No higher risk for colorectal cancer in atrophic gastritis-related hypergastrinemia

BackgroundAtrophic gastritis of the corporal mucosa is a frequent cause of hypergastrinemia. Hypergastrinemia is implicated in colorectal cancer development.AimTo assess whether hypergastrinemic atrophic gastritis is associated with a higher risk of neoplastic colorectal lesions.MethodsAmong 441 hypergastrinemic atrophic gastritis patients, 160 who were aged >40 and underwent colonoscopy for anaemia, diarrhoea or colorectal cancer-screening were retrospectively selected. Each patient was age- and gender-matched with a normogastrinemic control with healthy stomach. Controls had colonoscopy, gastroscopy with biopsies and gastrin assessment.Results160 hypergastrinemic atrophic gastritis patients and 160 controls were included. 28 atrophic gastritis patients and 36 controls had neoplastic colorectal lesions (p = 0.33). Patients and controls did not differ for frequency of colorectal adenomas (10.6% vs. 13.1%, p = 0.60) or cancer (6.9% vs. 9.4%, p = 0.54). Hypergastrinemic atrophic gastritis was not associated with a higher probability of developing colorectal cancer (OR 1.03, 95% CI 0.34–3.16). Age >50 years (OR 3.86) but not hypergastrinemia (OR 0.61) was associated with colorectal cancer.ConclusionsHypergastrinemic atrophic gastritis is not associated with higher risk for colorectal cancer. Atrophic gastritis-related hypergastrinemia is not associated with an increased risk of neoplastic colorectal lesions. Closer surveillance of colonic neoplasia in atrophic gastritis patients seems not appropriate.     

Random biopsies during surveillance colonoscopy increase dysplasia detection in patients with primary sclerosing cholangitis and ulcerative colitis

Background and aimPatients with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) are at increased risk of colon dysplasia. The role of random vs. target biopsies in these patients has not been investigated. Our aim was to evaluate the yield and clinical impact of random biopsies during surveillance colonoscopies in patients with PSC–UC.MethodsData from 71 patients (267 colonoscopies) with PSC and UC, who underwent surveillance colonoscopies and followed-up from 2001 to 2011 was obtained. Colonoscopy and pathology reports were reviewed to assess the yield of random biopsies.ResultsA total of 3975 (median 12) random biopsies were taken during surveillance colonoscopies. Overall, neoplasia was detected in 22 colonoscopies (16 patients): in 8 colonoscopies (36.4%) by targeted biopsies only and in 4 (18.2%) by both targeted and random biopsies. Neoplasia was detected in random biopsies only in 10 (45.5%) colonoscopies in 8 patients. On multivariate analysis, duration of UC (Odds ratio [OR] = 1.40; 95% confidence interval [CI], 1.08–1.81; P = 0.01), number of random biopsies (per increase by 8) (OR = 1.64; 95% CI, 1.18–2.28; P = 0.003) and target biopsies during colonoscopy (OR = 9.08; 95% CI, 3.18–26.0; P < 0.001) independently predicted the presence of dysplasia; endoscopic features of prior inflammation did not.ConclusionsRandom biopsies significantly increase the yield of dysplasia in patients with PSC and UC even in the absence of endoscopic features of prior inflammation and significantly impact clinical outcomes.     

Bowel preparation with polyethylene glycol electrolyte solution: optimizing the splitting regimen

AimQuality of bowel cleansing significantly increases the shorter the time between bowel solution intake and endoscopic examination. We tested the efficacy and patient tolerability following a modified polyethylene glycol electrolyte (PEG) splitting regimen.MethodsThis was a prospective, single-blind, randomized, study. Patients were assigned to receive either PEG 4 L the afternoon before colonoscopy or PEG 3 L the day before and 1 L 3 h before the procedure the day of colonoscopy.ResultsThe study population consisted of 336 patients, including 168 participants in each study arm. Although the bowel preparation quality was similarly quoted as excellent/good following the split and full regimen (95.2% vs 92.8%; p = 0.3), a significant (p < 0.0001) shift from good towards an excellent preparation (26.8% vs 68.4%) was observed following the split regimen as compared to the full regimen (55.4% vs 37.5%). The incidence of side-effects did not differ. When patients were asked about a future preparation if needed, 69% and 31% following the split and full regimen, respectively, declared to accept again the same preparation, the difference being statistically significant (p < 0.001).ConclusionsOur data found that an excellent bowel cleansing could be frequently achieved by simply modifying the split regimen from the standard PEG 2 plus 2 L to 3 plus 1 L.     

