哮喘基因新进展

截止到2007年底,相关文献共报道了171个哮喘相关基因,其中2006-2007年报道了53个基因。本篇综述将讨论发现这些基因的方法,并对近年来发现的主要哮喘基因进行简要概述,其中包括迄今为止发现的与哮喘关联最有充分证据的基因：ORMDL3基因。     

Racial Disparities in Pediatric Asthma: A Review of the Literature

The burden of asthma disproportionately affects children living in economically disadvantaged urban communities. The relationships between ethnicity, genetic differences, lower socioeconomic status, poor medication adherence, greater exposure to environmental triggers, and absence of regular asthma care all contribute to this disparity. This review aims to identify and discuss recent studies on additional factors that may also impact to pediatric asthma disparity. The body of work examined in this review suggests that these disparities are the result of gene–environment interactions, vitamin D metabolism, socioeconomic status, urban environment, healthcare setting, and associated health beliefs.     

Advances in the Management of Pediatric Asthma: A Review of Recent FDA Drug Approvals and Label Updates

Children have the highest prevalence of asthma of any age group. In the United States during 2001, there were 12.6 million physician and hospital outpatient visits for asthma treatment, of which almost 5 million involved children 18 years and younger. Therapeutic advances in pediatric asthma could improve patient outcomes and potentially reduce the burden on health care systems. Efforts to obtain efficacy and safety data in pediatric populations and develop pediatric formulations of asthma treatments have been encouraged by the FDA and clinicians. This article reviews the newest additions to asthma therapies approved for use in children, including an inhaled corticosteroid, some long-acting β₂-agonists, some leukotriene-receptor blockers, and a single-isomer, short-acting β₂-agonist.     

Advances in the Management of Pediatric Asthma: A Review of Recent FDA Drug Approvals and Label Updates

Children have the highest prevalence of asthma of any age group. In the United States during 2001, there were 12.6 million physician and hospital outpatient visits for asthma treatment, of which almost 5 million involved children 18 years and younger. Therapeutic advances in pediatric asthma could improve patient outcomes and potentially reduce the burden on health care systems. Efforts to obtain efficacy and safety data in pediatric populations and develop pediatric formulations of asthma treatments have been encouraged by the FDA and clinicians. This article reviews the newest additions to asthma therapies approved for use in children, including an inhaled corticosteroid, some long-acting β₂-agonists, some leukotriene-receptor blockers, and a single-isomer, short-acting β₂-agonist.     

Intergenerational Service-Learning: A Review of Recent Literature and Directions for the Future

This review examines recent studies that have addressed outcomes of intergenerational service-learning courses in gerontology. The history of service-learning pedagogy in higher education and its place in today's colleges is also reviewed. Particular attention is given to evaluations of stakeholders: students, older adult participants, agencies and staff, faculty, community residents, colleges, and the community itself. The need for adopting research designs that permit clear conclusions and for utilizing assessments that have psychometrically sound foundations is important in future studies to permit unambiguous comparisons from study to study. The value of the pedagogy for students in particular has been documented over a number of years. Equally important is today's need to assess the impact of the pedagogy on the community.     

Risk Factors for Pediatric Asthma in the South Bronx

We identified main asthma risk factors for children living in the South Bronx, where asthma rates are eight times higher than the national average. This case-control study enrolled 261 children at Lincoln Medical and Mental Health Center from 2002 to 2003. We questioned the mothers on medical history and home environment. The most important risk factors for asthma in the South Bronx pediatric population are Hispanic ethnicity, family history of asthma, and exposure to tobacco smoke. South Bronx children limited to breast-feeding during the first 3 months of age are less likely to develop asthma.     

Risk Factors for Pediatric Asthma in the South Bronx

We identified main asthma risk factors for children living in the South Bronx, where asthma rates are eight times higher than the national average. This case-control study enrolled 261 children at Lincoln Medical and Mental Health Center from 2002 to 2003. We questioned the mothers on medical history and home environment. The most important risk factors for asthma in the South Bronx pediatric population are Hispanic ethnicity, family history of asthma, and exposure to tobacco smoke. South Bronx children limited to breast-feeding during the first 3 months of age are less likely to develop asthma.     

