients with intermittent or mild asthma, so we cannot comment on the safety of SLIT for those with moderate or severe asthma. SLIT is associated with increased risk of all adverse events

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden. Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18\u201345 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment. Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR. . Conclusions: These fndings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed

Test bench for stabilizer devices on heavy vehicles

Test bench for stabilizer devices (11) on heavy work vehicles such as trucks provided with a concrete mixer, or pump for concrete, or truck crane, or other equipment for the building trade. The stabilizer device (11) has at least a frame (12) to which stabilizer arms (14, 15) are connected, angularly distanced

LOBAÇÃO, ÁRVORE BRÔNQUICA E VASCULARIZAÇÃO ARTERIAL DO PULMÃO DA PACA (Agouti paca, LINAEUS, 1766) LOBATION, BRONCHIAL TREE AND ARTERIAL SUPPLY OF PACA LUNG (Agouti paca, LINAEUS, 1766)

&lt;span&gt;&lt;p align="justify"&gt;Os pulmões são os principais órgãos do sistema respiratório, e o conhecimento morfológico da lobação, árvore brônquica e vascularização arterial torna-se imprescindível na prática clínica e cirúrgica. Os troncos pulmonares de dez pulmões de pacas foram injetados com látex e as peças fixadas em solução aquosa de formaldeído a 10%. Mediante dissecação, observou-se que, em 100% dos casos, o pulmão direito era constituído pelos lobos cranial, caudal, médio e acessório; o lobo médio era bilobado em partes cranial e caudal. O esquerdo possuía o lobo cranial, bilobado em partes cranial e caudal, lobo caudal e um pequeno lobo acessório. A artéria pulmonar direita emitia dois ramos para o lobo cranial, além dos ramos para as partes cranial e caudal do lobo médio, o ramo do lobo acessório e o do lobo caudal; a artéria pulmonar esquerda emitia dois ramos para a porção cranial e um para a porção caudal do lobo cranial; o lobo caudal esquerdo era irrigado pela continuação da artéria pulmonar esquerda, que emitia de cinco a seis ramos dorsais e de sete a oito ramos ventrais. Não houve variação nos pulmões estudados em relação aos lobos, nem no padrão de distribuição brônquica.&lt;/p&gt;&lt;p align="justify"&gt; &lt;/p&gt;&lt;p align="justify"&gt;PALAVRAS-CHAVE: &lt;em&gt;Agouti&lt;/em&gt; paca, artéria pulmonar, pulmões, roedor&lt;/p&gt;&lt;/span&gt; &lt;span&gt;&lt;p align="justify"&gt;Lungs are the main organs of the respiratory system and the morphological knowledge of lobation, bronchial tree and arterial vascularization becomes indispensable on clinics and surgery practice. The pulmonary trunks of 10 lungs were filled with latex and the anatomical sets were put in a 10% formaldehyde aqueous solution. By dissection, it was observed that, in 100% of the cases, the right lung was constituted by cranial, medium, caudal and accessory lobes. The medium lobe was divided into cranial and caudal portions. The left lung presented a cranial lobe, divided into cranial and caudal portions, a caudal lobe and a little accessory lobe. The right pulmonary artery gave off two branches to the cranial lobe, besides branches to the cranial and caudal portions of the medium lobe, and branches to the accessory and caudal lobes. The left pulmonary artery gave off two branches to the cranial and one to caudal portions of the cranial lobe; the left caudal lobe was supplied by the left pulmonary artery continuation, which gave off five to six dorsal and seven to eight ventral branches. There was no variation on the studied lungs as for lobes or bronchial tree model.&lt;/p&gt;&lt;p align="justify"&gt; &lt;/p&gt;&lt;p align="justify"&gt;KEY WORDS&lt;strong&gt;:&lt;/strong&gt; Agouti paca, lungs, pulmonary artery, rodent.&lt;/p&gt;&lt;/span&gt