Clinical evolution of patients with respiratory allergic disease due to sensitisation to Alternaria alternata being treated with subcutaneous immunotherapy

IntroductionSensitisation to Alternaria is a cause of respiratory disease in Spain, particularly in childhood, but it is also a significant marker of the severity of this disease. Therefore, the use of an aetiological treatment (allergen specific immunotherapy) is essential, and both subjective and objective clinical parameters should be used to follow up this treatment.ObjectiveThis open-label, uncontrolled, observational, prospective study was designed in order to study the evolution of these patients on allergen specific immunotherapy therapy in daily clinical practice and to assess the use of different monitoring tools.Material and MethodsA total of 99 patients were included. They were monosensitised to this perennial allergen and treated with subcutaneous allergen specific immunotherapy. After one year of follow-up, these patients were assessed for the presence of symptoms, use of medication, clinical incidents, quality of life and asthma control.ResultsAfter one year of treatment a significant fall was observed in the use of concomitant medication (β2-agonists: p = 0.0278, inhaled corticosteroids: p = 0.0007, anti-leukotrienes: p = 0.0495), nasal symptoms (p = 0.0081), quality of life (PAQLQ, p < 0.0001) and asthma control (ACQ, p < 0.0001). Twenty-one patients had to attend emergency department due to exacerbation of their allergic disease, and only one of them had to be admitted to hospital.Conclusionrespiratory allergic disease due to Alternaria alternata is a disease which is hard to control, and in our daily practice, the use of specific subcutaneous immunotherapy can be of significant benefit in our paediatric patients.     

Randomised controlled trial of paediatric magnetic positioning device assisted colonoscopy: A pilot and feasibility study

Background and aimsComplete colonoscopy is critical for the evaluation of many paediatric gastrointestinal diseases. The aim of the study was to investigate the feasibility of magnetic positioning device for paediatric colonoscopy and to compare completion rate and procedure time with and without the device.MethodsProspective randomised controlled trial of standard colonoscopy compared to magnetic positioning device assisted colonoscopy in children and adolescents ages 7–20 years was performed.ResultsAnalysis showed that the proportion of successfully completed colonoscopies were 19/20 (95%) in the MP arm versus 17/18 (94.4%) in the SC arm, p = NS. The median time to complete colonoscopy to the cecum was 16.5 min (range 6–52 min) in the MP arm and 12 min (range 6–33 min) in the SC arm, p = NS.ConclusionsOur preliminary data suggest that the use of magnetic positioning device for colonoscopy is feasible in paediatric patients. These data suggest that the use of magnetic positioning device may not be of benefit for experienced endoscopists who achieved very high colonoscopy completion rates without the MP device. Further studies are needed to determine its role in paediatric colonoscopy since this device may be of more benefit for physicians in training.     

Antiviral therapy and fibrosis progression in patients with mild-moderate hepatitis C recurrence after liver transplantation. A randomized controlled study

Backgrounds/aimsWe evaluated the effect of antiviral therapy on fibrosis progression in patients with histological features of mild/moderate HCV disease recurrence defined by a Grading score ≥ 4 and Staging score up to 3 (Ishak) at 1 year after liver transplantation.MethodsSeventy-three consecutive patients with mild/moderate recurrence were randomized either to no treatment or to receive Pegilated-Interferon-alfa-2b and ribavirin for 52 weeks. Liver biopsies obtained at baseline (1 year after transplantation) and 2 years afterwards were evaluated for assessment of disease progression, defined as worsening of at least 2 staging points or progression to stage 4 or higher.ResultsAs for these two major histological end points there were no statistically significant differences between the 2 groups (36.1% vs. 50%, p = 0.34 and 36.1% vs. 38.9%, p = 1). Fifteen treated patients (41%) achieved a sustained virological response which was associated with a reduced risk of fibrosis worsening for both endpoints when compared to viremic patients (p = 0.04).ConclusionsAlthough antiviral-therapy was beneficial in preventing fibrosis progression in patients achieving a sustained virological response, the majority of the overall population of our patients with mild–moderate disease recurrence could not benefit from antiviral therapy either because they either could not be treated or did not respond to treatment (EudraCT number: 2005-005760).     