Risk Factors for Pediatric Asthma Emergency Visits

The purpose of this study was to identify risk factors for pediatric asthma emergency department (ED) visits. A cross sectional sample of 307 families (24%) responded to a mailed survey. Respondents were similar to the target population of 2487 children with asthma. Thirty seven percent of respondents had two or more asthma ED visits in the past year. Asthma ED use was associated with persistent asthma symptoms, parents without high school diplomas, age under 4 years, African-American race/ethnicity, use of written care plans, and use of spacers at school. The latter two variables were associated with severe asthma. High risk children can be targeted for office based medical care.     

Psychological Factors Associated with Pediatric Asthma Death: A Review

The preceding review of the literature on pediatric asthma death encompasses a broad range of emotional and psychological variables, some of which may ultimately prove to be meaningfully related to asthma death in childhood. However, the essential question of the role of psychological factors in pediatric asthma death remains unanswered. This area of investigation is still in its earliest stages, having relied heavily to date on retrospection, anecdotal recordings, and theoretical speculation. Additionally, conceptualization of the problem has been impeded not only by the remaining medical mysteries of asthma, but by considerable overlap among the psychological constructs considered, and a lack of clarity and confirming evidence about the physiological and/or behavioral mechanisms which would mediate the influence of proposed psychological factors on the course of the disease. As has been common in the history of psychosomatic research, there has been a tendency to search for a unitary underlying psychological factor that would account for asthma death (e.g., anxiety, psychopathology, a symbiotic mother-child relationship, or nebulizer overuse). However, a perusal of the literature casts doubt on the likelihood that a single psychological factor will provide the answers. Rather, serious problems in pediatric asthma management and fatal outcome appear more likely to be the end result of disruptions in the complex interactions and delicate balance among physiological, pharmacological, environmental, and interpersonal factors. The interpersonal milieu itself may represent potentially complicated and dangerous elements as it consists of medical staff, patient, and family members, each with his or her own limitations of intellect, judgment, and capacity to cope with emotional stress and the stress engendered by a chronic, sometimes frustrating, and potentially lethal disease. Nevertheless, the literature offers a variety of features which thus far have been found to characterize at least some cases of pediatric asthma death. There is fairly consistent agreement demographically that children under 5 yr of age and between the ages of 10 and 14 yr are at increased risk, as are nonwhite children. Sex-related differences are less clear. While a standard medical profile of the pediatric asthma patient at high risk for a fatal outcome does not yet exist, a number of "increased risk" indicators have been suggested, including for example, a history of particularly severe asthma, rapid onset attacks, and medical complications.(ABSTRACT TRUNCATED AT 400 WORDS)     

Risk Factors for Progression in Hand Osteoarthritis: A Systematic Review

Objective

To assess the risk factors for progression of hand osteoarthritis (OA).

Methods

In a systematic review of cohort studies, medical literature databases were searched up to May 2012 for articles reporting data on the association between risk factors and hand OA progression. The quality of these studies was assessed by 2 independent reviewers using a criteria scoring system of 16 items, and studies were dichotomized into those with scores of 69% or over and those with scores under 69%. Best evidence synthesis was used to determine the level of evidence per risk factor.

Results

In total, 14 articles that fulfilled the selection criteria were included, of which 8 were high quality. The most frequently investigated risk factors were age, sex, radiographic features (e.g., erosive OA), and scintigraphy. Progression was mostly defined by radiographic criteria, but also clinical progression as an outcome was described. Most of the investigated risk factors showed limited or inconclusive evidence for an association with hand OA progression. Limited evidence according to the best evidence synthesis with most available studies was present for the association between a positive scintigraphic scan and radiographic progression (up to 2.8 times more progression than negative joints).

Conclusion

Limited evidence is available for a positive association between an abnormal scintigraphic scan and radiographic hand OA progression. These data suggest that a positive scintigraphic scan as an inclusion criterion for studies that aim to show structural modification can increase the power of such studies. Future longitudinal studies with a well‐defined baseline population are needed to search for risk factors of hand OA progression.     

Risk Factors for Depression in Long-Term Care: A Systematic Review

Objectives: Depression rates are substantially higher among older adults in long-term care when compared with older adults in the community. Furthermore, the needs of older adults in long-term care are increasingly complex, and risk factors that contribute to depression in this population are unclear. This limits not only the identification of those at risk for depression but also the development of therapeutic interventions. This review summarizes the evidence on risk factors for depression.