Composition of a fluid mix applicable as dummy fluid in wear testing of pumps

A composition of a fluid mix comprises water, stone aggregates and one or more binders in the form of pozzolanic additives comprising silicic fly ash, with the provision that it does not contain substantially other binding materials or substances which produce calcium hydroxide, in particular in the absence of cement or lime, both in the form of oxide and in the form of air-hardening lime or hydrated lime. This fluid mix does not harden or set over time in ambient temperature and is thus applicable as dummy fluid for testing wear in concrete pumps

Safety and efficacy of immunotherapy with Polistes dominulus venom: results from a large Italian database.

none10Severino M;Bonadonna P;Bilò MB;Cortellini G;Mauro M;Schiappoli M;Macchia D;Campi P;Manfredi M;Passalacqua GSeverino, M; Bonadonna, P; Bilò, Mb; Cortellini, G; Mauro, M; Schiappoli, M; Macchia, D; Campi, P; Manfredi, M; Passalacqua, Giovann

A management system for randomized clinical trials: A novel way to supply medication.

BackgroundRandomized controlled clinical trials require management effort, involving huge organizational, economic and informatics investments. Information technology offers opportunities to approach clinical trial methodology in new ways. However, there are only a few reports of computerized data and drug management systems.ObjectiveThis paper describes a novel software created specifically for the management of a randomized trial of diet and metformin in people with metabolic syndrome (the Me.Me.Me. trial).MethodsMe.Me.Me. is an ongoing phase III randomized controlled trial in healthy people with metabolic syndrome to test the hypothesis that comprehensive lifestyle changes and/or metformin can prevent age-related chronic non-communicable diseases. To manage all the phases of the trial, we created a software which is a state pattern machine, user friendly, web-based, able to maintain the correct balance between randomization groups, and structured in various levels of security in order to guarantee the participant's privacy and compliance with the study protocol. The software achieves budget savings: drug management is not based on patients' packs, but on the actual need for drugs according to each participant's "state", with strict guidelines for the handling and supply of medication.ResultsThe trial is ongoing and recruitment will close on August 31, 2018. To date, 11737 bottles of metformin/placebo have been dispensed to 1054 randomized participants, with drug savings of 29.5%.ConclusionsA software which takes into account the "state" of participant might be a powerful resource for developing and managing clinical trials, helping avoid poor treatment allocation, and wastage of drugs and money.Me.me.me. trialEUDRACT no. 2012-005427-32. ClinicalTrials.gov Identifier: NCT02960711

Treatment of intrabony defects with enamel matrix proteinsor or barrier membranes: Results from a multicenter practice-based clinical trial

Background: This prospective multicenter, randomized, controlled clinical trial compared the clinical outcomes of enamel matrix proteins (EMD) versus placement of a bioabsorbable membrane in conjunction with guided tissue regeneration (GTR). Methods: Seventy-five patients with advanced chronic periodontitis were recruited in seven centers in three countries. All patients had at least one intrabony defect of ≥3 mm. Heavy smokers (≥20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using the simplified papilla preservation flap and either the application of EMD or the placement of a GTR membrane. At baseline and 1 year following the interventions, clinical attachment levels (CAL), probing depths (PD), recession (REC), full-mouth plaque scores, and full-mouth bleeding scores were assessed. A total of 67 patients completed the study. Results: At 1 year, the EMD defects gained 3.1 ± 1.8 mm of CAL, versus 2.5 ± 1.9 mm for GTR defects. Probing depth reduction was 3.8 ± 1.5 mm and 3.3 ± 1.5 mm, respectively. A multivariate analysis indicated that the differences between EMD and GTR treatments were not significant while a center effect and baseline PD significantly influenced CAL gains. No significant differences in terms of frequency distribution of the outcomes were observed. All cases treated with GTR presented at least one surgical complication, mostly membrane exposure, while only 6% of EMD treated sites displayed complications (P<0.0001). Conclusions: The results of this trial failed to demonstrate superiority of one treatment modality over the other. GTR outcomes in this trial were lower than anticipated based on previous evidence. This was attributed to the high prevalence of post-surgical complications in the GTR group.Link_to_subscribed_fulltex