Overutilization of post-polypectomy surveillance colonoscopy in clinical practice: a prospective, multicentre study

BackgroundAlthough the adherence to post-polipectomy recommendations is advocated as a quality indicator of colonoscopy programmes, prospective data on actual use of surveillance are lacking.AimTo evaluate the appropriateness of post-polypectomy surveillance colonoscopy on a community-wide basis and to identify factors associated with it.MethodsData on consecutive post-polypectomy surveillance examinations performed over a 4-week period in 29 Italian endoscopy units were collected. The time interval between index and surveillance colonoscopy was calculated and compared to guidelines recommendations. Determinants of surveillance timing appropriateness were assessed by logistic step-wise regression.ResultsOf 7081 consecutive outpatients, 1218 (17.2%) were referred for post-polypectomy surveillance and 902 were included into the analysis. Surveillance colonoscopy was prescribed correctly in 330 subjects (36.6%) and earlier than recommended by guidelines in 490 (54.3%). Low-risk subjects had an anticipated surveillance colonoscopy more frequently than global cohort (67.4% vs. 54.3%, p < 0.001). At multivariate analysis, determinants of correct surveillance timing were high-volume workload centres (OR 1.92; 1.41–2.63 95%CI), centres providing written recommendation on surveillance interval (OR 1.70; 1.18–2.58 95%CI) and surveillance examinations performed within the national screening programme (OR 2.62; 1.92–3.59 95%CI).ConclusionsIn community practice, post-polipectomy surveillance colonoscopy is often performed earlier than recommended, especially in low-risk subjects. Interventions to improve adherence to guidelines and to reduce unnecessary examinations are needed.     

A randomized controlled trial evaluating a new 2-L PEG solution plus ascorbic acid vs 4-L PEG for bowel cleansing prior to colonoscopy

BackgroundBowel preparation is critical for the efficacy and safety of colonoscopy. Poor patient tolerance to bowel preparation has been associated with the high amount of fluid administered. A 2-L polyethylene glycol (PEG) solution containing ascorbic acid has been recently developed.AimsTo compare the efficacy, safety and acceptability of 2-L PEG + ascorbic acid vs 4-L PEG for colonoscopy.MethodsWe designed a single blind randomized non-inferiority study in order to compare the two bowel preparations. A blinded assessment of cleansing was made by the endoscopist according to the Aronchick scale. Acceptability was assessed by questionnaire. Intention-to-treat (ITT) and per-protocol (PP) analysis were reported.ResultsOverall, 169 patients (PP: 166) were selected for the 2-L PEG + ascorbic acid and 170 (PP: 166) for the 4-L PEG. When rating global bowel cleansing at ITT, an excellent-good level was reported in 84.6% (PP: 86.2%) of patients who received 2-L PEG + ascorbic acid and 75.3% (PP: 77%) of patients who received 4-L PEG (p = 0.04). Acceptability rate favoured 2-L PEG + ascorbic acid vs 4-L PEG (83% vs 76%; p = 0.02).Conclusions2-L PEG + ascorbic acid, completed with an additional L of clear fluids, provided bowel cleansing which appeared to be more effective and acceptable than 4-L PEG.     