Methods: Searches were performed using CINAHL, Cochrane Library, Ovid Medline, PsycINFO and Scopus for research published 1980–2017. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results: Eleven studies met the inclusion criteria, representing a total of 11,703 participants, with a mean sample size of 1,064. The most consistently supported risk factor was cognitive impairment, followed by functional impairment and baseline depression score.

Conclusions: The studies lacked a systematic approach to investigating risk factors for depression, and the research remains largely atheoretical. Few risk factors were consistently studied, with over 20 risk factors examined no more than once each. Psychological and environmental risk factors, which may be modifiable and have the potential to inform therapeutic interventions and preventative strategies, remain under-studied.

Clinical Implications: The most consistently supported risk factors—cognitive impairment, functional disability and baseline depression score—have the potential to inform screening protocols and should be monitored longitudinally. When developing psychotherapeutic interventions, close consideration should be given to cognitive and functional impairment as barriers to implementation and uptake.     

Objective and Subjective Measurement of Cough in Asthma: A Systematic Review of the Literature

Background

The extent to which objective and subjective tools has been used to measure the characteristics and burden of cough in patients with asthma has not been reported.

Objective

To review the large and extensive body of literature in asthma with the specific hypothesis that the characteristics of cough and clinical impact in this disease has only occasionally been studied.

Methods

For this systematic review, we searched EMBASE and MEDLINE databases using a combination of MeSH terms for “cough” and “asthma” for studies published up to and including end of August 2021. Studies included for analysis were confined to those undertaken in adult patients (≥?18 years) with asthma of any severity where any tool or method to specifically measure cough was employed.

Results

Of 12,090 citations identified after our initial search, 112 full-text articles met criteria for inclusion in our analysis. We found that a broad range of objective and subjective measures have been used albeit with a lack of consistency between studies. Clinically important levels of cough associated with impaired health status were identified in patients with asthma.

Conclusion

Although cough is a common symptom in asthma, the clinical features and accompanying healthcare burden have been studied infrequently. In studies where cough was measured, the methods employed varied considerably. A more consistent use of cough-specific measurement tools is required to better determine the nature and burden of cough in asthma.

     

Hepatopulmonary Syndrome and Liver Transplantation: A Recent Review of the Literature

A severe and common pulmonary vascular complication of liver disease is hepatopulmonary syndrome (HPS). It is a triad of liver dysfunction and/or portal hypertension, intrapulmonary vascular dilatations, and increased alveolar-arterial oxygen gradient. Prevalence varies according to various study groups from 4%–47%. While the most common presenting symptom of HPS is dyspnea, it is usually asymptomatic, and thus all liver transplant candidates should be screened for its presence. Pulse oximetry is a useful screening method, but arterial blood gas examination is the gold standard. If there is an abnormal P (A-a)O₂ gradient, microbubble transthoracic echocardiography should be done for diagnosis. Outcome is unpredictable, and there is currently no effective medical therapy. The only effective therapy is considered to be liver transplantation. Complete resolution of HPS after liver transplantation is seen within a year in most HPS patients.     

Current Advances in the Regeneration of Degenerated Articular Cartilage: A Literature Review on Tissue Engineering and Its Recent Clinical Translation

Functional ability is the basis of healthy aging. Articular cartilage degeneration is amongst the most prevalent degenerative conditions that cause adverse impacts on the quality of life; moreover, it represents a key predisposing factor to osteoarthritis (OA). Both the poor capacity of articular cartilage for self-repair and the unsatisfactory outcomes of available clinical interventions make innovative tissue engineering a promising therapeutic strategy for articular cartilage repair. Significant progress was made in this field; however, a marked heterogeneity in the applied biomaterials, biofabrication, and assessments is nowadays evident by the huge number of research studies published to date. Accordingly, this literature review assimilates the most recent advances in cell-based and cell-free tissue engineering of articular cartilage and also focuses on the assessments performed via various in vitro studies, ex vivo models, preclinical in vivo animal models, and clinical studies in order to provide a broad overview of the latest findings and clinical translation in the context of degenerated articular cartilage and OA.