Therapeutic conversion of the combination of ipratropium and albuterol to tiotropium in patients with chronic obstructive pulmonary disease

BackgroundIpratropium and albuterol, combined in a single formulation, is widely used as three to four times daily maintenance therapy in COPD. This trial compared tiotropium, once daily, as a potential alternative to patients already taking the ipratropium/albuterol combination.Methods676 patients with moderate to very severe stable COPD (mean FEV₁ = 39% of predicted) maintained on ipratropium/albuterol were randomized to receive over an 84 day period either tiotropium (18 mcg) each morning, or continue with ipratropium (26 mcg)/albuterol (206 mcg), 2 actuations 4 times daily, using a parallel group, double-blind, double-dummy design. Six-hour spirometry was assessed on study days 1, 22, and 84, along with safety assessments and other efficacy measures.ResultsIn terms of primary outcomes, mean trough FEV₁ at 84 days was larger in the tiotropium arm, as compared with the ipratropium/albuterol arm (difference = 86 ml; 95% CI, 49 to 123 ml, p < 0.0001). The mean FEV₁ AUC_0–6 at 84 days was also larger in the tiotropium arm (difference = 17 ml; 95% CI, ?21 to 56 ml), this difference being statistically non-inferior to the ipratropium/albuterol arm (p < 0.001), but not statistically superior (p = 0.37). Other efficacy measures were similar in the two groups. Lower respiratory adverse events were reported in 40 tiotropium patients vs. 52 ipratropium/albuterol patients. Safety reporting was otherwise similar.ConclusionPatients previously maintained on the ipratropium/albuterol combination taken four times daily can be switched to tiotropium once daily with the reasonable expectation of at least equivalent bronchodilation during daytime hours and superior bronchodilation during early morning hours.     

Additional effects of pranlukast in salmeterol/fluticasone combination therapy for the asthmatic distal airway in a randomized crossover study

BackgroundSalmeterol/fluticasone combination (SFC) therapy is used to control inflammation in the distal airway of patients with well-controlled asthma, but the efficacy of this approach is unclear.ObjectivesThe goal of the study was to evaluate the effect of pranlukast, a leukotriene receptor antagonist (LTRA), on distal airway inflammation and pulmonary resistance in patients with asthma that was well-controlled using SFC therapy alone.MethodsThe subjects were 32 patients with well-controlled asthma (age 61.1 ± 17.8 years old, Step 3 in the GINA guidelines, Asthma Control Test score 23.2 ± 1.8 points) based on use of SFC therapy alone for more than 3 months. These subjects were randomly assigned to groups receiving SFC alone or SFC + LTRA (pranlukast 450 mg daily) and then switched to the opposite group after 4 weeks in a crossover manner. Eosinophilic inflammation in induced sputum samples was assessed after each treatment period. Sputum was induced by inhalation of 10% hypertonic saline for 15 min. Impulse oscillometry parameters (R5, R20, X5 and AX) and spirometry were examined during each period. The Asthma-related Quality of Life Questionnaire (AQLQ) was also administered in each period.ResultsThe ECP levels in late-phase sputum were significantly higher than those in early-phase sputum with SFC therapy alone (178.3 ± 166.0 vs. 65.5 ± 68.9 μg/l, p < 0.001), whereas these values did not differ significantly with SFC + LTRA treatment (70.9 ± 95.1 vs. 54.6 ± 65.7, p = 0.554). ECP levels in late-phase sputum with SFC therapy were also significantly higher than those with SFC + LTRA (p = 0.045). The values of R5, R20, R5–R20 (kPa/(L/s)), and AX (kPa/L) all significantly improved during with SFC + LTRA treatment compared with SFC alone (median (25–75 percentile)): 0.350 (0.283–0.440) vs. 0.340 (0.280–0.378), p = 0.036; 0.280 (0.233–0.365) vs. 0.270 (0.240–0.318), p = 0.019; 0.050 (0.030–0.110) vs. 0.500 (0.030–0.073), p = 0.032; and 0.570 (0.308–1.045) vs. 0.410 (0.263–0.820), p = 0.014; respectively. Pulmonary function indexes did not differ significantly between the two treatments, but the symptom and activity limitation domains of the AQLQ were significantly improved by SFC + LTRA treatment.ConclusionThis study suggests that the combination of SFC and LTRA may give better control of residual eosinophilic inflammation in the distal airway compared with SFC therapy alone.     

Efficacy and safety of dexamethasone ointment on recurrent aphthous ulceration

ObjectiveRecurrent aphthous ulceration is the most common oral mucosal lesion and may be associated with many systemic diseases. Topical corticosteroids are used frequently for recurrent aphthous ulceration; however, the number of high-quality clinical experiments available is insufficient, and no reports exist on the blood level of corticosteroids after topical usage in the oral mucosa. The objective was to determine the efficacy and safety of dexamethasone ointment in the treatment of recurrent aphthous ulceration and detect serum dexamethasone concentrations in the patients.MethodsA randomized, double-blinded, placebo-controlled, parallel, multicenter clinical trial was conducted in 5 centers to compare the efficacy and safety of dexamethasone ointment with placebo. There were 810 patients with minor recurrent aphthous ulcerations screened for study eligibility, and 240 patients were enrolled at 5 centers from March 1, 2009 to April 30, 2010; 120 were assigned randomly to the treatment group and 120 to a control group. Patients were instructed to apply the given agent to the identified ulcer 3 times a day (after meals) for 5 days. The size, pain level, healing ratio, and average duration of ulcers and the safety of the agents were evaluated. The serum concentration of dexamethasone was detected using a high-performance liquid chromatography/mass spectrometry assay.ResultsThe results showed that baseline characteristics were similar (P >.5). At day 6 ± 2 after treatment, there was significant difference in the variation of ulcer size between the treatment group (7.167 ± 6.3415 mm²) and the control group (4.346 ± 7.0666 mm²; P = .000); and in the variation of pain level between the treatment group (5.623 ± 1.9570) and the control group (4.940 ± 2.2449; P = .001). The healing ratio was 83.33% in the treatment group and 54.70% in the control group (P = .000). No severe adverse reactions were observed. No serum dexamethasone was detected before or after the use of the agents (<0.502 ng/mL).ConclusionDexamethasone ointment was efficient in the treatment of recurrent aphthous ulceration and was safe as evaluated using clinical assessment and serum level detection.     

Effect of statin therapy on coronary fibrous-cap thickness in patients with acute coronary syndrome: assessment by optical coherence tomography study

BackgroundThe thickness of coronary fibrous caps is a major determinant of vulnerable plaques. Several clinical trials have suggested that statin therapy could stabilize vulnerable plaques. Recently, optical coherence tomography (OCT) has been proposed as an effective histology-resolution imaging modality for assessing such micro-structural changes.MethodsForty AMI patients with hyperlipidemia were enrolled and underwent percutaneous coronary intervention (PCI). They were divided into two groups; statin treatment group (n = 23) or control group (n = 17). Serial OCT analyses were performed at baseline and 9-month follow-up for a non-PCI lipid-rich plaque lesion.ResultsThe LDL-cholesterol level in the statin group was significantly lower than that in the control group at follow-up. Although the fibrous-cap thickness was significantly increased in both the statin treatment group (151 ± 110 to 280 ± 120 μm, p < 0.01) and the control group (153 ± 116 to 179 ± 124 μm, p < 0.01) during follow-up period, the degree of increase was significantly greater in the statin treatment group than in the control group (188 ± 64% vs. 117 ± 39%, p < 0.01). Furthermore, when the patients in the statin treatment group were divided into two subgroups (fibrous-cap thickness ConclusionThe lipid-lowering therapy with statin for 9 months after the onset of acute myocardial infarction significantly increased the fibrous-cap thickness in patients with hyperlipidemia.     

Four-year clinical outcomes of the OLIVUS-Ex (impact of Olmesartan on progression of coronary atherosclerosis: evaluation by intravascular ultrasound) extension trial

BackgroundThe previous OLIVUS trial reported a positive role in achieving a lower rate of coronary atheroma progression through the administration of Olmesartan, an angiotension-II receptor blocking agent (ARB), for stable angina pectoris (SAP) patients requiring percutaneous coronary intervention (PCI). However, the benefits between ARB administration on long-term clinical outcomes and serial atheroma changes by IVUS remain unclear. Thus, we examined the 4-year clinical outcomes from OLIVUS according to treatment strategy with Olmesartan.MethodsSerial volumetric IVUS examinations (baseline and 14 months) were performed in 247 patients with hypertension and SAP. When these patients underwent PCI for culprit lesions, IVUS was performed in their non-culprit vessels. Patients were randomly assigned to receive 20–40 mg of Olmesartan or control, and treated with a combination of β-blockers, calcium channel blockers, glycemic control agents and/or statins per physician's guidance. Four-year clinical outcomes and annual progression rate of atherosclerosis, assessed by serial IVUS, were compared with major adverse cardio- and cerebrovascular events (MACCE).ResultsCumulative event-free survival was significantly higher in the Olmesartan group than in the control group (p = 0.04; log-rank test). By adjusting for validated prognosticators, Olmesartan administration was identified as a good predictor of MACCE (p = 0.041). On the other hand, patients with adverse events (n = 31) had larger annual atheroma progression than the rest of the population (23.8% vs. 2.1%, p < 0.001).ConclusionsOlmesartan therapy appears to confer improved long-term clinical outcomes. Atheroma volume changes, assessed by IVUS, seem to be a reliable surrogate for future major adverse cardio- and cerebrovascular events in this study cohort.     

Comparison of levofloxacin-containing sequential and standard triple therapies for the eradication of Helicobacter pylori

BackgroundThere is an important concern about the success of standard triple treatment for Helicobacter pylori (H. pylori) in recent years. Better eradication rates have been reported with sequential treatment in current studies. This study aimed to compare the success of a novel levofloxacin-containing sequential regimen with standard triple therapy.MethodsH. pylori-positive patients with non-ulcer dyspepsia were randomly allocated to one of the study groups. The patients on sequential arm were given esomeprazole 40 mg BID and amoxicillin 1 g BID for the first week followed by esomeprazole 40 mg BID, levofloxacin 500 mg QD and metronidazole 500 mg TID for the second week. The patients on standard triple arm were given esomeprazole 40 mg BID, amoxicillin 1 g BID and clarithromycin 500 mg BID for 2 weeks. Eradication was assessed by urea breath test on 6th weeks.ResultsSeventy-five patients were enrolled in each group; 72 in sequential arm and 67 in standard arm completed the protocols. H. pylori eradication rate of per protocol was 90% in sequential versus 57% in standard treatment groups with a statistical significance (p < 0.000). Both regimens were similarly well tolerated and side effects were comparable. Only one patient in sequential arm stopped the treatment because of side effects.ConclusionThe levofloxacin-containing sequential therapy is a significantly better strategy than the standard triple treatment for H. pylori eradication. Standard triple treatment is no more effective for H. pylori in our population and levofloxacin-containing sequential regimen might be used as a first-line eradication option.     

Intensive versus conventional glucose control in critically ill patients: A meta-analysis of randomized controlled trials

BackgroundCritically ill patients commonly develop hyperglycemia. It remains unclear, however, to what extent correcting hyperglycemia will benefit these patients. We performed this meta-analysis to evaluate the benefits and risks of intensive glucose control versus conventional glucose control in critically ill adult patients.MethodsA systematic literature search of MEDLINE, PubMed, and Cochrane databases (until June 2011) was conducted using specific search terms. Randomized controlled trials that compared intensive glucose control with a target glucose goal < 6.1 mmol/l (110 mg/dl) to conventional glucose control in adult intensive care patients were included. The random-effect model was used to estimate the pooled risk ratio of the two treatment arms.ResultsTwenty two studies that randomized 13,978 participants were included in the meta-analysis. Overall, intensive glucose control did not reduce the short-term mortality (RR = 1.02, 95% CI: 0.95–1.10, p = 0.51), 90 day or 180 day mortality (RR = 1.06, 95% CI: 0.99–1.13, p = 0.08), sepsis (RR = 0.96, 95% CI: 0.83–1.12, p = 0.59) or new need for dialysis (RR = 0.96, 95% CI: 0.83–1.11, p = 0.57). The incidence of hypoglycemia was significantly higher in intensive glucose control group compared with conventional glucose control group (RR = 5.01, 95% CI: 3.45–7.28, p < 0.00001).ConclusionsThis meta-analysis found that intensive glucose control in critically ill adults did not reduce mortality but is associated with a significantly increased risk of hypoglycemia.     

Effectiveness of nebulized furosemide added to nebulized salbutamol in children with acute asthma

BackgroundNebulized furosemide has been shown to be protective against bronchoconstricting stimuli.MethodsTo investigate whether inhaled furosemide would exhibit an additional therapeutic effect in children with acute asthma we performed a double-blind, placebo-controlled study in which patients with acute asthma attack were randomized to receive either nebulized salbutamol (0.15 mg/kg) plus nebulized furosemide (10 mg/m2) or nebulized salbutamol (0.15 mg/kg) plus nebulized saline as placebo. In all patients, clinical asthma scores (CAS) were determined before and after drug administration. Peak expiratory flow rates (PEFR) were measured by a peak flow meter.ResultsCAS and PEFR improved in both groups with nebulized salbutamol treatment. The CAS changed from 3.56 ± 2.13 to 2.06 ± 1.84 (p = 0.0001) in the study group and from 4.44 ± 2.63 to 2.56 ± 1.86 (p = 0.0003) in the control group. PEFR increased from 177.50 ± 65.88 to 221.88 ± 66.05 L/min in the first group (p = 0.0001) and from 183.13 ± 51.73 to 218.13 ± 60.25 in the second group (p = 0.0001).ConclusionAdding nebulized furosemide to nebulized salbutamol in pediatric patients experiencing an acute asthma attack did not produce greater improvement in clinical (p = 0.3829) or spirometric (p = 0.3839) parameters than nebulized salbutamol alone.     

The beneficial effects of physical exercise on antioxidant status in asthmatic children

BackgroundThe pathogenesis of asthma involves both airway inflammation and an oxidant/antioxidant imbalance. It is demonstrated in asthmatic adults that exercise programmes improve lung function, a mechanism yet to be elucidated. The purpose of this study was to investigate the possible beneficial effects of physical exercise on antioxidant status in asthmatic children which may lead to ameliorated lung function.MethodsThe study enrolled thirteen control and thirty asthmatic children. The asthmatic group was subdivided into two: the first group receiving only pharmacological treatment (n = 15) and the second receiving pharmacological treatment with exercise programme (n = 15) for 8 weeks. Blood samples were drawn from the subjects before and after treatment periods. As oxidant stress markers blood levels of malondialdehyde (MDA) and total nitric oxide (NO), and as antioxidant status, glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activities were assessed.ResultsBefore any treatment was initiated, MDA and NO levels in the asthmatic group were significantly higher than the controls (3.40 ± 0.96 nmol/ml vs 2.46 ± 0.58 nmol/ml, and 12.53 ± 2.10 vs 9.40 ± 1.39 micromol/L, respectively). Both SOD (p = 0.0001) and GSH-Px (p = 0.023) activities were significantly lower in the asthmatic group. Pharmacological treatment and exercise programme together significantly improved lung performance and decreased the levels of oxidant stress markers, in concordance with a significantly increase in antioxidant enzyme activity measures when compared to the pharmacological treatment.ConclusionStructured exercise programme in asthmatic children resulted in better lung function, which may be attributed to its effect on antioxidant status.     

Altered monocyte CD44 expression in peripheral arterial disease is corrected by fish oil supplementation

Background and aimsCD44 and its splice variants can be expressed on all leukocytes, conferring adhesive properties and enhancing cellular recruitment to the endothelium during inflammation. CD44 expression is increased in inflammatory conditions such as rheumatoid arthritis and CD44 variant 3 (CD44v3) expression may be associated with inflammation. We have examined CD44 and CD44v3 expression on peripheral blood monocytes from patients with peripheral arterial disease (PAD) and healthy controls. We have also examined the effect of fish oil supplementation on these markers.Methods and resultsCD44 and CD44v3 were assessed at baseline and following dietary supplementation with fish oil for 12 weeks in both PAD and control groups. Monocytes from PAD patients had higher CD44 expression than those from controls (median intensity fluorescence (MIF): 480 ± 278 vs 336 ± 251 (mean ± SD); p < 0.001). Following 12 weeks dietary supplementation with fish oil, CD44 expression was reduced in PAD patients (MIF: 480 ± 278 vs 427 ± 262; p = 0.05) but not in controls (336 ± 251 vs 355 ± 280; ns). Monocyte CD44v3 expression was lower in cultured monocytes from PAD patients compared to those from controls (0.15 ± 0.15 vs 0.22 ± 0.14 OD units; p < 0.02). This was increased in the PAD group following fish oil supplementation (0.15 ± 0.14 to 0.27 ± 0.23 OD units; p < 0.001).ConclusionMonocyte CD44 and CD44v3 expression are altered in arterial disease but are returned towards levels seen in control subjects by dietary fish oil supplementation.     

Computed tomographic colonography in subjects with positive faecal occult blood test refusing optical colonoscopy

BackgroundRefusal of colonoscopy is a drawback of colorectal cancer screening programmes based on faecal occult blood test. Computed-tomographic-colonography is generally more accepted than colonoscopy.AimTo compare adherence to computed-tomographic-colonography and second-invitation colonoscopy in subjects with positive faecal test refusing colonoscopy.MethodsWe performed a prospective study in 198 subjects with positive faecal test who refused first referral to colonoscopy in one endoscopy service of the Florence screening programme. Subjects were randomly invited to computed-tomographic-colonography (n = 100) or re-invited to colonoscopy (n = 98). Mail invitation was followed by a questionnaire administered by phone. Computed-tomographic-colonography findings were verified with colonoscopy.Results32 subjects could not be reached, 71 (35.9%) had undergone colonoscopy on their own; 4 were excluded for contraindications; 30/48 (62.5%) in the computed-tomographic-colonography arm and 11/43 (25.6%) in the colonoscopy arm accepted the proposed examinations (p < 0.001). Four advanced adenomas and 1 cancer were found in the 28 subjects who ultimately underwent computed-tomographic-colonography and 2 advanced adenomas and 2 cancers in the 9 subjects who ultimately underwent second-invitation colonoscopy.ConclusionSubjects with positive faecal occult blood test refusing colonoscopy show a higher adherence to computed-tomographic-colonography than to second invitation colonoscopy.     

Inflammatory cytokines in insulin-treated patients with type 2 diabetes

ObjectiveAn association between type 2 diabetes mellitus and inflammation has been described in several studies. The aim of this study was to search for the presence of low-grade inflammation in a special group of insulin-treated patients with type 2 diabetes, and to investigate a possible correlation between inflammation and obesity, glucose homeostasis and insulin requirement (IU insulin/kg body weight, BW).MethodsWe studied 85 subjects with type 2 diabetes that were receiving insulin treatment (group A) and 32 receiving sulfonylurea treatment (group B), and 57 subjects without diabetes (group C). Interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and the soluble TNF-α receptors sTNFR-60 and sTNFR-80 were measured in serum samples taken from all patients.ResultsThe mean serum cytokine levels in group A vs. group B were: IL-6, 8.54 ± 11 vs. 2.71 ± 1.9 pg/ml (p = 0.000); TNF-α, 14.33 ± 24 vs. 5.12 ± 15 pg/ml (p = 0.016); sTNFR60, 3.9 ± 2.8 vs. 2.36 ± 1.4 ng/ml (p = 0.000); and sTNFR80, 11.9 ± 7 vs. 9.4 ± 6 ng/ml (p = 0.080). The mean serum cytokine levels in group A vs. group C were: IL-6, 8.54 ± 11 vs. 4.74 ± 7 pg/ml (p = 0.017); TNF-α, 14.33 ± 24 vs. 5.94 ± 3.4 pg/ml (p = 0.003); sTNFR60, 3.9 ± 2.8 vs. 2.54 ± 1.4 ng/ml (p = 0.000); and sTNFR80, 11.9 ± 7 vs. 10.85 ± 8 ng/ml (p = 0.470). A positive association between waist circumference and IL-6 (r = 0.165, p = 0.030) and sTNFR-60 (r = 0.276, p = 0.000) was detected. A significant correlation coefficient was observed between haemoglobin A1c (HbA1c) and both IL-6 (r = 0.278, p = 0.000) and sTNFR-60 (r = 0.293, p = 0.000), when the groups were studied as one. No correlation between inflammation and units of insulin/kg BW was found. In conclusion, low-grade chronic inflammation, as estimated by the relative levels of inflammatory cytokines, was present in patients with type 2 diabetes that were receiving insulin treatment, with significantly higher cytokine levels recorded compared to sulfonylurea-treated patients. In addition, an association between inflammation and both obesity and glucose homeostasis was detected.